Nine Cases of Methanogenic Archaea in Refractory Sinusitis, an Emerging Clinical Entity

The authors report the cases of 9 patients eventually diagnosed with methanogenic archaea refractory or recalcitrant chronic rhinosinusitis, a condition known to involve various anaerobic bacteria but in which the role of methanogenic archaea is unknown. The authors retrospectively searched these microorganisms by PCR in surgically-collected sinusal pus specimens from patients diagnosed with refractory sinusitis, defined by the persistance of sinus inflammation and related-symptoms for more than 12 weeks despite appropriate treatment. Of the 116 tested sinus surgical specimens, 12 (10.3%) from 9 patients (six females, three males; aged 20–71 years) were PCR-positive. These specimens were further investigated by fluorescence in-situ hybridization, PCR amplicon-sequencing and culture. Methanobrevibacter smithii was documented in four patients and Methanobrevibacter oralis in another four, one of whom was also culture-positive. They were associated with a mixed flora including Gram-positive and Gram-negative bacteria. In the latter patient, “Methanobrevibacter massiliense” was the sole microorganism detected. These results highlight methanogenic archaea as being part of a mixed anaerobic flora involved in refractory sinusitis, and suggest that the treatment of this condition should include an antibiotic active against methanogens, notably a nitroimidazole derivative

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

The dormancy of Mycobacterium tuberculosis in the natural history of tuberculosis

La tuberculose latente est une infection chronique asymptomatique associée à la forme dormante de M. tuberculosis indétectable par l’examen direct microscopique standard. Nous avons optimisé la technique microscopique de l’hybridation in situ en fluorescence (FISH) pour la détection spécifique des mycobactéries du complexe M. tuberculosis en ciblant leur ADN. L'application de FISH à 116 échantillons d'expectoration collectés de manière prospective a permis de détecter M. tuberculosis dans 31 échantillons positifs à l’examen direct par Ziehl-Neelsen et positifs en culture,et la détection FISH de M. tuberculosis est restée négative dans les 85 échantillons négatifs. Également, nous avons mis en place une méthode originale appelée marquage DDD permettant de détecter les trois états dynamique, dormant et mort de M. tuberculosis. Le marquage DDD a permis de quantifier les formes DDD chez un patient atteint de tuberculose pulmonaire avant et après initiation du traitement antituberculeux. Parallèlement, nous avons émis l'hypothèse d'un effet direct stimulateur des corticostéroïdes sur le réveil du bacille tuberculeux dormant. Pour cela nous avons exposé une souche de M. tuberculosis en dormance à la méthylprednisolone et au tampon salin (PBS) et nous avons suivi le réveil de la dormance par culture, microscopie et biologie moléculaire. Les résultats ont montré que la méthylprednisolone à une concentration de 1 µg/mL stimule la croissance des mycobactéries dormantes après remise en culture. Dans un autre volet, nous avons démontré la capacité de M. tuberculosis ingérée à transloquer du tube digestif vers d'autres organes, grâce à un modèle murin d'ingestion de M. tuberculosis.Latent tuberculosis is a chronic asymptomatic infection associated with the dormant form of M. tuberculosis undetectable by standard direct microscopic examination. We have optimised the microscopic technique of fluorescent in situ hybridisation (FISH) for the specific detection of M. tuberculosis complex mycobacteria by targeting their DNA. The application of FISH to 116 prospectively collected sputum samples resulted in the detection of M. tuberculosis in 31 Ziehl-Neelsen-positive and culture-positive samples, however FISH detection of M. tuberculosis remained negative in the 85 negative samples. In addition, we have implemented an original method called DDD staining to detect the dynamic, dormant and dead states of M. tuberculosis. The DDD staining allowed to quantify the DDD forms in a patient with pulmonary tuberculosis before and after initiation of tuberculosis treatment. We found a significant decrease in viable dynamic mycobacteria in the patient's sputum after treatment, correlated with a favorable clinical course. At the same time, we hypothesised a direct stimulating effect of corticosteroids on the awakening of the dormant tuberculosis bacillus. For this purpose we exposed a dormant strain of M. tuberculosis to methylprednisolone and saline buffer (PBS) and monitored mycobacterial reactivation by culture, microscopy and molecular biology. The results showed that methylprednisolone at a concentration of 1 µg/mL stimulates the growth of dormant mycobacteria after subculture. In another component, we demonstrated the ability of ingested M. tuberculosis to translocate from the digestive tract to other organs, using a mouse model of M. tuberculosis ingestion

Bead-captured Mycobacterium tuberculosis for next-generation sequencing diagnosis of uncultured tuberculosis

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Hardware architecture for H.264/AVC deblocking filter algorithm

International audienceThis paper presents novel hardware architecture for real-time implementation of adaptive deblocking filter algorithm used in H.264/AVC baseline profile video coding standard. This hardware is designed to be used as part of a complete H.264 video coding system for video conference applications. We use a novel edge filter ordering in a Macroblock to prevent the deblocking filter hardware from unnecessarily waiting for the pixels that will be filtered become available. This architecture presents minimum latency, maximum throughput, full utilization of hardware resources and combining both pipelining and parallel processing techniques. The proposed architecture is implemented in VHDL. The VHDL code is verified to work at 150 MHz in an ALTERA Stratix II FPGA

An Efficient FPGA parallel Architecture for H.264/AVC Intra Prediction Algorithm

International audienceIn Motion Picture Experts Group (MPEG) and Video Coding Experts Group (VCEG) standards, intra prediction is used to eliminate the spatial redundancy. Given that the intra prediction stage is very complex in terms of computational effort, a hardware implementation on a re-configurable circuit is crucial for the requirements of different real-time multimedia applications. In this paper, we present novel hardware architecture for real-time implementation of intra prediction algorithm used in H.264 Advanced Video Coding (AVC) baseline profile video coding standard. This hardware is designed to be used as part of a complete H.264 video coding system for videoconference applications. We use an approach based on a novel organization of the intra prediction equations. This architecture presents minimum latency, maximum throughput, full utilization of hardware resources and combining both pipelining and parallel processing techniques. The proposed architecture is implemented in VHDL. On ALTERA Stratix II FPGA, the VHDL code is verified to work at 300 MHz for the luma intra prediction 4x4 architecture and 176 MHz for the luma intra prediction 16x16

FPGA DESIGN FOR H.264/AVC ENCODER

International audienceIn this paper, we describe an FPGA H.264/AVC encoder architecture performing at real-time. To reduce the critical path length and to increase throughput, the encoder uses a parallel and pipeline architecture and all modules have been optimized with respect the area cost. Our design is described in VHDL and synthesized to Altera Stratix III FPGA. The throughput of the FPGA architecture reaches a processing rate higher than 177 million of pixels per second at 130 MHz, permitting its use in H.264/AVC standard directed to HDTV

An efficient and unified 2D-inverse integer cosine transform (IICT) FPGA-hardware implementation for HEVC standard

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An optimized and unified architecture design for H.265/HEVC 1-D inverse core transform

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