Clinical and microbial characteristics of invasive Streptococcus pyogenes disease in New Caledonia, a region in Oceania with a high incidence of acute rheumatic fever.

New Caledonia is an archipelago in the South Pacific with a high prevalence of acute rheumatic fever and rheumatic heart disease. Conducted in 2006, this study aimed at characterizing clinical manifestations and microbial features of isolates obtained from invasive Streptococcus pyogenes disease. Clinical and demographic data were collected prospectively. Isolates were biotyped, T typed, emm sequenced, and tested for antibiotic susceptibility. Detection of the speA, speB, speC, and ssa genes was also carried out. The estimated annual incidence of invasive S. pyogenes disease in 2006 was high at 38 cases/100,000 inhabitants in New Caledonia. Invasive isolates were obtained from 90 patients with necrotizing fasciitis (41 cases), bacteremia with no identified focus (12 cases), myositis (10 cases), septic arthritis (9 cases), erysipelas (8 cases), postpartum infection (4 cases), myelitis and osteomyelitis (3 cases), severe pneumonia (2 cases), and endocarditis (1 case). The most frequent associated comorbidities were skin lesions (71%) and obesity (29%). Thirty-one different emm types were identified, and the following six accounted for 54% of the isolates: emm15 (15.5%), emm92 (12.2%), emm106 (8.9%), emm74 (6.7%), emm89 (5.6%), and emm109 (5.6%). The speA, speC, and ssa genes were expressed at different frequencies in the various emm types. The first epidemiological study of invasive S. pyogenes disease in New Caledonia highlights that emm type distribution is particular and should be taken into account in the development of an appropriate vaccine. These findings support the prevention of pyoderma and other cutaneous lesions in order to limit the development of both invasive disease and poststreptococcal sequelae in the South Pacific.

Design, synthesis, and evaluation of a novel class of enantioselective electrophilic fluorinating agents: N-fluoro ammonium salts of cinchona alkaloids (F-CA-BF(4)).

The first enantiopure N-fluoro quaternary ammonium salts of cinchona alkaloids as enantioselective fluorinating agents are reported. A one-step transfer-fluorination on the naturally occurring cinchona alkaloids gave the fluorinating agents F-CA-BF(4). This new generation of fluorinating agents exhibited asymmetric induction up to 61% on fluorination of enolates and silyl enol ethers of 2-methyl-1-tetralone.

Nucleophilic trifluoromethylation of carbonyl compounds and disulfides with trifluoromethane and silicon-containing bases

Provided that DMF (or another N,N-dialkylformamide) is present in the reaction medium, at least in a catalytic amount, fluoroform trifluoromethylates efficiently carbonyl compounds, even enolizable ones, when opposed to (TMS)(2)N(-) M(+), generated in situ from N(TMS)(3) and M(+) F(-) or RO(-) Na(+). When F(-) is used in a catalytic amount, silylated alpha-(trifluoromethyl)carbinols are obtained: in this case, the four-component system HCF(3)/N(TMS)(3)/catalytic F(-)/catalytic DMF behaves like the Ruppert's reagent, especially as far as nonenolizable carbonyl compounds are concerned (CF(3)SiMe(3) remains more efficient for enolizable carbonyl compounds). This process involves an adduct between DMF and (-)CF(3) which is the true trifluoromethylating agent. In the same way, fluoroform efficiently trifluoromethylates disulfides and diselenides when deprotonated with a strong base selected from t-BuOK or N(SiMe(3))(3)/Me(4)NF (or TBAT). t-BuOK is more adapted to the trifluoromethylation of aryl disulfides whereas N(SiMe(3))(3)/F(-) is well suited to that of aliphatic disulfides.

[A study of prescriptions for psychotropic drugs at a French psychiatric hospital]. / Etude des prescriptions de médicaments psychotropes dans un hôpital psychiatrique français.

The prescribing habits were studied in a psychiatric hospital which provides services for one district of Paris. The sample consisted of 175 inpatients. A mean of 2.1 psychotropic drugs was prescribed per patient, and more than two-thirds received two psychotropic drugs or more. Almost one-half had a PRN order. Major tranquilizers were frequently used in patients not having a psychotic disorder and were associated to anticholinergic drugs in 55% of the cases. Factors associated with drug prescriptions were diagnosis, age and unit of treatment. Our results are similar to those of previous studies on excessive polypharmacy. The discussion draws attention on the need to obtain data on the rationale for prescribing and the response to treatment. Emphasis is placed on the potential usefulness of studying drug prescriptions for psychiatric practice.

[Percutaneous endopyelotomies. Preliminary results (a series of 16 patients)]. / Endopyélotomies percutanées. Résultats préliminaires (à propos d'une série de 16 malades).

Percutaneous endopyelotomy was performed in 16 patients with ureteropelvic junction obstruction. The procedure was always completed with no intra-operative complication. After a mean follow-up of 18 months (6-30 mos), we report 12 good results (75%), 2 patients with no clinical symptoms but remaining partial radiological obstruction, and 2 failures (12.5%) which required early open surgery. Much care must be given to the ureteral stenting: one of our failures was due to extra-pelvic migration of the stent. Endopyelotomy may be considered as an efficient procedure, but long-term evaluation is still required.

[Initial clinical experiences with the Storz Modulith SL 20 lithotripter: the results 3 months after a single session]. / Première expérience clinique du lithotripteur Storz Modulith SL 20: résultats à trois mois après une séance unique.

The objective of this study was to evaluate the performances of the Storz Modulith SL20 lithotriptor. Fifty patients with a total of 52 renal (31) or ureteric (21) stones were treated, in a single session, between June and October 1993. The mean stone diameter was 7.9 mm. All patients were reviewed after 3 months. The complete success rate, with radiological cure, was 65% at 3 months. The partial success rate, defined as fragmentation of the stone with persistence of residual fragments less than 3 mm in diameter, not requiring further treatment, was 12% at 3 months. The failure rate at 3 months was 23%. The commonest complication was renal colic in 12 patients (24%). Two patients developed an extrarenal haematoma. The Modulith SL20 possesses a good detection system: firing is well tolerated under minimal analgesia. Our success rates are slightly lower than those obtained by other teams using the same apparatus.

Grafting of monocarboxylic substituted polychlorotriphenylmethyl radicals onto a COOH-functionalized self-assembled monolayer through copper (II) metal ions.

A monocarboxylic substituted polychlorotriphenylmethyl radical (PTMCOOH) has been grafted onto a COOH-functionalized SAM (mercaptohexadecanoic acid, MHDA SAM), using copper (II) metal ions as linkers between the carboxyl groups of the SAM and the ligand. The metal-radical adlayer has been characterized thoroughly using different surface analysis techniques, such as contact angle, IRRAS, XPS, SPR, ToF-SIMS, SFM, and NEXAFS. The magnetic character was confirmed by EPR. The density of unoccupied states was investigated using X-ray absorption spectroscopy. A low-energy peak in the NEXAFS spectrum directly revealed the presence of partially occupied electronic levels, thus proving the open-shell character of the grafted ligands. SEM measurements on a laterally patterned sample prepared by muCP of MHDA in a matrix of hexadecane thiolate (a CH 3-terminated SAM) was performed to demonstrate that the metal-assisted anchoring of the open-shell ligand occurs selectively on the COOH terminated SAM. These results represent an easy and new approach to anchor organic radicals on surfaces and constitute a first step toward the growth of magnetic metal-organic radical-based frameworks on solid substrates.

Acylation and related reactions under microwaves. 4. Sulfonylation reactions of aromatics.

Solvent-free sulfonylation of benzene and its activated or deactivated derivatives were carried out under microwave (MW) irradiation and a catalytic amount of iron(III) chloride, which, under these conditions, is more active than other metallic salts. With more reactive and/or nonvolatile reagents (anisole, xylenes, mesitylene) expeditious conditions (short reaction time at constant MW power without control of the temperature) were used. With less reactive and/or low-boiling reagents (benzene, toluene, halobenzenes), the rise in temperature and the increase of reaction time were controlled either by sequential MW irradiation or by a temperature order. It was shown that MWs cause preferential interactions with polar species present in the reaction, especially the aryl sulfone and its FeCl3-complexed form. A MW nonthermal effect was not observed when identical temperature gradients were produced by classical heating and MW irradiation, and if reaction temperature was strictly controlled.