Real-world artificial intelligence-based interpretation of fundus imaging as part of an eyewear prescription renewal protocol.

OBJECTIVE: A real-world evaluation of the diagnostic accuracy of the Opthai® software for artificial intelligence-based detection of fundus image abnormalities in the context of the French eyewear prescription renewal protocol (RNO). METHODS: A single-center, retrospective review of the sensitivity and specificity of the software in detecting fundus abnormalities among consecutive patients seen in our ophthalmology center in the context of the RNO protocol from July 28 through October 22, 2021. We compared abnormalities detected by the software operated by ophthalmic technicians (index test) to diagnoses confirmed by the ophthalmologist following additional examinations and/or consultation (reference test). RESULTS: The study included 2056 eyes/fundus images of 1028 patients aged 6-50years. The software detected fundus abnormalities in 149 (7.2%) eyes or 107 (10.4%) patients. After examining the same fundus images, the ophthalmologist detected abnormalities in 35 (1.7%) eyes or 20 (1.9%) patients. The ophthalmologist did not detect abnormalities in fundus images deemed normal by the software. The most frequent diagnoses made by the ophthalmologist were glaucoma suspect (0.5% of eyes), peripapillary atrophy (0.44% of eyes), and drusen (0.39% of eyes). The software showed an overall sensitivity of 100% (95% CI 0.879-1.00) and an overall specificity of 94.4% (95% CI 0.933-0.953). The majority of false-positive software detections (5.6%) were glaucoma suspect, with the differential diagnosis of large physiological optic cups. Immediate OCT imaging by the technician allowed diagnosis by the ophthalmologist without separate consultation for 43/53 (81%) patients. CONCLUSION: Ophthalmic technicians can use this software for highly-sensitive screening for fundus abnormalities that require evaluation by an ophthalmologist.

Validation of the Diagnostic Accuracy Levels of International Classification of Diseases, 10th Revision Codes for Diabetic Ketoacidosis: A Multicentre, Cross-sectional Study of Adults.

OBJECTIVES: International Classification of Diseases (ICD) codes are commonly used to identify cases of diabetic ketoacidosis (DKA) in health services research, but they have not been validated. Our aim in this study was to assess the accuracy of ICD, 10th revision (ICD-10) diagnosis codes for DKA. METHODS: We conducted a multicentre, cross-sectional study using data from 5 hospitals in Ontario, Canada. Each hospitalization event has a single most responsible diagnosis code. We identified all hospitalizations assigned diagnosis codes for DKA. A true case of DKA was defined using laboratory values (serum bicarbonate ≤18 mmol/L, arterial pH ≤7.3, anion gap ≥14 mEq/L, and presence of ketones in urine or blood). Chart review was conducted to validate DKA if laboratory values were missing or the diagnosis of DKA was unclear. Outcome measures included positive predictive value (PPV), negative predictive value (NPV), sensitivity, and specificity of ICD-10 codes in patients with laboratory-defined DKA. RESULTS: We identified 316,517 hospitalizations. Among these, 312,948 did not have an ICD-10 diagnosis code for DKA and 3,569 had an ICD-10 diagnosis code for DKA. Using a combination of laboratory and chart review, we identified that the overall PPV was 67.0%, the NPV was 99.7%, specificity was 99.6%, and sensitivity was 74.9%. When we restricted our analysis to hospitalizations in which DKA was the most responsible discharge diagnosis (n=3,374 [94.5%]), the test characteristics were PPV 69.8%, NPV 99.7%, specificity 99.7%, and sensitivity 71.9%. CONCLUSION: ICD-10 codes can identify patients with DKA among those admitted to general internal medicine.

Validation and bifactor structure of the French Adult ADHD Symptoms Rating Scale v1.1 (ASRS).

BACKGROUND: Three scoring methods for the widely available Adult ADHD Symptoms Rating Scale v1.1 (ASRS) have been proposed to screen for ADHD, but these three methods have rarely been compared against formal clinical diagnoses. We aimed to validate the French version of the ASRS against a clinical interview using DSM-IV and DSM-5 diagnostic algorithms. METHODS: One hundred five adults from a convenience sample were evaluated with the ASRS and the DIVA 2.0, using both DSM-IV and DSM-5 criteria. We used Confirmatory Factor Analysis to investigate the underlying structure of the ASRS. Sensitivity, specificity, and classification accuracy were compared between the rating algorithms of the ASRS. RESULTS: The full score method had worse predictive performance than the Screener and the 2-stage scoring method. All characteristics of the three scoring methods for the ASRS were worse when applying DSM-5 criteria. The best-fitting structure was a bi-factor model with a general ADHD factor and three specific factors. CONCLUSIONS: ADHD was best conceived as a one-dimensional construct. The 2-stage scoring method superseded the Screener with comparable sensitivity and specificity.

Retrospective diagnosis of childhood ADHD using the Wender Utah Rating Scale.

OBJECTIVE: An external validation of the Wender Utah Rating Scale (WURS) against a clinical assessment is lacking, especially for French-speaking populations. METHOD: Participants completed three subsets of the WURS-61 and were assessed for ADHD using the DIVA 2.0 semi-structured interview. Exploratory factor analyses were performed. Logistic regression models and Receiver-Operating Curves were used to determine the cut-off scores that predicted childhood ADHD with best accuracy. RESULTS: One hundred three adults were included. Three factors were extracted for the WURS-25 and WURS-K, and four for the WURS-29. Cut-off scores are 44, 24 and 42, respectively. When considering DSM-5 rather than DSM-IV criteria, these values changed to 44, 36 and 44, respectively. More than 83% of the participants had been correctly classified. CONCLUSION: All three subsets of the WURS-61 retrospectively predict the presence of ADHD in childhood. This result might prove to be useful in screening and research procedures.

[Being and having been a psychiatric nurse]. / Être et avoir été infirmière en psychiatrie.

To work as a psychiatric sector nurse is to have built a know-how in the richness and multiplicity of the sectorization. Since the 1990s, this specificity has disappeared and with it the belonging to a common culture. Another conception of care is emerging, responding to general trends rather than to specific and territorial needs. Today, it is hoped that knowledge and know-how will be built and passed on as a reference in areas of exchange yet to be invented.

Poor performance of albumin or protein-adjusted plasma calcium to diagnose dyscalcemia in hospitalized patients: A confirmatory study in a general internal medicine department.

INTRODUCTION: Hypo- and hypercalcemia are common and some causes require urgent diagnosis and treatment. Measurement of ionized calcium is the reference test to diagnose calcium disorders but total calcium adjusted for protein or albumin concentration is more often used. METHODS: Patients hospitalised in a general internal medicine department from September 2013 to December 2015 who had a total plasma calcium concentration and a serum albumin or protein concentration measured within 24h of a ionized calcium blood measurement were included. Total calcium was adjusted for protein or albumin concentration using widely used formulas and compared to ionized calcium as the gold standard. RESULTS: Among 210 included patients, 46 (22%) had hypocalcemia, 124 (59%) normocalcemia and 40 (19%) hypercalcemia according to ionized calcium concentration. Total calcium had 50% sensitivity and 95% specificity to diagnose hypocalcemia and a 93% sensitivity and 89% specificity to diagnose hypercalcemia. Adjusting total calcium for protein or albumin concentrations did not increase and sometimes decreased diagnostic accuracy. CONCLUSION: Total calcium, with or without albumin/protein adjustment, is poorly sensitive to screen for hypocalcemia. Unadjusted total calcium is as sensitive as protein- or albumin-adjusted total calcium to screen for hypercalcemia. These data argue against the use of albumin- or protein-adjusted calcium. Ionized calcium measurement should be performed to confirm dyscalcemia in patients with abnormal total calcium concentration and to rule out hypocalcemia in patients with total calcium concentration in the lower range of normal values.

A review of the taxonomy, genetics, and biology of the genus Escherichia and the type species Escherichia coli.

Historically, bacteriologists have relied heavily on biochemical and structural phenotypes for bacterial taxonomic classification. However, advances in comparative genomics have led to greater insights into the remarkable genetic diversity within the microbial world, and even within well-accepted species such as Escherichia coli. The extraordinary genetic diversity in E. coli recapitulates the evolutionary radiation of this species in exploiting a wide range of niches (i.e., ecotypes), including the gastrointestinal system of diverse vertebrate hosts as well as non-host natural environments (soil, natural waters, wastewater), which drives the adaptation, natural selection, and evolution of intragenotypic conspecific specialism as a strategy for survival. Over the last few years, there has been increasing evidence that many E. coli strains are very host (or niche)-specific. While biochemical and phylogenetic evidence support the classification of E. coli as a distinct species, the vast genomic (diverse pan-genome and intragenotypic variability), phenotypic (e.g., metabolic pathways), and ecotypic (host-/niche-specificity) diversity, comparable to the diversity observed in known species complexes, suggest that E. coli is better represented as a complex. Herein we review the taxonomic classification of the genus Escherichia and discuss how phenotype, genotype, and ecotype recapitulate our understanding of the biology of this remarkable bacterium.

Adverse caregiving in early life: The trauma and deprivation distinction in young children.

Knowledge and understanding about the impact of cumulative adverse experiences on the health and wellbeing of children, adolescents, and adults has rapidly expanded over the past 30 years. Despite the invaluable attention and support this proliferation has drawn to the importance of early childhood experiences, we believe that it is time to move beyond broad indices of risk and toward more specific and individualized understanding of how risk exposures are linked to clinical outcomes in young children. Within infant and early childhood mental health, there is a need for greater specificity in linking adverse caregiving experiences in early life to psychopathology in children. We highlight a framework distinguishing experiences of trauma from experiences of deprivation and use the examples of posttraumatic stress disorder and reactive attachment disorder to demonstrate how greater specificity in our understanding of early adverse caregiving can lead to more accurate and targeted diagnosis and treatment for young children. Both researchers and clinicians benefit from an approach to gain a greater appreciation of the links between specific types of experiences and outcomes in the children that we serve.

El conocimiento y la comprensión acerca del impacto de experiencias adversas acumuladas sobre la salud y bienestar de los niños, adolescentes y adultos se ha expandido rápidamente durante los pasados 30 años. A pesar de la inestimable atención y apoyo que esta proliferación ha derivado con respecto a la importancia de las experiencias de la temprana niñez, creemos que es tiempo de pasar más allá de los amplios índices de riesgo hacia una comprensión más específica e individualizada de cómo el hecho de estar expuesto a riesgo se conecta con los resultados clínicos en niños pequeños. Dentro el camp de la salud mental infantil, hay una necesidad por mayor especificidad para conectar las adversas experiencias de prestación de cuidado en la temprana parte de la vida con la sicopatología en los niños. Enfatizamos un marco de trabajo que distingue las experiencias de trauma de las experiencias de privaciones y uso de ejemplos del trastorno de estrés postraumático y el trastorno reactivo de la vinculación para demostrar hasta qué punto la especificidad en nuestra comprensión del temprano cuidado adverso puede llevar a un diagnóstico y tratamiento más acertado y dirigido para los niños pequeños. Tanto los investigadores como el personal clínico se benefician de un acercamiento para obtener una mayor apreciación de os lazos entre tipos específicos y resultados en los niños a quienes les servimos.

Les connaissances et la compréhension sur l'impact d'une accumulation d'expériences adverses sur la santé et le bien-être des enfants, des adolescents et des adultes se sont rapidement étendues au fil des 30 dernières années. En dépit de l'attention précieuse et du soutien de cette prolifération qui ont montré l'importance des expériences de la petite enfance, nous pensons qu'il est temps de passer au-delà des indices généraux de risque pour désormais privilégier une compréhension plus spécifique et individualisée de la manière dont les expositions au risqué sont liées aux résultats cliniques chez les jeunes enfants. Au sein de la santé mentale du nourrisson, il est nécessaire d'avoir une plus grande spécificité dans le lien entre les expériences adverses de modes de soin au début de la vie à la psychopathologie chez les enfants. Nous mettons en lumière une structure qui distingue les expériences de trauma d'expériences de privation et utilisons les exemples du trouble de stress posttraumatique et du trouble de l'attachement réactif afin de démontrer la manière dont une plus grande spécificité dans notre compréhension peut mener à un diagnostic et à un traitement plus précis et plus ciblés pour les jeunes enfants. A la fois les chercheurs et les cliniciens bénéficient d'une approche qui nous fait gagner une plus grande appréciation des liens entre les types spécifiques d'expériences et les résultats chez les enfants que nous servons.

Can maximal handgrip strength and endurance be improved by an 8-week specialized strength training program in older women? A randomized controlled study.

Maximal handgrip strength and endurance are important indicators of upper limb function in older adults. Up to now, there is insufficient information regarding the efficacy of specialized strength training programs for improving handgrip strength. The purpose of this study was to investigate the effectiveness of an 8-week specialized handgrip strength training program on maximal handgrip strength and endurance in healthy older women. A randomized controlled trial was performed. Thirty-six healthy older women (>65 years) were randomly divided into a training group (TG) (n = 18) and a control group (CG) (n = 18). The TG participated in an 8-week specialized handgrip strength training program using rubber balls and hand grippers (2 training sessions/week, 10-15 min, 8-15 repetitions/set, 4-6 total sets/session). Prior to and after the completion of the program, maximal handgrip strength and dynamic endurance (indices: repeated maximal repetitions and percentage change in handgrip strength between first and last 6 repetitions) were assessed in both hands. Repeated measures MANOVA results indicated that maximal handgrip strength (+9.3%-10.4%) and strength values during repeated maximal repetitions (+14% to 27%) significantly increased in TG (p < 0.001), while the percentage change in handgrip strength between the first and last 6 repetitions decreased significantly (-6%) (p < 0.05), irrespective of the tested hand. The results of this study showed that an 8-week specialized handgrip strength training program can be used effectively by athletic trainers, physical and hand therapists to counteract the detrimental effects of the aging process on maximal handgrip strength and endurance in older adults.

Accuracy of diagnostic tests for American tegumentary leishmaniasis: a systematic literature review with meta-analyses.

OBJECTIVES: To analyse the accuracy of American tegumentary leishmaniasis (ATL) diagnostic methods and evaluate the quality of the existing publications by means of a systematic review. METHODS: Diagnostic tests evaluated in at least two studies with common reference standards were included in the sensitivity and/or specificity meta-analyses. Quality and susceptibility to bias were analysed using the QUADAS-2 and STARD tools. RESULTS: The title and abstract of 3387 publications were evaluated after deduplication resulting from database searches. Thirty-eight studies were included in the review, and 26 of them had results inserted in meta-analyses. The diagnostic methods with the highest pooled sensitivity values were ELISA, polymerase chain reaction (PCR), indirect immunofluorescence reaction and Montenegro's intradermal reaction. Cytometry was assessed in only two studies and presented 100% sensitivity in both. Smear slide microscopy and histopathology showed low pooled values of sensitivity. For specificity, the highest pooled values were identified for PCR. High values were also identified for ELISA, except for studies in which the reference standard for defining negative participants included individuals with Chagas' disease or paracoccidioidomycosis, which also occurred for cytometry. IFR had lower specificities than ELISA. There was a predominance of case-control designs of phase 1 or 2 and only four studies were strongly recommended as evidence generators. Several reference standards were adopted, and different methods were assessed in a small number of studies. CONCLUSION: PCR showed the highest accuracy for the diagnosis of ATL, and its use should be encouraged in clinical practice. ELISA is recommended for the screening of suspected individuals, but the possibility of cross-reactions should be considered. New validation studies for the tests evaluated in few publications and studies of phase 3 with appropriate methods are needed.

OBJECTIFS: Analyser l'exactitude des méthodes de diagnostic de la leishmaniose tégumentaire américaine (LTA) et évaluer la qualité des publications existantes au moyen d'une analyse systématique. MÉTHODES: Les tests diagnostiques évalués dans au moins deux études avec des étalons de référence communs ont été inclus dans les méta-analyses de sensibilité et/ou de spécificité. La qualité et la sensibilité au biais ont été analysées à l'aide des outils QUADAS-2 et STARD. RÉSULTATS: Le titre et le résumé de 3387 publications ont été évalués après déduplication résultant de recherches dans la base de données. 38 études ont été incluses dans la revue et 26 d'entre elles ont eu des résultats inclus dans des méta-analyses. Les méthodes de diagnostic avec les valeurs de sensibilité poolées les plus élevées étaient ELISA, la réaction en chaîne par polymérase (PCR), la réaction d'immunofluorescence indirecte et la réaction intradermique du Monténégro. La cytométrie a été évaluée dans seulement deux études et présentait une sensibilité de 100% dans les deux. La microscopie et l'histopathologie sur lame de frottis ont montré de faibles valeurs poolées de sensibilité. Pour la spécificité, les valeurs poolées les plus élevées ont été identifiées pour la PCR. Des valeurs élevées ont également été identifiées pour l'ELISA, à l'exception des études dans lesquelles la norme de référence pour définir les participants négatifs incluait des individus atteints de la maladie de Chagas ou de paracoccidioïdomycose, qui s'est également produite pour la cytométrie. L'IFR avait des spécificités plus faibles que l'ELISA. Il y avait une prédominance des essais cas-témoins de phases 1 ou 2 et seules quatre études étaient fortement recommandées comme génératrices de preuves. Plusieurs normes de référence ont été adoptées et différentes méthodes ont été évaluées dans un petit nombre d'études. CONCLUSION: la PCR a montré la plus grande exactitude pour le diagnostic de l'ATL et son utilisation doit être encouragée dans la pratique clinique. L'ELISA est recommandé pour le dépistage des personnes suspectées, mais la possibilité de réactions croisées doit être considérée. De nouvelles études de validation des tests évalués dans quelques publications et des études de phase 3 avec des méthodes appropriées sont nécessaires.

MicroRNA-760-mediated low expression of DUSP1 impedes the protective effect of NaHS on myocardial ischemia-reperfusion injury.

Myocardial ischemia-reperfusion injury (MIRI) is the leading cause of the poor prognosis for patients undergoing clinical cardiac surgery. Micro-RNAs are involved in MIRI; however, the effect of miR-760 on MIRI and the molecular mechanisms behind it have not yet been described. For our in-vivo experiments, 20 rats were randomly distributed between 2 groups (n = 10): the sham-treatment group and the ischemia-reperfusion (I/R) group. For our in-vitro experiments, H9C2 cells were subjected to hypoxia for 6 h, and then reoxygenated to establish an hypoxia-reoxygenation (H/R) model. High expression levels of of miR-760 were observed in the rats subjected to MIRI and the H9C2 cells subjected to H/R. Further, the levels of lactate dehydrogenase (LDH) and malonaldehyde (MDA) were increased, and the size of the myocardial infarct was notably greater in the rats subjected to MIRI, suggesting that miR-760 worsens the effects of MIRI. The inhibitory effects from NaHS on apoptosis were enhanced, as were the expression levels of cleaved caspase 3 and cleaved PARP in H9C2 cells exposed to H/R, and with low-expression levels of miR-760. TargetScan and dual luciferase reporter assays further confirmed the targeted relationship between dual-specificity protein phosphatase (DUSP1) and miR-760. Additionally, miR-760 overexpression and H/R treatment of H9C2 cells inhibited the expression of DUSP1, which further promoted apoptosis. Furthermore, DUSP1 enhanced the anti-apoptotic effects of NaHS in rats subjected to MIRI. Taken together, these findings suggest that miR-760 inhibits the protective effect of NaHS against MIRI.

Impact of diagnostic methods on efficacy estimation - a proof-of-principle based on historical examples.

INTRODUCTION: Accurate diagnostic methods are essential for evaluating treatment efficacy in clinical trials, including vaccine trials. Although a plethora of studies assessing novel or modified treatment options is available, clinical trials evaluating the sensitivity and specificity of diagnostic methods in compliance with the demands of drug registration trials are scarce. We assessed the accuracy of diagnostic methods in two vaccine trials conducted in 1995 and 2009 to demonstrate the impact of sensitivity and specificity on efficacy estimations. METHODS: We applied the sensitivity- and specificity-adjusted vaccine efficacy estimator of Lachenbruch for modelling the impact of test characteristics on the outcome of the two vaccine trials by varying diagnostic specificity. RESULTS: Because of non-ideal diagnostic sensitivity and specificity, the estimation of vaccine efficacy is compromised. We demonstrate the impact of diagnostic accuracy on efficacy estimations with increasing confidence limits. CONCLUSIONS: Because sensitivity and specificity less than one have a direct impact on efficacy estimations in clinical trials, evaluation of diagnostic methods should lead to a level of evidence comparable with the efficacy assessment of novel treatment options. Furthermore, statistical methods adjusted for sensitivity and specificity of diagnostic methods should be applied for efficacy estimations, or this lack of confidence has to be taken into account when interpreting the results of trials.

INTRODUCTION: Des méthodes de diagnostic précises sont essentielles pour évaluer l'efficacité du traitement dans les essais cliniques, y compris les essais de vaccins. Bien qu'une pléthore d'études évaluant des options de traitement nouvelles ou modifiées soit disponible, les essais cliniques évaluant la sensibilité et la spécificité des méthodes de diagnostic conformément aux exigences des essais pour l'enregistrement des médicaments sont rares. Nous avons évalué la précision des méthodes de diagnostic dans deux essais vaccinaux menés en 1995 et 2009 afin de démontrer l'impact de la sensibilité et de la spécificité sur les estimations d'efficacité. MÉTHODE: Nous avons appliqué l'estimateur d'efficacité vaccinale ajusté en fonction de la sensibilité et de la spécificité de Lachenbruch pour modéliser l'impact des caractéristiques des tests sur les résultats de deux essais vaccinaux en faisant varier la spécificité diagnostique. RÉSULTAT: En raison de la sensibilité et de la spécificité diagnostiques non idéales, l'estimation de l'efficacité du vaccin est compromise. Nous démontrons l'impact de la précision du diagnostic sur les estimations d'efficacité avec l'augmentation des limites de confiance. CONCLUSION: Etant donné que la sensibilité et la spécificité inférieures à un ont un impact direct sur les estimations d'efficacité dans les essais cliniques, l'évaluation des méthodes de diagnostic devrait conduire à un niveau d'évidence comparable à l'évaluation de l'efficacité de nouvelles options de traitement. En outre, des méthodes statistiques ajustées en fonction de la sensibilité et de la spécificité des méthodes de diagnostic doivent être appliquées pour les estimations de l'efficacité, ou alors ce manque de confiance devrait être pris en compte lors de l'interprétation des résultats des essais.

[Usefulness of frozen section exams during radical cystectomy for urothelial carcinoma]. / Utilité des examens extemporanés lors de la cystectomie totale pour carcinome urothélial.

AIM: To determine the usefulness of the frozen section exams of lymph nodes dissection, ureteral and urethral section during radical cystectomy for urothelial carcinoma and define the impact on the surgical procedure. METHOD: A retrospective, single-center study of data collected from 182 patients who underwent radical cystectomy for an cT=3bN0M0 urothelial bladder cancer between 2016 and 2018. Bladder cancer extension was determined by thoracoabdominal CT with contrast enhancement and urography and an 18-FDG PET scanner. No patient received neoadjuvant chemotherapy. The diagnostic performance of the frozen section exams was related to final examinations. The impact of the result on the initial intervention was determined. RESULTS: The frozen section were positive in 29 lymph nodes dissections (15.9 %), 59 (16.6 %) ureteral and 20 (10.9 %) ureteral recessions. With lymph nodes exams, sensitivity, specificity and positive and negative predictive values were 93.5 %, 100 %, 100 %, and 98.7 %, respectively. With ureteral sections exams the same values were 91.5 %, 100 %, 100 %, and 98.4 % respectively. With urethral section exams, all the values were of 100 %. Finally, all the procedure has been modified for all patients with positive frozen section exam except one positive urethral section that did not give rise to radical urethrectomy. CONCLUSION: Frozen section exams were useful to the urologist during radical cystectomy for urothelial carcinoma. The performances of the frozen section exams carried out were excellent. The information of the urologist of the positive frozen section leeds to modify its management during the intervention in all the studied cases with the exception of one case.

[Diagnosis of pelvic inflammatory disease: Clinical, paraclinical, imaging and laparoscopy criteria. CNGOF and SPILF Pelvic Inflammatory Diseases Guidelines]. / Diagnostic d'une infection génitale haute : critères cliniques, paracliniques, imagerie, et cœlioscopie. RPC infections génitales hautes CNGOF et SPILF.

The objective of this literature review is to update the recommendations for clinical practice about the diagnosis of pelvic inflammatory disease (PID), microbiologic diagnosis excluded. An adnexal pain or cervical motion tenderness are the signs that allow a positive diagnosis of PID (LE2). Associated signs (fever, leucorrhoea, metrorrhagia) reinforce clinical diagnosis (LE2). In a woman consulting for symptoms compatible with PID, a pelvic clinical examination is recommended (grade B). In cases of suspected PID, hyperleukocytosis associated with a high C-reactive protein suggests a complicated PID or a differential diagnosis such as acute appendicitis (LE3). The absence of hyperleukocytosis or normal CRP does not rule out the diagnosis of PID (LE1). When PID is suspected, a blood test with a blood count and a CRP test is recommended (grade C). Pelvic ultrasound scan does not contribute to the positive diagnosis of uncomplicated PID because it is insensitive and unspecific (LE3). However, ultrasound scan is recommended to look for signs of complicated PID (polymorphic collection) or differential diagnosis (grade C). Waiting for an ultrasound scan to be performed should not delay the start-up of antibiotic therapy. In case of diagnostic uncertainty, an abdominal-pelvic CT scan with contrast injection is useful for differential diagnosis of urinary, digestive or gynaecological origin (LE2). Laparoscopy is not recommended for the unique purpose of the positive diagnosis of PID (grade B).

Detection and differentiation of Vibrio parahaemolyticus by multiplexed real-time PCR.

Vibrio parahaemolyticus is a common and important pathogen that causes human gastroenteritis worldwide. A rapid, sensitive, and specific assay is urgently required for detection and differentiation of V. parahaemolyticus strains. We designed three sets of primers and probes using groEL and two virulence genes (tdh and trh) from V. parahaemolyticus, and developed a multiplex real-time PCR protocol. The sensitivity and specificity of the multiplex assay was evaluated by environmental and clinical specimens of V. parahaemolyticus. The multiplex PCR response system and annealing temperature were optimized. The detection limits of the multiplex real-time PCR were 104 and 105 CFU/mL (or CFU/g) in pure cultures and spiked oysters, respectively. The multiplex real-time PCR specifically detected and differentiated V. parahaemolyticus from 35 Vibrio strains and 11 other bacterial strains. Moreover, this method can detect and distinguish virulent from nonvirulent strains, with no cross-reactivity observed in the bacteria tested. This newly established multiplex real-time PCR assay offers rapid, specific, and reliable detection of the total and pathogenic V. parahaemolyticus strains, which is very useful during outbreaks and sporadic cases caused by V. parahaemolyticus infection.

[Cyto-histological correlation in the management of parotid gland tumors: A retrospective study of 160 cases]. / Corrélation cyto-histologique dans la prise en charge des tumeurs parotidiennes : étude rétrospective de 160 cas.

INTRODUCTION: The aim of this study was to correlate the cytological and histological results and evaluate the diagnostic performance of fine-needle aspiration cytology (FNAC) in the management of parotid gland tumors. METHODS: This retrospective study included 160 patients with a parotid gland tumor who underwent fine-needle aspiration and parotidectomy surgery between January 2005 and August 2016 at the Limoges university hospital center. RESULTS: On 160 fine-needle aspirations performed, fine-needle aspiration diagnoses were: 77 benign lesions, 35 malignant lesions and 48 non-diagnostic cases. Final histological diagnosis revealed there were 113 benign lesions and 47 malignant lesions. A hundred and one cytological diagnoses were accurate over 112 contributive fine-needle aspirations: seven false-negative cases and 4 false-positive cases were observed. The sensitivity, specificity, and accuracy were 82, 95 and 90% respectively for fine-needle aspiration, and 83, 95 and 92% respectively for association of fine-needle aspiration and magnetic resonance imaging. Diagnostic concordance between fine-needle aspiration and final histology for malignant lesions was 78%. A greater number of contributive fine-needle aspirations was observed among experimented operators. DISCUSSION: Fine-needle aspiration is a reliable, safe and effective diagnostic tool that allows good differentiation between malignant and benign diagnosis in the preoperative management of parotid gland tumors. The association of fine-needle aspiration and magnetic resonance imaging (MRI) can improve diagnostic performance.

Evidence of nonlocal muscle fatigue in male youth.

Evidence for nonlocal muscle fatigue (NLMF) has been inconsistent in adults, with no studies investigating youth. The objective was to examine NLMF in youth. Forty-two young males (age, 10-13 years) were tested for maximal voluntary isometric contraction (MVIC) force of the ipsilateral and contralateral knee extensors at 90° and 120° knee flexion, elbow flexors at 90°, handgrip, knee extensor isokinetic torque (300°·s-1 analyzed at 90° and 120° knee flexion), as well as a unilateral countermovement jump (CMJ) and Y Balance test (YBT). Isokinetic fatigue group (n = 15) had unilateral fatigue induced with 10 sets of 20 repetitions of maximal isokinetic knee extensor contractions at 300°·s-1. Isometric fatigue group (n = 15) used 10 repetitions of 6-s knee extensor MVIC whereas the control group (n = 12) were not fatigued. There was no significant difference in the response to the isometric- or isokinetic-fatigue intervention protocols. Main time effects indicated that NLMF was evident with the contralateral knee extensor MVIC at 90° (p = 0.008; 8.9%), knee extensor isokinetic torque at 90° (p < 0.001; 11.4%), and 120° (p = 0.05; 5.4%), CMJ (p = 0.02; 11.5%), handgrip (p = 0.06; 4.5%), elbow flexors (p < 0.001; 7.7%), and YBT (p = 0.001; 5.6%). Ipsilateral NLMF deficits occurred with handgrip (p < 0.001; 7.3%), elbow flexors MVICs (p < 0.001; 10.7%), CMJ (p = 0.02; 12.2%), and YBT (p = 0.002; 3.8%). NLMF with similar relative fatigue-induced deficits of fatigued and nonfatigued limbs suggest that youth fatigue is highly dependent upon the extent of activation or inhibition of the nervous system. Coaches of young athletes might consider developing technical motor skills before fatiguing exercise components, which might hinder the proficiency of their performance.

[Pediatric kidney transplantation]. / Transplantation rénale pédiatrique.

AIMS: To describe indications, surgical aspects, results and outcomes of kidney transplantation in children. MATERIAL AND METHODS: An exhaustive systematic review of the scientific literature was performed in the Medline database (http://www.ncbi.nlm.nih.gov) and Embase (http://www.embase.com) using different associations of the following keywords (MESH): "kidney transplantation", "pediatric", "children", "outcomes". Publications obtained were selected based on methodology, language, date of publication (last 10 years) and relevance. Prospective and retrospective studies, in English or French, review articles; meta-analysis and guidelines were selected and analyzed. This search found 2608 articles. After reading titles and abstracts, 18 were included in the text based on their relevance. RESULTS: Kidney transplantation is the gold-standard treatment for end stage renal kidney disease in children. The surgical procedure is well standardized with a retroperitoneal approach when child and kidney size allow it or a transperitoneal approach in child less than 15 kg and big size kidney graft. Anastomosis sites include iliac vessels in the retroperitoneal approach, and inferior vena cava and aorta in case of transperitoneal procedure. Ureteral reimplantation used most of the time a Campos Freire technique. Sometimes, particular conditions in the recipient (such as vena cava thrombosis) required procedure adaptation. CONCLUSION: Graft survival dramatically increased over the past few years and is now superior to those observed in adult kidney transplantation, particularly in experienced team with microsurgery skills. Immunosuppressive treatments are similar to adults. Viral infections and post-transplant lymphoproliferative disorder are the main complications of renal transplantation in children and may lead to lethal outcomes. An increase graft loss is observed during boyhood due to immunosuppressive drugs uncompliance.

DNA barcode variability and host plant usage of fruit flies (Diptera: Tephritidae) in Thailand.

The objectives of this study were to examine the genetic variation in fruit flies (Diptera: Tephritidae) in Thailand and to test the efficiency of the mitochondrial cytochrome c oxidase subunit I (COI) barcoding region for species-level identification. Twelve fruit fly species were collected from 24 host plant species of 13 families. The number of host plant species for each fruit fly species ranged between 1 and 11, with Bactrocera correcta found in the most diverse host plants. A total of 123 COI sequences were obtained from these fruit fly species. Sequences from the NCBI database were also included, for a total of 17 species analyzed. DNA barcoding identification analysis based on the best close match method revealed a good performance, with 94.4% of specimens correctly identified. However, many specimens (3.6%) had ambiguous identification, mostly due to intra- and interspecific overlap between members of the B. dorsalis complex. A phylogenetic tree based on the mitochondrial barcode sequences indicated that all species, except for the members of the B. dorsalis complex, were monophyletic with strong support. Our work supports recent calls for synonymization of these species. Divergent lineages were observed within B. correcta and B. tuberculata, and this suggested that these species need further taxonomic reexamination.