F-02: Antibiothérapies anti-SARM dans le traitement probabiliste des bactériémies à Staphylococcus aureus au CHU d'Angers

Introduction – objectifs La résistance à la méticilline du Staphylococcus aureus (SA) ne cesse de diminuer en France. Nous avons évalué la prescription des antibiothérapies probabilistes dans les bactériémies à SA et leur impact clinique. Matériels et méthodes Il s’agit d’une étude rétrospective incluant les bactériémies à Staphylococcus aureus sur le CHU d’Angers entre novembre 2012 et septembre 2013 avec recueil de l’antibiothérapie prescrite au rendu « cocci gram (CG)+ », à J5, hospitalisation depuis plus de 5 jours ou dans les six derniers mois, signes de gravité clinique, mortalité à J5. Résultats Nous avons inclus 146 épisodes de bactériémies. A l’annonce de CG+, 10 patients étaient décédés, 38,2 % ont reçu un anti-SARM (n = 52), 54,4 % un anti-SASM (n = 74), 7,4 % aucun antibiotique (n = 10). Parmi les bactériémies à SARM (n = 23), 60,9 % (n = 14) ont reçu une antibiothérapie initiale à visée SARM contre 36,3 % (n = 41) pour les bactériémies à SASM (n = 113) (OR = 2,71, p = 0,03). Cette adaptation semble influencée par une hospitalisation récente (OR = 1,82 ; p = 0,33) et la présence de signes de gravité (OR = 1,87, p = 0,23). Dans 21,4 % (n = 6) des bactériémies à SASM, l’antibiothérapie anti-SARM n’a pas été désecaladée. La mortalité à J5 est 13 %. L’absence d’antibiothérapie dans les 24 premières heures (OR = 2,97 ; p = 0,046) et une prescription de C3G (OR = 5,2, p = 0,05) en monothérapie augmentent le risque de décès à J5. Conclusion L’antibiothérapie initale semble adaptée à l’histoire et la présentation des patients. L’initiation sans délai, la visée staphylococcique et la désescalade sont les éléments importants du traitement

Contralateral Regional Recurrence in Lateralized or Paramedian Early-Stage Oral Cancer Undergoing Sentinel Lymph Node Biopsy—Comparison to a Historic Elective Neck Dissection Cohort

© Copyright © 2021 Mahieu, den Toom, Boeve, Lobeek, Bloemena, Donswijk, de Keizer, Klop, Leemans, Willems, Takes, Witjes and de Bree.Introduction: Nowadays, two strategies are available for the management of the clinically negative neck in early-stage (cT1-2N0) oral squamous cell carcinoma (OSCC): elective neck dissection (END) and sentinel lymph node biopsy (SLNB). SLNB stages both the ipsilateral and the contralateral neck in early-stage OSCC patients, whereas the contralateral neck is generally not addressed by END in early-stage OSCC not involving the midline. This study compares both incidence and hazard of contralateral regional recurrences (CRR) in those patients who underwent END or SLNB. Materials and Methods: A retrospective multicenter cohort study, including 816 lateralized or paramedian early-stage OSCC patients, staged by either unilateral or bilateral END (n = 365) or SLNB (n = 451). Results: The overall rate of occult contralateral nodal metastasis was 3.7% (30/816); the incidence of CRR was 2.5% (20/816). Patients who underwent END developed CRR during follow-up more often than those who underwent SLNB (3.8 vs. 1.3%; p = 0.018). Moreover, END patients had a higher hazard for developing CRR than SLNB patients (HR = 2.585; p = 0.030). In addition, tumor depth of invasion was predictive for developing CRR (HR = 1.922; p = 0.009). Five-year disease-specific survival in patients with CRR was poor (42%) compared to patients in whom occult contralateral nodal metastases were detected by SLNB or bilateral END (88%), although not statistically different (p = 0.066). Conclusion: Our data suggest that SLNB allows for better control of the contralateral clinically negative neck in patients with lateralized or paramedian early-stage OSCC, compared to END as performed in a clinical setting. The prognosis of those in whom occult contralateral nodal metastases are detected at an earlier stage may be favorable compared to those who eventually develop CRR, which highlights the importance of adequate staging of the contralateral clinically negative neck

Validation of HNO₃, ClONO₂, and N₂O₅ from the Atmospheric Chemistry Experiment Fourier Transform Spectrometer (ACE-FTS)

International audienceThe Atmospheric Chemistry Experiment (ACE) satellite was launched on 12 August 2003. Its two instruments measure vertical profiles of over 30 atmospheric trace gases by analyzing solar occultation spectra in the ultraviolet/visible and infrared wavelength regions. The reservoir gases HNO3, ClONO2, and N2O5 are three of the key species provided by the primary instrument, the ACE Fourier Transform Spectrometer (ACE-FTS). This paper describes the ACE-FTS version 2.2 data products, including the N2O5 update, for the three species and presents validation comparisons with available observations. We have compared volume mixing ratio (VMR) profiles of HNO3, ClONO2, and N2O5 with measurements by other satellite instruments (SMR, MLS, MIPAS), aircraft measurements (ASUR), and single balloon-flights (SPIRALE, FIRS-2). Partial columns of HNO3 and ClONO2 were also compared with measurements by ground-based Fourier Transform Infrared (FTIR) spectrometers. Overall the quality of the ACE-FTS v2.2 HNO3 VMR profiles is good from 18 to 35 km. For the statistical satellite comparisons, the mean absolute differences are generally within ±1 ppbv (±20%) from 18 to 35 km. For MIPAS and MLS comparisons only, mean relative differences lie within ±10% between 10 and 36 km. ACE-FTS HNO3 partial columns (~15–30 km) show a slight negative bias of -1.3% relative to the ground-based FTIRs at latitudes ranging from 77.8° S–76.5° N. Good agreement between ACE-FTS ClONO2 and MIPAS, using the Institut für Meteorologie und Klimaforschung and Instituto de Astrofisica de Andalucia (IMK-IAA) data processor is seen. Mean absolute differences are typically within ±0.01 ppbv between 16 and 27 km and less than +0.09 ppbv between 27 and 34 km. The ClONO2 partial column comparisons show varying degrees of agreement, depending on the location and the quality of the FTIR measurements. Good agreement was found for the comparisons with the midlatitude Jungfraujoch partial columns for which the mean relative difference is 4.7%. ACE-FTS N2O5 has a low bias relative to MIPAS IMK-IAA, reaching -0.25 ppbv at the altitude of the N2O5 maximum (around 30 km). Mean absolute differences at lower altitudes (16–27 km) are typically -0.05 ppbv for MIPAS nighttime and ±0.02 ppbv for MIPAS daytime measurements

Workers, Firms and Life-Cycle Wage Dynamics

Studies of individual wage dynamics typically ignore firm heterogeneity, whereas decompositions of earnings into worker and firm effects abstract from life-cycle considerations. We study firm effects in individual wage dynamics using administrative data on the population of Italian employers and employees. We propose a novel identification strategy for firm-related wage components exploiting the informative content of the wage covariance structure of coworkers. Wage inequality increases three-fold over the working life; firm effects are predominant while young, but sorting of workers into firms becomes increasingly important, explaining the largest share of lifetime inequality. Static models that do not allow for life-cycle dynamics underestimate the importance of sorting and overstate match and firm effects