Recommendation for hygiene and topical in neonatology from the French Neonatal Society.

We sought to establish guidelines for hygiene care in newborns based on a systematic review of the literature and grading of evidence using the Groupe de Réflexion et d'Evaluation de l'Environement des Nouveau-nés (GREEN) methodology. We examined 45 articles and 4 reports from safety agencies. These studies recommend a tub bath (rather than a sponge bath) for full-term infants and a swaddle bath for preterm newborns. They also recommend against daily cleansing of preterm infants. The literature emphasized that hygiene care must consider the clinical state of the newborn, including the level of awareness and behavioral responses. Hospitalized newborns treated with topical agents may also experience high exposure to potentially harmful excipients of interest. Caregivers should therefore be aware of the excipients present in the different products they use. In high-resource countries, the available data do not support the use of protective topical agents for preterm infants.Conclusions: We recommend individualization of hygiene care for newborns. There is increasing concern regarding the safety of excipients in topical agents that are used in neonatology. A multidisciplinary approach should be used to identify an approach that requires lower levels of excipients and alternative excipients. What is known: • Hygiene care is one of the most basic and widespread types of care received by healthy and sick newborns worldwide. • There is no current guideline on hygiene for preterm or hospitalized term newborn. What is new: • The French Group of Reflection and Evaluation of the environment of Newborns (GREEN) provided here guidelines based on the current body of evidence. • Caregivers should be aware of the many issues related to hygiene care of newborns including newborns' behavioral responses to hygiene care, exposition to excipients of interest, and the potential risk of protective topical agents in a preterm infant. provided here guidelines based on the current body of evidence. • Caregivers should be aware of the many issues related to hygiene care of newborns including newborns' possible behavioral responses to hygiene care, exposition to excipients of interest and the potential risk of protective topical agents in a preterm infant.

Interocular interaction of contrast and luminance signals in human primary visual cortex.

Interocular interaction in the visual system occurs under dichoptic conditions when contrast and luminance are imbalanced between the eyes. Human psychophysical investigations suggest that interocular interaction can be explained by a contrast normalization model. However, the neural processes that underlie such interactions are still unresolved. We set out to assess, for the first time, the proposed normalization model of interocular contrast interactions using magnetoencephalography (MEG) and to extend this model to incorporate interactions based on interocular luminance differences. We used MEG to record steady-state visual evoked responses (SSVER), and functional magnetic resonance imaging (fMRI) to obtain individual retinotopic maps that we used in combination with MEG source imaging in healthy participants. Binary noise stimuli were presented in monocular or dichoptic viewing and were frequency-tagged at 4 and 6 Hz. The contrast of the stimuli was modulated in a range between 0 and 32%. Monocularly, we reduced the luminance by placing a 1.5 ND filter over one eye in the maximal contrast condition. This ND filter reduces the mean light level by a factor of 30 without any alteration to the physical contrast. We observed in visual area V1 a monotonic increase in the magnitude of SSVERs with changes in contrast from 0 to 32%. For both eyes, dichoptic masking induced a decrease in SSVER signal power. This power decrease was well explained by the normalization model. Reducing mean luminance delayed monocular processing by approximately 38 ms in V1. The reduced luminance also decreased the masking ability of the eye under the filter. Predictions based on a temporal filtering model for the interocular luminance difference prior to the model's binocular combination stage were incorporated to update the normalization model. Our results demonstrate that the signals resulting from different contrast or luminance stimulation of the two eyes are combined in a way that can be explained by an interocular normalization model.

An innovative approach to the assessment of hydro-political risk: A spatially explicit, data driven indicator of hydro-political issues.

Competition over limited water resources is one of the main concerns for the coming decades. Although water issues alone have not been the sole trigger for warfare in the past, tensions over freshwater management and use represent one of the main concerns in political relations between riparian states and may exacerbate existing tensions, increase regional instability and social unrest. Previous studies made great efforts to understand how international water management problems were addressed by actors in a more cooperative or confrontational way. In this study, we analyze what are the pre-conditions favoring the insurgence of water management issues in shared water bodies, rather than focusing on the way water issues are then managed among actors. We do so by proposing an innovative analysis of past episodes of conflict and cooperation over transboundary water resources (jointly defined as "hydro-political interactions"). On the one hand, we aim at highlighting the factors that are more relevant in determining water interactions across political boundaries. On the other hand, our objective is to map and monitor the evolution of the likelihood of experiencing hydro-political interactions over space and time, under changing socioeconomic and biophysical scenarios, through a spatially explicit data driven index. Historical cross-border water interactions were used as indicators of the magnitude of corresponding water joint-management issues. These were correlated with information about river basin freshwater availability, climate stress, human pressure on water resources, socioeconomic conditions (including institutional development and power imbalances), and topographic characteristics. This analysis allows for identification of the main factors that determine water interactions, such as water availability, population density, power imbalances, and climatic stressors. The proposed model was used to map at high spatial resolution the probability of experiencing hydro-political interactions worldwide. This baseline outline is then compared to four distinct climate and population density projections aimed to estimate trends for hydro-political interactions under future conditions (2050 and 2100), while considering two greenhouse gases emission scenarios (moderate and extreme climate change). The combination of climate and population growth dynamics is expected to impact negatively on the overall hydro-political risk by increasing the likelihood of water interactions in the transboundary river basins, with an average increase ranging between 74.9% (2050 - population and moderate climate change) to 95% (2100 - population and extreme climate change). Future demographic and climatic conditions are expected to exert particular pressure on already water stressed basins such as the Nile, the Ganges/Brahmaputra, the Indus, the Tigris/Euphrates, and the Colorado. The results of this work allow us to identify current and future areas where water issues are more likely to arise, and where cooperation over water should be actively pursued to avoid possible tensions especially under changing environmental conditions. From a policy perspective, the index presented in this study can be used to provide a sound quantitative basis to the assessment of the Sustainable Development Goal 6, Target 6.5 "Water resources management", and in particular to indicator 6.5.2 "Transboundary cooperation".

[Impact of enterobacteriaceae-producing extended-spectrum beta-lactamases (ESBLE) incidence increasing on barrier precautions implementation in a university hospital]. / Impact de l'augmentation de l'incidence des entérobactéries productrices de bêta-lactamases à spectre étendu (EBLSE) sur l'application des précautions complémentaires dans un centre hospitalier universitaire.

AIM OF THE STUDY: The French national surveillance program of multidrug-resistant bacteria (MDR) shows an increase of enterobacteriaceae-producing extended-spectrum beta-lactamases (ESBLE) incidence. The objectives of this study were to assess: the incidence of EBLSE in a large French university hospital between 2005 and 2010, and the difference of barrier precautions implementation between ESBL and other MDR. METHODS: The ESBLE incidence measure used data from the laboratory of bacteriology. The application of isolation and barrier precautions was analyzed from the MRB national surveillance data over a 3-year period from 2006 to 2008. Data were entered and analyzed using Epi Info software. The Chi(2) test was used for the comparison of proportions. RESULTS: The overall incidence of ESBLE was significantly higher in 2010 than in 2005 (0.20/1000 patients-days vs 0.03/1000 patients-days, respectively) (P<0.001). The same was observed for Escherichia coli incidence with rates ranging from 0.02/1000 patients-days in 2005 to 0.15/1000 patients-days in 2010. Isolation precautions for patients with EBLSE were applied in relation for most patients with MRB (ESBLE vs others), without significant difference. CONCLUSION: The surveillance programme of MRB showed a significant increase of ESBLE, especially for E. coli. Isolation and barrier precautions were used for most patients with MRB, including ESBLE.

Relapse of Enterococcus hirae prosthetic valve endocarditis.

Enterococcus hirae, a gram-positive bacterium, is a rare isolate in clinical specimens. We report an unusual case of a relapse of prosthetic valve endocarditis due to E. hirae 6 months after the initial episode. Clonal relationship was proven by genomic analysis.

First report of a hip prosthetic and joint infection caused by Lactococcus garvieae in a woman fishmonger.

We describe the first case of hip prosthetic infection due to Lactococcus garvieae. The patient, a 71-year-old woman fishmonger, developed a hip infection 7 years after total hip arthroplasty. The origin of infection was possibly due to the manipulation or intake of seafood or fish contaminated with Lactococcus garvieae.

Clinical features of group B Streptococcus prosthetic joint infections and molecular characterization of isolates.

Twelve group B Streptococcus (GBS) prosthetic joint infection (PJI) cases are reported. The mean patient age was 55 years. Eleven infections were caused by GBS alone. The associated isolates belonged to phylogenetic lineages different from those that cause neonatal meningitis. The clinical outcome was favorable for the eight patients for whom follow-up data were available.

Semen cultures analysis: retrospective study during a 6-year period and interest in the management of infertility.

In the past decade, the number of couples consulting an assisted reproductive techniques (ART) center for infertility has increased in most European countries. In France, sperm bacterial examination must be performed every 6 months in couples undergoing in vitro fertilization (IVF) cycles, according to 2010 French ART Guidelines. The aim of this study was to analyze the results from such samples at Nantes University Hospital and to assess their potential value for infertile couples undergoing ART cycles. Between 2003 and 2008, semen cultures performed were analyzed according to bacterial enumeration, type and number of bacterial species, and their antibiotic resistance profile. A total of 14,119 semen cultures were performed, showing an annual increase of 45% from the start to the end of the study. The proportion of positive semen cultures was stable throughout the study period (40 to 45%). Many bacterial species were considered as contaminants (coagulase-negative staphylococci, alpha-hemolytic streptococci). For pathogen agents (in most cases, Enterobacteriaceae), the antibiotic resistance profile revealed mostly a susceptible phenotype. Finally, every positive bacterial result had direct consequences on the IVF cycle management, with subsequent reinforced advice on the hygiene procedure before sample collection and/or antibiotics prescription.

Prevalence of plasmid-mediated quinolone resistance determinants in ESBL Enterobacteriaceae clinical isolates over a 1-year period in a French hospital.

The prevalence of plasmid-mediated quinolone resistance (PMQR) determinants (qnrA, qnrB, qnrS, aac(6')-Ib-cr, and qepA) was investigated in a collection of 47 extended-spectrum ß-lactamase (ESBL) producing enterobacterial isolates with reduced susceptibility to fluoroquinolones, recovered at Nantes University hospital, in 2006. qnr, aac(6')-Ib-cr, and qepA genes were screened by PCR, and positive results were subsequently confirmed by sequencing. The epidemiological relationship between positive isolates was studied by pulsed-field gel electrophoresis (PFGE). qnr-positive isolates were analyzed for antimicrobial susceptibility and presence of mutations in the quinolone resistance-determining region (QRDR) of gyrA and parC genes. ESBL genes were characterized by PCR and sequencing. Conjugation experiments were performed to determine whether the qnr-carrying plasmids were self-transferable. Two Klebsiella pneumoniae isolates (4.3%), not clonally related, harboured a qnrS1 gene, whereas no qnrA- or qnrB-positive isolate was detected. The aac(6')-Ib-cr gene was detected in 11 Escherichia coli and one K. pneumoniae isolates. None of the 47 isolates carried the qepA gene. ESBLs associated with QnrS1 were CTX-M-14 and CTX-M-15. The CTX-M-15 producing isolate was highly resistant to fluoroquinolones and harboured three mutations in the QRDR and two PMQR determinants (qnrS1 and aac(6')-Ib-cr). The CTX-M-14-producing isolate exhibited reduced susceptibility or resistance to fluoroquinolones without resistance to nalidixic acid. This strain harboured only a qnr gene on a single 170 kb transferable plasmid, without any mutation in the QRDR. In conclusion, our study showed that aac(6')-Ib-cr gene had occurred in multiclonal ESBL-producing enterobacterial isolates collected at Nantes University hospital in 2006, with a higher prevalence than qnr genes.

Correlation between the VITEK2 system and cefoxitin disk diffusion for the daily detection of oxacillin resistance in a large number of clinical Staphylococcus aureus isolates.

The aim of the present study was to compare the performance of the new VITEK2 AST-P551 card with the cefoxitin disk diffusion method for the daily detection of methicillin resistance with a high number of Staphylococcus aureus clinical isolates. Detection of the PBP2a protein or mecA gene was performed for each discordant case. Seventy (3.3%) isolates out of 2,107 clinical strains showed discordant results, two very major errors, four major errors and 64 minor errors. Fifty-nine (84%) discordant results were resolved, with a final overall agreement of 99.5%. Eleven (0.5%) strains remained discordant (minor error [mE]). Four of 370 MRSA strains were misclassified as susceptible in daily practice by the cefoxitin disk diffusion method. All of these strains were resistant to aminoglycosides and/or fluoroquinolones. The VITEK2 system is highly reliable for methicillin resistance detection at the routine level. Oxacillin-susceptible classified clinical strains with associated resistance patterns required attention.

[Retrospective study of serological tests for syphilis diagnosis at Nantes University hospital, between 1999 and 2006]. / Etude rétrospective des sérologies de syphilis au CHU de Nantes, de 1999 à 2006.

Since 2000, a resurgence of syphilis cases was observed in France and, particularly, in Paris area. The aim of this study was to evaluate the evolution of syphilis prevalence in Nantes area and its impact on our laboratory activity. Between 1999 and 2006, serological tests for syphilis performed at the laboratory were analysed according to the results of these tests, the age and patient sex and the wards. We treated about 32,000 serological tests, over an eight-year period. The number of tests increased by 7.5% per year and patients with a positive result were multiplied by three. These patients were men for 78%, with an average age of 43.4 years. The serological tests providing positive results were in general from two sectors, the anonymous and free detection center and the internal medicine ward and infectious diseases unit. Our study highlighted a strong increase in the number of positive tests, since 2001, with a clear orientation towards a sex male ratio in our area. This inclination currently did not show any decrease, at the opposite to what was observed by the InVS in Paris area.

Input-output transformation in the visuo-oculomotor loop: comparison of real-time optical imaging recordings in V1 to ocular following responses upon center-surround stimulation.

In psychophysics and physiology, it is well established that lateral interactions are crucial mechanisms to constrain response normalization and contextual modulations. To study the cortical mechanisms involved in the contextual modulation of the behavioral contrast response function, we compared in behaving monkeys the Ocular Following Response (OFR) to V1 population activity measured using Optical Imaging of Voltage-Sensitive Dyes (VSD). If contrast response functions (CRF) to a simple local stimulus are similar in V1 and in the OFR, lateral interaction leads however to quite different modulation at those two levels. At the behavioural level, contrast response function is strongly suppressed by lateral interactions, and this suppression is stronger for higher contrasts. In V1, we showed a slow dynamic of facilitation for low contrasts integration and a fast suppression operating on high contrasts. These modulatory interactions influence differently the contrast response functions, interrupting the dynamic increase of contrast sensitivity in OFR, but not in V1 response. The temporal properties of those effects lead us to hypothesize that horizontal and feedback connectivity have differential effect on low and high contrasts integration in V1. V1 provides then an input to MT whose contextual dependency is not totally determined and must be refined before affecting the behavioural OFR.

Risk-factors for gastrointestinal colonisation with resistant Enterobacteriaceae among hospitalised patients: a prospective study.

This study assessed the incidence of gastrointestinal colonisation by resistant Enterobacteriaceae among hospitalised patients, and identified risk-factors for ceftazidime and ofloxacin resistance. A prospective cohort study was performed in five wards in a French teaching hospital during a 2-year period. Patients hospitalised for > 48 h were enrolled between 17 April 2000 and 30 April 2002. A rectal swab was taken at admission, then once-weekly and/or on the day of discharge. In total, 933 patients were investigated and 585 amoxycillin-resistant isolates were obtained. Resistance rates for ceftazidime and ofloxacin were 9.4% and 4.8%, respectively. Multivariate analysis indicated that previous hospitalisation (p < 0.004) and exposure to amoxycillin-clavulanate (p < 0.003) and ceftriaxone (p < 0.002) were associated significantly with ceftazidime resistance. Hospitalisation in the urology ward (p < 0.02) and previous exposure to fluoroquinolones (p < 0.01) were the two independent risk-factors associated with ofloxacin resistance. The results of the study confirmed that antibiotic use selected resistant Enterobacteriaceae from the gut flora. Resistance was observed mostly in patients with previous antibiotic exposure and previous hospitalisation in wards with a high antibiotic selection pressure.

Validation of an internal method for the diagnosis of infections with Chlamydophila abortus and Coxiella burnetii by real-time multiplex PCR.

Chlamydophila abortus and Coxiella burnetii are one of the major pathogens implicated in abortion in cattle. Their characteristic of obligate intracellular bacteria, and of zoonotic agents, makes their culture difficult in diagnostic laboratories, and the traditional tools of diagnosis (detection of sera antibodies by ELISA, Stamp's coloration) encounter specificity, sensitivity and interpretability limits. Individual PCR have recently been developed. Nevertheless, their income/cost is a limiting factor for breeders. As the symptoms are not specific, the request for analysis often concerns the two valences. Consequently, the development and the validation of an internal multiplex PCR appears to be a suitable solution.

[Parental perception of their involvement in the care of their children in French neonatal units]. / Perception des parents de leur participation aux soins de leur enfant dans les unités de néonatologie en France.

BACKGROUND: The experience of becoming the parent of a sick or premature newborn can be particularly distressing for parents. They often encounter challenges to the development of their parenting roles. Perception of the hospital stay has never been analyzed on a large scale. OBJECTIVE: To analyze parents' perception of their involvement in the care of their newborn. METHODS: An internet-based survey started in France in February 2014 on the basis of a validated questionnaire composed of 222 neonatal care-related items. A quantitative and qualitative analysis was performed on the items dealing with parents' involvement until August 2014. RESULTS: The survey was completed by 1500 parents, 98 % of whom were mothers. The infants had a mean GA of 32 weeks and a mean birth weight of 1600g. Parents rated their first care of their infant with mixed emotions (joy, stress, etc.). Parents were willing to practice new skills through guided participation, even for more complex care. Skin-to-skin care was only proposed after 7 days for 20 % of the parents; 10 % of the parents did not feel secure during this practice. The need for privacy and professional guidance was essential for meaningful skin-to-skin contact. DISCUSSION: Parents' perception of participating actively in their infant's care was positive and they felt guided by the nursing team. Most of them would have been more active with guidance. Skin-to-skin care was appreciated and desired, but could become stressful if the conditions were not optimal.

Chromosomally encoded cephalosporin-hydrolyzing beta-lactamase of Proteus vulgaris RO104 belongs to Ambler's class A.

Proteus vulgaris RO104 strain produces a chromosomally encoded beta-lactamase that confers resistance to various beta-lactam antibiotics including methoxyimino third-generation cephalosporins. The beta-lactamase hydrolyzes first- and second-generation cephalosporins efficiently and cefotaxime to a lesser extent. Catalytic activity is inhibited by low concentrations of clavulanic acid and sulbactam. By its broad-spectrum substrate profile, beta-lactamase of Proteus vulgaris RO104 belongs to the group 2e defined by Bush. The protein purified to homogeneity by a four-step procedure was characterized by a pI of 8.31 and a specific activity of 1200 U/mg. The beta-lactamase was digested by trypsin, endoproteinase Asp-N and chymotrypsin. Amino-acid sequence determinations of the resulting peptides allowed the alignment of the 271 amino-acid residues of the protein which did not contain any cysteine residue. From amino-acid sequence comparisons, Proteus vulgaris RO104 beta-lactamase was found to share about 68% identity with the chromosomally mediated beta-lactamases of Klebsiella oxytoca D488 and E23004. Therefore, the cephalosporin-hydrolyzing beta-lactamase of Proteus vulgaris RO104 belongs to Ambler's class A.

Characterization and amino acid sequence analysis of a new oxyimino cephalosporin-hydrolyzing class A beta-lactamase from Serratia fonticola CUV.

Serratia fonticola CUV produces two isoenzymes (forms I and II) with beta-lactamase activity which were purified by a five-step procedure. The isoenzymes had identical kinetic parameters and isoelectric point (pI = 8.12). They were characterized by a specific activity towards benzylpenicillin of 1650 U/mg. The beta-lactamase hydrolyzed benzylpenicillin, amoxycillin, ureidopenicillins, first- and second-generation cephalosporins. Carboxypenicillins and isoxazolylpenicillins were hydrolyzed to a lesser extent. Towards cefotaxime and ceftriaxone (third-generation cephalosporins), the S. fonticola enzyme exhibited catalytic efficiencies much higher than those of MEN-1 and extended-spectrum TEM derivative beta-lactamases. The beta-lactamase from S. fonticola was markedly inhibited by beta-lactamase inhibitors such as clavulanic acid, sulbactam and tazobactam. The purified isoenzymes were digested by trypsin, endoproteinase Asp-N and chymotrypsin. Amino acid sequence determinations of the resulting peptides allowed the alignment of 267 amino acid residues (Swiss-Prot, accession number P 80545) for form I beta-lactamase. Form II is five residues shorter than form I at its N-terminus. From amino acid sequence comparisons, S. fonticola CUV beta-lactamase was found to share more than 69.3% identity with the chromosomally encoded beta-lactamases of Klebsiella oxytoca, Proteus vulgaris, Citrobacter diversus and the plasmid-mediated enzymes MEN-1 and Toho-1. Therefore, the oxyimino cephalosporin-hydrolyzing beta-lactamase of S. fonticola belongs to Ambler's class A. Contribution of the serine at ABL 237 in the broad-spectrum activity of these beta-lactamases is discussed.

Subversion of human intestinal mucosa innate immunity by a Crohn's disease-associated E. coli.

Adherent-invasive Escherichia coli (AIEC), associated with Crohn's disease, are likely candidate contributory factors in the disease. However, signaling pathways involved in human intestinal mucosa innate host response to AIEC remain unknown. Here we use a 3D model of human intestinal mucosa explant culture to explore the effects of the AIEC strain LF82 on two innate immunity platforms, i.e., the inflammasome through evaluation of caspase-1 status, and NFκB signaling. We showed that LF82 bacteria enter and survive within a few intestinal epithelial cells and macrophages, without altering the mucosa overall architecture. Although 4-h infection with a Salmonella strain caused crypt disorganization, caspase-1 activation, and mature IL-18 production, LF82 bacteria were unable to activate caspase-1 and induce IL-18 production. In parallel, LF82 bacteria activated NFκB signaling in epithelial cells through IκBα phosphorylation, NFκBp65 nuclear translocation, and TNFα secretion. In addition, NFκB activation was crucial for the maintenance of epithelial homeostasis upon LF82 infection. In conclusion, here we decipher at the whole-mucosa level the mechanisms of the LF82-induced subversion of innate immunity that, by maintaining host cell integrity, ensure intracellular bacteria survival.

Results of radiation treatment of medulloblastoma in adults.

From 1961 to 1982, 20 adults (greater than 16 years of age) were treated with radiation therapy following surgery for medulloblastoma. All patients received neuro-axis irradiation. Five patients received adjuvant chemotherapy. A 5- and 10-year survival rate of 78 and 55%, respectively, were achieved. Treatment failures were mainly a result of local recurrences, but also of metastases. One patient died of acute myeloid leukemia. One patient developed paraplegia. The survival rate was better in males (2 deaths out of 14) than in females (5 deaths out of 6). All the survivors are free of deficit or sequelae, except the patient with paraplegia.