Feasibility of performing treadmill walking test for patients with peripheral arterial occlusive disease by the advanced practice nurses.

AIM: The treadmill walking test with post-exercise pressure measurement can be used as a diagnostic test and could classify peripheral arterial disease of the lower limbs. It can also exclude the diagnosis allowing to raise the possibility of differential diagnoses. In this study, we assessed the feasibility of performing treadmill test by advanced practice nurse to assess suspected lower extremity peripheral artery disease patients. DESIGN AND METHOD: This is a longitudinal monocentric study to assess the feasibility of a treadmill walking test performed by an advanced practice nurse. The primary endpoint was the number of tests performed during this period. The secondary objectives were to evaluate the reasons for requesting the test, the main results obtained in terms of the test's contribution and diagnoses, and patients' clinical characteristics. RESULTS: From February to May 2023, amongst 31 patients who underwent the treadmill walking test, 4 tests were able to rule out peripheral arterial disease and to detect differential diagnoses. For the remaining 27 patients, 4 had stage IIa of the Leriche classification, 23 had stage IIb, 2 of which were associated with a narrow lumbar spine. In contrast to the usual report, the APN's report on the walking test included an identification of cardiovascular risk factors, as well as a possible medical reorientation linked to the correction of a detected cardiovascular risk factor. CONCLUSION: The treadmill walking test can be performed by an advanced practice nurse. He/She added a comprehensive/global patient management, with the detection of cardiovascular risk factors. This new profession led to an increase in the number of tests performed of more than 50% over the period and reduced the time to access the test.

Muscular pseudotumor revealing a mycobacterial granuloma after bacillus Calmette-Guérin therapy.

INTRODUCTION: The Bacillus Calmette-Guérin (BCG) is a live attenuated strain of Mycobacterium bovis. Intravesical therapy with BCG has long been proved to be effective in treating early-stage bladder carcinoma. CASE REPORT: A 81-year-old male patient with former history of BCG instillations for bladder cancer two years ago was admitted in February 2020 to our department for a pulsatile and painful tumefaction of the right thigh that lasted for 6 months, due to a muscular M. bovis granuloma leading to femoral artery erosion. Emergency vascular surgery associated with prolonged antibiotherapy provided full recovery. DISCUSSION: Late infectious complications of intravesical BCG instillations are classical but rare. Isolated muscular involvement is exceptional. CONCLUSION: Mycobacterial infection should be carefully screened face to a granuloma presenting as muscular pseudotumor. A history of BCG therapy, even decades earlier, enhances this hypothesis and should lead to enforce microbiological testing, especially molecular test.

[Bronchial involvement in an immunocompetent adult with varicella pneumonia]. / Atteinte bronchique au cours d'une pneumonie varicelleuse chez un adulte immunocompétent.

INTRODUCTION: Pneumonitis caused by varicella infection is a serious and potentially life-threatening complication of the disease when it occurs in adults. The incidence of this complication has increased in the last 10 years. OBSERVATION: We report the case of a non-immunocompromised patient admitted to hospital because of varicella pneumonia not requiring intensive care. Bronchoscopy revealed vesicular lesions on the bronchial mucosa. The patient made a full recovery with anti-viral therapy. CONCLUSION: Vesicular lesions can be observed on the bronchial mucosa of adult patients with varicella zoster infection.

Untargeted next-generation sequencing-based first-line diagnosis of infection in immunocompromised adults: a multicentre, blinded, prospective study.

OBJECTIVE: Infections are the major cause of morbidity and mortality in immunocompromised patients. Improving microbiological diagnosis in these patients is of paramount clinical importance. METHODS: We performed this multicentre, blinded, prospective, proof-of-concept study, to compare untargeted next-generation sequencing with conventional microbiological methods for first-line diagnosis of infection in 101 immunocompromised adults. Patients were followed for 30 days and their blood samples, and in some cases nasopharyngeal swabs and/or biological fluids, were analysed. At the end of the study, expert clinicians evaluated the results of both methods. The primary outcome measure was the detection rate of clinically relevant viruses and bacteria at inclusion. RESULTS: Clinically relevant viruses and bacteria identified by untargeted next-generation sequencing and conventional methods were concordant for 72 of 101 patients in samples taken at inclusion (κ test=0.2, 95% CI 0.03-0.48). However, clinically relevant viruses and bacteria were detected in a significantly higher proportion of patients with untargeted next-generation sequencing than conventional methods at inclusion (36/101 (36%) vs. 11/101 (11%), respectively, p <0.001), and even when the latter were continued over 30 days (19/101 (19%), p 0.003). Untargeted next-generation sequencing had a high negative predictive value compared with conventional methods (64/65, 95% CI 0.95-1). CONCLUSIONS: Untargeted next-generation sequencing has a high negative predictive value and detects more clinically relevant viruses and bacteria than conventional microbiological methods. Untargeted next-generation sequencing is therefore a promising method for microbiological diagnosis in immunocompromised adults.

Switch to oral antibiotics in the treatment of infective endocarditis is not associated with increased risk of mortality in non-severely ill patients.

Although many international guidelines exist for the management of infective endocarditis (IE), recommendations are lacking on the opportunity of switching antibiotics from the intravenous (IV) to oral route during treatment. We present a cohort study of 426 cases of IE over a period of 13 years (2000-2012), including 369 cases of definite IE according to the Duke criteria. Predictors of mortality were identified using the Cox proportional hazard analysis. The median (range) age at diagnosis was 64.5 (7-98) years. One hundred six patients (25%) had healthcare-associated IE. Oral streptococci (n = 99, 23%) and Staphylococcus aureus (n = 81, 19%) were the predominant microorganisms. Ninety-two patients (22%) died during follow-up. After an initial phase of IV antibiotherapy, 214 patients (50%) were switched to oral route a median (range) of 21 (0-70) days after diagnosis of IE. Patients in the oral group had fewer comorbidities, and criteria of severity at inclusion and were less frequently infected by S. aureus. Oral antibiotics were amoxicillin alone in 109 cases or a combination therapy of clindamycin, fluoroquinolone, rifampicin and/or amoxicillin in 46 cases, according to the susceptibility of the microorganisms. In the multivariate analysis, a switch to oral route was not associated with an increased risk of mortality. During follow-up, only two relapses and four reinfections were observed in the oral group (compared to nine and eight in the IV group, respectively). In this study, switching to oral administration was not associated with an increased risk of relapse or reinfection. These promising results need to be confirmed by prospective studies.

Fatal necrotizing fasciitis due to necrotic toxin-producing Escherichia coli strain.

We report a fatal case of necrotizing soft tissues infection caused by an Escherichia coli strain belonging to phylogenetic group C and harbouring numerous virulence factors reported to be part of a pathogenicity island (PAI) such as PAI IIJ96 and conserved virulence plasmidic region.

Overproduction and characterization of the iclR gene product of Escherichia coli K-12 and comparison with that of Salmonella typhimurium LT2.

The iclR gene of Escherichia coli K-12, which encodes a regulatory protein (repressor) for the aceBAK operon, is located between that operon and metH in the 91-min region of the chromosome. The iclR gene was cloned and expressed in a coupled T7 RNA polymerase/promoter system and the gene product was identified by specific binding to a fragment containing the aceBAK operator region. The iclR gene product is a polypeptide of 274 amino acids (aa) with a calculated Mr of 29,741. Comparison of the deduced IclR aa sequence to that of Salmonella typhimurium revealed that the two IclR repressors exhibit 89% identity. A possible helix-turn-helix motif characteristic of DNA-binding proteins was found within the IclR sequence. A search in protein data banks revealed that IclR has a score of similarity of 43.7% with GylR, a transcriptional regulator of the glycerol operon of Streptomyces coelicolor.

Role of lysyl-tRNA in the regulation of lysine biosynthesis in Escherichia coli K12.

A mutant of lysyl-tRNA synthetase has been isolated in Escherichia coli K12. With this strain the Kmapp for lysine is 25 fold higher than with the parental strain. The percentage of charged tRNAlys in vivo is only 7 per cent (as against 65 per cent with HFR H). Under these conditions no derepression of synthesis is observed for three lysine biosynthetic enzymes (AK III, ASA-dehydrogenase, DAP-decarboxylase) ; a partial derepression is obtained in the case of the dhdp-reductase. Thus lysyl-tRNA does not act as the only corepressor molecule in the lysine regulon.

Linear chromosome of Borrelia burgdorferi.

The DNA organization of several European and American isolates of Borrelia burgdorferi, the aetiological agent of Lyme disease, was analysed in pulse-field agarose gel electrophoresis. The results of in situ cell lysis in agarose plugs demonstrated a unique arrangement for the DNA of this spirochete. The chromosome of Borrelia behaved as a eukaryotic linear chromosome with a size of around 1,000 kb. The genome also comprised several circular and linear plasmids which varied in size from 15 to 60 kb.

Two genomic species in Borrelia burgdorferi.

A total of 13 Borrelia burgdorferi strains (responsible for Lyme borreliosis) and representatives of 3 other Borrelia species (B. hermsii, B. parkeri, B. turicatae) associated with relapsing fever were studied by DNA/DNA hybridization and rRNA gene-restriction patterns. Two genomic DNA hybridization groups were observed which could be differentiated by rRNA gene-restriction patterns. Moreover, the number and size of restriction fragments suggest the existence of a single set of 16 and 23 S rRNA genes in Borrelia.

Astrocytes and oligodendrocytes reactions after a total section of the rat spinal cord.

Regeneration after an injury in the Central Nervous System is dependent on intrinsic and extrinsic factors. Among the latter are the reactions of glial cells. Using the model of total section of adult rat spinal cord, we have studied the spatial and temporal responses of astrocytes and oligodendrocytes to the lesion of spinal cord axons. We studied at molecular and cellular levels the specific markers GFAP (glial fibrillary acidic protein) for the astrocytes, CNP (2'-3' cyclic 3' nucleotide phosphodiesterase) which is principally expressed by immature oligodendrocytes, and MBP (myelin basic protein) implicated later in the myelin compaction, and which is more specific of mature oligodendrocytes. After injury, all astrocytes, but more markedly those of the grey matter, reacted by an increase of GFAP messenger and protein. This increase was very rapid for messenger, and peaked at 3 days. This increase was more protracted for the protein and persisted after 3 weeks. Messenger increase is more marked and more protracted below than above the lesion. Oligodendrocytes also reacted quickly by an increase of CNP and MBP messengers. For CNP, both messenger and protein increased rapidly and returned to control level after 1 week. MBP showed the same time course of changes, with lower and slower decrease above the lesion. Counts of oligodendrocytes showed that the percentage of the less mature form (light oligodendrocytes) increased dramatically above and below the lesion. After 1 week, above the lesion, this percentage was well below that of the control, whereas below the lesion, it reverted to control value. These results indicate that, following a lesion, astrocytes react quickly and intensely, but more so below the lesion; oligodendrocytes resume a sequence of maturation which is eventually completed above the lesion where remyelinisation can occur and which is prematurely interrupted below the lesion. However, intact oligodendrocytes persist below the lesion, where they constitute a potential for remyelinisation of regenerated and/or transplanted axons.

The C23A: first step to a monitoring system of CELSS in flight.

Studies for every level of CELSS: Waste processing, food production, photosynthesis system, and so on ..., imply an automatic system to control, command and quantify gases, water and chemical compounds. Used for many years in plant physiology studies, the C23A system monitors the analysis and quantifies gases (O2, CO2. N2, ...), physical parameters (temperature, humidity, ...) and chemical compounds (NH4+, N03-, ...) on numerous experiments. In the new version, the architecture of the computing system is near of the space requirements. We have chosen a structure with three independent levels: acquisition, monitoring and supervision. Moreover, we use multiplexed analysers: IRGA, mass spectrometer and cheminal analyser. The multiplexing increases the accuracy of the measurements and could facilitate the spatialization. Thus the whole structure anticipates the entire separation between automation in space and control-command on ground.

Effect of CO2 and O2 on development and fructification of wheat in closed systems.

The cultivation of wheat (Triticum aestivum L.) was performed in controlled environment chambers with the continuous monitoring of photosynthesis, dark respiration, transpiration and main nutrient uptakes. A protocol in twin chambers was developed to compare the specific effects of low O2 and high CO2. Each parameter is able to influence photosynthesis but different effects are obtained In the development, fructification and seed production, because of the different effects of each parameter on the ratio of reductive to oxidative cycle of carbon. The first main conclusion is that low level of O2, at the same rate of biomass production, strongly acts on the rate of ear appearance and on seed production. Ear appearance was delayed and seed production reduced with a low O2 treatment (approximately 4%). The O2 effect was not mainly due to the repression of the oxidative cycle. The high CO2 treatment (700 to 900 microl l-1) delayed ear appearance by 4 days but did not reduce seed production. High CO2 treatment also reduced transpiration by 20%. Two hypothesis were proposed to explain the similarities and the difference in the O2 and CO2 effects on the growth of wheat.

Does medical treatment of lymphedema act by increasing lymph flow?

The lymphatic origin of chronic edema of the lower limbs was identified by lymphoscintigraphic exploration. Patients underwent therapy involving 8 days of manual lymph drainage combined with elevation of the limbs during rest periods and double compression bandaging. Manual drainage increased lymph flow in 16 limbs, implying that the edema resulted from a functional lymphatic anomaly. In contrast, manual drainage did not increase lymph flow in 9 limbs, suggesting a structural anomaly of the lymphatics. Hence, the same clinical picture corresponded to two different lymphatic anomalies, distinguished by lymphoscintigraphy. However, the therapeutic results were independent of the lymphoscintigraphic results. Increased lymph flow is therefore not the only explanation for the decrease in edema during therapy.

[Study of the etiologic mechanism of valvular regurgitation using Doppler echography]. / Etude du mécanisme étiologique des régurgitations valvulaires en écho-Doppler.

Doppler echocardiography is currently the method of choice for diagnosing and determining the mechanism and etiology of valvular regurgitation. The recent introduction of transesophageal echo coupled with color Doppler has increased the value of these ultrasonic methods. The analysis of the valvular lesion should be particularly precise and accurate in severe mitral insufficiency because of the possibility of surgical valvuloplasty, the indications of which are now much broader than was the case at the beginning of the nineteen eighties.

[Björk-Shiley-Monostrut prosthesis of the aortic valve. Mid-term development]. / Prothèse de Björk-Shiley-Monostrut en position aortique. Evolution à moyen terme.

From July 84 to June 88, 100 patients underwent an isolated aortic valve replacement by a Monostrut-Björk-Shiley prosthesis. Fifty-one had calcified aortic stenosis, 24% aortic insufficiency, 25% mixed aortic lesions. Pre-operatively, their mean age was 57 years, 68% were male, 46% were in NYHA class II or IV, 43% had angina, all were in sinus rhythm. Operative mortality was 4%. All the survivors were followed-up for a mean period of 22 months (6 to 58) with a cumulative follow-up of 183 patients-years. All patients were placed on a long-term regimen of anticoagulant therapy. Two late deaths occurred (1 myocardial infarction, 1 cerebral hemorrhage). The 4 years survival rate was 94%. Postoperative functional results were excellent. Nearly all patients were asymptomatic. Concerning valve related complications: the 4 years actuarial rate of patients free from thromboembolism, hemorrhage, valve thrombosis, periprosthetic leakage and endocarditis were respectively 97%, 97%, 100%, 100% and 100%. No patient were reoperated on. Valvular function was evaluated by mean transprothetic gradient on echo-doppler (61 cases) and by the calculation of the valvular area with transseptal catheterization (21 cases). For small sizes prosthesis (annulus diameter of 19 or 21 mm), medium size prosthesis (23 or 25 mm), large size prosthesis (27 to 29 mm), mean transprothetic gradient were respectively 16, 10 and 6.9 mmHg and valvular aortic area were respectively 1.5, 1.9 and 2.4 cm2. Mid term results of the Monostrut-Björk-Shiley prosthesis on aortic position are good with a low rate of valve related complications and good hemodynamic results, even with the small valve size.

[Manual fragmentation of deep vein thrombosis]. / La fragmentation manuelle des thromboses veineuses profondes.

To preserve the venous function after deep vein thrombosis, physical treatment combines elastic stockings, active exercises, lower limbs elevation, ventilatory exercises and manual lymph drainage. When this traditional treatment is not sufficient, we use a new technique. It aims at fragmenting thrombus by compressing it between the physiotherapist's fingers and the patient's bone. In order to define the fragmentation sites we use the Triplex ultrasonography. This technique has been tested on ten patients with serious thrombosis, whom the thromboembolic risk was first controlled. The evaluation was performed by the clinical examination, echography and occlusive impedance plethysmography rheography. The improvement of the subjective and objective signs leads to use our technique. It has to be validated on a larger scale to extend its use.

[The vena cava in surgery of renal cancer in the adult]. / La veine cave dans la chirurgie du cancer du rein de l'adulte.

In a series of 171 radical nephrectomies performed by the authors, 10 patients presented vena cava extension (5.8%). The extension was infrahepatic (stage C) in 6 cases, retrohepatic (stage B) in 1 case and involved the right auricle (stage A) in 2 cases, while the upper limit of the thrombus could not be defined in the remaining case. All patients were operated upon. There was one post-operative death (stage B), while the other patients had an uncomplicated post-operative course, despite the need for open-heart surgery in two cases. Seven patients died from metastatic after an interval of 2 and 4 years. The prognosis is therefore reserved, but seems to be better than in the case of lymph node metastases, justifying an aggressive surgical approach.