31 research outputs found

    Campylobacter Antimicrobial Drug Resistance among Humans, Broiler Chickens, and Pigs, France

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    We describe isolates from human Campylobacter infection in the French population and the isolates' antimicrobial drug resistance patterns since 1986 and compare the trends with those of isolates from broiler chickens and pigs from 1999 to 2004. Among 5,685 human Campylobacter isolates, 76.2% were C. jejuni, 17.2% C. coli, and 5.0% C. fetus. Resistance to nalidixic acid increased from 8.2% in 1990 to 26.3% in 2004 (p<10-3), and resistance to ampicillin was high over time. Nalidixic acid resistance was greater for C. coli (21.3%) than for C. jejuni (14.9%, p<10-3). C. jejuni resistance to ciprofloxacin in broilers decreased from 31.7% in 2002 to 9.0% in 2004 (p = 0.02). The patterns of resistance to quinolones and fluoroquinolones were similar between 1999 and 2004 in human and broiler isolates for C. jejuni. These results suggest a potential benefit of a regulation policy limiting use of antimicrobial drugs in food animals

    Introduction of SARS in France, March–April, 2003

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    We describe severe acute respiratory syndrome (SARS) in France. Patients meeting the World Health Organization definition of a suspected case underwent a clinical, radiologic, and biologic assessment at the closest university-affiliated infectious disease ward. Suspected cases were immediately reported to the Institut de Veille Sanitaire. Probable case-patients were isolated, their contacts quarantined at home, and were followed for 10 days after exposure. Five probable cases occurred from March through April 2003; four were confirmed as SARS coronavirus by reverse transcription–polymerase chain reaction, serologic testing, or both. The index case-patient (patient A), who had worked in the French hospital of Hanoi, Vietnam, was the most probable source of transmission for the three other confirmed cases; two had been exposed to patient A while on the Hanoi-Paris flight of March 22–23. Timely detection, isolation of probable cases, and quarantine of their contacts appear to have been effective in preventing the secondary spread of SARS in France

    Apports et limites de l'IRM de perfusion et de la neuronavigation dans l'approche stéréotaxique des tumeurs cérébrales

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    Objectifs : Les biopsies stéréotaxiques sont soumises à un risque important d erreurs. Le choix de la cible apparaît cruciale. La présence d une prise de contraste comme marqueur indirect de malignité peut être pris en défaut. Les auteurs sont partis de l hypothèse que l IRM de perfusion pouvait améliorer le choix de la cible lors des biopsies stéréotaxiques. L objectif secondaire était de déterminer la précision des biopsies guidées par neuronavigation. Matériels et méthodes : Il s agit d une étude portant sur 21 biopsies consécutives réalisées dans le service de neurochirurgie d Amiens entre juin 2009 et mars 2010. Résultats : L imagerie de perfusion a été utile à la définition de la cible dans 11 cas (52,4% des cas). A chaque fois il s agissait de tumeurs gliales (soit 84,6% des tumeurs gliales). La cartographie de perfusion apportait soit une cible mieux délimitée (9 cas) soit une cible différente (1 cas) soit une cible identique à la prise de contraste (1 cas). Les prélèvements réalisés à partir des cibles déterminées à l aide de l imagerie de perfusion apportaient à chaque fois le typage cellulaire et le grade. On retrouve une corrélation significative (p<0,01) entre le rCBV et le grade tumoral. La précision moyenne à la cible des procédures de biopsies sous neuronavigation par guidage IRM 3T était de 3,39 mm. Au point d entrée, la précision moyenne était de 9,2 mm. Lors de biopsies guidées par TDM en imagerie de référence avec co-régistration TDM/IRM, la précision moyenne à la cible était de 3,4 mm. La précision moyenne au point d entrée était de 4,3 mm. Conclusions : L utilisation de l IRM de perfusion pour guider les biopsies stéréotaxiques améliore le choix de la cible dès qu il existe une augmentation du rCBV (hyper perfusion). Le choix de la cible sur les données de l imagerie de perfusion permet de biopsier les contingents de plus fortes néoangiogénèses donnant par la même les contingents les plus malins de la lésion. Les biopsies sous neuronavigation par guidage IRM 3T seul sont soumises à un risque d imprécision important en raison de la distorsion majeure de l image. Une co-régistration avec imagerie TDM servant de référence est une solution. Les biopsies de lésions profondes et/ou a environnement vasculaire important nécessitent des procédures avec cadre et/ou fiduciaire invasif.Object: Stereotactic biopsies are subjects to sampling errors essentially due to target selection. Presence of contrast enhancement as indirect marker of malignity is not reliable. The author hypothesized that perfusion weighted imaging can improve target selection in stereotactic biopsies. The second objective was to establish the accuracy of 3T Mri guided frameless biopsies. Methods: We perform a prospective study among 21 consecutives patients between june 2009 and march 2010. Perfusion-weighted imaging and conventional weighted Mri guided all biopsies. Results: Perfusion weighted imaging helped for the determination of the target in 52,4% (11) cases. In all this cases, the histopathological diagnosis was a glial tumor. Perfusion weighted imaging afford a more precise target than contrast enhancement in 9 cases, a different target in 1 case and strictly the same target in 1 case. Perfusion selected sampling afford in all this cases cellular identity and grading. rCBV was significantly associated with grading (p<0,01). For lesions with no high rCBV value, perfusion weighted Mri did not help to determine the target but was useful for the surgical management. Mean accuracy was 9,2 mm at the entry point and 3,39 mm at the target point for 3T Mri alone frameless guided biopsies. Mean accuracy was 4,3 mm at the entry point and 3,4 mm at the target point for frameless biopsies with CT scan as reference imaging co registered with Mri. Conclusions:The use of the IRM of perfusion to guide the stereotaxic biopsies improves the choice of the target as soon as there is an increase in the rCBV (hyper perfusion). The choice of the target on the data of the imagery of perfusion allows of biopsier the quotas of stronger néoangiogénèses consequently giving the most malignant quotas of the lesion. The biopsies under neuronavigation by guidance IRM 3T only are subjected at the important risk of inaccuracy because of the major distortion of the image. A Co-registration with imagery TDM being used as reference is a solution. The biopsies of major lesions and/or has important vascular environment require procedures with framework and/or fiduciary invasive.AMIENS-BU Santé (800212102) / SudocSudocFranceF

    Hepatitis C virus genotype 3 and the risk of severe liver disease in a large population of drug users in France

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    International audienceAlthough risk factors for cirrhosis in chronic hepatitis C virus (HCV) infection have been identified, the role of HCV-genotype 3 remains controversial, and limited data are available in drug users. The aim of the study was to assess risk factors for severe liver disease (cirrhosis/hepatocellular carcinoma) in HCV-infected drug users between 2001 and 2007 in France. Patients who reported drug use and who had been referred for HCV infection to hepatology centres from a national surveillance system were identified. The severity of liver disease was assessed clinically and histologically (Metavir score). Factors associated with sever liver disease were analysed after estimating missing values by multiple imputation. Of the 4065 drug users naive to anti-HCV treatment who were referred to the 26 participating centres, 8.0% had severe liver disease, 25.7% were infected with HCV-genotype 3. Factors associated independently with an increased risk of severe liver disease were HCV-genotype 3 (adjusted odds ratio, multiple imputation, (aORMI) = 1.6, [95%CI: 1.2-2.1]), HIV infection (aORMI = 1.8, [1.2-2.8]), male sex (aORMI = 2.0, [1.4-2.8]), age over 40 years (aORMI = 2.1, [1.6-2.9]), history of excessive alcohol consumption (aORMI = 2.8, [2.1-3.7]) and duration of infection ≥18years (aORMI = 2.9, [2.0-4.3]). This analysis shows that HCV-genotype 3 is associated with severe liver disease in drug users, independently of age, sex, duration of infection, alcohol consumption and co-infection with HIV. These results are in favour of earlier treatment for drug users infected with HCV-genotype 3 and confirm the need for concomitant care for excessive alcohol consumption

    STUDY GLYCOLYTIC METABOLISM IN 1H-MRS MONOVOXEL IN THE MOST AGGRESSIVE PART OF 62 GLIOBLASTOMAS BEFORE AND AFTER 18 MONTHS OF TREATMENT

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    14th Meeting of the European-Association-of-Neuro-Oncology (EANO), Lyon, FRANCE, SEP 19-22, 2019International audienc

    A community-wide outbreak of legionnaires disease linked to industrial cooling towers. How far can contamined aerosols spread ?

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    International audienceA community-wide outbreak of legionnaires disease occurred in Pas-de-Calais, France, in November2003-January 2004. Eighteen (21%) of 86 laboratory-confirmed cases were fatal. A case-control study identified smoking,silicosis, and spending 1100 min outdoors daily as risk factors for acquiring the disease. Legionella pneumophila strain Lens was isolated from cooling towers, wastewater, and air samples from plant A. This unique strain matched all 23 clinical isolates, as assessed by pulsed-field gel electrophoresis subtyping. Modeling of atmosphericdispersion of aerosols emitted from plant A cooling towers showed good coverage of the communes where patients lived and showed that the dispersion extended over a distance of at least 6 km from plant A. No other aerosolproducing installation was identified as a plausible source, and no common source of indoor exposure was found. These findings implicate plant A as the most likely outbreak source and suggest that the distance of airborne transmission of L. pneumophila may be greater than previously reported

    Expression Analysis of α5 Integrin Subunit Reveals Its Upregulation as a Negative Prognostic Biomarker for Glioblastoma

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    Integrin α5β1 was suggested to be involved in glioblastoma (GBM) aggressiveness and treatment resistance through preclinical studies and genomic analysis in patients. However, further protein expression data are still required to confirm this hypothesis. In the present study, we investigated by immunofluorescence the expression of integrin α5 and its prognostic impact in a glioblastoma series of patients scheduled to undergo the Stupp protocol as first-line treatment for GBM. The integrin α5 protein expression level was estimated in each tumor by the mean fluorescence intensity (MFI) and allowed us to identify two subpopulations showing either a high or low expression level. The distribution of patients in both subpopulations was not significantly different according to age, gender, recursive partitioning analysis (RPA) prognostic score, molecular markers or surgical and medical treatment. A high integrin α5 protein expression level was associated with a high risk of recurrence (HR = 1.696, 95% CI 1.031–2.792, p = 0.0377) and reduced overall survival (OS), even more significant in patients who completed the Stupp protocol (median OS: 15.6 vs. 22.8 months; HR = 2.324; 95% CI 1.168–4.621, p = 0.0162). In multivariate analysis, a high integrin α5 protein expression level was confirmed as an independent prognostic factor in the subpopulation of patients who completed the temozolomide-based first-line treatment for predicting OS over age, extent of surgery, RPA score and O-6-methylguanine-DNA methyltransferase (MGMT) promoter methylation (p = 0.029). In summary, for the first time, our study validates that a high integrin α5 protein expression level is associated with poor prognosis in GBM and confirms its potential as a therapeutic target implicated in the Stupp protocol resistance

    Temozolomide and Bevacizumab Induction before Chemoradiotherapy in Patients with Bulky Glioblastoma and/or with Severe Neurological Impairment

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    International audienceBackground. New approaches are needed for patients newly diagnosed with bulky glioblastoma (GB) and/or with severe neurological impairment that cannot benefit from first line temozolomide (TMZ)-based chemoradiotherapy. Bevacizumab (BEV), an antiangiogenic anti-VEGF-R monoclonal antibody, has a rapid impact on tumor-related brain edema in recurrent GB. The present study reports the feasibility and efficacy of an induction treatment with TMZ and BEV to alleviate the initial neurological impairment and/or to reduce the tumor volume before a delayed chemoradiotherapy. Methods. We retrospectively analyzed tumor and target volumes and clinical neurological status in 39 patients with bulky GB and/or with severe neurological impairment after an induction treatment combining TMZ and BEV. Neurological and radiological responses were assessed according to RANO criteria. Calculating gross tumor and clinical target volumes (GTV and CTV) was done at diagnosis and before radiotherapy. Progression-free survival (PFS) and overall survival (OS) were determined by Kaplan Meier methods. Safety was reported according to NCTCAE. Results. A cohort of 39 patients was analyzed between December 2010 and April 2014. Upfront standard TMZ-based chemoradiotherapy was recused due either to tumor volume or impairment of neurological status and/or performance status. After TMZ/BEV induction (median time of 3 months), 6 (15%) patients achieved a partial response (PR), and 17 (44%) had a stable disease. 24 patients (62%) received a radical-intent chemoradiotherapy. TMZ-BEV induced median reduction of the clinical target volume (CTV) was 25.9% [-84.4%; - 4.8%]. The median PFS and OS were 8.4 months [95% CI: (6.6 - 9.9)] and 11.0 months [95% CI: (9.3 - 13.7)], respectively in the whole cohort and 10.8 [95% CI: (9.3 - 12.9)] and 15.0 [95% CI: (13.2 - 17.8)] for irradiated patients. Induction treatment led to corticosteroid dose reduction or cessation in 21 patients (54%). KPS improvement was observed in 38% of patients. Toxicity was mild with only 7/39 (18%) grade III-IV toxicity, including 1 digestive bleeding and 1 epistaxis. Conclusion. TMZ-BEV induction led to CTV reduction allowing for optimal chemoradiotherapy in a majority (62%) of patients for which radiotherapy was initially recused. A clinical benefit was obtained with improved KPS and a decrease in steroid dose
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