Diffuse laser illumination for Maxwellian view Doppler holography of the retina

We describe the advantages of diffuse illumination in laser holography for ophthalmology. The presence of a diffusing element introduces an angular diversity of the optical radiation and reduces its spatial coherence, which spreads out the energy distribution of the illumination beam in the focal plane of the eyepiece. The field of view of digitally computed retinal images can easily be increased as the eyepiece can be moved closer to the cornea to obtain a Maxwellian view of the retina without compromising ocular safety. Compliance with American and European safety standards for ophthalmic devices is more easily obtained by preventing the presence of a laser hot spot observed in front of the cornea in the absence of a scattering element. Diffuse laser illumination does not introduce any adverse effects on digitally computed laser Doppler images.Comment: 9 page

Book Review: Lessons from the Lobster-Eve Marder's Work in Neuroscience - Eve Marder’s Work in Neuroscience

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Teaching Neuroanatomy in the 19th Century: Dr Auzoux’s Papier-mâché Anatomical Models (S12.003)

International audienceObjective: To review and describe the anatomical models related to the brain and nervous system produced in the “Ateliers de l’anatomie clastique”(clastic anatomy workshops) founded by Dr Auzoux at Saint-Aubin-D’Ecrosville (Normandy, France) in 1828 Background: Dr Louis Thomas Jérôme Auzoux (1797–1880) was a French physician who specialized in the design, industrial production and sales of detachable anatomical models using his own innovative technique of papier mâché. His catalogue included a wide variety of human, animal, and botanical models. Our university’s collections include a few examples of these models, including a human brain. Design/Methods: Nonsystematic database (PubMed, Google Scholar, JSTOR, Internet Archive, Gallica) search, antique postcards database search and screening of online newspapers archives (RetroNews®, Newspapers. com®), with the search terms (English & French) Dr Auzoux, papier mâché, clastic anatomy (search period: 1797–1880) Results: Auzoux’s anatomy models were made of several solid parts that could be removed one by one, mimicking the dissection process:“a brain is constructed, in which, by means of numerous sections and the super-position of different parts, are shown all the details of its structure as well as the origin of the nerves in the whole extent of the cerebro-spinal axis”(“Catalogue of preparations of artificial anatomy”, 1841). Auzoux’s models of human neuroanatomy included brains (of different sizes) and the spinal marrow. Its comparative anatomy catalogue (1844) included the brain and the spinal marrow of several animals (rat, cat, goose, viper, tortoise, carp, molusca) and the nervous system of others (spider, crab, articulata & radiata). Conclusions: During the 19th century, Dr Auzoux’s brain anatomical models were used to teach neuroanatomy in different contexts, for both students (universities, schools) and the general public

The hidden faces of apomorphine : lessons from the past, current experimentations and future challenges

Doyenne de la thérapeutique antiparkinsonienne, puissant outil pharmacologique au profil singulier, l’apomorphine est aujourd’hui indiquée comme thérapeutique de deuxième intention, au stade où les fluctuations liées au traitement oral handicapent le quotidien des patients. Si ses effets sur la triade parkinsonienne et les fluctuations motrices sont connus et objectivés depuis le milieu du XXème siècle, son spectre d’action sur les troubles non moteurs a, quant à lui, été encore peu exploré. Ce travail de thèse avait deux objectifs : (1) établir un état de l’art quant aux connaissances actuelles sur l’apomorphine et (2) étudier les effets d’un traitement par pompe à apomorphine sur la symptomatologie non motrice parkinsonienne, en particulier aux plans cognitifs et émotionnels, sur une période de six mois. Pour ce faire, deux études ont été menées. La première, intitulée APO-TEP, s’intéressait à l’évolution de l’état cognitif et de la qualité de vie de patients présentant la maladie à un stade avancé, mais ne pouvant bénéficier de la chirurgie de stimulation cérébrale profonde du noyau subthalamique. Une exploration du métabolisme cérébral était associée à l’évaluation clinique. Ce travail a permis de mettre en évidence une amélioration significative des fonctions motrices, cognitivo-psychiatriques (fonctions exécutives et apathie) et de la qualité de vie après six mois de traitement. Des modifications d’activité cérébrale dans les réseaux fonctionnels cognitifs, moteurs et limbiques ont par ailleurs été observées, soutenant l’idée d’un substratum anatomo-fonctionnel diffus. La seconde étude, intitulée APO-EMO, évalue les effets du traitement par pompe à apomorphine sur la sphère émotionnelle, souvent altérée dans la maladie de Parkinson. Cette dernière étude est toujours en cours ; les résultats préliminaires ne mettent pour l’heure pas en évidence d’effets sur la perception individuelle des émotions (intelligence émotionnelle et expressivité). Les analyses visant à explorer les effets du traitement sur le mimétisme facial et la reconnaissance des expressions faciales émotionnelles seront menées dans un second temps. L’ensemble de ces résultats expérimentaux est discuté à la lumière des données de la littérature et plusieurs perspectives cliniques et de recherche sont développées. De nouveaux travaux, visant à mieux comprendre les réseaux neuronaux et les voies neurochimiques activées par l’apomorphine en perfusion continue, sont à mener. Longtemps cantonnée au rang de curiosité pharmacologique, l’apomorphine semble enfin trouver sa place dans l’arsenal thérapeutique.Apomorphine is a peculiar drug, currently used as a second-line therapy in Parkinson’s disease (PD). If its motor efficacy has been amply established, questions remain about its effect on non motor symptoms, a common burden in PD. This thesis address these questions by (1) reviewing the state of the art of the current knowledge about apomorphine (history, pharmacology and current interest in neurological disorders) and (2) exploring the effect of continuous subcutaneous apomorphine infusion (CSAI) on cognitive and emotional symptoms in PD, while studying brain metabolism. Two studies were conducted: APO-TEP and APO-EMO. Well-tolerated, CSAI appears to be an interesting option in advanced PD. Changes in brain metabolism (motor, cognitive and limbic networks) were observed at 6 months and correlated to clinical improvement (executive functions, apathy and motricity) in patients with advanced PD and contra-indications for subthalamic nucleus deep brain stimulation. Preliminary results of the ongoing APO-EMO study suggest that CSAI does not seem to improve emotional self-perception in patients; however we will further explore its effect on facial mimicry and facial emotion recognition. If further research is still needed, apomorphine seems to be destined to become a key feature of future therapeutic strategies, in PD (nonmotor symptoms, advanced PD, withdrawal of oral medications) but also in other dopaminergic disorders, and rightly so

War neuroses at the beginning of the Great War in France: the case of Eugene Bouret (1887-1914)

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Perspectives pour l'amélioration du bon usage des antibiotiques au centre hospitalier et universitaire de Rennes

Depuis de nombreuses années, l'émergence de souches bactériennes résistantes aux antibiotiques préoccupe la communauté scientifique. En France, la consommation d'antibiotiques reste supérieure à celle de ses voisins européens, en ville comme à l'hôpital. Additionnées à un mésusage de certain des molécules, ces tendances ont conduit à l'apparition de situations d'impasse thérapeutique de plus e plus fréquentes. AU CHU de Rennes, une politique antibiotique a été établie depuis le début des années 1990, permettant de maintenir l'établissement à un rang satisfaisant dans le classement national en termes de consommation d'antibiotiques. Cependant, une faible consommation n'est pas forcément synonyme de bon usage, et de nombreuses actions peuvent être engagées à différents niveaux pour renforcer une politique déjà bien établie et fonctionnelle, aux enjeux à la fois sanitaires et économiques. Après avoir dressé un état des lieux, nous avons mené une revue de littérature dans le but d'envisager les différentes mesures susceptibles d'être mises en place au sein du CHU. Les paramètres indispensables à la réussite à long terme de toute politique antibiotique sont un soutien financier (et donc administratif) conséquent et durable, ainsi qu'un engagement de l'ensemble des professionnels hospitaliers concernés. Les efforts déjà engagés au CHU doivent être poursuivis et diffusés à l'ensemble des personnels concernés, l'éducation étant une des clés de voûte de la réussite de ce type de programme. Les perspectives phares sont la création d'un binôme permanent infectiologue-pharmacien dédié à la gestion de l'antibiothérapie, associée à une logistique renforcée et des mesures éducatives réitérées.Despite numerous guidelines and recommendations, antibiotic use in French hospital remains above the European average, with a high risk of misuse fostering he emergence of multi-resistant bacteria. Antibiotic prescribing in hospital is highly complex and requires the expertise of all practitioners. At the Teaching Hospital of Rennes, there have been on-going efforts to implement a sustainable antibiotic policy. The aim of this study was to find new ways of improving our antibiotic policy, through a literature review and an analysis of the local situation. The biggest obstacle remains lack of funding to ensure the development and success of a multimodal antimicrobial stewardship program; administrative support is much needed. The main perspectives to improve antibiotic stewardship at the Teaching Hospital of Rennes are the creation of a dedicated team composed of an infectious disease specialist and a pharmacist, bolstered by computerized decision support, on-going education and implication of all the health-care professionals as well as financial support.LYON1-BU Santé (693882101) / SudocRENNES1-BU Santé (352382103) / SudocSudocFranceF

John Yerbury Dent and Apomorphine: an unfinished history

International audienc

From Shadow to Spotlight: The (Re)discovery of Trepanned Skulls in France During the 19th Century

International audienceObjective: To understand the French interest in trepanation that emerged following Broca’s paper (1867) in various scientific disciplines, including neurology. To describe the trepanned skulls found on French soil during the 19th century.Background: The study of trepanation is one of Paul Broca’s many contributions to the medical field. His interest in brains and skulls led Ephraim Georges Squier, an American diplomat and archaeologist, to travel to Paris to show him an old Peruvian skull presenting a seemingly man-made rectangular opening. Following this encounter, Broca published a first analysis on Squier’s skull in 1867, suggesting that the cranial opening was the result of surgery. This landmark paper initiated a scientific fascination with ancient skulls found on French soil.Design/Methods: A literature search for French articles related to trepanned skulls discovery and/or analysis between 1800 and 1900 was undertaken, using various databases such as Calames, BnF Gallica Archives, JStor, Internet Archive and Google Scholar.Results: The discovery of trepanned skulls, particularly from the Neolithic period, was not rare on French soil. If some of these skulls were found prior to 1867, and even before the birth of the 19th century, the majority of them were retrieved and analyzed following the excitement initiated by Broca’s papers. Along with Paul Broca, Barthélémy Prunières, Ernest Chantre, Paul du Chatellier and Armand de Quatrefages are the most prominent figures in the study of trepanation in France during the 19th century. Together, they described dozens of trepanned skulls found in different areas (eg: Lozère, Bretagne or Paris Bassin) and discussed several theories on trepanation.Conclusions: The study of French ancient skulls, initiated by a brilliant neurologist, brought together experts from several disciplines (archeology, neurology and anthropology), highlighting the close relationship that has always existed between medicine and humanities

New tricks for an old dog a repurposing approach of apomorphine

International audienceApomorphine is a 150-year old nonspecific dopaminergic agonist, currently indicated for treating motor fluctuations in Parkinson's disease. At the era of drug repurposing, its pleiotropic biological functions suggest other possible uses. To further explore new therapeutic and diagnostic applications, the available literature up to July 2018 was reviewed using the PubMed and Google Scholar databases. As many of the retrieved articles consisted of case reports and preclinical studies, we adopted a descriptive approach, tackling each area of research in turn, to give a broad overview of the potential of apomorphine. Apomorphine may play a role in neurological diseases like restless legs syndrome, Huntington's chorea, amyotrophic lateral sclerosis, Alzheimer's disease and disorders of consciousness, but also in sexual disorders, neuroleptic malignant(-like) syndrome and cancer. Further work is needed in both basic and clinical research; current developments in novel delivery strategies and apomorphine derivatives are expected to open the way

Hidden in plain sight: a rationale for repurposing apomorphine in addiction disorders

International audienceObjective: To investigate the potential role of apomorphine as a treatment for addiction disorders.Background: 19.7 million American adults suffered from a substance abuse disorder in 2017 (National Survey on Drug Use and Health). To date, effective treatment for addiction is still lacking, and many of the programs often fail to keep patients drug-free. Considering the health, social and economic burden of addiction, new strategies are needed. Drug repurposing may be one option, with candidates such as apomorphine. Currently prescribed in Parkinson’s disease, apomorphine has already been used as a treatment for addiction, mainly to alcohol (but also opiates), between the beginning of the 20th century and the late 1970’s. If aversion therapy was the most common approach, some clinicians suspected another action, based on possible anti-craving properties.Design/Methods: A nonsystematic database (PubMed, Google Scholar, JSTOR, Internet Archive, BnF Gallica) search for French and English articles related to the use of apomorphine in addiction (regardless of the type) was undertaken.Results: Several historical reports (starting as early as 1899) suggest that apomorphine may play a role in relieving alcoholic craving. These empirical assumptions are supported by recent data from animal models. The dopaminergic and serotonergic (5-HT1 & 5-HT3 receptors) systems, both involved in alcohol dependence, are targeted by apomorphine stimulation. Apomorphine upregulates NGF and GDNF synthesis in cell cultures: these neurotrophic factors are known to modulate addictive behavior. Additionally, apomorphine displays neuroprotective properties against ethanol-induced neurodegeneration in the adult rat cortex. Finally, a recent review on smoking cessation suggested that apomorphine might be a useful treatment.Conclusions: There is now a considerable body of both historical and neuromolecular evidence to support further research studying the role of apomorphine in addiction