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Objectifs : La Haute Autorité de santé a publié en 2019 des recommandations concernant la prise en charge des dermohypodermites bactériennes non nécrosantes (DHBNN). L’objectif de cette étude était d’évaluer le suivi de ces recommandations au centre hospitalo-universitaire de Poitiers sur les trois années suivant leur publication. Matériel et méthodes : Étude rétrospective monocentrique sur dossiers de patients admis aux urgences pour prise en charge d’une DHBNN entre avril 2019 et avril 2022. Résultats : Cent cinquante patients ont été inclus (50 patients par année). Il s’agissait de 87 femmes et 63 hommes d’un âge moyen de 77 ans. Le choix de l’antibiotique était jugé adéquat chez 130 patients (87 %) sans différence significative selon les périodes analysées. La posologie d’amoxicilline était adéquate chez 62 patients (59 %) toutes périodes confondues et dans 49, 62 et 68 % des cas sur les années n + 1, n + 2, n + 3, respectivement (NS). La durée de l’antibiothérapie était de 7 ± 2 jours et conforme aux recommandations dans 67 % des cas toutes périodes confondues. Elle était adéquate dans 56, 69 et 77 % des cas sur les années n + 1, n + 2, n + 3, respectivement. Une différence de pratique statistiquement significative était notée entre la période n + 1 et n + 3 (p = 0,03). Une porte d’entrée cutanée était retrouvée et traitée chez la plupart des patients (80 %). Les mesures associées (surélévation du membre, mise en place de contention veineuse, vaccination antitétanique, conseils diététiques) étaient peu proposées. Conclusion : Cette étude met en évidence une adhésion croissante aux recommandations qui reste encore modeste concernant la posologie (trop faible) et la durée de l’antibiothérapie (trop prolongée). Il semble également nécessaire de rappeler l’importance des mesures associées et de prévention des récidives. La mise en place d’outils spécifiques (feuilles préremplies, fiche d’informations patient) pourrait favoriser leur application.

Introducción: Las guías europeas de hipertensión arterial pulmonar (HAP) estratifican el riesgo valiéndose de característicasclínicas y estudios complementarios entre los cuales está la prueba cardiopulmonar de ejercicio (PCPE), de la cual toma encuenta 3 parámetros: el consumo de O2 (VO2) pico, su porcentaje respecto del predicho y la pendiente ventilación minuto/producción de dióxido de carbono (VE/VCO2). Sin embargo, ninguno de los modelos que validaron esta forma de estratificarel riesgo incluyeron la PCPE entre sus variables.Objetivos: Determinar qué proporción de pacientes con HAP del grupo I considerados de bajo riesgo y que caminan >440metros en la prueba de caminata de 6 minutos (PC6M) tienen en la PCPE parámetros considerados de riesgo moderado o alto.Material y métodos: Se incluyeron pacientes >18 años con diagnóstico de HAP del grupo I considerados de bajo riesgo conuna PC6M >400 metros a los que se les realizó una PCPE en la que se registró el VO2 pico, su porcentaje respecto del VO2predicho y la pendiente VE/VCO2. Se determinó qué proporción de pacientes presentaban estos parámetros en un estrato deriesgo mayor a bajo riesgo (VO2 pico 36).Resultados: Se incluyeron 18 pacientes. A pesar de ser pacientes de bajo riesgo y con buena clase funcional todos presentaronun VO2 pico menor al 85% del predicho, lo cual determina un deterioro al menos leve de la capacidad funcional. Un únicopaciente (6%) presentó los tres parámetros evaluados en bajo riesgo, 8 pacientes (44%) tuvieron al menos un parámetro alterado,7 pacientes (39%) presentaron 2 parámetros alterados y en 2 pacientes (11%) todos los parámetros estuvieron alterados.Los parámetros que más frecuentemente se vieron alterados fueron el porcentaje respecto del VO2 predicho y la pendienteVE/VCO2, en el 67% de los casos. Solo 4 pacientes presentaron un VO2 pico

Introducción: Los puntajes de riesgo cardiovascular tienen limitaciones relacionadas con la calibración, la discriminación y labaja sensibilidad. Se han identificado diferentes “moduladores de riesgo” que permiten mejorar la estratificación del riesgocardiovascular: placa aterosclerótica carotídea (PAC), puntaje de calcio arterial coronario (pCAC) y lipoproteína(a) [Lp(a)].Objetivos: 1) determinar la prevalencia de los moduladores de riesgo citados en una población en prevención primaria; 2)determinar la concordancia entre los 2 métodos de detección de aterosclerosis subclínica; 3) establecer qué proporción depacientes deberían recibir estatinas inicialmente, según su puntaje de riesgo, y posteriormente con el conocimiento de losmoduladores de riesgo.Material y métodos: Se incluyeron individuos de 18 a 79 años, que asistieron para una evaluación de riesgo cardiovasculary que no estaban recibiendo tratamiento hipolipemiante. Se calculó el puntaje de riesgo (ASCVD Risk Estimator) en cadapaciente. Se evaluó la presencia de PAC, el pCAC y el nivel plasmático de Lp(a).Resultados: Se incluyeron 348 pacientes (edad media 55,6 ± 12,2 años, 45,4% hombres). En la población total, 29,8%, 36,8%y 53,2% de los pacientes mostraron un valor de Lp(a) ≥ 50 mg/dL, PAC o un pCAC > 0, respectivamente. La prevalencia dePAC y pCAC fue progresivamente mayor según la categoría de riesgo cardiovascular; sin embargo, la proporción de sujetos debajo riesgo que tenían moduladores de riesgo fue considerable (Lp(a) ≥ 50 mg/dl: 25,7%; PAC: 22%; pCAC > 0: 33%). En los60 individuos menores de 45 años la prevalencia de pCAC > 0 y PAC fue de 18,3% y 10%, respectivamente. La concordanciaentre los dos métodos para determinar la presencia de ateromatosis subclínica fue discreta (kappa 0,33). La indicación deltratamiento con estatinas aumentó un 31,6% luego de evaluar la presencia de moduladores.Conclusión: La presencia de moduladores de riesgo fue frecuente en esta población en prevención primaria, incluso en sujetosde bajo riesgo o menores de 45 años. La detección de moduladores de riesgo podría mejorar la estratificación inicial y llevara reconsiderar el tratamiento con estatinas.

International audience; The use of psychotropics during the COVID-19 pandemic has raised two questions, in order of importance: first, what changes should be made to pharmacological treatments prescribed to mental health patients? Secondly, are there any positive side effects of these substances against SARS-CoV-2? Our aim was to analyze usage safety of psychotropics during COVID-19; therefore, herein, we have studied: (i) the risk of symptomatic complications of COVID-19 associated with the use of these drugs, notably central nervous system activity depression, QTc interval enlargement and infectious and thromboembolic complications; (ii) the risk of mistaking the iatrogenic impact of psychotropics with COVID-19 symptoms, causing diagnostic error. Moreover, we provided a summary of the different information available today for these risks, categorized by mental health disorder, for the following: schizophrenia, bipolar disorder, anxiety disorder, ADHD, sleep disorders and suicidal risk. The matter of psychoactive substance use during the pandemic is also analyzed in this paper, and guideline websites and publications for psychotropic treatments in the context of COVID-19 are referenced during the text, so that changes on those guidelines and eventual interaction between psychotropics and COVID-19 treatment medication can be reported and studied. Finally, we also provide a literature review of the latest known antiviral properties of psychotropics against SARS-CoV-2 as complementary information.

Objectives Osteoarthritis is a painful joint disease responsible for walking impairment. Its quantitative assessment by gait analysis in mice may be a relevant and noninvasive strategy to assess the disease severity. In this study, we aimed to determine the severity of osteoarthritis at the tissular and gait levels in unilateral and bilateral posttraumatic murine osteoarthritis. Methods Twenty-four C57BL/6 male mice were randomly assigned to 3 groups ( n = 8/group): controls, unilateral surgery, and bilateral surgery. Posttraumatic osteoarthritis was induced unilaterally or bilaterally by destabilization of the medial meniscus. Gait analysis was performed weekly with the CatWalkTM XT system until the 16th week after surgery. After animal sacrifices, histological and micro–computed tomographic assessment was performed. Results Operated knees showed a significant increase in the histological score compared with controls ( P < 0.001). Calcified anterior medial meniscal bone volume was higher on the ipsilateral side after unilateral destabilization of the medial meniscus ( P < 0.001) and on both sides after bilateral intervention ( P < 0.01). One week after surgery, the mice mean speed decreased significantly in both operated groups ( P < 0.001 and P < 0.05). In the unilateral group, a significant increase in the contralateral hind print area appeared from week 4 to week 16. Conclusions While bilateral destabilization of the medial meniscus induced no detectable gait modification except 1 week after surgery, unilateral model was responsible for a gait disturbance on the contralateral side. Further studies are needed to better define the place of the CatWalkTM in the evaluation of mouse models of osteoarthritis.

The Gram-negative bacterium Klebsiella pneumoniae is notorious for a strong increase of infections with antibiotic resistant strains. To treat infections with antibiotic resistant K. pneumoniae, clinicians increasingly need to use the last resort antibiotic colistin. K. pneumoniae can develop colistin resistance by modifying its membranes. During infection the membranes of Gram-negative bacteria are also targeted by the human immune system via the complement system. Gram-negative bacteria have an outer and inner membrane separated by a thin cell wall. Activation of the complement system leads to the formation of the membrane attack complex (MAC), a pore that inserts into the outer membrane, and ultimately leads to lysis of the bacterium. As both colistin and the MAC interact with the outer membrane of Gram-negative bacteria, we wondered if developing colistin resistance influences MAC-mediated killing of K. pneumoniae.Using clinical isolates that developed colistin resistance, we found that the strain Kp209_CSTR became more sensitive to MAC-mediated killing compared to the wild-type strain. MAC-mediated membrane permeabilization of Kp209_CSTR required antibody dependent activation of the classical complement pathway. Strikingly, Kp209_CSTR was bound by IgM in human serum that did not recognise the wild-type strain. Depletion of Kp209_CSTR-specific antibodies from serum prevented MAC-mediated membrane permeabilization, which was restored by adding back IgM. Genomic sequence comparison revealed that Kp209_CSTR has a deletion in the phoQ gene. RNAseq analysis suggested that this mutation locks PhoQ in a constitutively active state. These results indicate that PhoQ activation in Kp209_CSTR leads to both colistin resistance and sensitivity to MAC-mediated killing. Together, our results show that developing colistin resistance can sensitize K. pneumoniae to killing by the immune system.

In Re Y [2020] EWCA Civ 1038, the local authority (‘LA’) applied to revoke placement orders for children, aged 11 and 9 years because it was unable to identify suitable adoptive placements. The par...

International audience; Purpose Suspended particulate matter (SPM) transport through rivers is a major vector of nutrients and pollutants to continental shelf areas. To develop efficient sediment management strategies, there is a need to obtain quantitative information on SPM sources. For many years, the geochemical properties of SPM have been commonly used as tracers to identify sediment sources. In large watersheds, with numerous sources, the expected alteration of tracers during their transport requires that their reactivity be taken into account.Materials and methods To overcome this issue, we tested the use of major and trace element signatures in the residual fraction of SPM, using two different extraction methods. This original fingerprinting approach was applied to the Upper Rhone River basin (similar to 20,000 km(2)) in order to assess the respective SPM contributions of its main five tributaries (Arve, Ain, Fier, Guiers, and Bourbre Rivers) for contrasted hydrological conditions (base flow periods, flood events and dam flushing). By incorporating element concentrations previously corrected from particle size distribution in a mixing model coupled to Monte Carlo simulations, we estimated the associated uncertainties of the SPM contributions from each tributary. The relative SPM contributions obtained using this fingerprinting approach were compared with those calculated with a 1-D hydro-sedimentary model.Results and discussion The use of element concentrations, such as Zn, P, Cu, Pb, Mn, or Sr, in the total fraction of SPM as conservative fingerprinting properties was not suitable, since they are mainly bound (> 50%) to reactive carrier phases. By using Ba, Ni, Fe, Mg, Cu, Sr, and V concentrations in the SPM residual fraction, the apportionment modeling of SPM sources was successfully assessed. The fingerprinting approach showed that, in base flow conditions, SPM originated mainly from the Arve River. During dam flushing event, the fingerprinting approach consistently estimated that re-suspended sediments came from the Arve River, while the 1-D hydro-sedimentary model estimated a proportion of re-suspended sediment originating within the Rhone River.Conclusions This original fingerprinting approach highlighted the relevance of using geochemical properties in the non-reactive fraction of SPM in order to obtain reliable information on spatial sources of SPM in a large river basin. This methodology opens up promising perspectives to better track SPM sources in highly reactive environments such as estuaries/delta or in historical sediment archives.

As I formally retire, the editors, my friends and colleagues Mavis Maclean and Dr Emma Hitchings have asked me to write a short piece reflecting on my experiences researching and explaining law. Th...

Although lithium is widely used in current practice to treat bipolar disorder (BD) and treatment-resistant major depressive disorder (MDD) among older adults, little is known about its efficacy and tolerability in this population, which is generally excluded from randomized clinical trials. The objective of this study was to evaluate the efficacy and tolerability of long-term use of lithium among older adults with BD and MDD.Data from the Cohort of individuals with Schizophrenia and mood disorders Aged 55 years or more (CSA) were used. Two groups of patients with BD and MDD were compared: those who were currently receiving lithium versus those who were not. The effects of lithium on psychiatric (i.e., depressive symptoms severity, perceived clinical severity, rates of psychiatric admissions in the past-year), geriatric (overall and cognitive functioning) and physical outcomes (i.e., rates of non-psychiatric medical comorbidities and general hospital admissions in the past-year) were evaluated. All analyses were adjusted for age, sex, duration of disorder, diagnosis, smoking status, alcohol use, and use of antipsychotics, antiepileptics or antidepressants.Among the 281 older participants with BD or MDD, 15.7% were taking lithium for a mean duration of 12.5(SD = 11.6) years. Lithium use was associated with lower intensity of depressive symptoms, reduced perceived clinical global severity and lower benzodiazepine use (all p 0.05), without being linked to greater rates of medical comorbidities, except for hypothyroidism.Data were cross-sectional and data on lifetime history of psychotropic medications was not assessed.Our results suggest that long-term lithium use may be efficient and relatively well-tolerated in older adults with BD or treatment-resistant MDD.

Background Numerous inclusion and exclusion criteria are involved in phase III moderate to severe psoriasis trials investigating the safety and efficacy of biologics. This questions the generalization of results. Methods In this cohort study, we applied inclusion/exclusion criteria for phase III trials from original protocols (adalimumab - REVEAL, ustekinumab - PHOENIX, brodalumab - AMAGINE, secukinumab FIXTURE) to all patients enrolled in the PsoBioTeq prospective registry who received a biological agent for the first time between July 2012 and November 2017. We then compared the efficacy, drug survival and occurrence of adverse events between patients who satisfied/did not satisfy the eligibility criteria for these phase III trials. Results A total of 1267 patients were enrolled, of whom 993 (78.4%) were not eligible for at least one RCT (randomized controlled trial) and 251 (19.1%) did not meet the PASI/PGA severity requirements. Apart from disease severity, the most frequent criteria resulting in exclusion were as follows: non-plaque psoriasis (12.6%), significant cardiac disease (8.4%), significant liver disease (7.3%), elevated liver enzymes (4.9-9.6%) and personal history of diabetes (9.2%). There was no difference in drug survival between the two groups. The incidence ratio of adverse events was significantly lower in eligible versus non-eligible patients [0.78 (95% CI 0.62-0.97) (P = 0.03)]. Conclusion The majority of patients treated with biologics in the PsoBioTeq real-life registry would not have been eligible for phase III moderate to severe psoriasis trials. Patients not eligible for psoriasis phase III clinical trials have a higher incidence of adverse events.

Photochemistry using inexhaustible solar energy is an eco-friendly way to produce fine chemicals outside the typical laboratory or chemical plant environment. However, variations in solar irradiation conditions and the need for an external energy source to power electronic components limits the accessibility of this approach.In this work, a chemical solar-driven “mini-plant” centred around a scaled-up luminescent solar concentrator photo microreactor(LSC-PM) was built. To account for the variations in solar irradiance at ground level and passing clouds ,a responsive control system was designed that rapidly adapts the flow rate of the reagents to the light received by the reaction channels. Supplying the plant with solar panels, integrated into the module by placing it behind the LSC to utilize the transmitted fraction of the solar irradiation, allowed this setup to be self-sufficient and fully operational off-grid. Such a system can shine in isolated environments and in a distributed manufacturing world, allowing to decentralize the production of fine chemicals.

International audience; Background: Patient suicide (PS) is known to be a frequent and challenging occupational hazard for mental health professionals. No study previously explored the prevalence and impact of PS in a large sample of French psychiatrists.Method: A national web-based survey was performed between September and December 2019 to assess (a) the prevalence of the exposure to PS, (b) the emotional, traumatic and professional impacts of PS, and (c) the perceived support in the aftermath of PS in French psychiatrists. Participants were contacted through email to answer the online 62-item questionnaire, including a measure of traumatic impact through the Impact of Event Scale-Revised. Emotional and professional impacts and perceived support were assessed through dedicated items.Results: A total of 764 psychiatrists fully completed the survey. Of them, 87.3% reported an exposure to PS and 13.7% reported PTSD symptoms afterward. Guilt, sadness and shock were the most frequent emotions. Among the exposed psychiatrists, 15.1% have temporarily considered changing their career path. The most emotionally distressing PS occurred during their ten first years of practice or during residency. A total of 37.1% of respondents felt unsupported and 50.4% reported that no team meeting had been organized in the aftermath. The feeling of responsibility for the death was strongly associated with negative impacts.Conclusion: Our results entail considerations to prevent negative mental health outcomes in psychiatrists after PS. Notably, our results advocate for the implementation of educational programs during psychiatric residency and postvention programs in healthcare settings to effectively help psychiatrists in dealing with PS.

Sunlight strikes our planet every day with more energy than we consume in an entire year. Therefore, many researchers have explored ways to efficiently harvest and use sunlight energy for the activation of organic molecules. However, implementation of this energy source in the large-scale production of fine chemicals has been mostly neglected. The use of solar energy for chemical transformations suffers from potential drawbacks including scattering, reflections, cloud shading and poor matches between the solar emission and absorption characteristics of the photochemical reaction. In this account, we provide an overview of our efforts to overcome these issues through the development of Luminescent Solar Concentrator-based PhotoMicroreactors (LSC-PM). Such reactors can efficiently convert solar energy with a broad spectral distribution to concentrated and wavelength-shifted irradiation which matches the absorption maximum of the photocatalyst. Hence, the use of these conceptually new photomicroreactors provides an increased solar light harvesting capacity, enabling efficient solar-powered photochemistry.