Bed bug infestation in a French university hospital: control strategy, financial impact and perspectives.

BACKGROUND: With the increase in international travel and development of insecticide resistance, a re-emergence of the bed bug has been observed since the 2000s and it is becoming a worldwide public health problem. Hospitals and other medical settings have not been spared, while the cases reported remain limited. However, there are no specific recommendations for the healthcare settings in the literature. AIM: To report our experience of a bed bug infestation in a medical unit, in the French University Hospital Centre of Brest, caused by the admission of a patient carrier in October 2020. We described the practical methods used to control bed bugs infestation, evaluated the cost of this episode and created a specific procedure to take care of at-risk patients or known carriers of bed bugs. FINDINGS: The decision to close the unit for global treatment was taken after the investigations using a sniffer dog revealed that four rooms were infested. The closure lasted 24 days. We estimated the total cost of the infestation to be approximately US$400,000. No other wave of infestation occurred. We created a specific protocol of care for patients who were known carriers or at risk of carriage of bed bugs to graduate a strategy of control. CONCLUSION: Bed bug infestations in health facilities have a major impact on the care of patients and relevant economic consequences. Prevention and education policies are an essential starting point to respond to the scale of the phenomenon.

Assessment and monitoring of water quality of the gulf of Morbihan, a littoral ecosystem under high anthropic pressure.

This field study is intended to propose a global methodology to assess and monitor the water quality of the gulf of Morbihan, a littoral ecosystem under increasing anthropic pressure. To this end, the Locmariaquer site, where Crassostrea gigas is extensively cultivated, was selected to perform a one-year follow-up of tissular glutathione S-transferase and acetylcholinesterase specific activities in this filter feeder organism. Calculation of an integrated index, corresponding to the ratio of the two enzymes activities, allowed to discriminate from the environmental noise, several clusters which could be representative environmental stress, potentially latent pollution. Moreover, the estrogenic activity was assessed in water samples collected at Locmariaquer and other strategic sites of the gulf. The results evidenced a low estrogenic-disrupting compound contamination of waters. Overall, this methodology produced an accurate outlook of a basal state for the gulf and could be developed in the context of a chronic monitoring of this site.

Formation mechanism of glyoxal-DNA adduct, a DNA cross-link precursor.

DNA nucleobases undergo non-enzymatic glycation to nucleobase adducts which can play important roles in vivo. In this work, we conducted a comprehensive experimental and theoretical kinetic study of the mechanisms of formation of glyoxal-guanine adducts over a wide pH range in order to elucidate the molecular basis for the glycation process. Also, we performed molecular dynamics simulations to investigate how open or cyclic glyoxal-guanine adducts can cause structural changes in an oligonucleotide model. A thermodynamic study of other glycating agents including methylglyoxal, acrolein, crotonaldehyde, 4-hydroxynonenal and 3-deoxyglucosone revealed that, at neutral pH, cyclic adducts were more stable than open adducts; at basic pH, however, the open adducts of 3-deoxyglucosone, methylglyoxal and glyoxal were more stable than their cyclic counterparts. This result can be ascribed to the ability of the adducts to cross-link DNA. The new insights may contribute to improve our understanding of the connection between glycation and DNA cross-linking.

The effect of high indoor temperatures on self-perceived health of elderly persons.

INTRODUCTION: Exposure to high ambient temperatures leads to an increase in mortality and morbidity, especially in the elderly. This relationship is usually assessed with outdoor temperature, even though the elderly spend most of their time indoors. Our study investigated the relationship between indoor temperature and heat-related health problems of elderly individuals. MATERIAL AND METHODS: The study was conducted in the Netherlands between April and August 2012. Temperature and relative humidity were measured continuously in the living rooms and bedrooms of 113 elderly individuals. Respondents were asked to fill out an hourly diary during three weeks with high temperature and one cold reference week, and a questionnaire at the end of these weeks, on health problems that they experienced due to heat. RESULTS: During the warmest week of the study period (14-20 August), average living room and bedroom temperatures were approximately 5°C higher than during the reference week. More than half of the respondents perceived their indoor climate as too warm during this week. The most reported symptoms were thirst (42.7%), sleep disturbance (40.6%) and excessive sweating (39.6%). There was a significant relationship between both indoor and outdoor temperatures with the number of hours that heat-related health problems were reported per day. For an increase of 1°C of indoor temperature, annoyance due to heat and sleep disturbance increased with 33% and 24% respectively. Outdoor temperature was associated with smaller increases: 13% and 11% for annoyance due to heat and sleep disturbance, respectively. The relationship between outdoor temperature and heat-related health problems disappeared when indoor and outdoor temperatures were included in one model. CONCLUSIONS: The relationship with heat-related health problems in the elderly is stronger with indoor (living room and bedroom) temperature than with outdoor temperature. This should be taken into account when looking for measures to reduce heat exposure in this vulnerable group.

Radiation-mediated formation of complex damage to DNA: a chemical aspect overview.

During the last three decades, a considerable amount of work has been undertaken to determine the nature, the mechanism of formation and the biological consequences of radiation-induced DNA lesions. Most of the information was obtained via the development of chemical approaches, including theoretical, analytical and organic synthesis methods. Since it is not possible to present all the results obtained in this review article, we will focus on recent data dealing with the formation of complex DNA lesions produced by a single oxidation event, as these lesions may play a significant role in cellular responses to ionizing radiation and also to other sources of oxidative stress. Through the description of specific results, the contribution of different chemical disciplines in the assessment of the structure, the identification of the mechanism of formation and the biological impacts in terms of repair and mutagenicity of these complex radiation-induced DNA lesions will be highlighted.

Representations and practices of prevention in elderly populations: investigating acceptance to participate in and adhesion to an intervention study for the prevention of Alzheimer's disease (ACCEPT study)--the need for a multidisciplinary approach.

BACKGROUND: In the domain of Alzheimer's disease (AD) prevention, various potentially protective factors have been identified in epidemiological studies. Although the results of these observational studies have been relatively consistent, the results of intervention studies remain disappointing. Methodological problems could explain these negative results, like the selection of the population; a plausible assumption is that the older people who agree to take part in these intervention studies differ from those who refuse, and are those that are least likely to benefit from such programs. The aim of this study was (i) to study the determinants of participation in and adhesion to a prevention trial in a population of older individuals via a quantitative approach using a questionnaire, (ii) to study the representations and practices of prevention in this population using a qualitative approach using semi-structured interviews and focus groups. METHOD: The study population for the ACCEPT study was recruited at the time of inclusion of subjects in a prevention trial. The population was made up of persons aged 70 years or older, living at home and demonstrating some form of frailty, defined as a spontaneous memory complaint to their general practitioner or difficulties in carrying out instrumental activities of daily living. We used a quantitative approach based on the administration of a self-completed questionnaire sent to 1680 subjects having accepted to take part in the prevention trial, and to the sample of subjects meeting the inclusion criteria but having refused to take part. The qualitative approach, carried out at the moment of inclusion, involved subjects that having accepted to take part and subjects that having refused. Semi-structured interviews were carried out in order to understand the logic leading to refusal or acceptance. CONCLUSION: The analysis of the results will combine the viewpoints of the different disciplines. It will allow us to better understand the logic at work, to characterise the populations at risk of refusal, and perhaps to remove some of the barriers to participation in prevention programs. The identification of such barriers will provide feedback in terms of the conception and management of prevention measures.

Does Brillouin light scattering probe the primary glass transition process at temperatures well above glass transition?

The primary alpha-relaxation time (tau(alpha)) for molecular and polymeric glass formers probed by dielectric spectroscopy and two light scattering techniques (depolarized light scattering and photon correlation spectroscopy) relates to the decay of the torsional autocorrelation function computed by molecular dynamics simulation. It is well known that Brillouin light scattering spectroscopy (BLS) operating in gigahertz frequencies probes a fast (10-100 ps) relaxation of the longitudinal modulus M*. The characteristic relaxation time, irrespective of the fitting procedure, is faster than the alpha-relaxation which obeys the non-Arrhenius Vogel-Fulcher-Tammann equation. Albeit, this has been noticed, it remains a puzzling finding in glass forming systems. The available knowledge is based only on temperature dependent BLS experiments performed, however, at a single wave vector (frequency). Using a new BLS spectrometer, we studied the phonon dispersion at gigahertz frequencies in molecular [o-terphenyl (OTP)] and polymeric [polyisoprene (PI) and polypropylene (PP)] glass formers. We found that the hypersonic dispersion does relate to the glass transition dynamics but the disparity between the BLS-relaxation times and tau(alpha) is system dependent. In PI and PP, the former is more than one order of magnitude faster than tau(alpha), whereas the two relaxation times become comparable in the case of OTP. The difference between the two relaxation times appears to relate to the "breadth" of the relaxation time distribution function. In OTP the alpha-relaxation process assumes a virtually single exponential decay at high temperatures well above the glass transition temperature, in clear contrast with the case of the amorphous bulk polymers.

Scaling of the structural relaxation in simulated liquid silica.

A scaling law for the alpha relaxation time tau , involving the ratio of a density-dependent energy to the thermal energy, has been found to hold in many fragile glass-forming liquids. This scaling has been recently linked to a local quantity n{loc}(rho,T) relating the variation of tau with density to its variation with temperature. In many fragile liquids, the variation of n{loc}(rho,T) is weak enough to take it as constant over the experimental temperature and density domain. We show that simulated liquid silica has an opposite behavior; close to T{g}, n{loc} is negative for moderate densities and exhibits a significant variation with rho and T, reaching positive values for higher temperature and/or densities. Moreover, those variations linearly correlate to a measure of the bonding properties of the liquid.

Comparison of cardiac output measurements between NICO and the pulmonary artery catheter during repeat surgery for total hip replacement.

OBJECTIVE: The aim of this study was to compare cardiac output measurements of the non-invasive cardiac output and the pulmonary artery catheter during repeat surgery for hip replacement. METHODS: In this prospective observational study, patients undergoing repeat hip surgery who needed a pulmonary artery catheter were included. A standard protocol was followed for induction, endotracheal intubation and maintenance of anaesthesia (sufentanil, etomidate, sevoflurane, cisatracurium). After endotracheal intubation, the non-invasive cardiac output was connected and a pulmonary artery catheter was inserted. Data were collected every 3 min until patients were extubated. RESULTS: Ten patients were included and 2455 points of comparison recorded. Cardiac output from the pulmonary artery catheter varied from 1.7 to 8.9 L min(-1) (mean 4.1 L min(-1)) and the non-invasive cardiac output (using averaging mode) from 1.7 to 8.0 L min(-1) (mean 3.7 L min(-1)). There was a significant correlation between them (P < 0.01; bias 0.3 L min(-1); limits of agreement +1.9 and -2.5 L min(-1)), although these differed between patients. CONCLUSION: The perioperative bias was small and the non-invasive cardiac output slightly underestimated cardiac output intraoperatively compared to the pulmonary artery catheter. The bias was smaller when mean cardiac output was below 3 L min(-1). Core temperature between 34.4 degrees C and 37.6 degrees C had no influence on the differences.

*H atom and *OH radical reactions with 5-methylcytosine.

The reactions between either a hydrogen atom or a hydroxyl radical and 5-methylcytosine (5-MeCyt) are studied by using the hybrid kinetic energy meta-GGA functional MPW1B95. *H atom and *OH radical addition to positions C5 and C6 of 5-MeCyt, or *OH radical induced H-abstraction from the C5 methyl group, are explored. All systems are optimized in bulk solvent. The data presented show that the barriers to reaction are very low: ca. 7 kcal/mol for the *H atom additions and 1 kcal/mol for the reactions involving the *OH radical. Thermodynamically, the two C6 radical adducts and the *H-abstraction product are the most stable ones. The proton hyperfine coupling constants (HFCC), computed at the IEFPCM/MPW1B95/6-311++G(2d,2p) level, agree well with B3LYP results and available experimental and theoretical data on related thymine and cytosine radicals.

Molecular structure of a D-homoandrostanyl steroid derivative: single crystal and powder diffraction analyses.

The knowledge of the structure of a molecular crystal is frequently a prerequisite for the understanding of its solid state properties. Even though single-crystal diffractometry is the method of choice when it comes to crystal structure determination, methods using powder diffraction data become more and more competitive. There has been much recent interest in the development of a new generation of "direct-space" approaches that are particularly suited for molecular crystals. The crystallographic structure of a steroid derivative molecule (17,17-di-n-propyl-17a-aza-D-homo-5alpha-androstan-3beta-ol) was obtained in two independent ways: from a single crystal by laboratory X-rays and from a polycrystalline powder by high-resolution synchrotron powder diffraction. The molecule crystallizes in the orthorhombic space group P2(1)2(1)2(1) (a = 6.5346, b = 17.6006 and c = 19.6978 A). Hydrogen bonds form infinite chains of molecules parallel to the c axis.

Intraoperative detection of cell injury and cell death with an 800 nm near-infrared fluorescent annexin V derivative.

The intraoperative detection of cell injury and cell death is fundamental to human surgeries such as organ transplantation and resection. Because of low autofluorescence background and relatively high tissue penetration, invisible light in the 800 nm region provides sensitive detection of disease pathology without changing the appearance of the surgical field. In order to provide surgeons with real-time intraoperative detection of cell injury and death after ischemia/reperfusion (I/R), we have developed a bioactive derivative of human annexin V (annexin800), which fluoresces at 800 nm. Total fluorescence yield, as a function of bioactivity, was optimized in vitro, and final performance was assessed in vivo. In liver, intestine and heart animal models of I/R, an optimal signal to background ratio was obtained 30 min after intravenous injection of annexin800, and histology confirmed concordance between planar reflectance images and actual deep tissue injury. In summary, annexin800 permits sensitive, real-time detection of cell injury and cell death after I/R in the intraoperative setting, and can be used during a variety of surgeries for rapid assessment of tissue and organ status.

Three catheter-based strategies for cardiac delivery of therapeutic gelatin microspheres.

Gelatin hydrogel microspheres (GHMs) have been reported as novel non-viral vectors for gene or protein delivery (GHM therapy). However, the components of an effective catheter-based delivery strategy for GHM therapy are unknown. We evaluated the effectiveness of three catheter-based strategies for cardiac GHM therapy: (1) antegrade injection (AI) via coronary arteries; (2) retrograde injection (RI) via coronary veins; and (3) direct myocardial injection (DI) via the coronary sinus. AI distributed microspheres homogeneously throughout the target area with 73+/-11% retention. RI scattered microspheres non-homogenously with 22+/-8% retention. DI distributed microspheres in the needle-advanced area with 47+/-14% retention. However, despite high efficiency, AI did not show biological effects of inducing angiogenesis from basic fibroblast growth factor bound to GHMs. Furthermore, focal micro-infarctions, owing to micro-embolism of aggregated GHMs into small coronary arterioles, were detected in the AI group. Conversely, only RI and DI groups displayed increased coronary flow reserve. DI groups also demonstrated increased capillary density. These results suggest that RI and DI are effective for cardiac GHM therapy, while AI appears inappropriate owing to the risk of focal infarctions.

[Consensus statement on severe dementia]. / Consensus sur la démence de type Alzheimer au stade sévère.

Under the auspices of the French Society of Gerontology and Geriatrics, a multidisciplinary group of experts, including geriatricians, neurologists, epidemiologists, psychiatrists, pharmacologists, and public health specialists developed consensus recommendations about care for patients with severe dementia. They defined 21 recommendations for general practitioners, long-term care physicians, and specialists, based on the knowledge currently available (2005). The aim of care at all stages is to mitigate the quality-of-life of patient, caregiver, and family insofar as possible, combining care and future planning until the end of life. Management, to take into account problems including nutritional status, behavior disorders, and ability (or inability) to perform activities of daily living, must be global, multidisciplinary, and coordinated and must optimize use of local medical and social resources. The group also stressed the importance of clinical research to improve knowledge of disease course and assess management strategies and recommended specific area for research.

[Consensus statement on severe dementia]. / Consensus sur la démence de type Alzheimer au stade sévère.

Under the auspices of the French Society of Gerontology and Geriatrics, a multidisciplinary team including geriatritians, neurologists, epidemiologists, psychiatrists, pharmacologists and public health specialists developed a consensus on care for patients with severe dementia. They defined 21 recommendations for general practitioners, long-term care physicians and specialists based on knowledge available in 2005. At all stages of the disease, the objective of care is to improve as much as possible quality-of-life for the patient and his/her family, including a life project until the end of life. It is always possible to do something for these patients and their family: nutritional status, behavior disorders, and incapacities to deal with basic activities of daily life have to be taken in consideration. Resource allocation and proximity care have to be targeted. Research areas necessary to improve the care of patients with severe dementia has been selected.

Changes in informal care over one year for elderly persons with Alzheimer's disease.

BACKGROUND: Informal caregivers play a major role in all types of assistance for elderly persons with Alzheimer's disease but few longitudinal studies reports change in this role over time. OBJECTIVE: The aim of our research was to describe the objective and subjective burden of informal caregivers of elderly persons with dementia of Alzheimer type, and to follow its evolution during one year. METHODS: A multicentre prospective study of 333 principal caregivers of patients with Alzheimer's disease, followed for one year. RESULTS: At inclusion, the majority of caregivers were involved in most tasks of assistance (activities of daily living, handling money, supervision, organisation of support services) but only 13.4% were involved in basic activities of daily living. As expected, during follow-up, the involvement of caregivers increased and extended to all tasks: whereas at inclusion 11.0% regularly assisted in all tasks, after only 12 months follow-up this figure rose to 28.9% (P < 0.001). Whereas 45.9% of caregivers became involved in carrying out new tasks (mainly organisation of support services and help with basic activities of daily living), 8.9% no longer carried out certain tasks (essentially supervision and organisation of support services), 7.3% replaced one task by another, and for 37.8% there was no change. During the same time, the mean burden experienced by the caregiver showed a very slight change (increasing from a mean score of 21.08 +/- 14.65 to 22.68 +/- 16.45, P = 0.044) with great variation between caregivers. Those who increased their involvement also had a significant increase in caregiver burden. CONCLUSION: While home caregiving appeared to follow an even course, the needs of the care recipient changed rapidly over time and caregivers differed in their response to these changes, indicating that regular follow-up is required.

[Demography of oncologic practitioners working in France. Projection elements for the next 30 years]. / Démographie des oncologues praticiens en exercice en France. Eléments de projection pour les trente prochaines années.

In the early eighties, French medical regulatory authorities have decided to control the access to medical studies by restricting the number of admittances. From that date, the numerous clauses was unchanged, leading the physicians to observe a deep reduction in the number of young oncologists. The goal of this study was to define precisely the demography of French medical oncologists and the needs for new specialists. Our model used data from a wide range of sources was developed under the guidance of epidemiologists. We determined current and projected numbers and demographics of oncologists in France workforce from 2002 to 2032. The number of oncologists and physicians implicated in oncology (organ specialists, radiotherapists and paediatricians) entering the marked in the next few years will not be modified. Consequently, the number of physicians will dramatically decrease in the next 15 years resulting in a 25% global working-age population reduction. Our present analysis indicates that the number of oncologists will not be sufficient to meet future demand. Our data suggests that steps should be taken to stop the ongoing decline in the number of physicians involved in oncology and the decline of physicians in training. Consideration should be given to actions designed to increase the number of oncologists in practise in the years ahead.