Like Frying Multiple Eggs in One Pan: a Qualitative Study Exploring the Understanding of Inter-speciality Training in Cancer Care.

H igh-quality cancer care is a key priority worldwide. Caring for people affected by cancer requires a range of specific knowledge, skills and experience to deliver the complex care regimens both within the hospital and within the community environment. In June 2022, the European Cancer Organisation along with 33 European cancer societies began working together to develop a curriculum for inter-speciality training for healthcare professionals across Europe. As part of the project, this research consisted of a qualitative survey distributed to the European Union societies via email. The aim of this paper is to disseminate the qualitative findings from healthcare professionals across Europe. Questionnaires were sent out to a convenience sample of 219 healthcare professionals and patient advocates with a response rate of 55% (n = 115). The findings identified that there were four key themes: 'What is inter-speciality training?', 'Barriers and challenges', 'Support throughout the cancer journey' and 'New ways of working'. These results are part of a larger needs analysis and scoping review to inform the development of a core competency framework which will be part of an inter-speciality curriculum for specialist cancer doctors, nurses and other healthcare professionals across Europe. Healthcare professionals will be able to access education and training through the virtual learning environment and workshops and by clinical rotations to other specialties.

Variability in breast cancer surgery training across Europe: An ESSO-EUSOMA international survey.

BACKGROUND: At present there is a lack of standardization of training in breast cancer surgery across Europe. The aim of this survey was to assess current practice in Europe regarding training in breast cancer (BC) surgery. MATERIAL AND METHODS: General surgeons, surgical oncologists, gynecologist, and plastic surgeons in Europe were invited to participate in this bespoke survey including 19 questions. RESULTS: The survey was sent to 3.000 surgical oncologists across Europe. A total of 671 physicians (387 general surgeons, 152 gynecologists, 126 surgical oncologist, 31 plastic surgeons) answered the survey (23% response rate). Four hundred and sixty-eight physicians devoted between 50% -100% of their job to treating breast cancer. 45% worked in a community/University hospital within a dedicated Breast Unit. Specific additional breast surgery training was not universal: 20% had undertaken an accredited breast fellowship, 30% in a Breast Unit as a trainee, 21% had done additional courses, masters or diploma and 8% had not done any additional training. The majority (61%) of respondents worked in Units treating >150 BC cases per year, while 26% of the responders treat >120 new primary cases per year, and 23% less than 50 new cases a year. Multivariate analysis showed that breast surgeons working in a Breast Unit and treating more than 50 cases/year significantly performed oncoplastic procedures. CONCLUSION: There is a great variability in breast cancer surgery training in Europe. It is imperative to develop quality standards for breast cancer surgery training to ensure that patients get standardized and certified surgical management regardless of the country in which they are treated.

No-go decision: A newly identified adverse event in orthopaedic surgery - causes and medico-legal implications.

BACKGROUND: No-go designates a decision not to perform surgery when it becomes apparent that safety and/or feasibility requirements are not met. No-go decisions can occur at any time between patient admission to a hospital department and immediately before the first incision. The primary objective of this study was to assess the causes of no-go decisions reported as healthcare-associated adverse events (HAAEs). HYPOTHESIS: Most no-go decisions in orthopaedic surgery are related to problems with medical devices. MATERIAL AND METHODS: A preliminary retrospective study assessed HAAEs reported over the 1-year period from 1st October 2014 to 30th September 2015, using the risk-management tool ALARM. A prospective survey was then performed by emailing a 15-item questionnaire to the 1828 members of Orthorisq (the French orthopaedic surgeon accreditation agency). Responses were either yes/no or open. Statistical comparisons were performed, using the paired Wilcoxon signed-rank test to estimate p values. RESULTS: Among reported HAAEs, 5.6% were no-go decisions. Of the 101 reported no-go decisions, 43.5% and 45.2% were due to problems with managing implantable medical devices in the retrospective and prospective assessments, respectively. In over 85% of cases, surgery was cancelled or postponed. Over half the no-go decisions were associated with unnecessary anaesthesia. Checklist completion was performed in only half the cases and was not associated with no-go decisions (p>0.8). DISCUSSION: This study provides descriptive data on no-go decisions in orthopaedic surgery. Healthcare professionals use many methods to enhance patient safety by preventing adverse events or diminishing their impact. Errors in managing implantable medical devices are the leading cause of no-go decisions. The current checklist is not appropriate for managing implantable medical devices in orthopaedic surgery, in part because it does not include checking devices upon receipt. Before surgery, patients should be informed of the risk of a no-go decision, since unnecessary anaesthesia occurs in over half the cases. LEVEL OF EVIDENCE: IV, prospective study.

Global curriculum in research literacy for the surgical oncologist.

BACKGROUND: The ability to provide optimal care to cancer patients depends on awareness of current evidence-based practices emanating from research or involvement in research where circumstances permit. The significant global variations in cancer-related research activity and its correlation to cancer-specific outcomes may have an influence on the care provided to cancer patients and their outcomes. The aim of this project is to develop a global curriculum in research literacy for the surgical oncologist. MATERIALS AND METHODS: The leadership of the Society of Surgical Oncology and European Society of Surgical Oncology convened a global curriculum committee to develop a global curriculum in research literacy for the Surgical Oncologist. RESULTS: A global curriculum in research literacy is developed to incorporate the required domains considered to be essential to interpret the published research or become involved in research activity where circumstances permit. The purpose of this curriculum is to promote research literacy for the surgical oncologist, wherever they are based. It does not mandate direct research participation which may not be feasible due to restrictions within the local health-care delivery environment, socio-economic priorities and the educational environment of the individual institution where they work. CONCLUSIONS: A global curriculum in research literacy is proposed which may promote research literacy or encourage involvement in research activity where circumstances permit. It is hoped that this will enhance cancer-related research activity, promote awareness of optimal evidence-based practices and improve outcomes for cancer patients globally.

Global Curriculum in Research Literacy for the Surgical Oncologist.

BACKGROUND: The ability to provide optimal care to cancer patients depends on awareness of current evidence-based practices emanating from research or involvement in research where circumstances permit. The significant global variations in cancer-related research activity and its correlation to cancer-specific outcomes may have an influence on the care provided to cancer patients and their outcomes. The aim of this project is to develop a global curriculum in research literacy for the surgical oncologist. MATERIALS AND METHODS: The leadership of the Society of Surgical Oncology and European Society of Surgical Oncology convened a global curriculum committee to develop a global curriculum in research literacy for the Surgical Oncologist. RESULTS: A global curriculum in research literacy is developed to incorporate the required domains considered to be essential to interpret the published research or become involved in research activity where circumstances permit. The purpose of this curriculum is to promote research literacy for the surgical oncologist, wherever they are based. It does not mandate direct research participation which may not be feasible due to restrictions within the local health-care delivery environment, socio-economic priorities and the educational environment of the individual institution where they work. CONCLUSIONS: A global curriculum in research literacy is proposed which may promote research literacy or encourage involvement in research activity where circumstances permit. It is hoped that this will enhance cancer-related research activity, promote awareness of optimal evidence-based practices and improve outcomes for cancer patients globally.

[For a targeted use of aspirin]. / Pour une prescription ciblée de l'aspirine.

The use of low-dose aspirin in pregnancy should remain a highly targeted indication since its long-term safety has not been established and should be restricted to women at high risk of vascular complications. Indications for which the benefit of aspirin has been shown are women with a history of preeclampsia responsible for a premature birth before 34 weeks, those having at least two history of preeclampsia, those with an antiphospholipid syndrome and those with lupus associated with positive antiphospholipid antibodies or renal failure. In all other cases, the level of evidence of the benefit of aspirin is insufficient to recommend its routine prescription.

Global curriculum in surgical oncology.

BACKGROUND: The significant global variations in surgical oncology training paradigms can have a detrimental effect on tackling the rising global cancer burden. While some variations in training are essential to account for the differences in types of cancer and biology, the fundamental principles of providing care to a cancer patient remain the same. The development of a global curriculum in surgical oncology with incorporated essential standards could be very useful in building an adequately trained surgical oncology workforce, which in turn could help in tackling the rising global cancer burden. MATERIALS AND METHODS: The leaders of the Society of Surgical Oncology and European Society of Surgical Oncology convened a global curriculum committee to develop a global curriculum in surgical oncology. RESULTS: A global curriculum in surgical oncology was developed to incorporate the required domains considered to be essential in training a surgical oncologist. The curriculum was constructed in a modular fashion to permit flexibility to suit the needs of the different regions of the world. Similarly, recognizing the various sociocultural, financial and cultural influences across the world, the proposed curriculum is aspirational and not mandatory in intent. CONCLUSIONS: A global curriculum was developed which may be considered as a foundational scaffolding for training surgical oncologists worldwide. It is envisioned that this initial global curriculum will provide a flexible and modular scaffolding that can be tailored by individual countries or regions to train surgical oncologists in a way that is appropriate for practice in their local environment.

Variations in training of surgical oncologists: Proposal for a global curriculum.

BACKGROUND: The global cancer burden is predicted to rise significantly over the next few decades. While there are several barriers to providing optimal cancer care on the global stage, some are related to the absence of an adequately trained workforce. This could be attributed in part to the significant global variations in the training of surgical oncology professionals. There are currently no published data mapping the training pathways for surgical oncologists for all countries in the world. The aims of this descriptive article are to report on the training paradigms in surgical oncology for all countries in the world, and to correlate the influence of economic standing on these training paradigms. MATERIALS AND METHODS: The training paradigms for all countries in the world were analyzed and categorized on the basis of the six World Health Organization geographic regions and economic standing stratified by the Human Development Index. RESULTS: Data on the training paradigms were obtained for 174 countries from a total of 211 (82%). We noted extremely significant and concerning variations in the length, availability and structure of training paradigms depending on the geographic region and economic standing. CONCLUSIONS: The results of our study demonstrated significant global variations in the training paradigms of surgical oncologists. These variations call for a global curriculum which has been developed by the Society of Surgical Oncology and the European Society of Surgical Oncology. It is hoped that this curriculum will serve a role in streamlining education to tackle the rising global cancer burden.

Variations in Training of Surgical Oncologists: Proposal for a Global Curriculum.

BACKGROUND: The global cancer burden is predicted to rise significantly over the next few decades. While there are several barriers to providing optimal cancer care on the global stage, some are related to the absence of an adequately trained workforce. This could be attributed in part to the significant global variations in the training of surgical oncology professionals. There are currently no published data mapping the training pathways for surgical oncologists for all countries in the world. The aims of this descriptive article are to report on the training paradigms in surgical oncology for all countries in the world, and to correlate the influence of economic standing on these training paradigms. MATERIALS AND METHODS: The training paradigms for all countries in the world were analyzed and categorized on the basis of the six World Health Organization geographic regions and economic standing stratified by the Human Development Index. RESULTS: Data on the training paradigms were obtained for 174 countries from a total of 211 (82 %). We noted extremely significant and concerning variations in the length, availability and structure of training paradigms depending on the geographic region and economic standing. CONCLUSIONS: The results of our study demonstrated significant global variations in the training paradigms of surgical oncologists. These variations call for a global curriculum which has been developed by the Society of Surgical Oncology and the European Society of Surgical Oncology. It is hoped that this curriculum will serve a role in streamlining education to tackle the rising global cancer burden. © 2016 Society of Surgical Oncology and the European Society of Surgical Oncology. Published by SpringerNature. All rights reserved.

Global Curriculum in Surgical Oncology.

BACKGROUND: The significant global variations in surgical oncology training paradigms can have a detrimental effect on tackling the rising global cancer burden. While some variations in training are essential to account for the differences in types of cancer and biology, the fundamental principles of providing care to a cancer patient remain the same. The development of a global curriculum in surgical oncology with incorporated essential standards could be very useful in building an adequately trained surgical oncology workforce, which in turn could help in tackling the rising global cancer burden. MATERIALS AND METHODS: The leaders of the Society of Surgical Oncology and European Society of Surgical Oncology convened a global curriculum committee to develop a global curriculum in surgical oncology. RESULTS: A global curriculum in surgical oncology was developed to incorporate the required domains considered to be essential in training a surgical oncologist. The curriculum was constructed in a modular fashion to permit flexibility to suit the needs of the different regions of the world. Similarly, recognizing the various sociocultural, financial and cultural influences across the world, the proposed curriculum is aspirational and not mandatory in intent. CONCLUSIONS: A global curriculum was developed which may be considered as a foundational scaffolding for training surgical oncologists worldwide. It is envisioned that this initial global curriculum will provide a flexible and modular scaffolding that can be tailored by individual countries or regions to train surgical oncologists in a way that is appropriate for practice in their local environment. © 2016 Society of Surgical Oncology and the European Society of Surgical Oncology. Published by SpringerNature. All rights reserved.

[Osteochondral autograft for osteochondritis dissecans of the capitulum in adolescent: report of six cases and review of the literature]. / Traitement de l'ostéochondrite disséquante du capitulum chez l'adolescent par autogreffe ostéochondrale monobloc: à propos de six cas et revue de la littérature.

PURPOSE OF THE STUDY: We present the cases of six adolescents (four high-level gymnastics specialists) with osteochondritis dissecans of the capitulum who were treated with an en bloc osteochondral autograft. There are few series of this rare condition reported in the literature. MATERIAL AND METHODS: All six patients presented pain over the lateral aspect of the elbow and limited extension; pronosupination was unaffected. Physical examination and plain X-rays enabled the diagnosis of osteochondritis dissecans. Postoperative X-rays confirmed good integration of the bone graft. These patients underwent lateral arthrotomy for curettage and avivement followed by an en bloc grafting. The graft was harvested from the homolateral knee via minimal arthrotomy, from a non-weight-bearing zone of the lateral condyle. RESULTS: At three months, complete pain-free range of motion was achieved in four of six patients. Graft integration was confirmed in all six patients on the three months plain X-rays, arthro-CT, or MRI. The four gymnastic specialists resumed their high-level sports activities at one year (at six months for one of them). DISCUSSION: Various surgical methods have been proposed. Series reported in the literature, like ours, have been small, with short follow-up. We have observed good results with an en bloc graft, encouraging us to continue with this surgical strategy.

Vestibular memory-contingent whole-body return: brave exocentered dancers.

A whole-body, self-driven return from passive rotation (90 degrees to 270 degrees ) test was executed by male and female subjects, and by professional female ballet dancers. To accomplish the return task, subjects were free to use the egocentered reference frame (inversion) or the exocentered one (completion). The results show that with inversion all kinetic parameters were reproduced, whereas the completion performance was highly variable. Although inversion was the default strategy, female subjects used more completions than male subjects, and female dancers still more, although not more accurately. The high variability noted in completion shows a deficiency in integrating vestibular signals for updating the egocentric representation of an external target during passive body rotations, even in dancers. Furthermore, with completions after 180 degrees stimuli, the results suggest that both ego- and exocentered reference frames cannot be used simultaneously.

Multifactorial interactions involved in linear self-transport distance estimate: a place for time.

As the vestibular system is the only sensory organ whose primary function is self-motion detection, we examined the conditions under which the otoliths, which detect the linear acceleration of the head, could be used to estimate traveled distance. In order to isolate the contribution of the otoliths (with the somatosensory system) from contributions of the visual and motor systems subjects were transported in darkness. We initially hypothesized that self-transport with continuously varying linear velocity should facilitate distance computation by continuously stimulating the otoliths, and that active control of self-motion should also help subjects estimate the distance traveled. However, it was found that the distance covered during self-motion is actually better estimated when transport velocity is quasi-constant. Nevertheless, such estimates strongly depend upon velocity magnitude; subjects show an idiosyncratic preferred self-motion velocity for which distance measurements are most accurate. Furthermore, the active control of self-transport improves estimates of self-motion mainly because the subjects can then adopt a constant velocity, and more precisely their preferred one. It was finally found that subjects mentally count in order to assess their displacement length, and that time perception is indeed disturbed by varying self-motion velocity.

[Reconstruction-arthrodesis of the first metatarsophalangeal joint iatrogenic bone defects]. / Reconstruction-arthrodèse des pertes de substances osseuses iatrogènes métatarso-phalangiennes du premier rayon.

PURPOSE OF THE STUDY: Arthrodesis-reconstruction for metatarsophanlangeal bone defects of the great toe after hallux valgus or hallux rigidus is rarely performed and only a few series are found in the literature. In these series, retarded bone fusion, skin rupture, and interphalangeal intolerance (both clinically and radiologically) have been frequent. The purpose of this work was to determine what parameters contribute to minimizing these postoperative risks. MATERIAL AND METHODS: Thirteen patients, mean age 60 years, were reviewed at a mean follow-up of 7 years. Mean delay from initial surgery to revision surgery was greater than 6 years. Preoperative complaints included metatarsophalangeal pain and especially transfer metatarsalgia. The procedure used corticocancellous bone grafting associated with osteosynthesis and unloading of the forefoot for three months. RESULTS: Eleven of the 13 patients achieved full relief of their metatarsophalangeal pain and metatarsalgia. Twelve of the 13 patients had a satisfactory great toe axis, including 2 who had a secondary osteotomy for correction. Bone fusion was achieved in all 13 patients; one at 8 months. Mean lengthening was 5.1 mm; reconstruction with the corticocancellous graft reconstruction generally filled the bone defect resulting from ablation of the joint prosthesis in 7 cases. The interphalangeal joint was pain free at last follow-up in all cases despite radiological evidence of suffering in one (similar to the situation before the revision surgery). DISCUSSION AND CONCLUSION: Correct position of the arthrodesis is essential to alleviate transfer metatarsalgia. A moderate lengthening of the great toe can minimize the risk of skin rupture. In order to preserve the interphalangeal joint, the position of the arthrodesis must be precise both in the sagittal and horizontal plane, leaving sufficient valgus and avoiding the need for temporary interphalangeal pinning.

[Triple fracture of the superior shoulder suspensory complex]. / Triple fracture du complexe suspenseur superieur de l'epaule: presentation d'un cas.

The authors present the case of a displaced fracture of the coracoid process associated with a displaced fracture of the acromion, an undisplaced fracture of the clavicule and fractures of the first to fifth ribs. Open reduction of the coracoid process fracture was performed. At the last follow-up, the coracohumeral distance was restored (10 mm), but the acromiohumeral distance in the sagittal place was decreased (5 mm). The authors recommend open reduction of displaced fractures around the rotator cuff to limit the risk of impingement between the cuff and the coracoid process or the acromion.

[Sagittal equilibrium of the pelvis: analysis of the inclination of the ischio-pubic ramus from the horizontal]. / Equilibre sagittal du bassin : analyse de l'inclinaison de la branche ischio-pubienne par rapport à l'horizontale.

PURPOSE OF THE STUDY: The sagittal equilibrium of the spine and pelvis has been examined in numerous studies looking for the origin of certain posture disorders of the spine and the cause of lower back pain. Sagittal x-rays of the pelvis provide an analysis of the degree of inclination of the pelvis from the horizontal and the bi-coxo-femoral axis and information on the form of the sacrum. There is no radiographic parameter however which analyzes the transition between the pelvis-sacrum component and the femoral component, i.e. the periacetabular region. In the sagittal plane, a line tangent to the ischio-pubic ramus would appear to best reflect the orientation of the periacetabular region and the muscular forces applied to this region. The purpose of this work was to analyze the inclination of the ischio-pubic ramus from the horizontal and its relations with other sagittal radiographic parameters in a population of growing children with spinal disorders. MATERIALS AND METHOD: The study population included 100 children with spinal disorders who underwent a teleradiographic series with lateral view in the upright position. Most of the children had scoliosis (80 cases), 7 had kyphoscoliosis, 4 isthmic spondylolysis with spondylolisthesis, 1 spondylodiscitis and 4 lower back pain. Mean age was 13 years (range 2.5-22 years). We measured 7 radiographic parameters: lumbo-sacral angle, slope of the sacrum, pelvic version, incidence, thickness, overhang, and inclination of the ischio-pubic ramus from the horizontal. Data were analyzed to search for correlations between radiographic parameters and between radiographic parameters and clinical features. RESULTS: Mean inclination of the ischio-pubic ramus from the horizontal was 33.9 degrees (SD =5.9 degrees ). The only positive statistical correlation between the inclination of the ischio-pubic ramus and the clinical data was a relationship with the position of the arms compared with the horizontal (p =0.04). There was no correlation with age, sex, ethnic background, etiology. There was no correlation between the inclination of the ischio-pubic ramus and the other radiographic parameters (coefficient r ranging from 0.06 to 0.43). DISCUSSION: The interdependence of sagittal radiographic parameters of the pelvis and the spine have been largely demonstrated. Certain pathological situations (isthmic spondylolysis with spondylolisthesis, lower back pain, etc.) can be explained by the value of these parameters, particularly incidence. The inclination of the ischio-pubic ramus from the horizontal reflects the periacetabular region. When analyzed in the sagittal plane, it was found to be a more stable parameter, independent of most clinical criteria (particularly age, and etiology) and of the other radiographic parameters studied. The only determining factor appears to be acquisition of the upright position. The consistency of this parameter constrasts with the variability of the other radiographic parameters of the pelvis and the spine, particularly incidence, although the inclination of the ischio-pubis ramus is an expression of a region different than the pelvis. This study suggests that the periacetabular region plays a key role in acquisition of the upright position in humans. The periacetabular region would be a fixed point around which the lower limbs and spine describe varying orientations.

[Complications associated with the use of first generation Harris-Galante porous-coated acetabular component after a mean follow-up of 7 years]. / Complications liées à l'utilisation de la cupule de Harris-Galante de première génération au recul moyen de 7 ans.

MATERIAL AND METHODS: Hundred and twelve hip were studied in 107 patients with a mean follow-up of 7 years (range, 6-9 years). Harris and Postel-Merle d'Aubigné clinical hip scores were used. The prosthetic components were evaluated using radiographic criteria. RESULTS: The mean Harris score was 91 (range, 34-100). The incidence of proximal pain was 3.7 p. 100 in anterior area and also 3.7 p. 100 in posterior area. Radiolucent lines were present in one acetabular zone in 28.5 p. 100 of cases, in two zones in 26 p. 100, in all three zones in 5.5 p. 100. No statistical significant corelation was identified relating pain and radiolucent lines. The mean rate of linear wear per year was 0.1 millimeter. A statistically significant corelation was identified relating a linear wear per year above 0.12 millimeter and the presence of radiolucent lines. A major polyethylene wear (from 2.75 to 3.5 millimeters) was found in 5 cases. One of them had an acetabular osteolysis. One acetabular liner was found unstable in the metal shell during a hip revision for a major wear. Two patients had a dislocation of the liner in the metal-back. Eight hips needed a revision surgery, always for a failure of the polyethylene liner, never for a loosening between the socket and the acétabulum. DISCUSSION AND CONCLUSION: The acetabular component bone fixation of this Harris-Galante prosthesis appears optimum. The polyethylene wear and the unstability between the polyethylene cup and the metal socket need to stop using this component. The fixation between his two parts have to be improved.

[Idiopathic scoliosis: evaluation of the results]. / Scoliose idiopathique: évaluation des résultats.

Natural history studies in idiopathic scoliosis must be known to assess the effectiveness of treatment. Natural history is better known to day for mild angulations but as far as scoliosis are operated on for greater angulations natural history of scoliotic population with Cobb angle greater than fifty degrees is less and less available. Effectiveness of school screening is debated because of over-referral of either non scoliotic children or patient with mild non evolutive scoliosis. Attempt to find any criteria for evolutive scoliosis was disappointing. Only scoliosis with Cobb angle greater than thirty five degrees during growth spurt is defined as an evolutive scoliosis with a 95% confidence interval. Scoliotic curves show a tendency to progress even during adult life especially if the Cobb angle is over thirty degrees at skeletal maturity. Effectiveness of bracing is established for Cobb angle over thirty degrees. Comparing natural history and the results of bracing for mild idiopathic scoliosis controversies remain according to the effectiveness of bracing. Scoliotic population is more at risk for back pain than a population based control group. In severe idiopathic scoliosis non operated patients ar more at risk for back pain than operated one. Multi-hooks systems used for surgical correction of scoliosis are helpful in term of coronal plan correction but no system effectively derotates the spine. Scoliotic population experiences significatively more back pain than control group. There is a higher prevalence of negative perception of health but a more positive perception of self in the scoliotic population compared to a control group.

Differential behaviors of Staphylococcus aureus and Escherichia coli type II DNA topoisomerases.

Staphylococcus aureus gyrA and gyrB genes encoding DNA gyrase subunits were cloned and coexpressed in Escherichia coli under the control of the T7 promoter-T7 RNA polymerase system, leading to soluble gyrase which was purified to homogeneity. Purified gyrase was catalytically indistinguishable from the gyrase purified from S. aureus and did not contain detectable amounts of topoisomerases from the E. coli host. Topoisomerase IV subunits GrlA and GrlB from S. aureus were also expressed in E. coli and were separately purified to apparent homogeneity. Topoisomerase IV, which was reconstituted by mixing equimolar amounts of GrlA and GrlB, had both ATP-dependent decatenation and DNA relaxation activities in vitro. This enzyme was more sensitive than gyrase to inhibition by typical fluoroquinolone antimicrobial agents such as ciprofloxacin or sparfloxacin, adding strong support to genetic studies which indicate that topoisomerase IV is the primary target of fluoroquinolones in S. aureus. The results obtained with ofloxacin suggest that this fluoroquinolone could also primarily target gyrase. No cleavable complex could be detected with S. aureus gyrase upon incubation with ciprofloxacin or sparfloxacin at concentrations which fully inhibit DNA supercoiling. This suggests that these drugs do not stabilize the open DNA-gyrase complex, at least under standard in vitro incubation conditions, but are more likely to interfere primarily with the DNA breakage step, contrary to what has been reported with E. coli gyrase. Both S. aureus gyrase-catalyzed DNA supercoiling and S. aureus topoisomerase IV-catalyzed decatenation were dramatically stimulated by potassium glutamate or aspartate (500- and 50-fold by 700 and 350 mM glutamate, respectively), whereas topoisomerase IV-dependent DNA relaxation was inhibited 3-fold by 350 mM glutamate. The relevance of the effect of dicarboxylic amino acids on the activities of type II topoisomerases is discussed with regard to the intracellular osmolite composition of S. aureus.