3D-printed simulator for nasopharyngeal swab collection for COVID-19.

OBJECTIVES: Diagnosis of COVID-19 is essential to prevent the spread of SARS-CoV-2. Nasopharyngeal swabs (NPS) remain the gold standard in screening, although associated with false negative results (up to 30%). We developed a 3D simulator of the nasal and pharyngeal cavities for the learning and improvement of NPS collection. PATIENTS AND METHODS: Simulator training sessions were carried out in 11 centers in France. A questionnaire assessing the simulator was administered at the end of the sessions. The study population included both healthcare workers (HCW) and volunteers from the general population. RESULTS: Out of 589 participants, overall satisfaction was scored 9.0 [8.9-9.1] on a scale of 0 to 10 with excellent results in the 16 evaluation items of each category (HCWs and general population, NPS novices and experienced). The simulator was considered very realistic (95%), easy to use (97%), useful to understand the anatomy (89%) and NPS sampling technique (93%). This educational tool was considered essential (93%). Participants felt their future NPS would be more reliable (72%), less painful (70%), easier to perform (88%) and that they would be carried out more serenely (90%). The mean number of NPS conducted on the simulator to feel at ease was two; technical fluency with the simulator can thus be acquired quickly. CONCLUSION: Our simulator, whose 3D printing can be reproduced freely using a permanent open access link, is an essential educational tool to standardize the learning and improvement of NPS collection. It should enhance virus detection and thus contribute to better pandemic control.

Comparing zonal and CFD model predictions of isothermal indoor airflows to experimental data.

It is inappropriate to use the assumption of instantaneously well-mixed zones to model airflows and pollutant transport in large indoor spaces. We investigate two approaches for describing the details of airflows in large indoor spaces, for accuracy and suitability for integration with multi-zone infiltration models. One approach, called the zonal method, was developed over the last 15 years to provide an improvement over the well-mixed assumption. The second approach is the use of a computational fluid dynamics simulation using a coarse grid model of the large indoor space. We compare velocity predictions from different formulations of zonal methods and coarse-grid k-epsilon computational fluid dynamics (CFD) models, to measurements, in a 2D mechanically ventilated isothermal room. Our results suggest that, when airflow details are required, coarse-grid CFD is a better-suited method to predict airflows in large indoor spaces coupled with complex multi-zone buildings, than are the zonal methods. Based on the comparison of pressure predictions from different models, we offer guidance regarding the coupling of a model of detailed airflow in large spaces to algebraic multi-zone infiltration models.

[Adult celiac disease: importance of delay to diagnosis]. / La maladie coeliaque de l'adulte: un diagnostic souvent évoqué tardivement.

OBJECTIVE: Adult celiac disease is a genetically determined condition resulting from intolerance to gluten. This familial disease is associated with HLA B8 DR3 and is characterized by cytotoxic T-lymphocyte reaction in the digestive wall leading to a maladsorption syndrome. Adult celiac disease would be an expression of a silent disease already present in childhood. PATIENTS AND METHODS: We conducted a retrospective study in 19 patients. Diagnosis was established in a department of internal medicine in adulthood. We analyzed histological findings and the clinical history and course. RESULTS: The age curve at diagnosis peaked at 22 years and 67 years. Female sex predominated. Average delay to diagnosis was 3.1 years. The patients were admitted for reasons other than digestive disorders in 17 out of 19 cases. Careful history taking did however disclose subtle digestive signs. The principal manifestations were hematological disorders such as chronic anemia, abnormal liver function tests, and poor control of associated diseases. Type 1 diabetes mellitus was the main associated disease (4/19). Patients with prolonged nutritional deficiencies experienced serious situations. CONCLUSION: Adult celiac disease is a clinical variant suggesting the presence of other non-digestive disorders. Specific antibodies should be assayed in patients with even minimal signs of deficiency in order to identify associated diseases. The principal cause of mortality is digestive T-cell lymphoma. A gluten-free diet is essential to control the course of this chronic disease.

[Diffuse digestive tract B-cell lymphoma manifesting as exudative enteropathy]. / Entéropathie exsudative révélant un lymphome digestif B diffus.

BACKGROUND: Early manifestations of primary lymphomas of the digestive tract generally include general signs and abdominal pain. Diarrhea is uncommon and may result from several mechanisms. We report a case of primary lymphoma of the digestive tract in a patient presenting exsudative enteropathy. CASE REPORT: A 68-year-old woman was hospitalized for profuse diarrhea of 15 days duration. Laboratory tests showed major hypoalbuminemia. Malabsorption could not be evidenced and no infectious foyer was found. Biopsies at different levels of the digestive tract showed mucosal invasion by MALT type B-cell lymphoma. The clinical course was initially favorable after chemotherapy. DISCUSSION: Classification of digestive tract lymphomas differentiates MALT type B-cell lymphoma (the most frequently encountered type in western countries), Mediterranean lymphomas, and T-cell lymphomas generally complicating coeliac disease. MALT type lymphomas may occur in association with Helicobacter pylori infection, usually in a gastric localization. Multiple localizations are uncommon and diffuse involvement of the digestive tract as in our observation appears exceptional. This extension would explain the exsudative enteropathy which regressed with chemotherapy.

[Late manifestation of common variable immunodeficiency by Biermer's disease]. / Hypogammaglobulinémie commune variable révélée tardivement par une maladie de Biermer.

BACKGROUND: Common variable immunodeficiency (CVI) is a heterogeneous disorder characterized by decreased production of antibodies. Clinical presentation of CVI is generally that of recurrent pyogenic infections. Autoimmune diseases can also occur. The age of onset of symptoms shows two peaks at 1-5 and 16-20 years. CASE REPORT: A 77-year-old man was admitted in hospital for pernicious anemia. We discovered hypogammaglobulinemia with low levels of immunoglobulin G, A and M, but normal T-cell levels. We diagnosed common variable immunodeficiency. This patient had not had recurrent pyogenic infections. DISCUSSION: This case shows that common variable immunodeficiency can be revealed late by an autoimmune disease. The pathogenesis of autoimmune diseases in this immunodeficiency remains unknown despite several possible explanations.

Treatment of ureteric colic. Intravenous versus rectal administration of indomethacin.

A randomised multicentre clinical trial was undertaken to compare the effect on pain of indomethacin administered either intravenously or rectally to 116 patients with ureteric colic. Adverse reactions were also assessed. Of the patients receiving the intravenous injection, 48/53 (91%) achieved good pain relief (i.e. no supplementary analgesia was required) 30 min after administration, compared with 46/63 (73%) receiving the enema. Significantly more side effects occurred in the group treated intravenously. It was concluded that indomethacin administered as an enema was less effective than the intravenous form, but it should be regarded as a good alternative in the treatment of ureteric colic.

Relationship between Gene Dosage and Gene Expression in the Chloroplast of Chlamydomonas reinhardtii.

Expression of three chloroplast genes encoding proteins of different chloroplast complexes and the rRNA gene has been examined in cells having reduced numbers of chloroplast genomes as a result of growth in the presence of the thymidine analog 5-fluorodeoxyuridine. While accumulation of total mRNA for rpl2 (ribosomal protein L-1), rbcL (ribulose bisphosphate carboxylase large subunit) and atpA (alpha-subunit of ATP synthase) declined with gene copy number, the levels of translatable mRNA and rates of synthesis of these three proteins were largely unaffected. Accumulation of rRNA declined less precipitously than mRNA levels for the three proteins in response to the reduction in chloroplast genome number. Chlamydomonas appears to compensate for reductions in the number of chloroplast genomes at several different levels. Populations of cells with only one-fourth the wild-type amount of chloroplast DNA per cell on average have half the normal level of chloroplast ribosomes and nearly normal rates of CO(2) fixation and levels of specific chloroplast encoded proteins. These results suggest that normal cells accumulate a large excess of transcripts for chloroplast genes and that levels of expression of these genes are regulated by posttranscriptional mechanisms.

Interactions of Escherichia coli and marine bacteria with 241Am in laboratory cultures.

In nutrient media, Escherichia coli and selected strains of marine facultative anaerobes accumulated significant amounts of the transuranic radioisotope 241Am. The pattern of uptake varied among strains and was dependent upon pH, culture media and growth stage of the population. Desorption of 241Am to montmorillonite was significantly less in filtered media from some bacterial cultures than in "unconditioned" control media, suggesting that bacterial exometabolites may form complexes with Am thereby increasing its solubility.

Intraspecific variation in the structural organization and redundancy of chloroplast ribosomal DNA cistrons in Euglena gracilis.

Chloroplast DNAs from six different laboratory collections of Euglena gracilis "strain Z" and var. bacillaris were analyzed with restriction endonucleases EcoRI and Bam HI. The most variable portion of the organelle genome is the region containing the ribosomal cistrons. Intraspecific differences occur in both ribosomal DNA cistron number (one or three) and structural organization among those strains designated as "strain Z" and bacillaris. One culture previously designated as "Z" is most likely bacillaris.

Perturbation of chloroplast DNA amounts and chloroplast gene transmission in Chlamydomonas reinhardtii by 5-fluorodeoxyuridine.

5-Fluorodeoxyuridine selectively decreases the rate of chloroplast DNA replication in Chlamydomonas resulting after several generations of growth in equilibrium levels as low as one-seventh of normal. When the maternal parent is treated prior to mating, the decrease of chloroplast DNA appears to perturb the normal maternal transmission of chloroplast genes, dramatically increasing the proportion of exceptional zygotes transmitting chloroplast genes from the paternal parent.