First Isolation and Identification of Agriphages in Vegetable Crops in West Africa (Cȏte d’Ivorie): Potential Uses of Biocontrol in Plants

Agriphages or bacterial viruses are ubiquitous in the environment. The discovery of virulent phages against phytobacteria improves crop growth and proposes biopesticide uses for plant diseases. In Africa, many phytobacteria such as Ralstonia, Clavibacter, and Xanthomonas were reported in several regions. This paper focuses on evaluating the presence of agriphages for the biocontrol of phytobacteria in Côte d'Ivoire. Leaves and soil samples were collected from healthy and diseased plants in three sites located in Anyama, Abidjan, and Bingerville. The pretreatments occurred with sterile and physiological water for leaves and soil samples, respectively. The isolation of agriphages was done on specific media with Xanthomonas campestris as bacterial host. Lytic activity was tested on agar media for five bacteria strains. After DNA extraction using the Qiagen method kit, molecular confirmation of agriphages was done by Random Amplified Polymorphic DNA-PCR. From this study, five (5) agriphages were isolated in soil and leaves in site 2. These agriphages have all been isolated from Xanthomonas campestris and have a broad spectrum of lytic activity. Molecular characterization by RAPD-PCR showed that three of these agriphages are DNA phages. The dendrogram showed that phages ΦXanS1 and ΦXanS2 have 93% similarities, while ΦXanS1 and ΦXanS2 are 62% similar to ΦXanF1. This study is the first reported agriphages in West Africa, alongside their potential uses against phytobacteria for biocontrol infection in crops

Multiple star systems in the Orion nebula

This is the author accepted manuscript. The final fersion is available from EDP Sciences via the DOI in this record.This work presents an interferometric study of the massive-binary fraction in the Orion Trapezium cluster with the recently comissioned GRAVITY instrument. We observed a total of 16 stars of mainly OB spectral type. We find three previously unknown companions for θ1 Ori B, θ2 Ori B, and θ2 Ori C. We determined a separation for the previously suspected companion of NU Ori. We confirm four companions for θ1 Ori A, θ1 Ori C, θ1 Ori D, and θ2 Ori A, all with substantially improved astrometry and photometric mass estimates. We refined the orbit of the eccentric high-mass binary θ1 Ori C and we are able to derive a new orbit for θ1 Ori D. We find a system mass of 21.7 M⊙ and a period of 53 days. Together with other previously detected companions seen in spectroscopy or direct imaging, eleven of the 16 high-mass stars are multiple systems. We obtain a total number of 22 companions with separations up to 600 AU. The companion fraction of the early B and O stars in our sample is about two, significantly higher than in earlier studies of mostly OB associations. The separation distribution hints toward a bimodality. Such a bimodality has been previously found in A stars, but rarely in OB binaries, which up to this point have been assumed to be mostly compact with a tail of wider companions. We also do not find a substantial population of equal-mass binaries. The observed distribution of mass ratios declines steeply with mass, and like the direct star counts, indicates that our companions follow a standard power law initial mass function. Again, this is in contrast to earlier findings of flat mass ratio distributions in OB associations. We excluded collision as a dominant formation mechanism but find no clear preference for core accretion or competitive accretion.Marie Skłodowska-Curie Grant AgreementFCT-PortugalERC Starting Gran

Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome associated with COVID-19: An Emulated Target Trial Analysis.

RATIONALE: Whether COVID patients may benefit from extracorporeal membrane oxygenation (ECMO) compared with conventional invasive mechanical ventilation (IMV) remains unknown. OBJECTIVES: To estimate the effect of ECMO on 90-Day mortality vs IMV only Methods: Among 4,244 critically ill adult patients with COVID-19 included in a multicenter cohort study, we emulated a target trial comparing the treatment strategies of initiating ECMO vs. no ECMO within 7 days of IMV in patients with severe acute respiratory distress syndrome (PaO2/FiO2 <80 or PaCO2 ≥60 mmHg). We controlled for confounding using a multivariable Cox model based on predefined variables. MAIN RESULTS: 1,235 patients met the full eligibility criteria for the emulated trial, among whom 164 patients initiated ECMO. The ECMO strategy had a higher survival probability at Day-7 from the onset of eligibility criteria (87% vs 83%, risk difference: 4%, 95% CI 0;9%) which decreased during follow-up (survival at Day-90: 63% vs 65%, risk difference: -2%, 95% CI -10;5%). However, ECMO was associated with higher survival when performed in high-volume ECMO centers or in regions where a specific ECMO network organization was set up to handle high demand, and when initiated within the first 4 days of MV and in profoundly hypoxemic patients. CONCLUSIONS: In an emulated trial based on a nationwide COVID-19 cohort, we found differential survival over time of an ECMO compared with a no-ECMO strategy. However, ECMO was consistently associated with better outcomes when performed in high-volume centers and in regions with ECMO capacities specifically organized to handle high demand. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Simple scoring system to predict in-hospital mortality after surgery for infective endocarditis

BACKGROUND: Aspecific scoring systems are used to predict the risk of death postsurgery in patients with infective endocarditis (IE). The purpose of the present study was both to analyze the risk factors for in-hospital death, which complicates surgery for IE, and to create a mortality risk score based on the results of this analysis. METHODS AND RESULTS: Outcomes of 361 consecutive patients (mean age, 59.1\ub115.4 years) who had undergone surgery for IE in 8 European centers of cardiac surgery were recorded prospectively, and a risk factor analysis (multivariable logistic regression) for in-hospital death was performed. The discriminatory power of a new predictive scoring system was assessed with the receiver operating characteristic curve analysis. Score validation procedures were carried out. Fifty-six (15.5%) patients died postsurgery. BMI >27 kg/m2 (odds ratio [OR], 1.79; P=0.049), estimated glomerular filtration rate 55 mm Hg (OR, 1.78; P=0.032), and critical state (OR, 2.37; P=0.017) were independent predictors of in-hospital death. A scoring system was devised to predict in-hospital death postsurgery for IE (area under the receiver operating characteristic curve, 0.780; 95% CI, 0.734-0.822). The score performed better than 5 of 6 scoring systems for in-hospital death after cardiac surgery that were considered. CONCLUSIONS: A simple scoring system based on risk factors for in-hospital death was specifically created to predict mortality risk postsurgery in patients with IE

Quels sont les déterminants à la 1ère installation en médecine générale ? (étude qualitative de médecins généralistes remplaçants et jeunes installés du Nord-Pas-de-Calais)

Le problème de démographie médicale en France est une réalité : les médecins de plus de 60 ans représentent 24,7% des médecins inscrits à l Ordre au 1er janvier 2013. Le numerus clausus a ainsi été majoré au début des années 2000, mais les jeunes médecins tardent à s installer. L âge moyen de première installation est évalué à 39 ans alors que leur formation initiale se termine généralement vers 30 ans. Ils effectuent entre-temps une période de remplacements plus ou moins longue avant de s installer en ambulatoire ou à l hôpital. Quelles sont les causes de ce retard à l installation ? Ces jeunes médecins sont-ils suffisamment formés ? Comment vivent-ils cette période de remplacement ? Sont-ils influencés par leur environnement socio-familial ? Comment envisagent-ils leur future pratique ? Quelle est leur représentation de l installation ? Cette étude qualitative est basée sur 4 focus-groups regroupant 23 médecins, remplaçants et jeunes installés depuis moins de 4 ans, du Nord-Pas-de-Calais. Les entretiens ont été retranscris intégralement et ont fait l objet d un codage thématique. Leur formation initiale au second cycle n est pas assez orientée vers la spécialité médecine générale, qui subit un manque de considération. Le 3e cycle permet la découverte de leur métier, mais ils ressentent un manque de pratique en ambulatoire, et leur formation théorique est trop abstraite. Cette période de remplacement leur permet de jouir d une liberté qui leur a fait défaut pendant leur long et rigide cursus. Ils considèrent que cette étape de transition est nécessaire pour renforcer leur formation et élaborer leur projet professionnel. Le métier de remplaçant est cependant instable et intellectuellement monotone. Ce sont aussi de jeunes adultes qui placent la cellule familiale au centre de leurs préoccupations. Cette génération post-ENC propose également une nouvelle vision de leur métier. Ils refusent le consumérisme médical et dénient le modèle du sacerdoce pratiqué par leurs aînés. Ils souhaitent travailler en groupe pour mieux maîtriser la permanence des soins et jouir d une certaine qualité de vie. La précarité du statut de médecin libéral les inquiète, et le salariat les séduit. Ils aiment leur métier de médecin généraliste mais souhaitent le pratiquer à leur manière, en éduquant les patients et en se formant régulièrement. Ils craignent les tâches administratives et semblent perdus dans le dédale administratif que représente leur installation.LILLE2-BU Santé-Recherche (593502101) / SudocSudocFranceF

Association française de chirurgie du piedLe pied bot varus équin : traitement chez l’enfant et devenir à l’âge adulte

Purpose of the symposium Treatment of idiopathic talipes varus, or congenital clubfoot, is designed to realign the foot to alleviate pain and allow plantigrade weight bearing with adequate joint motion despite the subnormal radiographic presentation. This symposium was held to review current management practices for congenital clubfoot in children and to analyze outcome in adults in order to propose the most appropriate therapeutic solutions. Management of congenital clubfoot in children Idiopathic talipes varus can be suspected from the fetal ultrasound. Parents should be given precise information concerning proposed treatment after birth. Deviations must be assessed in the newborn then revised regularly using objective scales during and after the end of treatment. This enables a better apprehension of the evolution in comparison with the severity of the initial deformation. Conservative treatment is proposed by many teams: a functional approach (rehabilitation and minimal use of orthetic material) or the Ponseti method (progressive correction using casts associated with percutaneous tenotomy of the calcaneal tendon) are currently preferred. If such methods are insufficient or unsuccessful, surgery may be performed as needed at about 8 to 11 months to achieve posteromedial release. Good results are obtained in 80% of patients who generally present minimal residual deformations (adduction of the forefoot, minimal calcaneal varus, residual medial rotation, limitation of dorsal flexion), which must be followed regularly through growth. The difficulty is to distinguish acceptable from non-acceptable deformation. At the end of the growth phase, severe articular sequelae are rare (stiff joint, recurrence of initial deformation, overcorrection) but difficult to correct surgically: osteotomy, tendon transfer, double arthrodesis, Ilizarov fixator. Gait analysis is essential to quantify function and obtain an objective assessment of the impact on higher joints, providing valuable guidance for surgical correction. Outcome in adulthood There have been very few studies evaluating the long-term functional outcome after treatment during childhood. According to two studies presented at this symposium (Brussels, Lausanne), results have been generally good but with subnormal radiographs irrespective of the type of treatment or how early treatment started in childhood. Hypoplasia of the talar dome is a constant finding and is correlated with limitation of dorsal flexion of the ankle joint. A small degree undercorrection is often observed but well tolerated while overcorrection is generally less well tolerated. Functional outcome depends highly on preservation of subtalar joint motion. There have been no reports on the results of treatment of sequelae in adults. Most problems (pain, stiffness, osteoarthritis) are observed in the mid or rear foot. Indications for conservative surgery (osteotomy) of the mid or rear foot are rare compared with indications for combined arthrodesis. Talocrural decompensation is a turning point observed in the adult. Management at this point is difficult: fusion of the ankle worsens the situation by increasing the stress on the forefoot and aggravating the disability; implantation of an ankle prosthesis is technically difficult and remains to be fully developed. Treatment of the dorsal bunion of the great toe may require tendon transfer and/or fusion. Conclusion A child born with clubfoot will never have a normal foot in adulthood. Sequelae present at the end of growth will intensify during adult life; undercorrection is easier to treat in adulthood than overcorrection. The most difficult problems in adulthood are: neglected clubfoot, over correction, and degradation of the talocrural joint