Stroke

Background and Purpose-The aim of the present study was to evaluate the relationship between normal-appearing white matter (NAWM) integrity and postischemic stroke recovery in 4 main domains including cognition, mood, gait, and dependency. Methods-A prospective study was conducted, including patients diagnosed for an ischemic supratentorial stroke on a 3T brain MRI performed 24 to 72 hours after symptom onset. Clinical assessment 1 year after stroke included a Montreal Cognitive Assessment, an Isaacs set test, a Zazzo cancelation task, a Hospital Anxiety and Depression scale, a 10-meter walking test, and a modified Rankin Scale (mRS). Diffusion tensor imaging parameters in the NAWM were computed using FMRIB (Functional Magnetic Resonance Imaging of the Brain) Diffusion Toolbox. The relationships between mean NAWM diffusion tensor imaging parameters and the clinical scores were assessed using linear and ordinal regression analyses, including the volumes of white matter hyperintensities, gray matter, and ischemic stroke as radiological covariates. Results-Two hundred seven subjects were included (66±13 years old; 67% men; median National Institutes of Health Stroke Scale score, 3; interquartile range, 2-6). In the models including only radiological variables, NAWM fractional anisotropy was associated with the mRS and the cognitive scores. After adjusting for demographic confounders, NAWM fractional anisotropy remained a significant predictor of mRS (β=-0.24; P=0.04). Additional path analysis showed that NAWM fractional anisotropy had a direct effect on mRS (β=-0.241; P=0.001) and a less important indirect effect mediating white matter hyperintensity burden. Similar results were found with mean diffusivity, axial diffusivity, and radial diffusivity. In further subgroup analyses, a relationship between NAWM integrity in widespread white matter tracts, mRS, and Isaacs set test was found in right hemispheric strokes. Conclusions-NAWM diffusion tensor imaging parameters measured early after an ischemic stroke are independent predictors of functional outcome and may be additional markers to include in studies evaluating poststroke recovery. © 2020 Lippincott Williams and Wilkins. All rights reserved.Translational Research and Advanced Imaging Laborator

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

ADSORPTION OF ISOPROTURON ON HOMOIONIC CLAYS

International audienceThe adsorption of isoproturon [3-(4-isopropylphenyl)-1,1 dimethylurea)] on a montmorillonite and on a kaolinite was studied by batch experiments and Fourier transform infrared spectroscopy (FF-IR). The clays were saturated with cations such as A13+, Ca 2÷, Cu 2÷, Na + and hexadecyltrimethylammonium (HDTMA). The studied clays did not show detectable catalytic activity on abiotic degradation of isoproturon, as evidenced by HPLC analysis. Adsorption was found related to clay specific external surface for HDTMA-saturated clays, while it seems independent from clay kind and inorganic cation. For clays saturated with inorganic cations, no penetration into the montmorillonite interlayer was found and FT-IR spectroscopy showed the involvement of C=O group of isoproturon in adsorption

ADSORPTION OF ISOPROTURON ON HOMOIONIC CLAYS

International audienceThe adsorption of isoproturon [3-(4-isopropylphenyl)-1,1 dimethylurea)] on a montmorillonite and on a kaolinite was studied by batch experiments and Fourier transform infrared spectroscopy (FF-IR). The clays were saturated with cations such as A13+, Ca 2÷, Cu 2÷, Na + and hexadecyltrimethylammonium (HDTMA). The studied clays did not show detectable catalytic activity on abiotic degradation of isoproturon, as evidenced by HPLC analysis. Adsorption was found related to clay specific external surface for HDTMA-saturated clays, while it seems independent from clay kind and inorganic cation. For clays saturated with inorganic cations, no penetration into the montmorillonite interlayer was found and FT-IR spectroscopy showed the involvement of C=O group of isoproturon in adsorption

Evaluation des potentialités de lessivage de la terbuthylazine et de l'atrazine dans trois sols de la région Centre

The objective of this work was to compare the mobility of atrazine and terbuthylazine in three soils : a loamy clay soit, a calcareous clay soit and a high clay soit in order to estimate the risks of contamination of the groundwater. The batch adsorption/desorption studies were conducted in the laboratory. The three soils had more affinity for terbuthylazine than for atrazine. No simple relation was observed between adsorption and clay content. It has been shown that in addition to the organic content, the nature of the organic matter played an important role in the adsorption, with the most humified organic matter having the highest affinity for the two triazines. Laboratory incubation experiments, under controlled conditions showed a faster biodegradation of atrazine than of terbuthylazine, and a more important linon extractable" residue formation with terbuthylazine (38%) th an atrazine (22%). In experiments in laboratory soit columns, we appreciated the potentialleaching of the two triazines in relation with the characteristics of the three soHs. The transport of atrazine is greater than of terbuthylazine. Furthermore the leaching of the two triazines was more intense in the loamy clay soil th an in the two others. In opposite with these laboratory models, we set up outdoor Iysimeters, in order to study under natural conditions the different behaviours of atrazine in the three soits. The persistence of atrazine under outdoor conditions was 2 to 3 times greater th an that estimated in the laboratory. Moreover the results obtained with Iysimeters indicated a more important migration of the triazine-residues in the calcareous clay soit than in the two others. The percolated radioactivity was more important in the calcareous clay soil (3,3%), compared to the high clay soil (1,1 %), and the loamy clay soit (0,9%). AbstractL'objectif de ce travail était de comparer la mobilité de l'atrazine et de la terbuthylazine dans trois types de sol : un sol brun calcique, un sol brun calcaire et un pélosol, et d'évaluer les risques de contamination des nappes phréatiques par ces xénobiotiques. Des études d'adsorption et de désorption en batch ont été menées au laboratoire. Les résultats ont montré que les trois sols possèdent une affinité plus élevée pour la terbuthylazine que pour l'atrazine. 1\ n'a pas été observé de relation entre l'adsorption et le taux d'argile. L'adsorption de ces triazines augmente non seulement avec la teneur en carbone organique, mais aussi avec le degré d'humification et de polymérisation de la matière organique des sols. Des incubations en conditions contrôlées au laboratoire ont montré une biodégradation plus rapide de l'atrazine par rapport à la terbuthylazine, et une formation de résidus "non extractibles" plus importante dans le cas de la terbuthylazine, 38% contre 22% pour l'atrazine. Des expériences ont été conduites en colonne de laboratoire avec des sols reconstitués afin d'apprécier les possibilités de lessivage des deux triazines. Les profils de distribution des deux herbicides montrent que les quantités d'atrazine désorbées en surface se redistribuent plus profondément que pour la terbuthylazine. De plus, la vitesse de migration des deux triazines est plus élevée dans le sol brun calcique que dans les deux autres sols. Parallèlement à ces modèles de laboratoire, la mise en place de Iysimètres en plein champ a permis d'étudier, sous conditions naturelles, les différences de comportement de l'atrazine dans les trois sols. La persistance de l'atrazine est alors deux à trois fois supérieure à celle estimée au laboratoire. Par ailleurs, les résultats indiquent une migration plus importante des résidus s-triaziniques dans le sol brun calcaire par rapport aux deux autres sols. Ainsi, les pertes par lessivage sont de 3,3% de la quantité d'atrazine appliquée pour le sol brun calcaire, contre 1,1 % pour le pélosol et 0,9% dans le sol brun calcique

Etude du transfert de pesticides dans les sols Exemple de divers herbicides organiques de synthèse et d'un produit minéral : le cuivre

Ce mémoire présente une synthèse de mes activités scientifiques depuis 1994 en matière de transferts de pesticides, et plus spécifiquement d’herbicides dans les sols. En guise d’introduction, je présenterai la problématique, la réglementation en matière de pesticides et des généralités sur leurs transferts. La première partie de ce travail, la plus volumineuse, correspond aux diverses échelles auxquelles il est possible d’étudier le lessivage des pesticides dans les sols ; les exemples sont choisis de la parcelle à la colonne de sol. Le second chapitre aborde le transfert facilité des herbicides dans les sols, plus précisément, sous l’action des matières exogènes pouvant perturber la mobilité d’un herbicide : exemple du cuivre et de la matière organique dissoute (MOD), apportés par la bouillie bordelaise et les amendements organiques. Dans ces deux chapitres, la problématique, les travaux de la littérature et notre contribution à cette problématique seront présentés pour finir sur un bilan et des perspectives. Le lecteur aura peut-être le sentiment de synthèses bibliographiques trop denses par endroit, mais j’ai tenu à faire d’abord le point sur l’état des connaissances des diverses problématiques abordées. La dernière partie correspond à des perspectives de recherche visant à proposer des solutions dans le cadre de pratiques culturales alternatives pour limiter le lessivage des pesticides en vue d’une agriculture durable

Lessivage de la terbuthylazine et de l'atrazine en colonnes de sol au laboratoire

International audienceThe leaching of terbutbylazine and atrazine was studied through laboratory soil columns using little to moderately carbonated soils and with fine texture. Mobility in the three soils was greater for atrazine than terbuthylazine. This might be related to the higher water solubility of atrazine,30 mg L-’ versus 8.5 mg L-’ for terbuthylazine, and to the smaller Freundlich adsorption coefficient of atrazine, from 0.96 to 1.22 depending on the soil, compared with 1.88 to 2.33 for terbutbylazine. No significant difference in mobility was observed between the three soils.Le lessivage de la terbuthylazine et de l’atrazine a été étudié en colonnes de sol au laboratoire, dans des sols peu à modérément carbonatés et à texture fine. La mobilité de l’atrazine est supérieure à celle de la terbuthylazine, en relation avec la solubilité plus élevée de l’atrazine, 30 mg L-’ contre 8,5 mg L-‘. Les coefficients d’adsorption de Freundlich sont plus faibles pour l’atrazine, de 0,96 à 1,22 selon le sol, contre 1,88 à 2,33 pour la terbuthylazine, mais aucune différence significative de mobilité n’a été observée selon le type de sol

Compost effect on diuron retention and transport in structured vineyard soils.

12 pagesInternational audienceDiuron is frequently detected in surface- and groundwater under the vineyards, where organic amendments are often used, in Burgundy of France. Undisturbed column experiments were conducted to study the influence of three composted organic amendments on diuron leaching through columns of two vineyard soils from Vosne-Romanée (VR, calcareous Cambisol) and Beaujolais (Bj, sandy Leptosol), France. Bromide (used as non-reactive tracer) and diuron breakthrough curves (BTCs) were analyzed using convectivedispersive equation (CDE), two-region (mobile-immobile, MIM) and two-site models. No influence of the composts was observed on the bromide recovery rates. The CDE model described well the bromide BTCs for all columns of the Bj soil and seven of the VR soil, suggesting a homogeneous water flow. However, for five VR soil columns, the MIM model fitted better, suggesting a partition of the water flow (15%–50% of matrix flow). The texture, the coarse material content and the tillage of the VR soil could explain this heterogeneity. However, for all columns, diuron leaching was greater through the Bj soil (46%–68%) than the VR soil (28%–39%). The compost addition resulted in a contrasting effect on diuron leaching: no difference or a decrease was observed for the VR soil, probably due to an increase of adsorption sites, whereas no difference or an increase was observed for the Bj soil possibly because of interactions and/or competition of diuron with the compost water-extractable organic matter which could facilitate its transport. All the diuron BTCs were best described using the two-site model, suggesting a large proportion of time-dependent sorption sites (30%–50%). The soil type and the nature of the amendments had contrasting influences on diuron transport. Composts with a high water-soluble fraction must be avoided in sandy soils to reduce the risk of groundwater contamination