Evaluating the impact of substrate addition for anaerobic co-digestion on biogas production and digestate quality: The case of deinking sludge.

To reduce greenhouse gas emissions from organic waste, anaerobic digestion has created new opportunities for energy and nutrient recovery from these wastes. However, the use of certain organic wastes in anaerobic digestion is limited due to their atypical physicochemical characteristics (e.g. unbalanced carbon to nitrogen ratio, high ash concentration). Deinking sludge is a residue from the paper recycling industry and is one of such substrates. This study aims at evaluating the impact of deinking sludge (DS) addition into a conventional co-digestion mixture on methane production and digestate quality. To this end, an integrated method was proposed, combining the analysis of physicochemical and biodegradability characteristics with parsimonious modeling using the SYS-Metha tool. The measured characteristics of the deinking sludge showed that its potential use in mono-digestion conditions is very limited. When co-digested with food waste and municipal sludge, no significant synergies or antagonisms were found. Based on these experiments, model simulations were executed to determine the optimal conditions for co-digestion with food waste and municipal sludge. A maximum of 22% of deinking sludge on a fresh mass basis can be added into a co-digestion mixture to achieve proper wet anaerobic digestion conditions. Regarding digestate quality, the addition of DS reduced nutrient and contaminants concentrations, which have an impact on digestate management, particularly for land application. Overall, the proposed methodology in this study allows determining optimal co-digestion mixtures and highlighted the limits needing further investigation under pilot/real conditions.

Transcriptome Analysis of Plasmodium falciparum Isolates From Benin Reveals Specific Gene Expression Associated With Cerebral Malaria.

Cerebral malaria (CM) is the severest form of Plasmodium falciparum infection. Children under 5 years old are those most vulnerable to CM, and they consequently have the highest risk of malaria-related death. Parasite-associated factors leading to CM are not yet fully elucidated. We therefore sought to characterize the gene expression profile associated with CM, using RNA sequencing data from 15 CM and 15 uncomplicated malaria isolates from Benin. Cerebral malaria parasites displayed reduced circulation times, possibly related to higher cytoadherence capacity. Consistent with the latter, we detected increased var genes abundance in CM isolates. Differential expression analyses showed that distinct transcriptome profiles are signatures of malaria severity. Genes involved in adhesion, excluding variant surface antigens, were dysregulated, supporting the idea of increased cytoadhesion capacity of CM parasites. Finally, we found dysregulated expression of genes in the entry into host pathway that may reflect greater erythrocyte invasion capacity of CM parasites.

[Sleeping Sickness: A Cause of False Positive HIV Rapid Diagnostic Tests]. / Maladie du Sommeil: Une Cause de Faux Positifs des Tests de Diagnostic Rapide du VIH.

Approaching the mechanisms related to false positives HIV rapid diagnostic tests (RDT) in patients with sleeping sickness may help to improve the accuracy of screening for HIV infection in areas endemic for Human African trypanosomiasis (HAT).We report on a patient from Congo who was managed like an AIDS-associated meningoencephalitis, based on a false positive HIV RDT at admission, and eventually received a diagnosis of sleeping sickness. A further retrospective cohort study performed in patients with HAT shows that most of positive HIV RDT obtained prior to treatment for sleeping sickness are false positives. We found that half of them were cleared at the end of treatment course, suggesting an early clearance of some antibodies involved in cross-reactivity.A substantial clearance of HIV RDT false positives occurs during therapy for HAT. In areas where Elisa HIV tests are not readily available, repeating the HIV RDT at the end of therapy may help to identify roughly half of false positives.

PfEMP1 A-Type ICAM-1-Binding Domains Are Not Associated with Cerebral Malaria in Beninese Children.

PfEMP1 is the major antigen involved in Plasmodium falciparum-infected erythrocyte sequestration in cerebrovascular endothelium. While some PfEMP1 domains have been associated with clinical phenotypes of malaria, formal associations between the expression of a specific domain and the adhesion properties of clinical isolates are limited. In this context, 73 cerebral malaria (CM) and 98 uncomplicated malaria (UM) Beninese children were recruited. We attempted to correlate the cytoadherence phenotype of Plasmodium falciparum isolates with the clinical presentation and the expression of specific PfEMP1 domains. Cytoadherence level on Hbec-5i and CHO-ICAM-1 cell lines and var genes expression were measured. We also investigated the prevalence of the ICAM-1-binding amino acid motif and dual receptor-binding domains, described as a potential determinant of cerebral malaria pathophysiology. We finally evaluated IgG levels against PfEMP1 recombinant domains (CIDRα1.4, DBLß3, and CIDRα1.4-DBLß3). CM isolates displayed higher cytoadherence levels on both cell lines, and we found a correlation between CIDRα1.4-DBLß1/3 domain expression and CHO-ICAM-1 cytoadherence level. Endothelial protein C receptor (EPCR)-binding domains were overexpressed in CM isolates compared to UM whereas no difference was found in ICAM-1-binding DBLß1/3 domain expression. Surprisingly, both CM and UM isolates expressed ICAM-1-binding motif and dual receptor-binding domains. There was no difference in IgG response against DBLß3 between CM and UM isolates expressing ICAM-1-binding DBLß1/3 domain. It raises questions about the role of this motif in CM pathophysiology, and further studies are needed, especially on the role of DBLß1/3 without the ICAM-1-binding motif.IMPORTANCE Cerebral malaria pathophysiology remains unknown despite extensive research. PfEMP1 proteins have been identified as the main Plasmodium antigen involved in cerebrovascular endothelium sequestration, but it is unclear which var gene domain is involved in Plasmodium cytoadhesion. EPCR binding is a major determinant of cerebral malaria whereas the ICAM-1-binding role is still questioned. Our study confirmed the EPCR-binding role in CM pathophysiology with a major overexpression of EPCR-binding domains in CM isolates. In contrast, ICAM-1-binding involvement appears less obvious with A-type ICAM-1-binding and dual receptor-binding domain expression in both CM and UM isolates. We did not find any variations in ICAM-1-binding motif sequences in CM compared to UM isolates. UM and CM patients infected with isolates expressing the ICAM-1-binding motif displayed similar IgG levels against DBLß3 recombinant protein. Our study raises interrogations about the role of these domains in CM physiopathology and questions their use in vaccine strategies against cerebral malaria.

BK polyomavirus in the urine for follow-up of kidney transplant recipients.

OBJECTIVES: After kidney transplantation, human BK polyomavirus (BKPyV) can induce a progressive disease, in three stages: viruria, viraemia, and then nephropathy after a few months of viral replication. Therapeutic intervention is recommended when BKPyV is detected in the plasma. The objective of our study was to assess urinary BKPyV nucleic acid test as a predictor for developing viraemia. METHODS: We first defined a viruria threshold based on 393 time-matched urine and plasma samples collected after kidney transplantation; to validate this threshold, we followed-up a cohort of 236 kidney transplant patients. RESULTS: A BKPyV viruria threshold of 6.71 log10 copies/mL best discriminated between plasma-positive and plasma-negative patients (sensitivity 90.9% (95% CI 86.5-95); specificity 90.3% (95% CI 86.3-94.3); area under the curve 0.953 (95% CI 0.933-0.974). In the validation cohort, the risk of developing BKPyV viraemia at 1 year was 16.5% (39/236) and rose to 90.7% (39/43) if BKPyV viruria remained above the threshold of 6.71 for more than 1 month. CONCLUSIONS: Sustained BKPyV viruria is a reliable, early marker of patients at high risk of developing BKPyV viraemia. This marker should alert the clinician early, and thus allow timely therapeutic intervention.

Determinants of primary healthcare seeking behaviours for children during the first 18 months of life in Benin.

Background: Primary healthcare is a key element of management of childhood illness in Africa. The objectives were to identify primary care seeking determinants among infants and young children up to 18 mo in a birth cohort from Benin. Methods: From 2007 to 2009 in Benin, a birth cohort was followed until the age of 18 mo in three health centres. Multilevel Poisson regression models were fitted to identify the factors related to the monthly number of consultations. Maternal and newborn characteristics and infant general health parameters were considered. Results: A total of 566 children were followed. On average, 0.46 consultations per month per child were recorded. The number of consultations was significantly lower after the first 6 mo of life (p<0.001). A distance >1000 m was associated with fewer consultations (p=0.01). Primiparity was significantly associated with higher care seeking (relative risk 1.17 [95% CI 1.05 to 1.30], p<0.01). No child characteristics at birth were significantly associated with the number of consultations (all p>0.16). Conclusions: Development of health structures and improvement of access remain important goals for strengthening of the primary care health system. Studying factors of care seeking behaviour, like parity, can help to identify women more prone to seek care for their child during the first year of life.

Primary care physician management of tick bites in the Franche-Comté region (Eastern France, 2013).

INTRODUCTION: Tick bites, which may lead to Lyme disease, often prompt patients to consult their primary care physicians (PCPs). The aim of the present study was to assess how and how often PCPs in the Franche-Comté region of France manage tick bites. MATERIAL AND METHODS: Standardized questionnaires were sent to a random sample of 400 PCPs in the Franche-Comté region, requesting their voluntary and anonymous participation. The questionnaires collected socio-demographic details and practice-related information about tick-bite prophylaxis, Lyme serology, and tick-borne encephalitis vaccination. RESULTS: The crude response rate was 54.5% of the PCPs contacted. Tick-bite prophylaxis was prescribed as per current guidelines. However, Lyme serology seemed to be largely overprescribed for tick bites and in case of erythema migrans. A clear lack of knowledge about tick-borne encephalitis vaccination was also observed. DISCUSSION: PCPs provide the first line of care for patients presenting with tick bites. This study showed that although PCPs of the Franche-Comté region manage tick bites as per current guidelines, they need further training on Lyme serology limitations and availability of tick-borne encephalitis vaccination.

Paecilomyces variotii Fungemia in a Patient with Lymphoma Needing Liver Transplant.

Paecilomyces sp. are emerging pathogens in immunocompromised patients. We report here a case of Paecilomyces variotii fungemia, cured with amphotericin and anidulafungin, illustrating difficulties of early diagnosis and therapeutic choice in such rare fungal infection.

Antibiotics usage in infants during the first 18 months of life in Benin: a population-based cohort study.

Data centered on antibiotics usage and their determinants in African pediatric populations are limited. In order to define the determinants of antibiotics prescriptions (ABPr), we analyzed the data of a birth cohort in Benin. From 2007 to 2009, 538 infants were followed from birth to 18 months in three different health centers. The following determinants were assessed: infants' clinical findings at consultations, mothers' and children's characteristics at birth, and health parameters recorded at scheduled follow-up of general health parameters. Multilevel logistic models were performed for analysis. Among the 4394 consultations, fever represented 53.7 % of consultations, 64.1 % of which were non-malarial fevers. Antibiotics were prescribed during 44.2 % of the consultations and the proportion of ABPr differed significantly among health centers (p < 10(-3)). Nearly 40 % of ABPr were related to children without fever. During the first semester of life, the percentage of ABPr was twice lower than after (27.4 vs. 54.7, p < 10(-3)). Respiratory and enteric symptoms were positively associated with ABPr (p < 10(-3)). Malaria was significantly associated with a lower ABPr after the first semester [odds ratio (OR) = 0.55, 95 % confidence interval (CI) = 0.44-0.67, p < 10(-3)]. No maternal and child at-birth characteristics were associated with ABPr. ABPr was positively associated with a low breastfeeding score (p < 10(-3)). Studies on the rational use of antibiotics in this population should give priority to children more than 6 months of age, without malaria, and with respiratory and/or enteric symptoms. Our data also advocate for studies specifically designed to assess and improve healthcare providers' compliance to guidelines on antibiotics usage.

Compliance to recommendations for the management of curative treatment of Plasmodium vivax/ovale infections.

OBJECTIVES: We assessed the compliance to recommendations for the routine management of Plasmodium vivax/ovale malaria, and analyzed the impact of discrepancies on the quality of care. PATIENTS AND METHODS: We reviewed the cases of P. ovale and P. vivax malaria treated at the Besançon University Hospital, France (2008-2013). RESULTS: Chloroquine was prescribed in 44% of the 18 cases (4 due to P. ovale, 14 to P. vivax). Radical cure with primaquine was prescribed after the first bout of malaria for 6 patients. The primaquine dose prescribed was inferior to the recommended one for 4 patients. The mean delay between schizonticide treatment and primaquine cure was 43 days. CONCLUSIONS: The delay before access to primaquine radical cure was the only parameter, likely to alter treatment effectiveness, but also difficult to shorten. Future national guidelines should take into account that not all patients have access to primaquine treatment immediately after schizonticide treatment.

Leptospirosis in Franche-Comté (FRANCE): clinical, biological, and therapeutic data.

OBJECTIVES AND METHOD: We report the patient data in 77 cases of leptospirosis confirmed by PCR and/or serology (micro-agglutination), observed between 1994 and 2008 at the Besançon teaching hospital. Our aim was to compare the epidemiological, clinical, biological, and therapeutic characteristics of leptospirosis in the Franche-Comté region, to those reported in other regions. RESULTS: The median age was 42years and 95% were male patients. Leptospirosis acquisition was likely related to aquatic leisure activities (50.6%), professional exposure (28.6%), building maintenance works (11.7%), or unknown (9.1%). Forty-eight cases were uncomplicated and 29 were severe presentations of leptospirosis. Among severe cases, eight patients had to be managed in an intensive care unit, and one patient died. L. grippotyphosa and L. icterohaemorrhagiae were the main serogroups involved. Age above 50years and serogroup L. icterohaemorrhagiae were positively associated with clinical severity. The outcome was favorable for 15 patients treated with ceftriaxone for less than 7days. CONCLUSIONS: We recommended conducting clinical trials aiming at validating short courses of ceftriaxone to treat leptospirosis.

Typhoidal tularemia: 2 familial cases.

Eastern France was not known as a region endemic for tularemia until year 2006. We report on 2 cases of typhoidal tularemia in Eastern France, a 43-year-old hospitalized woman and her husband. Diagnosis was established after fever clearance on serodiagnosis criteria. The source of infection is unclear. As persons in the same family may likely be exposed to a common zoonotic source of infection, tularemia should be considered in the etiologies of familial fever epidemics.

[Treatment of pediatric malaria in Africa: act at issue]. / Traitement du paludisme de l'enfant en Afrique: les act en question.

Artemisinin-based combination therapies (ACT) have been proposed as alternatives to currently used antimalarials and are poised large-scale deployment in Africa. These combinations are particularly attractive for managing malaria in children. Expected benefits of ACT include enhanced efficacy, rapid action, stabilized antimalarial resistance growth and lower malaria transmission. This article discusses what can be reasonably expected of ACT in an African setting with emphasis on patient comfort.

[Splenic metastasis from a bronchial carcinoma]. / Métastase splénique d'un cancer broncho-pulmonaire.

INTRODUCTION: Isolated splenic metastases from a bronchial carcinoma, without other visceral metastatic involvement, are exceptionally uncommon. CASE REPORT: The authors report the finding of an isolated splenic metastasis 21 months after a left pneumonectomy for an undifferentiated large cell carcinoma, initially staged pT3N1M0. The splenic metastasis presented as a major deterioration in general health and sharp pains in the left hypochondrium. Splenectomy confirmed the metastatic nature of the splenic tumour and relieved the severe abdominal pains. Two years after the splenectomy and with out adjuvant treatment the patient remains in complete remission. CONCLUSION: Splenectomy for a metastasis from a bronchial carcinoma should avoid the later complications of this type of metastasis: severe abdominal pain, splenic rupture and compression of neighbouring vessels. If the bronchial carcinoma is controlled locally and the splenic metastasis is isolated, splenectomy offers, perhaps, a further chance of prolonged survival.

Traitement du paludisme de l'enfant en Afrique : les ACT en question

Les Artemisinin-based Combination Therapies (ACT) representent la majorite des alternatives aux antipaludiques de reference et sont sur le point d'etre deployees largement en Afrique. Elles sont particulierement attractives pour traiter les enfants. Les vertus annoncees de ces associations sont multiples : puissance accrue; rapidite d'action; stabilisation de la chimioresistance et reduction de la transmission. L'abondante litterature consacree aux ACT depuis quelques annees permet de faire le point sur ces divers aspects; en insistant sur la question du confort des enfants malades

Detection of functional platelet-activating factor receptors on leukemic B cells of chronic lymphocytic leukemic patients.

Although platelet-activating factor receptors (PAF-R) are reported on normal B cells, few results are available concerning leukemic ones. We demonstrated functional PAF-R on cell and nuclear surfaces of leukemic B cells of chronic lymphocytic leukemic (CLL) patients. Analysis of 102 patients revealed dramatic differences for their membrane PAF-R expression, a result that might be related to their plasma IL-4 levels. In the light of the potent immunoregulatory role of PAF on B cell physiology, it is suggested that the presence or absence of PAF-R on leukemic B cells may profoundly affect their in vivo behavior.

Mouse embryonic stem cell sorting for the generation of transgenic mice by sedimentation field-flow fractionation.

Mouse embryonic stem (ES) cells are an important tool for generation of transgenic mice and genetically modified mice. A rapid and efficient separation of ES cells that respects cell integrity, viability, and their developmental potential while also allowing purified ES fraction collection under sterile conditions might be of great interest to facilitate the generation of chimeric animals. In this study, we demonstrated for the first time the effectiveness of a sedimentation field-flow fractionation (SdFFF) cell sorter to provide, with a characteristic DNA content, a purified ES cell fraction and with a high in vivo developmental potential to prepare transgenic mice by generation of chimeras having a high percentage of chimerism.

[Predictive factors of virological response to primary antiretroviral treatment]. / Facteurs prédictifs de la réponse virologique à un premier traitement antirétroviral.

OBJECTIVES: During 1999, first-line antiretroviral combinations for the treatment of HIV infections have diversified. The aim of our study was two-fold: define the factors associated with initial success and define the factors associated with virological rebound in patients in whom a primary antiretroviral therapy (ARV) had been initiated between 1999 and 2000. METHOD: We conducted a retrospective multicenter study regrouping 6 HIV clinics in the North-East of France. Data were Issued from the patients medical files. Primary success was defined as plasma HIV RNA viral load (VL<200 copies/ml within 6 Months of therapy and two consecutive VL<200 copies/ml. Virological rebound was defined as two consecutive VL>1000 copies/ml after primary success. Predictors of success were determined using multivariate logistic regression and SAS 8.2 software. RESULTS: Analysis concerned 123 patients, with 19% stage C when ARV was initiated. Their median CD4 and PVL values at baseline were 233/mm3 and 73,000 copies/ml respectively. The median duration of follow-up was of 20.7 Months [(mean (STD): 20.6 (6.7)]. Initial treatments were distributed as follows: 2 NRTI + 1NNRTI, n=66 (54%); 2 NRTI+1PI, n=44 (36%); 3 NRTI, n=13 (10%). Primary success was obtained in 100 (81,3%) patients. Among these, 6 (6%) developed secondary virologic failure. The absence of change in initial ARV treatment within first 4 Months, and good compliance to treatment were statistically associated with primary success in univariate (p values respectively: 0.004 and 0.04) and in multivariate analysis (p respectively: 0.009 and 0.03). The proportion of failure was higher in the patients with lower baseline CD4 levels lesser than 200/mm3 (p=0.09). CONCLUSION: In this cohort of patients, tolerance and compliance to the first regimen were associated to primary success. These results emphasize the role of compliance in primary success and reinforces need to work on compliance in such patients.