Estimating the burden of influenza-attributable severe acute respiratory infections on the hospital system in Metropolitan France, 2012-2018

BACKGROUND

To date, estimating the burden of seasonal influenza on the hospital system in France has been restricted to influenza diagnoses in patients (estimated hospitalization rate of 35/100,000 on average from 2012 to 2018). However, many hospitalizations for diagnosed respiratory infections (e.g. pneumonia, acute bronchitis) occur without concurrent screening for virological influenza, especially in the elderly. Specifically, we aimed to estimate the burden of influenza on the French hospital system by examining the proportion of severe acute respiratory infections (SARI) attributable to influenza.

METHODS

Using French national hospital discharge data from 1/7/2012 to 30/6/2018, we extracted SARI hospitalizations with ICD-10 codes J09-J11 (influenza codes) in main or associated diagnoses, and J12-J20 (pneumonia and bronchitis codes) in main diagnoses. We estimated influenza-attributable SARI hospitalizations during influenza epidemics, as the number of influenza-coded hospitalizations plus the influenza-attributable number of pneumonia- and acute bronchitis-coded hospitalizations using periodic regression and generalized linear models. Additional analyses stratified by age group, diagnostic category (pneumonia and bronchitis), and region of hospitalization were performed using the periodic regression model only.

RESULTS

The average estimated hospitalization rate of influenza-attributable SARI during the five annual influenza epidemics covered (2013-2014 to 2017-2018) was 60/100,000 with the periodic regression model, and 64/100,000 with the generalized linear model. Over the six epidemics (2012-2013 to 2017-2018), of the 533,456 SARI hospitalizations identified, an estimated 227,154 were influenza-attributable (43%). Fifty-six percent of cases were diagnosed with influenza, 33% pneumonia, and 11% bronchitis. Diagnoses varied between age groups: 11% of patients under 15 years old had pneumonia versus 41% of patients aged 65 and older.

CONCLUSION

Compared to influenza surveillance in France to date, analyzing excess SARI hospitalizations provided a much larger estimate of the burden of influenza on the hospital system. This approach was more representative and allowed the burden to be assessed according to age group and region. The emergence of SARS-Cov-2 has led to a change in the dynamics of winter respiratory epidemics. The co-circulation of the three current major respiratory viruses (influenza, SARS-Cov-2, and RSV) and the evolution of diagnostic confirmation practices must now be taken into account when analyzing SARI.

First ICON-FUV Nighttime NmF2 and hmF2 Comparison to Ground and Space-Based Measurements

The Far Ultra Violet (FUV) ultraviolet imager onboard the NASA-ICON mission is dedicated to the observation and study of the ionosphere dynamics at mid and low latitudes. We compare O⁺ density profiles provided by the ICON FUV instrument during nighttime with electron density profiles measured by the COSMIC-2 constellation (C2) and ground-based ionosondes. Co-located simultaneous observations are compared, covering the period from November 2019 to July 2020, which produces several thousands of coincidences. Manual scaling of ionogram sequences ensures the reliability of the ionosonde profiles, while C2 data are carefully selected using an automatic quality control algorithm. Photoelectron contribution coming from the magnetically conjugated hemisphere is clearly visible in FUV data around solstices and has been filtered out from our analysis. We find that the FUV observations are consistent with the C2 and ionosonde measurements, with an average positive bias lower than 1 × 10¹¹ e/m³. When restricting the analysis to cases having an N_mF₂ value larger than 5 × 10¹¹ e/m³, FUV provides the peak electron density with a mean difference with C2 of 10%. The peak altitude, also determined from FUV observations, is found to be 15 km above that obtained from C2, and 38 km above the ionosonde value on average.

Characteristics of hospitalizations with influenza diagnosis, France, 2012-2017

Background

Seasonal influenza surveillance in France is based on several data sources (ambulatory data, emergency department and intensive care unit (ICU) admissions, laboratory data, mortality). However, the data do not provide a complete measure of the impact of the epidemics on the hospital system. The objective of the study was to describe the characteristics of influenza hospitalizations from the French national hospital discharge database (PMSI) between 2012 and 2017 and to precise the burden of influenza by age group and by season.

Methods

All hospitalizations in metropolitan France with at least one ICD-10 code related to influenza (J09, J10, J11) as a principal, related or associated diagnosis between 1 July 2012 to 30 June 2017 were extracted from the PMSI. For each season, the total number of hospitalizations, admissions to ICU, incidence and lethality rates, lengths of stay and classification in diagnosis-related groups were described by age group.

Results

During the 5 seasons, 91 255 hospitalizations with an influenza-diagnosis were identified. The incidence varied significantly between seasons, from 12.7/100 000 in 2013-2014 to 45.9/100 000 in 2016-2017. A high number of cases was observed in elderlies in 2014-2015 and 2016-2017, marked by the circulation of A (H3N2) virus. The proportion of hospitalizations with an admission in ICU was 10%, and was higher in the 40-79 age group (19%). Lethality increased steadily with age, from 0.5% under 20 years to 10% in 80 years and older. Length of stay also increased with age. Significant regional disparities were observed, with higher incidence rates in South-Eastern France each season.

Conclusions

The analysis of influenza hospitalizations from the PMSI provides important elements on influenza burden, not available in the current surveillance systems. An annual analysis, stratified by age group, would provide an indicator of the impact of the epidemics on hospital system at the end of each influenza season.

Key messages

Important influenza incidence variations were observed between seasons by age groups. Severity and impact of influenza (mortality, ICU, length of stay) varied significantly by age group.

Modelling interacting plant and livestock renewal dynamics helps disentangle equilibrium and nonequilibrium aspects in a Mongolian pastoral system

The interplay of livestock density dependence drivers and climate hazards is thought to cause pasture deterioration and poverty in Mongolian pastoral systems. We assessed their relative weights in a system of the Gobi exposed to high rainfall variability and harsh winters, which suggests that climate is the main system's driver. In this aim we modelled how interacting plant and livestock renewal dynamics impact herder performances, under the influence of climate. Plant dynamics was studied through an underground biomass sub-model because local pastures are dominated by perennial species. This approach enabled us studying pastoral issues in a holistic way, by integrating plant underground organs, livestock populations, herder income, and climate drivers. Models described that current grazing practices can significantly reduce underground biomass (-30% after 20years), but not entirely deplete it. They also showed that competition between herders could trap the smallest ones in poverty, by preventing the growth of their herds. This competition operates through density dependent factors affecting livestock productivity and vulnerability to climate shocks. This competition effect is all the more important since small herders could grow their herd and escape poverty if they were alone in the system. This result shows that density dependent factors could significantly impact herder performances and suggests that forage resource allocation is a driver as powerful as climate, even in the local harsh bioclimatic configuration of the Mongolian Gobi.

Does the ecological quality of inherited campsites cause persistent inequalities and poverty in pastoral Mongolia?

Most socioeconomic surveys carried out in Mongolia since the regime change of the 1990s report persistent inequalities and poverty in pastoral communities. To understand the reasons for this phenomenon, we studied the relationships between livestock numbers and ecological characteristics of herders’ seasonal campsites in a community of the Mongolian Gobi. We classified herders with help of a regression tree into three categories, where herd size is correlated with the proportion of the Stipa glareosa and Psammochloa villosa grasses around campsites. We established in addition from livestock-based income estimations that poverty could affect the small herd category, owning on average less than 180 heads of livestock. We finally observed that herders mostly transmit their campsites to their descendants, particularly in the small herd category. Herders are hence durably associated with campsites whose quality is related to livestock numbers, which may be a factor of inequality and poverty persistence. To further understand these processes, the zootechnical influence of S. glareosa and P. villosa should be investigated, as well as historical and anthropological determinants of campsites repartition.

The Ionospheric Connection Explorer Mission: Mission Goals and Design

The Ionospheric Connection Explorer, or ICON, is a new NASA Explorer mission that will explore the boundary between Earth and space to understand the physical connection between our world and our space environment. This connection is made in the ionosphere, which has long been known to exhibit variability associated with the sun and solar wind. However, it has been recognized in the 21st century that equally significant changes in ionospheric conditions are apparently associated with energy and momentum propagating upward from our own atmosphere. ICON's goal is to weigh the competing impacts of these two drivers as they influence our space environment. Here we describe the specific science objectives that address this goal, as well as the means by which they will be achieved. The instruments selected, the overall performance requirements of the science payload and the operational requirements are also described. ICON's development began in 2013 and the mission is on track for launch in 2017. ICON is developed and managed by the Space Sciences Laboratory at the University of California, Berkeley, with key contributions from several partner institutions.

Pilot-Scale Pulsed UV Light Irradiation of Experimentally Infected Raspberries Suppresses Cryptosporidium parvum Infectivity in Immunocompetent Suckling Mice

Cryptosporidium spp., a significant cause of foodborne infection, have been shown to be resistant to most chemical food disinfectant agents and infective for weeks in irrigation waters and stored fresh vegetal produce. Pulsed UV light (PL) has the potential to inactivate Cryptosporidium spp. on surfaces of raw or minimally processed foods or both. The present study aimed to evaluate the efficacy of PL on viability and in vivo infectivity of Cryptosporidium parvum oocysts present on raspberries, a known source of transmission to humans of oocyst-forming apicomplexan pathogens. The skin of each of 20 raspberries was experimentally inoculated with five 10-μl spots of an oocyst suspension containing 6 × 10(7) oocysts per ml (Nouzilly isolate). Raspberries were irradiated by PL flashes (4 J/cm(2) of total fluence). This dose did not affect colorimetric or organoleptic characteristics of fruits. After immunomagnetic separation from raspberries, oocysts were bleached and administered orally to neonatal suckling mice. Seven days after infection, mice were euthanized, and the number of oocysts in the entire small intestine was individually assessed by immunofluorescence flow cytometry. Three of 12 and 12 of 12 inoculated mice that received 10 and 100 oocysts isolated from nonirradiated raspberries, respectively, were found infected. Four of 12 and 2 of 12 inoculated mice that received 10(3) and 10(4) oocysts from irradiated raspberries, respectively, were found infected. Oocyst counts were lower in animals inoculated with 10(3) and 10(4) oocysts from irradiated raspberries (92 ± 144 and 38 ± 82, respectively) than in animals infected with 100 oocysts from nonirradiated raspberries (35,785 ± 66,221, P = 0.008). PL irradiation achieved oocyst reductions of 2 and 3 log for an inoculum of 10(3) and 10(4) oocysts, respectively. The present pilot-scale evaluation suggests that PL is an effective mode of decontamination for raspberries and prompts further applicability studies in industrial contexts.

Negative emotion does not enhance recall skills in adults with autistic spectrum disorders

Recent empirical findings suggest a significant influence of emotion on memory processes. Surprisingly, although emotion-processing difficulties appear to be a hallmark feature in autism spectrum disorders (ASD), their impact on higher-level cognitive functions, such as memory, has not been directly studied in this population. The aim of this study was to address this issue by assessing whether the emotional valence of visual scenes affects recall skills in high-functioning individuals with ASD. To this purpose, their recall performance of neutral and emotional pictures was compared with that of typically developing adults (control group). Results revealed that while typically developing individuals showed enhanced recall skills for negative relative to positive and neutral pictures, individuals with ASD recalled the neutral pictures as well as the emotional ones. Findings of this study thus point to reduced influence of emotion on memory processes in ASD than in typically developing individuals, possibly owing to amygdala dysfunctions.

[Quality indicator survey of anaesthesia records in hospitals of Aquitaine]

OBJECTIVES

Assessing the quality of anaesthesia records according to the criteria of the reference frame of professional practices evaluation proposed by the French Anaesthetists College (Cfar) in 2005.

STUDY DESIGN

Retrospective, multicentric study.

MATERIALS AND METHODS

Fifty anaesthesia records were randomly selected from each of the 64 health care settings in Aquitaine with an inpatient surgery activity. Survey sampling was based on hospital stays longer than 24h occurring during the second half of 2005 and including a surgical procedure under anaesthesia, excepting local anaesthesia or regional analgesia for labour and delivery. Information regarding the 10 evaluation criteria defined by the Cfar and the French National Authority for Health were gathered. For each setting, the mean completion of the 50 records was rated by a global indicator defined by the number of criteria in conformity divided by the number of relevant criteria.

RESULTS

Three thousand one hundred and ninety-three anaesthetic files were screened. The completion of criteria varied between 1 and 92% with a wide dispersion for some criteria according to settings. Completions of airway assessment, preanaesthetic visit and perianaesthetic incidents/accidents were lower than 50%. The median conformity rate of the global indicator was 57%.

CONCLUSION

This study brings information concerning the clinical relevance of anaesthesia records and preoperative evaluation practices.

Influence of prefermentary clarification on the composition of apple musts

The polyphenol contents and colors of cider apple juices were compared before (NCM, not clarified must) and after five clarification treatments: enzymatic depectinization by pectinases followed by (i) sedimentation (depectinized and decanted juice), (ii) tangential microfiltration (microfiltered juice) or (iii) fining using gelatin (gelatin-treated juice); (iv) enzymatic gelification of pectin by pectin methylesterase followed by natural keeving by a cider manufacturer (producer keeved juice), or (v) flotation (floated with nitrogen gas juice). The pressing of the apples led to the highly selective extraction of the flavan-3-ols with the lowest molecular weights: In the apples, the number average degree of polymerization of the flavanols was 14.7, and it dropped to 2.2 in the NCM. Keeving had the highest impact on the reduction of both flavanol content and number average degree of polymerization. The flavanol concentrations were decreased in the permeate by fining (30%) much more than by depectinization. The clarification step led to a further decrease of the number average degree of polymerization. Hydroxycinnamic acids were less affected by the extraction process (with extraction yields >50%) and not affected by clarification. The color evolved with all treatments: L*, a*, b*, and chromaticity distance index measures indicated a reduction of orange-yellow saturation except after sedimentation.

Brief report: recognition of emotional and non-emotional biological motion in individuals with autistic spectrum disorders

This study aimed to explore the perception of different components of biological movement in individuals with autism and Asperger syndrome. The ability to recognize a person's actions, subjective states, emotions, and objects conveyed by moving point-light displays was assessed in 19 participants with autism and 19 comparable typical control participants. Results showed that the participants with autism were as able as controls to name point-light displays of non-human objects and human actions. In contrast, they were significantly poorer at labeling emotional displays, suggesting that they are specifically impaired in attending to emotional states. Most studies have highlighted an emotional deficit in facial expression perception; our results extend this hypothesized deficit to the perception and interpretation of whole-body biological movements.

The anti-inflammatory effect of inhaled nitric oxide on pulmonary inflammation in a swine model

Cardiopulmonary bypass (CPB) is associated with an inflammatory process that leads to lung injury. In this study, we hypothesized that inhaled nitric oxide (INO) possesses the ability to modulate CPB-induced inflammation. Fifteen male pigs were randomly divided into 3 groups: Sham, CPB+LPS (CPB and lipopolysaccharide), and CPB+LPS+INO. INO (20 parts per million) was administered for 24 h after anesthesia. CPB was performed for 90 min, and LPS was infused (1 µg/kg) after CPB. Bronchoalveolar lavage (BAL) fluid and blood were collected at T0(before CPB), at 4 h, and at 24 h. At 24 h, BAL interleukin-8 (IL-8) levels were not increased as expected in the CPB+LPS group compared with the Sham group, but they were reduced significantly in the CPB+LPS+INO group. Cell hypo reactivity observed in the groups receiving LPS also seemed to downregulate endothelial nitric oxide synthase NOS protein expression relative to the Sham group. Nitrite and nitrate (NOx) concentrations were decreased significantly in the groups without INO. Moreover, animals treated with INO showed higher rates of pulmonary apoptosis compared with their respective controls. These results demonstrate that NOx production is reduced after CPB and that INO acts on the inflammatory process by diminishing neutrophils and their major chemoattractant, IL-8. INO also increases cell apoptosis in the lungs under inflammatory conditions, which may explain, in part, how it resolves pulmonary inflammation.Key words: CPB, nitric oxide, apoptosis, LPS, IL-8.

[New anesthetic and resuscitation techniques in adult cardiac surgery]

Anesthetic techniques and treatment of cardiac surgery patients have considerably evolved over the past twenty years. The demand for cardiac surgical procedures is increasing. This demand coincides with a change in the profile of patients presenting for surgery, requiring modification in perioperative management strategies. Several new anesthetics, related drugs, and technologies have become available in recent years that inevitably have made new approaches with patient management possible. In parallel to these new developments, there have appeared real opportunities to apply novel physiologic and pharmacologic concepts that may redefine our clinical practice. Fast-tracking, which emphasizes the major role of anesthetic management in postoperative outcome, is one such line of investigation. Fast-tracking was first introduced in an attempt to decrease the time to tracheal extubation and reduce expensive time in intensive care unit areas. Large doses of opioids have been clearly identified as a factor in delaying weaning from mechanical ventilatory support after cardiac surgery. Thus, early investigations emphasized the importance of limiting the dose of potent opioid analgesics during the intraoperative period to achieve early recovery. Supplementation with hypnotic drugs allows reduction of the opioid dose, enabling earlier extubation without compromising hemodynamic stability. Fast track cardiac anesthesia (FTCA) is becoming an accepted practice for perioperative management of cardiac surgical patients. FTCA is a key component to successful conduction of fast-track cardiac surgery. Also, analgesia management in cardiac surgery is becoming more important with the establishment of minimally invasive direct coronary artery bypass surgery and fast track management of conventional cardiac surgery patients.

Repeat capture-recapture studies as part of the evaluation of the surveillance of Legionnaires' disease in France

We evaluated improvements made to the mandatory notification surveillance system for Legionnaires' disease in France by estimating its sensitivity in 1995 and 1998 using a repeat capture-recapture method. A case of Legionnaires' disease was defined as a person treated for pneumonia in whom legionella had been detected. Patient details were collected from (1) mandatory notifications; (2) the National Reference Centre for Legionella; (3) a postal survey of all hospital laboratories. The three sources were cross-matched and 715 individual cases were identified. A log-linear model, which included an interaction term between mandatory notifications and both the National Reference Centre and Laboratory sources, provided an estimated total of 1124 cases (95% CI 973-1275) in 1998, a twofold increase compared with 1995. The sensitivity of the surveillance system improved from 10% in 1995 to 33% (95% CI 29-38%) in 1998. Capture-recapture methods are important tools in the evaluation of surveillance systems.

Peripheral vascular surgery: update on the perioperative non-surgical management for high cardiac risk patients

This review of the recent literature regarding perioperative management in peripheral vascular surgery emphasizes some of the important features for the 2003 state-of-the-art on non surgical perioperative care for these high cardiac risk patients. The most adapted preoperative cardiac evaluation for each patient is guided by its individual risk factors and clinical history. Perioperative medication should nowadays consist of pre- and postoperative beta-blockers and acetyl salicylic acid, both reducing cardiac morbidity and mortality. Neuraxial locoregional anaesthesia techniques are reasonable alternatives to general anaesthesia because of their potential advantages, by reducing postoperative inflammatory response and reducing procoagulating activity, and increasing peripheral vascular graft patency, but the individual benefit/risk balance has always to be evaluated for patients submitted to aggressive antithrombotic therapy. During the postoperative course, early detection and treatment of postoperative myocardial ischemia or infarction by ST wave changes and/or cardiac enzyme control has to be considered.

Histologic multifocality is predictive of skin recurrences after conserving treatment of stage I and II breast cancers

OBJECTIVE

To distinguish various types of local recurrence after conserving treatment of breast cancer and to evaluate their predictive value.

MATERIALS AND METHODS

We first researched the pronostic factors after local recurrence and second evaluated the predictive factors of skin and inflammatory recurrences out of a series of 605 cases of stage I and stage II breast cancer of less than 4 cm in diameter that occurred after conserving treatment.

RESULTS

Multivariate analysis revealed two major predictors of poor prognosis associated with recurrence: early appearance Hazard ratio 3.0 (1.28-7.00) (p = 0.011) and inflammatory or skin involvement Hazard ratio 3.38 (1.36-8.45) (p = 0.009). A local recurrence multiplied the relative risk for metastasis by 2.6. This result depended on the type of recurrence: when those with inflammatory and cutaneous types were excluded, local recurrence was no longer a poor prognostic factor. Patients who experienced primary invasive tumor with histologic multifocality have a 4.08 (1.44-11.59) (p < 0.004) times greater risk of developing cutaneous or inflammatory recurrences compared with patients who experienced breast cancer unique localization.

CONCLUSION

As histologic multifocality is the only factor predictive of dark prognosis local breast cancer recurrences, aggressive therapy at the time of the primary treatment could be the therapeutic implications of such finding on the original tumor.

Low body mass index is an independent predictive factor of local recurrence after conservative treatment for breast cancer

BACKGROUND

Obesity or increased body mass index (BMI) has been shown to have two important adverse effects related to breast cancer. First, several studies have identified an association between increased BMI and advanced stage breast cancer. Second, increased BMI has been shown to be associated with poorer prognosis. In a previous report, we had identified low BMI as a risk factor for local reccurence at five years. The objectives of this study were to evaluate the relationship between BMI and local control and to confirm this prognostic factor in a larger population with an important follow-up.

MATERIALS AND METHODS

Between 1976 and 1988, 605 women with invasive breast carcinoma less than 4 cm in diameter underwent conservative surgery with axillary dissection and radiation therapy. The median follow-up time was 82 months. The risk of local recurrence and distant metastasis was evaluated by univariate retrospective analysis using Kaplan-Meier method for the main clinical and histologic factors. Those found to be significant were entered in a Cox model for multivariate analysis.

RESULTS

Since the beginning of the study, 80 patients had developed local recurrence. The 5 years and 10 years local control rates were 91% and 83%, respectively. Four parameters were independent predictive factors of local recurrence: Age lower than 40 years (HR = 2.42 95% CI = [1.35-4.34]), BMI: elevation of one unit reducing the local recurrence of 0.92 95%CI = [0.85-0.99], multifocality of the tumor on pathological examination (HR = 2.12 95% CI = [1.16-3.88]) and positive axillary nodes HR = 0.54 95% CI = [0.31-0.95]. Size of the breast was not a predictive factor for local cancer recurrence. Low BMI did not increase risk of distant.

CONCLUSION

Our study offers new data concerning the possibility that thinness may be related to local recurrence of breast cancer.

Haemolytic uraemic syndrome and Shiga toxin-producing Escherichia coli infection in children in France. The Société de Néphrologie Pédiatrique

We conducted a study to determine the incidence of haemolytic uraemic syndrome (HUS) in children in France and to assess the role of Shiga-toxin-producing Escherichia coli (STEC) infection in the aetiology of HUS. In collaboration with the Société de Néphrologie Pédiatrique we undertook a retrospective review of all cases of HUS hospitalized from January 1993 to March 1995 and a 1-year prospective study (April 1995-March 1996) of epidemiological and microbiological features of cases of HUS. The polymerase chain reaction (PCR) procedure was used to detect stx, eae, e-hlyA genes directly from case stool samples. Serum samples from cases were examined for antibodies to lipopolysaccharide (LPS) of 26 major STEC serogroups. Two hundred and eighty-six cases were reported. The average incidence per year was 0.7/10(5) children < 15 years and 1.8/10(5) children < 5 years. During the prospective study, 122/130 cases were examined for evidence of STEC infection using PCR and/or serological assays and 105 (86%) had evidence of STEC infection. Serum antibodies to E. coli O157 LPS were detected in 79 (67%) cases tested. In conclusion, this study showed that STEC infection is an important cause of HUS in children in France, with a high proportion related to the O157 serogroup.

Cytotoxic drugs efficacy correlates with adipose tissue docosahexaenoic acid level in locally advanced breast carcinoma

Experimental studies indicated that long-chain polyunsaturated fatty acids may increase sensitivity of mammary tumours to several cytotoxic drugs. To evaluate this hypothesis in breast cancer, we have prospectively studied the association between levels of fatty acids stored in breast adipose tissue and the response of the tumour to chemotherapy in 56 patients with an initially localized breast carcinoma. Adipose breast tissue was obtained at the time of biopsy, and individual fatty acids were measured as a percentage of total fatty acids using capillary gas chromatography. Patients then received primary chemotherapy, combining mitoxantrone, vindesine, cyclophosphamide and 5-fluorouracil every 4 weeks. Tumour size was reassessed after three cycles of chemotherapy. Tumour response was evaluated according to World Health Organization criteria. Complete or partial response to chemotherapy was achieved in 26 patients (47%). Level of n-3 polyunsaturated fatty acids in adipose tissue was higher in the group of patients with complete or partial response to chemotherapy than in patients with no response or with tumour progression (P < 0.004). Among n-3 polyunsaturated, only docosahexaenoic acid (22:6n-3) was significantly associated with tumour response (P < 0.005). In a logistic regression analysis taking into account age, body mass index and tumour size, 22:6 n-3 level proved to be an independent predictor for chemosensitivity (P = 0.03). These results suggest that, in breast cancer, 22:6 n-3 may increase the response of the tumour to the cytotoxic agents used.

Influence of induction of anaesthesia on intubating conditions one minute after rocuronium administration: comparison of ketamine and thiopentone

We compared the effect of thiopentone and ketamine on intubating conditions after rocuronium 0.6 mg.kg-1 in two groups of patients (n = 16 each), aged 21-44 years, undergoing elective surgery. Premedication consisted of alprazolam 1 mg by mouth 1 h before surgery. All patients received midazolam 2 mg intravenously 2 min before intravenous administration of thiopentone 5 mg.kg-1 or ketamine 2.5 mg.kg-1. Muscle relaxation was provided by rocuronium 0.6 mg.kg-1. One minute after rocuronium administration, tracheal intubation was performed within 15 s by a skilled anaesthetist blinded to the treatment group assignment. Intubating conditions were graded as excellent, good, fair or poor on the basis of jaw relaxation, position of vocal cords and diaphragmatic response. Neuromuscular transmission was assessed at the adductor pollicis muscle using a TOF-GUARD monitor. Excellent and good intubating conditions were obtained in 100% of patients in the ketamine group and in 50% of patients in the thiopentone group (p = 0.002). Jaw relaxation was similar in both groups but vocal cord conditions were better and the diaphragmatic response less marked in the ketamine group compared with the thiopentone group (p = 0.002). The degree of neuromuscular block [% decrease of T1, mean (SD)] at the time of intubation was similar: 51.8 (25)% (ketamine group) and 54.3 (23.1)% (thiopentone group). We conclude that ketamine 2.5 mg.kg-1 provides better intubating conditions than thiopentone 5 mg.kg-1 1 min after administration of rocuronium 0.6 mg.kg-1.

Diarrhoea-related morbidity and rotavirus infection in France

To assess the importance of diarrhoea in France and, specifically, rotavirus-related diarrhoea among children, we reviewed data obtained from three complementary sources: (1) general practitioner (GP) sentinel surveillance; (2) hospital discharge data from paediatric hospitals; and (3) laboratory based surveillance. The GP sentinel network is based on 500 physicians who electronically notify new cases of eight illnesses, including diarrhoea, each week. It was estimated that about 3.3 million patients seek medical attention for diarrhoea from their GP each year, with a winter outbreak associated with an increased rate of isolation of rotavirus. A national system of hospital discharge diagnosis was used to estimate the burden of diarrhoeal morbidity in two paediatric wards in Tours, France. Between 1994 and 1996, 1164 patients under 15 y of age (9.7% of all admissions) were admitted for diarrhoea, of whom 83% were reported as having viral gastroenteritis; 14.3% were dehydrated and 52% were under 1y old. Hospital admissions had a seasonal pattern similar to notifications from sentinel GP for children under 5 y old. A centralized laboratory surveillance network representing 17 of the 22 French regions describes a rotavirus outbreak each winter that is concomitant of outbreaks detected by the GP sentinel network and seen in hospitals. Most of the isolates (98%) identified through this surveillance system are among children under 5y of age. All the data reviewed in this study indicate that the epidemiology of rotavirus diarrhoea in France fits well with what has been reported in other developed countries.

Reasoning enantioselectivity and kinetics of seleno-subtilisin from the subtilisin template

The active-site serine (Ser221) of subtilisin Carlsberg(from Bacillus licheniformis) and subtilisin BPN' (fromBacillus amyloliquefaciens) was chemically converted into a selenocystein. Contrary to subtilisin's protease activity the semisynthetic seleno-subtilisin catalyzed the reduction of hydroperoxides. Enantioselectivity and kinetics of this reaction were studied by kinetic resolution of five racemic alkyl aryl hydroperoxides catalyzed by the seleno-subtilisin variants. Due to the identical tertiary structure of subtilisin and seleno-subtilisin, the enzymes have comparable substrate binding properties. Thus, a rational screening for suitable peroxidase substrates featuring structural characteristics of known subtilisin substrates was enabled. The enantioselective recognition of (S)-configured alkyl aryl hydroperoxides by seleno-subtilisin was comprehensible by subtilisin's preference for comparable (S)-alkyl aryl amines or alcohols. The analysis of chiral products by multidimensional gas chromatography revealed enantiomeric excesses up to 98%. Kinetics of seleno-subtilisin were rationalized on the basis of the established substrate-catalyst interactions of the subtilisin framework. The Carlsberg and BPN' peroxidase variants revealed typical differences in turnover numbers (kcat) and Michaelis-Menten affinity constants (Km) already known from subtilisin variants. Turnover numbers of seleno-subtilisin BPN' were lower and Km values were higher in comparison to Carlsberg variant. Substrate affinity of several substituted 1-arylethyl hydroperoxides to seleno-subtilisin was reasonable in comparison to corresponding aryl boronic acid inhibitors of subtilisin.

Underreporting of legionnaires disease in France : the case for more active surveillance

In France, surveillance of legionnaires disease started in 1987 with a mandatory clinician-based notification system. An average of 54 cases were reported yearly between 1988 and 1995 and six non-nosocomial clusters were identified. In 1995 the surveilla

[Reproduction techniques and infectious risks: study of practices in French centers in 1997]

In the absence of specific legislation or consensual recommendations in France regarding the routine screening of infectious transmissibility risk before intra-couple medically assisted procreation (MAP), an inquiry about the practice of screening management in France has been performed. 500 questionnaires were sent, and 104 answers were received. The results of such inquiry coming from 62 private and 42 public centers are the subject of this paper.

Recent changes in meningococcal disease in Europe

Few infections can cause the social stress that occurs when meningococcal disease enters a community. The ability of Neisseria meningitidisto kill a healthy child within a few hours is one reason for this fear. It is also clear that preventive measures ag

Surveillance of meningococcal disease in France, 1990-1997

The surveillance of meningococcal disease in France is based on four complementary sources of data. 1. Meningococcal disease has been a notifiable disease since 1902. A case definition for surveillance was introduced in 1985, based on the isolation of Ne