Extensive myelitis associated with anti-NMDA receptor antibodies.

International audienceBACKGROUND: Encephalitis with anti-N-methyl-D-aspartate receptor antibodies (anti-NMDAR-Ab) is a rapid-onset encephalitis including psychosis, seizures, various movement disorders and autonomic system disturbances. CASE PRESENTATION: We report a very unusual case of extensive myelitis associated with anti-NMDAR-Ab. MRI also revealed a hyperintense T2 lesion, non-suggestive of MS, which progressively extended, associated with periventricular gadolinium enhancement visualized on brain MRI. Ophthalmological evaluation showed subclinical right optic neuritis. The absence of anti-AQP4 antibody argued against neuromyelitis optica spectrum disorder. A slight psychomotor slowing prompted us to search for various causes of autoimmune encephalitis. Anti-NMDAR-Ab was found in cerebrospinal fluid. CONCLUSION: In patients with extensive myelitis who are seronegative for anti-AQP4 antibodies, and after other classical causes have been excluded, the hypothesis of atypical anti-NMDAR-Ab encephalitis should also be considered

Plum pudding random medium model of biological tissue toward remote microscopy from spectroscopic light scattering

Biological tissue has a complex structure and exhibits rich spectroscopic behavior. There is \emph{no} tissue model up to now able to account for the observed spectroscopy of tissue light scattering and its anisotropy. Here we present, \emph{for the first time}, a plum pudding random medium (PPRM) model for biological tissue which succinctly describes tissue as a superposition of distinctive scattering structures (plum) embedded inside a fractal continuous medium of background refractive index fluctuation (pudding). PPRM faithfully reproduces the wavelength dependence of tissue light scattering and attributes the "anomalous" trend in the anisotropy to the plum and the powerlaw dependence of the reduced scattering coefficient to the fractal scattering pudding. Most importantly, PPRM opens up a novel venue of quantifying the tissue architecture and microscopic structures on average from macroscopic probing of the bulk with scattered light alone without tissue excision. We demonstrate this potential by visualizing the fine microscopic structural alterations in breast tissue (adipose, glandular, fibrocystic, fibroadenoma, and ductal carcinoma) deduced from noncontact spectroscopic measurement

Dépister la fragilité pour identifier les ainés à risque de délirium à l'urgence

Problématique : Le délirium est une complication fréquente mais sous-diagnostiquée chez les ainés qui séjournent dans les urgences et est associé à des issues de santé défavorables. La fragilité est un autre syndrome gériatrique reconnu comme un prédicteur indépendant d’issues défavorables chez les ainés et son dépistage est recommandé dans les urgences. Objectif : Évaluer si le dépistage de la fragilité permet d’identifier les patients âgés à risque de délirium survenant lors d’un séjour prolongé aux urgences. Méthode : Les données de la première phase de l’étude de cohorte prospective multicentrique MIDI-INDEED de 2015-2016 ont été utilisées. Les participants étaient âgés de 65 ans et plus, étaient sans délirium à leur admission aux urgences et y avaient tous séjourné 8 heures ou plus. La fragilité a été évaluée au moment de l’inclusion à l’aide du Canadian Study of Health Aging -Clinical Frailty Scale. Le délirium a été dépisté à l’aide du CAM, 2 fois par jour, pendant toute la durée du séjour aux urgences et jusqu’à 24 heures après l’admission sur une unité de soins. Résultats : Des 335 participants, 70 étaient fragiles, alors que 285 étaient robustes. L’incidence cumulée de délirium en fin de suivi était de 12 %. Parmi les patients fragiles, 20 (28,6 %) ont présenté un délirium durant leur séjour comparativement à 20 (7,6 %) patients robustes. Le risque ajusté de développer un délirium pendant le séjour aux urgences étaient 3,2 fois supérieur chez les patients fragiles. Aussi, le rapport de hasards ajusté de délirium démontre que le temps entre l’admission et le début du délirium était 2,44 ([1.26- 4.76], p=0.008) fois plus court chez les patients fragiles que chez les robustes. Conclusion: La fragilité est associée à un risque plus élevé de délirium survenant lors d’un séjour prolongé aux urgences. Le dépistage de la fragilité pourrait aider à identifier les ainés les plus à risque de délirium.Background: Delirium is a frequent complication among seniors in the emergency department (ED). This condition is often underdiagnosed by ED professionals even though it is associated with functional & cognitive decline, longer hospital length of stay, institutionalization and death. Besides, frailty is increasingly recognized as an independent predictor of adverse events in seniors and screening for frailty in EDs is now recommended. Objectives: The aim of this study was to assess if screening seniors for frailty could help identify those at risk of developing delirium during their ED stay. Methodology: This study is part of the multicenter prospective cohort MIDI-INDEED 2015- 2016 study. Patients aged ³ 65 years old, initially free of delirium were recruited after 8 hours of ED exposure & followed up to 24h after ward admission. Frailty was assessed at ED admission using the Canadian Study of Health and Aging-Clinical Frailty Scale (CSHA-CFS) which classified seniors from robust (1/7) to severely frail (7/7). Seniors with CSHA-CFS ≥ 5/7were considered frail. Their Delirium status was assessed twice daily using the Confusion Assessment Method (CAM). Results: Among the 335 participants, 70 patients were considered frail, while 265 were considered robust. The cumulative Incidence of delirium at the end of follow-up was 12%. Among the frail seniors, there were 20 (28.6%) patients with delirium, while there were 20 (7.6%) in the non-frail group. The risk of delirium during the ED stay was 3.2 times higher in frail patients then in robust ones, after adjusting for age (p<0,0001). Adjusted hazard of delirium was 2.44 times higher in frail than in robust patients(HR=2.44 [1.26-4.74] p=0.0083), suggesting that “time to delirium” was 2.44 times shorter in frail older patients than the robust ones. Conclusion: Increased frailty appears to be associated with increased incident delirium in older ED patients. Screening for frailty at emergency triage could help ED professionals identify seniors at higher risk

Essais thérapeutiques dans la sclérose en plaques (existe-t-il un biais dans la sélection des patients?)

LILLE2-BU Santé-Recherche (593502101) / SudocSudocFranceF

AAV9-Mediated Expression of SMN Restricted to Neurons Does Not Rescue the Spinal Muscular Atrophy Phenotype in Mice

International audienceSpinal muscular atrophy (SMA) is a neuromuscular disease mainly caused by mutations or deletions in the survival of motor neuron 1 (SMN1) gene and characterized by the degeneration of motor neurons and progressive muscle weakness. A viable therapeutic approach for SMA patients is a gene replacement strategy that restores functional SMN expression using adenoassociated virus serotype 9 (AAV9) vectors. Currently, systemic or intra-cerebrospinal fluid (CSF) delivery of AAV9-SMN is being explored in clinical trials. In this study, we show that the postnatal delivery of an AAV9 that expresses SMN under the control of the neuron-specific promoter synapsin selectively targets neurons without inducing re-expression in the peripheral organs of SMA mice. However, this approach is less efficient in restoring the survival and neuromuscular functions of SMA mice than the systemic or intra-CSF delivery of an AAV9 in which SMN is placed under the control of a ubiquitous promoter. This study suggests that further efforts are needed to understand the extent to which SMN is required in neurons and peripheral organs for a successful therapeutic effect

Is the drug burden index related to functional status at follow-up in community-dwelling seniors consulting for minor injuries-results from the Canadian Emergency Team Initiative cohort study

Background : The Canadian Emergency Team Initiative (CETI) cohort showed that minor injuries like sprained ankles or small fractures trigger a downward spiral of functional decline in 16% of independent seniors up to 6 months post-injury. Such seniors frequently receive medications with sedative or anticholinergic properties. The Drug Burden Index (DBI), which summarises the drug burden of these specifc medications, has been associated with decreased physical and cognitive functioning in previous research. Objectives : We aimed to assess the contribution of the DBI to functional decline in the CETI cohort. Methods : CETI participants were assessed physically and cognitively at baseline during their consultations at emergency departments (EDs) for their injuries and up to 6 months thereafter. The medication data were used to calculate baseline DBI and functional status was measured with the Older Americans Resources and Services (OARS) scale. Multivariate linear regression models assessed the association between baseline DBI and functional status at 6 months, adjusting for age, sex, baseline OARS, frailty level, comorbidity count, and mild cognitive impairment. Results : The mean age of the 846 participants was 77 years and their mean DBI at baseline was 0.24. Complete follow-up data at 3 or 6 months was available for 718 participants among whom a higher DBI at the time of injury contributed to a lower functional status at 6 months. Each additional point in the DBI lead to a loss of 0.5 points on the OARS functional scale, p<0.001. Among those with a DBI≥1, 27.4% were considered ‘patients who decline’ at 3 or 6 months’ follow-up, compared with 16.0% of those with a DBI of 0 (p=0.06). Conclusions : ED visits are considered missed opportunities for optimal care interventions in seniors; Identifying their DBI and adjusting treatment accordingly may help limit functional decline in those at risk after minor injury

Clinical phase I and pharmacokinetic study of S 16020, a new olivacine derivative: report on three infusion schedules.

S 16020, a new 9-OH olivacine derivative, is a novel topoisomerase II inhibitor with activity in cell lines presenting the classical multidrug resistance phenotype. This report summarizes, in addition to pharmacokinetic data, the whole phase I clinical experience of S 16020 using three different infusion schedules. Asthenia and skin toxicity were the main side effects. In an attempt to understand the skin toxicity mechanism, experiments in animals were performed, the results of which are reported. S 16020 showed rapid tumor necrotizing activity in some patients, with soft tissue metastases of epidermoïd tumors and pain at the tumor site. To document the side effects of S 16020 and tumor site reactions (pain, edema, inflammatory signs), inflammatory parameters and some cytokines were measured. In our patients there was no hemolysis and no detection of anti-S 16020 antibodies, confirming the absence of immunogenicity of the compound. Based on the overall data of the three infusion schedules of S 16020, the dose of 100 mg/m(2) over 3 h every 3 weeks was selected for phase II studies.Clinical TrialClinical Trial, Phase IJournal ArticleMulticenter Studyinfo:eu-repo/semantics/publishe

Histoire de l’éducation populaire, 1815-1945

L'histoire de l’éducation populaire suscite des recherches depuis une trentaine d’années mais il n’existe pas de bilan des travaux. Vingt-huit contributions concernant la France, d’autres pays européens et le Québec mettent l’accent sur le rapport complexe à l’école, la question du genre et la dimension politique de l’éducation populaire. L’action d’individus connus (Édouard Petit) ou méconnus (Maud Pledge), de groupes (les fouriéristes) est aussi bien évoquée que celle d’institutions comme les universités populaires de province ou la Jeunesse ouvrière chrétienne. Un intérêt particulier a été porté aux techniques : chanson, lecture populaire, documentation, cinéma, sans oublier plusieurs chapitres à caractère historiographique. En un volume est dressé un tableau de l’éducation populaire dans sa diversité, entre 1815 et 1945, date qui marque le début de son institutionnalisation.The history of Popular Education (Non Formal Education) has aroused research work for thirty years but yet no review of this work has been published. 28 contributions dealing with France, other European countries and Quebec focus on the complex relationship to school, gender and the political dimension of Popular Education