[Fat overload syndrome]. / Syndrome de surcharge en lipides : un accident iatrogène rare.

We report the case of a 21-month-old child suffering from pulmonary fibrosis, who presented with acute respiratory distress and liver damage, due to an accidental overdose of intravenous lipid emulsion. This poisoning is a rare entity, whose potential severity and almost exclusive iatrogenic effect deserve to be remembered.

[Infections of central venous catheters in home parenteral nutrition: a retrospective monocentric study over 2 years]. / Infections des voies veineuses centrales en nutrition parentérale à domicile : étude rétrospective monocentrique sur 2ans.

BACKGROUND AND STUDY AIMS: Infection of the central venous catheter (CVC) is the main aggravating factor of parenteral nutrition. The aim of this study was to determine the ecology of these infections in our home parenteral nutrition center and to evaluate our care protocol. PATIENTS AND METHODS: The present study was monocentric and retrospective, and was conducted in the parenteral nutrition service of the Marseille University Hospital between 1 January 2011 and 31 May 2012. During this period, all the children who presented fever and a positive hemoculture in a medical emergency were taken into account, and the characteristics of the infection were analyzed. RESULTS: After 17 months, 17 children had been subject to an infection in their central catheter: 47 bacteremia were identified, which is equivalent to 5.4 infections for 1000 days of CVC. An average 2.8 hemocultures were performed during this time. The most common bacterium was Staphylococcus hominis. The children affected by a digestive stoma or by a gastrostomy were not subject to more infections and their ecology was not different. All the children were referred to the hospital and treated with an intravenous antibiotic through the CVC. DISCUSSION: As expected during the time of the study, the infection rate was very high. This finding led us to reassess our prevention protocol. It is also very likely that the number of infections was overestimated due to the protocol for sampling in the hemocultures and their subsequent analysis. Lastly, some children relapsed easily, although no predisposing factor was found in the present study. The therapy chosen was in agreement with the best practices and the ecology recovered. CONCLUSION: The high number of infections observed during the study encourages a prospective evaluation of current practices.

Process design for wastewater treatment: catalytic ozonation of organic pollutants.

Emerging micropollutants have been recently the target of interest for their potential harmful effects in the environment and their resistance to conventional water treatments. Catalytic ozonation is an advanced oxidation process consisting of the formation of highly reactive radicals from the decomposition of ozone promoted by a catalyst. Nanocarbon materials have been shown to be effective catalysts for this process, either in powder form or grown on the surface of a monolithic structure. In this work, carbon nanofibers grown on the surface of a cordierite honeycomb monolith are tested as catalyst for the ozonation of five selected micropollutants: atrazine (ATZ), bezafibrate, erythromycin, metolachlor, and nonylphenol. The process is tested both in laboratorial and real conditions. Later on, ATZ was selected as a target pollutant to further investigate the role of the catalytic material. It is shown that the inclusion of a catalyst improves the mineralization degree compared to single ozonation.

Industrial wastewater re-use: closure of water cycle in the main water consuming industries--the example of paper mills.

Paper mill, chemistry, textile and food processing industries are high water consumers. Within the framework of the European project Aquafit4Use, the possibility to close the on-site water loop is studied. The aim is to find new technologies or innovative treatment trains to produce water that is 'fit for use' in the industrial process; an example of a paper mill is given. Laboratory-scale tests on nine technologies were carried out to determine the best suitable treatment train: anaerobic process (already on site) --> aerobic process (already on site) --> Flexible Fibre Filter Module --> softening --> nanofiltration --> evapoconcentration or ozonation on nanofiltration (NF) concentrate. This treatment train is currently compared on site at pilot scale to another treatment train including some modifications on the existing on-site biological treatment: anaerobic process --> softening --> membrane bioreactor --> nanofiltration --> evapoconcentration or ozonation of NF concentrate.

CSF biomarkers in posterior cortical atrophy.

OBJECTIVE: To describe CSF biomarker profiles in posterior cortical atrophy (PCA), which induces high-order visual deficits often associated with Alzheimer disease (AD) pathology, and relate these findings to clinical and neuropsychological assessment. METHODS: This prospective observational study included 22 patients with PCA who underwent CSF biomarker analysis of total tau (t-tau), phosphorylated tau on amino acid 181 (p-tau181), and amyloid ß (Aß(42)). At group level, the CSF profiles of patients with PCA were compared to those of patients with typical AD and patients with other dementia (OD). Individually, the clinical presentation of patients with PCA was correlated to their CSF profile to assess the predictability of clinical features for diagnosis of underlying AD pathology. RESULTS: At group level, the PCA biomarker profile was not different from that of the AD group, but very different from that of the OD group (p < 0.001). More than 90% of patients with PCA had CSF profiles consistent with AD. All patients with PCA with either isolated higher-order visual deficit (n = 8) or visual deficit associated with memory impairment (n = 11) had CSF profiles consistent with AD. Only one of the 3 patients with PCA with asymmetric motor signs fulfilled biological CSF criteria for AD. CONCLUSIONS: PCA syndrome is usually associated with CSF biomarkers suggestive of AD, as shown by previous neuropathologic studies. This does not apply in case of motor signs suggesting associated corticobasal syndrome. CSF biomarkers help to discriminate AD from non-AD processes associated with this condition.

Electrochemical treatment of wastewater polluted by nitrate: selective reduction to N2 on boron-doped diamond cathode.

Electrochemical tests of nitrate reduction on Boron-Doped Diamond cathode are investigated through a Design of Experiments (DOE) method. The results show good reduction of nitrate into almost exclusively N2. In the studied domain, the best experimental conditions are high initial nitrate content, low acidic pH values and low working current densities. The application of DOE conclusions on an agro-industrial wastewater gives really satisfying results: final nitrate contents lower than 50 mg/L without nitrite or ammonium formation, and with low energy consumption (under 25 kWh/kgNO3).

[Epidermolysis bullosa acquisita of childhood]. / Epidermolyse bulleuse acquise de l'enfant.

BACKGROUND: Epidermolysis bullosa acquisita (EBA) is a subepidermal autoimmune blistering disease characterized immunologically by autoantibodies to type VII collagen. Its occurrence in childhood is rare. Thirty-five cases have been described to date in the literature. PATIENTS AND METHODS: We report the case of an 8-year-old girl presenting blistering lesions on the cheeks, extremities and limb extension areas. The diagnosis of EBA was confirmed by histology, direct immunofluorescence of a perilesional skin biopsy specimen, indirect immunofluorescence on salt-split skin substrate and direct electron microscopy. The patient was controlled clinically under treatment with dapsone alone. DISCUSSION: This 36th childhood case of EBA presented typical clinical features, a similar prognosis and comparable treatment response to other paediatric cases. Clinical presentation is inflammatory and affects the face. As in our case, in childhood, prognosis is often better than in adults without the need for immunosuppressive agents.

Linking diatom community structure to pesticide input as evaluated through a spatial contamination potential (Phytopixal): a case study in the Neste river system (South-West France).

A large-scale field survey was undertaken in the Neste system (South-West France) to investigate the impact of pesticide inputs on the structure of riverine benthic diatom communities. A total of 18 sites in the "Coteaux de Gascogne" study area were sampled during periods of pesticide use over two consecutive years (2005-2006). The typology of the diatoms collected was determined using artificial neural networks generating patterns in diatom community composition that indicated the species influenced by pesticide inputs, combined with organic pollution. Small, pioneer species of the Achnanthales group were more frequent in the pesticide-contaminated assemblages, whereas slower colonizers were more often found in the sites where disturbance was lower. The Phytopixal approach, a means to assess the spatial contamination potential, provided valuable information about pesticide exposure and was a successful means of discriminating diatom assemblages, suggesting that a global estimate of pesticide pollution risk, although rough, would be more appropriate and more representative than sporadic pesticide analyses.

Sensitivity of freshwater periphytic diatoms to agricultural herbicides.

The biomonitoring of pesticide pollution in streams and rivers using algae such as diatoms remains difficult. The responses of diatom communities to toxic stress in stream water are disturbed by the variations of environmental parameters. In this study, periphytic algae collected in situ were exposed under controlled conditions to two major herbicides used in French agriculture (isoproturon and s-metolachlor). Three exposure regimes were tested: 5 and 30 microg L(-1) for 6 days and 30 microg L(-1) for 3 days followed by a recovery period of 3 days. The algal biomasses were assessed from pigment concentrations (chlorophyll a and c) and from live cell density. The highest concentration (30 microg L(-1)) of isoproturon inhibited the biomass increase statistically significantly. In periphyton exposed to 5 and 30 microg L(-1) of s-metolachlor, chlorophyll c concentration and live cell density were also statistically significantly lower than in the control. Periphyton left to recover after reduced exposure duration (3 days) showed higher growth rates after treatment with s-metolachlor than with isoproturon. Taxonomic identifications showed that species like Melosira varians, Nitzschia dissipata and Cocconeis placentula were not affected by the herbicide exposure. Other species like Eolimna minima and Navicula reichardtiana were more sensitive. Studying diatoms according to their trophic mode showed that facultative heterotroph species were statistically significantly favoured by isoproturon exposure at the highest concentration. Results obtained with s-metolachlor exposure showed a disturbance of cell multiplication rather than that of photosynthesis. These results suggest that photosynthesis inhibitors like isoproturon favour species able to survive when the autotroph mode is inhibited.

Intestinal loop lengthening: early treatment of vanishing bowel.

Bianchi's procedure experience for short bowel syndrome in children is positive. This technique is generally performed after the first year of life. Here the authors propose a case of gastroschisis with prenatal spontaneous closure of abdominal defect and vanishing gut presenting as intestinal atresia, absence of ileo-cecal valve, and residual short intestinal dilatation, treated by early gut lengthening (ILP).

Zero Liquid Discharge approach in plating industry: treatment of degreasing effluents by electrocoagulation and anodic oxidation.

Degreasing waste effluents issued from a surface treatment plant were treated by electrochemical techniques in an attempt to reduce COD so that clean water can be returned to the rinse bath. Electrocoagulation, both with iron and aluminium anodes, and anodic oxidation with boron doped diamond (BDD) anodes were tested. In the electrocoagulation tests, the nature of the anodes did not impact significantly the reduction of COD. Electrocoagulation showed good COD removal rates, superior to 80%, but it was not able to reduce COD down to low levels. Anodic oxidation was able to reduce COD down to discharge limits; the oxidation efficiency was superior to 50%. Economical calculations show that anodic oxidation is best used as a polishing step after electrocoagulation. The bulk of the COD would be reduced by electrocoagulation and, then, anodic oxidation would reduce COD below discharge limits. The maximum treatable flow is somewhat hindered by the small sizes of current BDD installation but it would reach 600 m(3)/year if anodic oxidation is coupled with electrocoagulation, the operational cost being 2.90 Euros /m(3).

Herbicide effects on freshwater benthic diatoms: induction of nucleus alterations and silica cell wall abnormalities.

Benthic diatoms are well known bio-indicators of river pollution by nutrients (nitrogen and phosphorus). Biological indexes, based on diatom sensitivity for non-toxic pollution, have been developed to assess the water quality. Nevertheless, they are not reliable tools to detect pollution by pesticides. Many authors have suggested that toxic agents, like pesticides, induce abnormalities of the diatom cell wall (frustule). High abnormal frustule abundances have been reported in natural diatom communities sampled in streams contaminated by pesticides. However, no direct link was found between the abundances of abnormal frustules in these communities and the pesticide concentrations in stream water. In the present study, a freshwater benthic diatom community, isolated from natural biofilm and cultured under controlled conditions, was treated with a known genotoxic herbicide, maleic hydrazide (MH). Cells were exposed to three concentrations of MH (5x10(-6), 10(-6), 10(-7)M) for 6h followed by a 24h-recovery time. After MH treatments, nucleus alterations were observed: abnormal nucleus location, micronucleus, multinuclear cell or disruption of the nuclear membrane. A dose-dependent increase of nuclear alterations was observed. The difference between the control (9.65 nuclear alterations per 1000 cells observed (9.65 per thousand), S.D.=4.23) and the highest concentrations (29.40 per thousand, S.D.=8.49 for 10(-6)M and 35.96 per thousand, S.D.=3.71 for 5x10(-6)M) was statistically significant (Tukey test, P<0.05). Diatoms also exhibited frustules with deformed morphology and abnormal ornamentation. Significantly increased abundances of abnormal frustules were observed for the highest concentrations (10(-6) and 5x10(-6)M; Tukey test, P<0.05). These two parameters tended to increase together (Pearson correlation=0.702, P<0.05). The results suggest that the induction of abnormal frustules could be associated with the genotoxic effects of MH. The alterations observed could be related to the effects of MH on the synthesis of the proteins involved in frustule formation or in the regulation of the cytoskeleton of the diatom cells.

Long-term survey of heavy-metal pollution, biofilm contamination and diatom community structure in the Riou Mort watershed, South-West France.

In a metal-polluted stream in the Riou Mort watershed in SW France, periphytic biofilm was analyzed for diatom cell densities and taxonomic composition, dry weight and metal bio-accumulation (cadmium and zinc). Periphytic diatom communities were affected by the metal but displayed induced tolerance, seen through structural impact (dominance of small, adnate species) as well as morphological abnormalities particularly in the genera Ulnaria and Fragilaria. Species assemblages were characterized by taxa known to occur in metal-polluted environments, and shifts in the community structure expressed seasonal patterns: high numbers of Eolimna minima, Nitzschia palea and Pinnularia parvulissima were recorded in Summer and Autumn, whereas the species Surirella brebissonii, Achnanthidium minutissimum, Navicula lanceolata and Surirella angusta were dominant in Winter and Spring. Commonly used indices such as the Shannon diversity index and Specific Pollution Sensitivity Index reflected the level of pollution and suggest seasonal periodicity, the lowest diversities being observed in Summer.

[Impact of a triage scale in a pediatric emergency department]. / Impact d'une grille de tri à l'accueil d'un service d'urgence pédiatrique.

UNLABELLED: The pediatric nursing staff of the emergency unit has established a list of items for the triage of patients which can be used by the registered nurses. This scale defined 3 stages of severity. OBJECTIVES: 1) to estimate the relevance of this list through the appraisal of the total time necessary to take care of the patients according to their severity stage, and the confrontation of the severity stage determined by the registered nurse and the severity stage determined by the paediatrician; 2) to determine a possible correlation between the severity stage and the rate of hospitalization. METHOD: This prospective study was carried out over a period of 1 month in winter for every child admitted in the pediatric emergency unit for medical reasons (traumatisms excluded). RESULTS: One thousand six hundred and fifty-six children have been included in the study. Among them, 136 have been classified stage I, 1020 stage II and 500 stage III. The children have been taken care of in an average period of 20 min for stage I, 32 min for stage II, 43 min for stage III. The coherence rate between the severity stage determined by the nurse and the severity rate determined by the paediatrician was good. The rate of sub-estimation was low (4,2%). Nevertheless the reception nurses tend to overestimate the stage of severity in 17,6% of the cases. The prediction rate for hospital admittance was good: 68,7% of children classified in stage 1 were admitted, 23,5% of children in stage 2 and only 1,6% of children in stage 3. CONCLUSION: Patients suffering from severe illnesses were taken care without injurious delay which was the main purpose of this list.

Typology of diatom communities and the influence of hydro-ecoregions: a study on the French hydrosystem scale.

By comparing diatom communities in natural and disturbed sites, indicators for different types and levels of anthropogenic disturbance can be found. As a first step, this study aims to describe the different natural and disturbed community types found throughout the French hydrosystem. 836 diatom samples were analysed with an unsupervised neural network, the self-organising-map, a well accepted method for community ordination. 11 different communities were identified, 5 corresponding to non-impacted or slightly impacted conditions and representing the diatom natural variability of our dataset. These 5 communities corresponded to 5 different hydro-ecoregions, i.e. 5 river types with similar geological context and range in altitude. The 6 other communities were typical of rivers under anthropogenic pressure. The influence of natural conditions within the hydro-ecoregions was overwhelmed by the nature and the intensity of the pollution at the sampling stations. This work was done in the context of the application and enforcement of the Water Framework Directive.

Validation of biomarkers for impact evaluation of aqueous industrial waste in mesocosms.

The use of exposure biomarkers in measuring the impact of aqueous waste holds promise because such tools have short response times, are flexible in use and may give an indication about the type of pollution. However, their ecological significance has not yet been demonstrated. It is necessary to validate these responses under controlled conditions before using such biomarkers for biomonitoring. The TotalFinaElf company has developed a pilot scheme incorporating such controlled conditions. This pilot is a dynamic open mesocosm (16 channels 40 m in length supplied with river water). The research programme currently carried out in the "Pilot Rivers" aims at validating biochemical parameters (components of phases I and II (de)toxication metabolism and propionylcholinesterase activity), measured in a fresh water bivalve Corbicula fluminea as a biomarker of water quality. The comparison between biomarker responses and community ones (reference) gives information about the precocity and sensitivity of these biomarker responses. Pure substances (trichloroethylene (TCE), cadmium (CD) and anthracenic oil (AO)) have been injected during one month. Biomarker responses are as sensitive as the most sensitive community response in the presence of CD and AO. With TCE, community responses are more sensitive. Precocity of biomarker response is observed only in the presence of CD.

Impacts of Cd and Zn on the development of periphytic diatom communities in artificial streams located along a river pollution gradient.

Many field and experimental studies have been conducted to reveal modifications of periphytic diatom communities under metal pollution, but most of the approaches presented drawbacks: variability of environmental factors for field studies and lack of representativity for experimental ones. An original approach that allows growth of periphytic communities under conditions more controlled than in the field and more realistic than experimental investigations was developed to try conclusions being drawn on the real impact of metallic pollution. Artificial streams were placed on the river bank at three sites along the pollution gradient (Cd/Zn) of the River Lot (SW France): reference (upstream pollution discharge), slightly polluted (around 1.5 microg Cd x L(-1) and 50 microg Zn x L(-1)), and polluted (around 6 microg Cd x L(-1) and 400 microg Zn x L(-1)) sites. Structural characteristics of diatom communities growing in these artificial streams, on glass substrates, and under homogenized current velocity and water depth were compared after four durations (1, 2, 3, and 4 weeks) to study effects of metal on first steps of community development. Marked perturbations of diatom community development were observed overall in the polluted site: after 1 week, early biofilms differed already by taxonomic composition; after 4 weeks, cell density was significantly lower than in the reference site and taxonomic composition was very different. These results, generated by a methodology intermediate between field and experimental approaches, compare well with literature findings based on more traditional approaches, strongly attesting that metallic pollution affects diatom community architecture and induce rising of abnormal cells.

Diatom analysis in victim's tissues as an indicator of the site of drowning.

The diagnosis of drowning is one of the most difficult in forensic pathology and previously we proposed criteria for a positive tissue analysis according to the qualitative and quantitative diatom investigations. In the positive cases, we studied the reliability of determining the site of drowning by comparing the diatom taxa found in the lung samples with those of the water samples or in the absence of these samples with the results of the water diatom monitoring programme set up in our region. In this study, we present two series of cases, the first is one of 20 corpses who died from accidental or suicidal drowning with known drowning site, and the second of 20 corpses for which the drowning site was unknown. The results showed that a concordance of the abundance of the diatom taxa in tissues compared to the site of drowning and their distribution relative to one another was 65% in the group where the site of drowning was known and 35% in the other group. The concordance of the individual distribution in the lungs of water diatom taxa may be an interesting method to guide the investigations for determining the site of drowning. The two limiting factors are the concentration of diatoms in the lungs and the development of a river monitoring programme in the district of the study.