Antiretroviral-naive and -treated HIV-1 patients can harbour more resistant viruses in CSF than in plasma

Objectives The neurological disorders in HIV-1-infected patients remain prevalent. The HIV-1 resistance in plasma and CSF was compared in patients with neurological disorders in a multicentre study. Methods Blood and CSF samples were collected at time of neurological disorders for 244 patients. The viral loads were >50 copies/mL in both compartments and bulk genotypic tests were realized. Results On 244 patients, 89 and 155 were antiretroviral (ARV) naive and ARV treated, respectively. In ARV-naive patients, detection of mutations in CSF and not in plasma were reported for the reverse transcriptase (RT) gene in 2/89 patients (2.2%) and for the protease gene in 1/89 patients (1.1%). In ARV-treated patients, 19/152 (12.5%) patients had HIV-1 mutations only in the CSF for the RT gene and 30/151 (19.8%) for the protease gene. Two mutations appeared statistically more prevalent in the CSF than in plasma: M41L (P = 0.0455) and T215Y (P = 0.0455). Conclusions In most cases, resistance mutations were present and similar in both studied compartments. However, in 3.4% of ARV-naive and 8.8% of ARV-treated patients, the virus was more resistant in CSF than in plasma. These results support the need for genotypic resistance testing when lumbar puncture is performe

EEG and acute confusional state at the emergency department

International audienceObjectives: Acute confusional state (ACS) is a common cause of admission to the emergency department (ED). It can be related to numerous etiologies. Electroencephalography (EEG) can show specific abnormalities in cases of non-convulsive status epilepticus (NCSE), or metabolic or toxic encephalopathy. However, up to 80% of patients with a final diagnosis of NCSE have an ACS initially attributed to another cause. The exact place of EEG in the diagnostic work-up remains unclear.Methods: Data of consecutive patients admitted to the ED for an ACS in a two-year period and who were referred for an EEG were collected. The initial working diagnosis was based on medical history, clinical, biological and imaging investigations allowing classification into four diagnostic categories. Comparison to the final diagnosis was performed after EEG recordings (and sometimes additional tests) were performed, which allowed the reclassification of some patients from one category to another.Results: Seventy-five patients (mean age: 71.1 years) were included with the following suspected diagnoses: seizures for 8 (11%), encephalopathy for 14 (19%), other cause for 34 (45%) and unknown for 19 (25%). EEG was recorded after a mean of 1.5 days after symptom onset, and resulted in the reclassification of patients as follows: seizure for 15 (20%), encephalopathy for 15 (20%), other cause for 29 (39%) and unknown cause for 16 (21%). Moreover, ongoing epileptic activity (NCSE or seizure) and interictal epileptiform activity were found in eight (11%) patients initially diagnosed in another category.Discussion: In our cohort, EEG was a key examination in the management strategy of ACS in 11% of patients admitted to the ED. It resulted in a diagnosis of epilepsy in these patients admitted with unusual confounding presentations

Evaluating OPTISAS, a visual method to analyse sleep apnea syndromes.

International audienceThe sleep apnea syndrome is a real public health problem. Improving its diagnosis using the polysomnography is of huge importance. Optisas was a visual method allowing translating the polysomnographic data into a meaningful image. In a previous paper, it was shown to bring extra information in 62% of cases. Here its capacity for displaying information of the same relevance as the one got using the classical report of the polysomnography is studied. The main result is that this capacity is weak and seems to be present only to identify the obstructive sleep apnea syndrome. Moreover this study suggests to improve the standardization of the classical report in the framework of a quality insurance process

Etude de la coordination interpersonnelle de patients souffrant de schizophrénie en Interaction Homme Robot

International audienceL'objectif de cette étude est d'analyser la coordination interpersonnelle chez les patients schizophrènes (SZ) en utilisant un robot humanoïde contrôlé par un modèle neuronal entraîné par le mouvement humain et capable de se synchroniser sur ce dernier. L'utilisation d'un robot présente l'avantage de pouvoir être modifié et contrôlé sans être influencé par les patients comme le serait un humain. Plus spécifiquement, nous nous sommes intéressés aux coordinations non-intentionnelles qui sont, d'après la littérature, préservées chez les SZ. Nous avons réalisé une expérience dans laquelle il a été demandé aux patients et aux sujets contrôles, d'exécuter des mouvements de fitness conjointement avec le robot qui était soit synchronisé de façon bidirectionnelle aux sujets soit à fréquence fixe (uni-directionnel). Nous montrons ainsi dans cette étude que les patients SZ présentent des difficultés à être stable à un rythme donné. De plus, nos résultats montrent que dans le cadre spécifique d'une interaction à la fréquence préférentielle des sujets, il y a peu de différence entre SZ et contrôles en terme de capacité de synchronisation (coordination interpersonnelle). Aussi, la meilleure synchronisation, la meilleure stabilité ainsi que la meilleure performance en termes de vitesse ont été obtenus avec la condition bidirectionnelle

Study of Coordination Between Patients with Schizophrenia and Socially Assistive Robot During Physical Activity

International audienceThe goal of this study was to analyze the interpersonal coordination of patients suffering from schizophrenia (SZ) using a humanoid robot NAO. NAO was controlled by a neurally-inspired model that enables motions synchronization between robot and human. Using a robot has the advantage in that it can be modified and controlled without being influenced by the human with whom they are interacting. More specifically, we were interested in non-intentional interpersonal coordination which has been found in previous studies to be preserved for SZ. We performed an experiment in which we asked patients and control participants to jointly perform fitness movements with the robot which was programmed to either synchronize with the human (a bidirectional condition) or move at a fixed frequency with them (a unidirectional condition). We showed that non-intentional interpersonal coordination was preserved for SZ during Human/Robot interaction (as for human/human interaction). Also, the best synchronization, stability and the best performance in term of speed were obtained with the bidirectional condition. Our results showed that, in this specific context of an interaction at preferential frequency of subject, there were only a few differences between SZ and controls in terms of interpersonal synchronization skills. Nevertheless, we observed more variability for SZ which could partly be explained by the weaker intrapersonal coordination that they exhibited

Jeu d’acteurs

Comment aborder les films à partir du jeu de l’acteur, cet art si singulier du corps et des gestes au cinéma ? De la gestique transgressive de Greta Garbo à la gestuaire subversive de Marlon Brando ; de la neutralité de Tadanobu Asano à la volubilité d’Emmanuelle Devos ; de l’histrionisme de Johnny Depp au jeu de dos de Wu Nien-jen ; de la fossette de Stephen Boyd à celle plus « exposée » de Cary Grant ; des cris de Fay Wray aux larmes de Stefania Sandrelli ; de la « féline » Sigourney Weaver à la « louve » Anna Magnani… Ce volume présente une série d’études actorales, analyses ontologiques et stylistiques de certaines stratégies gestuelles et formes d’expression corporelles puisées dans un corpus éclectique, au sein de différents genres et à l’intérieur de cinématographies aussi bien occidentales qu’asiatiques, à l’échelle de longues filmographies ou au cœur d’un seul film, chez des stars ou des acteurs moins connus, d’hier et d’aujourd’hui

Cherubism as a systemic skeletal disease: evidence from an aggressive case

International audienceBackground: Cherubism is a rare autosomal dominant genetic condition caused by mutations in the SH3BP2 gene. This disease is characterized by osteolysis of the jaws, with the bone replaced by soft tissue rich in fibroblasts and multinuclear giant cells. SH3BP2 is a ubiquitous adaptor protein yet the consequences of SH3BP2 mutation have so far been described as impacting only face. Cherubism mouse models have been generated and unlike human patients, the knock-in mice exhibit systemic bone loss together with a systemic inflammation.Case presentation: In light of these observations, we decided to search for a systemic cherubism phenotype in a 6-year-old girl with an aggressive cherubism. We report here the first case of cherubism with systemic manifestations. Bone densitometry showed low overall bone density (total body Z-score = - 4.6 SD). Several markers of bone remodelling (CTx, BALP, P1NP) as well as inflammation (TNFα and IL-1) were elevated. A causative second-site mutation in other genes known to influence bone density was ruled out by sequencing a panel of such genes.Conclusions: If this systemic skeletal cherubism phenotype should be confirmed, it would simplify the treatment of severe cherubism patients and allay reservations about applying a systemic treatment such as those recently published (tacrolimus or imatinib) to a disease heretofore believed to be localised to the jaws

Automatic sleep stage identification: difficulties and possible solutions

International audienceThe diagnosis of many sleep disorders is a labor intensive task that involves the specialised interpretation of numerous signals including brain wave, breath and heart rate captured in overnight polysomnogram sessions. The automation of diagnoses is challenging for data mining algorithms because the data sets are extremely large and noisy, the signals are complex and specialist's analyses vary. This work reports on the adaptation of approaches from four fields; neural networks, mathematical optimisation, financial forecasting and frequency domain analysis to the problem of automatically determining a patient's stage of sleep. Results, though preliminary, are promising and indicate that combined approaches may prove more fruitful than the reliance on a single approach