2022 Recommendations of the AFU Lithiasis Committee: Management of symptomatic urinary stones.

The acute situation, caused by an obstructive stone, is defined by a renal colic that may be uncomplicated, complicated, or at risk in specific conditions. Its management may be medical or require interventional treatment by extracorporeal shockwave lithotripsy, endoscopic removal, or ureteroscopy. METHODOLOGY: These recommendations were developed using two methods, the Clinical Practice Recommendations (CPR) and the ADAPTE method, in function of whether the question was considered in the European Association of Urology (EAU) recommendations (https://uroweb.org/guidelines/urolithiasis) [EAU Guidelines on urolithiasis. 2022] and whether they could be adapted to the French context.

Time-resolved near backscatter imaging system on Laser MegaJoule.

The newly operating near-backscattering imaging (NBI) system on the Laser MegaJoule (LMJ) is briefly described with emphasis on the temporally resolved measurements and their synchronization with the LMJ laser pulse through target shots taken as part of the diagnostic commissioning campaign. The NBI measures the stimulated Brillouin and Raman scattered light around two quadruplets (one inner and one outer) of the upper LMJ hemisphere. The temporal resolution is achieved with a unique system: a specifically designed wide-open optical lens images 40 points of a diffuser onto an array of optical fibers with the scattered light recorded on a multiplexed photodiode array.

Clinical outcome of patients with self-inflicted burns.

INTRODUCTION: Patients with self-inflicted burns (SIB) are thought to have a longer length of stay compared to patients with accidental burns. However, other predictors for a longer length of stay are often not taken into account, e.g. percentage of the body surface area burned, age or comorbidities. Therefore, we wanted to study the outcome of patients with SIB at our burn center. METHODS: A retrospective, observational study was conducted. All adult patients with acute burns admitted to the burn center of the Martini Hospital Groningen, between January 1, 2009 and December 31, 2013 were included. Data on characteristics of the patient, injury, and outcome (LOS, mortality, discharge destination) were collected. In patients with SIB, suicide attempts (SA) were distinguished from self-harm without the intention to die (non-suicidal self-injury, NSSI). To evaluate differences in outcome, each patient with SIB was matched on variables and total score of the Abbreviated Burn Severity Index (ABSI) to a patient with accidental burns (AB). RESULTS: In total 29 admissions (21 SA and 8 NSSI) were due to SIB and 528 due to accidents. Overall, when compared to AB, there were significant differences with respect to mortality and LOS for SA and/or NSSI. Mortality was higher in the SA group, while the LOS was higher in both the SA and NSSI groups compared to the AB group. However, after matching on ABSI, no statistical significant differences between the SA and SA-match or the NSSI and NSSI-match group were found. CONCLUSION: With the right and timely treatment, differences in mortality rate or length of stay in hospital could all be explained by the severity of the burn and the intention of the patient.

[Impact of endocrine disrupting chemicals on birth outcomes]. / Effets des perturbateurs endocriniens sur les marqueurs de la périnatalité

BACKGROUND: Endocrine disruptors are ubiquitous chemicals contaminants in the environment, wildlife, and humans. Their adverse effects on reproduction are well-documented. There is growing evidence that they can contribute to the current emergence of chronic diseases. OBJECTIVES: Our aim is to assess the relationships between endocrine disruptors and the neonatal health outcomes. METHODS: Two persons have independently reviewed Medline and Toxline databases about the following pollutants: bisphenol A, phthalates, parabens, brominated flame retardants and perfluorinated compounds. Only the human epidemiological studies, in general population with an abstract available, published between 2007 January the 1st and 2011 December the 31st, were analysed. The quality of each study was assessed with the Strobe score. RESULTS: Twenty-five out of 680 studies were included in the analysis. All pollutants were widely detected in maternal and new borns samples. Most of the studies have shown associations between bisphenol A, brominated flame retardants and perfluorinated compounds and lower birth weight. The effects on gestational age were less documented and have shown no clear connection. Results for phthalates were more ambiguous. Only one non-instructive study was found on parabens. DISCUSSION: Due to the inherent methological bias on endocrine disruptors research, further additional studies on environmental health must be investigated. It seems necessary to adopt preventive health measures first for vulnerable population.

Why GPs do not follow computerized guidelines: an attempt of explanation involving usability with ASTI guiding mode.

Clinical decision support systems (CDSSs) have the potential to increase guideline adherence, but factors of success are not well understood. ASTI-GM is an on demand guideline-based CDSS where the user interactively characterizes her patient by browsing the system knowledge base to obtain the recommended treatment. We conducted a web-based evaluation of ASTI-GM as a before-after study to assess whether the system improves general practitioners' (GPs) performance and how they would use it. Five clinical cases had to be solved, as usual in the before phase, and using ASTI-GM in the after phase. On a 2-month period, 266 GPs participated and 1,981 prescription orders were collected. The overall guideline adherence rate increased from 27.2% to 64.3%. Only 56.4% of ASTI-GM uses corresponded to a "good use" of the system. Adherence increased from 28.5% to 86.1% in the sub-group of "good uses", whereas it only increased from 28.1% to 36.6% in the complementary sub-group. Reasons for non "good uses" of CDSSs should be investigated since they impede their potential impact.

Efficacy and safety of abatacept or infliximab vs placebo in ATTEST: a phase III, multi-centre, randomised, double-blind, placebo-controlled study in patients with rheumatoid arthritis and an inadequate response to methotrexate.

OBJECTIVES: This double-blind trial evaluated the efficacy and safety of abatacept or infliximab vs placebo. The primary objective of this study was to evaluate the mean change from baseline in Disease Activity Score (based on erythrocyte sedimentation rates; DAS28 (ESR)) for the abatacept vs placebo groups at day 197. METHODS: Patients with rheumatoid arthritis (RA) and an inadequate response to methotrexate (MTX) were randomised 3:3:2 to abatacept ( approximately 10 mg/kg every 4 weeks, n = 156), infliximab (3 mg/kg every 8 weeks, n = 165), or placebo (every 4 weeks, n = 110) and background MTX. Safety and efficacy were assessed throughout the study. RESULTS: Similar patient demographics and clinical characteristics were present at baseline between groups, with mean scores of approximately 1.7 for HAQ-DI and 6.8 for DAS28 (ESR). At 6 months, mean changes in DAS28 (ESR) were significantly greater for abatacept vs placebo (-2.53 vs -1.48, p<0.001) and infliximab vs placebo (-2.25 vs -1.48, p<0.001). For abatacept vs infliximab treatment at day 365, reductions in the DAS28 (ESR) were -2.88 vs -2.25. At day 365, the following response rates were observed for abatacept and infliximab, respectively: American College of Rheumatology (ACR) 20, 72.4 and 55.8%; ACR 50, 45.5 and 36.4%; ACR 70, 26.3 and 20.6%; low disease activity score (LDAS), 35.3 and 22.4%; DAS28-defined remission, 18.7 and 12.2%; good European League Against Rheumatism (EULAR) responses, 32.0 and 18.5%; and Health Assessment Questionnaire Disability Index (HAQ-DI), 57.7 and 52.7%. Mean changes in physical component summary (PCS) were 9.5 and 7.6, and mental component summary (MCS) were 6.0 and 4.0, for abatacept and infliximab, respectively. Over 1 year, adverse events (AEs) (89.1 vs 93.3%), serious AEs (SAEs) (9.6 vs 18.2%), serious infections (1.9 vs 8.5%) and discontinuations due to AEs (3.2 vs 7.3%) and SAEs (2.6 vs 3.6%) were lower with abatacept than infliximab. CONCLUSIONS: In this study, abatacept and infliximab (3 mg/kg every 8 weeks) demonstrated similar efficacy. Overall, abatacept had a relatively more acceptable safety and tolerability profile, with fewer SAEs, serious infections, acute infusional events and discontinuations due to AEs than the infliximab group. TRIAL REGISTRATION NUMBER: NCT00095147.

Epidemiological analysis of patients with Type 2 diabetes in France.

This paper presents the baseline epidemiological data from 5548 patients with type 2 diabetes enrolled in a French observational study that aims to examine the safety, tolerability and use of acarbose as prescribed by general practitioners (GPs). Patients were recruited and monitored by a representative sample of GPs. Recruitment did not depend on a patient's suitability for acarbose treatment. The data revealed that the mean age of the patient population was 63 years, and that more than 50% of patients were over 65 years old. The population was markedly overweight [mean body mass index(BMI): males, 28.4 kg/m(2); females, 29.1 kg/m(2)] and the mean duration of diabetes was 10 (+/-7.3) years. Over 37% of patients had at least one diabetic complication, and the frequency of complications increased with both age and the duration of diabetes. The most frequently reported complications were cardiac (17.8%), vascular (14.5%) and ocular (12%). At recruitment, almost 90% of patients were being treated with oral antidiabetic agents (OADs). Sulphonylureas (74%) and biguanides (50%) were the most commonly prescribed agents. Acarbose was used to treat 17% of patients and 1% were receiving insulin. GPs set glycaemic treatment goals for 44% of patients in the study. Fasting glycaemia was the primary goal for 37% of the total study population, and HbA(1c) levels for 21% of patients. Postprandial glycaemia was generally given as a secondary or tertiary goal. In conclusion, this study provides the most up-to-date epidemiological data for patients with type 2 diabetes in France.

Enumeration of total viable microorganisms in an antibiotic raw material using ChemScan solid phase cytometer.

A preliminary study was performed for the enumeration of microorganism contamination of the macrolide antibiotic, Spiramycin, using epifluorescence with the ChemScan solid phase cytometer. The artificial spiking of Spiramycin powder antibiotic with pure culture of four microorganisms led to complete recovery of the tested organisms, whatever their sensitivity to the bacteriostatic activity of the drug. With the conventional plate method run in parallel, complete recovery was only obtained for Spiramycin resistant organisms. The spiked microorganisms that were sensitive to the antibiotic remained inhibited or stressed by the action of the Spiramycin and did not grow on the plate.

[Cervical ectopic thymus]. / Timo ectópico cervical.

We present a case of ectopic thymus in an eight month old male baby, with a right lateral tumor of the neck. Ectopic thymus is a pathology rarely observed, its embryogenesis could explain its cervical localization. X Ray, ultrasonography, IRM, esophagoscophy and laryngoscophy may be helpful in the differential diagnosis with other tumors of the neck. Due to the fact that cystic lesions and neoplasis developments take place, the chosen treatment is the complete chirurgical extirpation. But at the absence of symptoms, no treatments is advisable because eventually the thymus spontaneously involutionates.

[Eosinophilia in pediatrics. Report of clinical cases]. / Eosinofilia en pediatría. Presentación de casos clínicos.

We present four clinical cases where eosinophilia was a prominent sign. Final Diagnoses were Toxocariasis, Ascaris Lumbricoides Infection, Acute Lymphocytic Leukaemia and Histiocytosis of Langerhans Cells.

Human T-cell lymphotropic virus type 1 infection and tropical spastic paraparesis in Belgian expatriates.

A case of HTLV-1 associated tropical spastic paraparesis is described in a Belgian nun who had been working as a midwife in Central Africa. Occupational exposure was the only risk factor identified. Among 2,482 Belgian expatriates in tropical countries, 92% of whom had resided in sub-Saharan Africa for an average of 15.5 years, only one Belgian-born man was found seropositive for HTLV-1. He was married to an African woman and living in Central Africa for 23 years. The risk of HTLV-1 infection is low in Belgian expatriates and on its own does not support generalised anti-HTLV screening in autochthonous Belgian blood donors.

[Natural inhibitor of metalloproteinases: structural and functional study]. / Inhibiteur naturel des métalloprotéinases: étude structurale et fonctionnelle.

A potent collagenase inhibitor was purified from cells of calf aorta medial tissue maintained in culture. This molecule was characterized and identified as TIMP (Tissue Inhibitor of Metalloproteinases). Formation of a TIMP--collagenase complex was demonstrated chromatographically using pure TIMP and pure pig synovial cell collagenase. The N-terminal aminoacid sequence of TIMP was determined and, using appropriate oligonucleotide probes the human genes was cloned from a human cDNA bank. This gene was expressed in E. coli, and fully active TIMP was obtained after a denaturation renaturation process. The interest of TIMP as a model for the design of novel collagenase inhibitors is discussed.

Risk factors for infection with human immmunodeficiency virus among European expatriates in Africa.

The pattern of cases of AIDS in Belgium suggests that Europeans infected with human immunodeficiency virus (HIV) acquired the infection in Africa. The prevalence of infection was assessed in Belgian advisers and European expatriates and risk factors for infection defined in a case-control study of expatriate men. Fifteen (1.1%) of 1401 Belgian advisers working in Africa and 41 (0.9%) of 4564 European expatriates living in Africa, were positive for antibody to HIV in a voluntary screening programme in Belgium. Among subjects with antibody to HIV the ratio of men to women was 3:1. These subjects did not have a history of intravenous drug abuse or blood transfusion and only one was homosexual. In a case-control study of 33 expatriate men who had antibody to HIV and 119 controls the men with antibody reported significantly more female sexual partners, who were more commonly local; and significantly more sexual contact with prostitutes in Africa. They had a significantly higher prevalence of history of sexually transmitted disease and had received significantly more injections by unqualified staff in Africa during the previous five years. No specific sexual practices were associated with having antibody to HIV. After multivariate analysis sexual contact with local women (adjusted odds ratio 14.7; 95% confidence interval 2.81 to 76.9), sexual contact with prostitutes (adjusted odds ratio 10.8 (1.6 to 71.9), and injections by unqualified staff (adjusted odds ratio 13.5 (3.7 to 49.8) remained independent risk factors for infection. European expatriates in Africa were at increased risk from infection with HIV and were a means of introducing HIV into the heterosexual population in Europe. Transmission from women to men by vaginal intercourse seemed to be the most probable route of infection.

Sequence of a cellulase gene of the thermophilic bacterium Clostridium thermocellum.

The nucleotide sequence of the celA gene, encoding the extracellular endoglucanase A of Clostridium thermocellum, was determined and compared with the NH2-terminal amino acid sequence of the purified enzyme. The mature protein appeared to be extended by a signal sequence of 32 amino acids. A segment of 23 amino acids was duplicated at the COOH-terminal end of the protein. The putative GUG initiation codon was preceded by an AGGAGG sequence, typical of procaryotic ribosomal binding sites. The segment of DNA presumably specifying transcriptional initiation contained a high percentage of adenine and thymine residues, including an adenine-thymine tract extending over 54 base pairs.

Identification of the endoglucanase encoded by the celB gene of Clostridium thermocellum.

The endoglucanase encoded by the celB gene of Clostridium thermocellum was purified from an E. coli strain carrying and expressing the C. thermocellum gene cloned in the plasmid pBR322. The preparation showed two active bands, with Mr 55,000 and 53,000, presumably derived from the primary translation product by proteolysis. Specific antiserum raised against these bands was used to identify the corresponding antigen in the culture supernatant of C. thermocellum: in a double immunodiffusion test (Ouchterlony), a precipitin line was observed which fused completely with that formed by an E. coli extract containing endoglucanase B expressed from the cloned gene. Proteins from C. thermocellum supernatant were further analyzed by SDS-polyacrylamide gel electrophoresis and transferred to a nitrocellulose sheet. After incubating the nitrocellulose blot with antiserum and subsequently with 125I-labeled protein A, a band with Mr 66,000, corresponding to the celB gene product expressed by C. thermocellum, was detected by autoradiography.

[Epidemiological control of intestinal nematodoses in a rural area of Zaïre (author's transl)]. / Contrôle épidémiologique des nématodoses intestinales dans une zone rurale au Zaïre.

In order to establish the rational organization of a mass campaign intended to control intestinal parasites in villages of a rural zone in Lower Zaïre, a prevalence study was made of a total population of 3,056 inhabitants. Coprologic examination allowed to determine the following mean levels of prevalence: Ascaris, Lumbricoides 57 per cent, ankylostoma 51 per cent, Stronglyoides stercoralis 14 per cent and Trichuris trichiura 11 per cent. In a prospective survey of nine months allowed to determine the optimal therapeutic coverage to be realized in the municipalities concerned using the epidemiological date as a reference.

Mass control of ascariasis with single oral doses of levamisole. A controlled comparison in 3,056 subjects between three incomplete population coverages.

Ninety-, 60-, and 40-percent population coverages with levamisole 2.5 mg/kg of body weight were compared for their effects on Ascaris lumbricoides, ancylostoma, Strongyloides stercoralis, and Trichuris trichiura infections. They were shown to be effective in maintaining a reduced prevalence of A. lumbricoides in the treated subjects for 9, 6, and 3 months, respectively. Nine months after treatment, the prevalence of ascariasis was still lower than before treatment both in the levamisole and in the control subjects, regardless of the population coverage. This was probably because the egg output had been reduced. It is concluded that mass treatment with single oral doses of levamisole repeated at 3-month intervals might help control ascariasis, and that population coverages between 60 and 90% might be appropriate. No clear-cut effects against hookworms could be shown, possibly because the first follow-up examinations were performed three months after treatment. No changes in the prevalence of S. stercoralis and T. trichiura could be demonstrated. There were no adverse exp