Prions in Milk from Ewes Incubating Natural Scrapie

Since prion infectivity had never been reported in milk, dairy products originating from transmissible spongiform encephalopathy (TSE)-affected ruminant flocks currently enter unrestricted into the animal and human food chain. However, a recently published study brought the first evidence of the presence of prions in mammary secretions from scrapie-affected ewes. Here we report the detection of consistent levels of infectivity in colostrum and milk from sheep incubating natural scrapie, several months prior to clinical onset. Additionally, abnormal PrP was detected, by immunohistochemistry and PET blot, in lacteal ducts and mammary acini. This PrPSc accumulation was detected only in ewes harbouring mammary ectopic lymphoid follicles that developed consequent to Maedi lentivirus infection. However, bioassay revealed that prion infectivity was present in milk and colostrum, not only from ewes with such lympho-proliferative chronic mastitis, but also from those displaying lesion-free mammary glands. In milk and colostrum, infectivity could be recovered in the cellular, cream, and casein-whey fractions. In our samples, using a Tg 338 mouse model, the highest per ml infectious titre measured was found to be equivalent to that contained in 6 µg of a posterior brain stem from a terminally scrapie-affected ewe. These findings indicate that both colostrum and milk from small ruminants incubating TSE could contribute to the animal TSE transmission process, either directly or through the presence of milk-derived material in animal feedstuffs. It also raises some concern with regard to the risk to humans of TSE exposure associated with milk products from ovine and other TSE-susceptible dairy species

Defining the course of neurosarcoidosis according to presentation at onset and disease modifying treatment: a cohort study of 84 patients

Background: Neurosarcoidosis is a rare manifestation of sarcoidosis with heterogeneous presentations. Patient management is challenging due to the current lack of knowledge about the long-term disease course. Objective: To identify specific disease courses of neurosarcoidosis according to the clinical and paraclinical presentations at onset. Methods: We conducted an observational multicenter cohort study by retrospectively collecting data from the medical records of 84 patients diagnosed with definite, probable, or possible neurosarcoidosis in three tertiary referral centers in France (Nancy, Strasbourg, and Bordeaux). We collected demographic characteristics, clinical and paraclinical data at the beginning of patient management, and during follow-up under the different treatment lines. Two expert neurologists determined disease course profiles. Results: The mean follow-up was 6.6 years. Almost every patient (96.4%) received steroids at some point of their follow-up. Tumor Necrosis Factor-alpha blockers were given in 10.7% as first-line treatment and in 33.3% during follow-up. Every patient presented with a relapsing disease, often monophasic (75%) and sometimes polyphasic with the recurrence of identical manifestations (11.9%). Patients developing new neurological symptoms during follow-up were a minority (13.1%). No patients exhibited a progressive course. Patients with isolated cranial nerves injury or aseptic meningitis always exhibited a monophasic course, and 62.5–75% of them had a full recovery after first-line treatments. This proportion was 15.6% in other forms of the disease. Those with peripheral presentations were more likely to present a polyphasic course than patients with other forms of neurosarcoidosis. Spinal cord presentations were monophasic, but resulted in sequelae and exhibited poor response to first-line treatments despite frequent use of TNF-alpha blockers. Conclusion: Identification of these disease course profiles, based on the initial clinical and paraclinical presentation, could guide the clinician to select the optimal therapeutic approach and follow-up modalities for their patients with neurosarcoidosis

L'ordinaire des sciences et techniques. Cultures populaires, cultures informelles (6)

International audienceLa présente édition de la Lucarne matérialise la poursuite d’un travail engagé depuis 2013. Comme pour la précédente livraison, il a été réalisé dans le cadre d’un atelier collaboratif d’histoire socioculturelle. L’atelier lui-même est animé par un collectif formé des enseignant∙e∙s et auditeur∙rice∙s des formations du CNAM dédiées à la médiation socioculturelle des sciences et techniques. Certificat de compétences, Licence professionnelle ou Magister s’attèlent ainsi à la réflexion, à la conception et à la réalisation de dispositifs pour la médiation des sciences et techniques en société par le design culturel. C’est dans ce cadre de réalisation pédagogique que sont rassemblés ces textes et documents pour lesquels sont proposés de courtes analyses sur leur fonction de support de diffusion massive dans l’espace public d’une culture populaire et ordinaire des sciences et techniques. Tous ont été rédigés dans le cadre d’un exercice exigé pour la validation d’un enseignement. Si le résultat final peut s’avérer inégalement satisfaisant à l’aune des critères de leurs commanditaires, tous les textes apportent cependant un regard jugé pertinent sur un des aspects des manifestations des sciences et techniques dans leurs rapports à la société au travers de la production et de la consommation culturelle de masse. Quelques-uns ont été un peu remaniés pour la présente édition. Retrouvez-les tous, ainsi que d’autres non publiés dans ce volume, sur le site de la Lucarne : http://ateliercst.hypotheses.org

Pregnancy in women with Neuromyelitis Optica Spectrum Disorders: Recommendations from the French Multiple Sclerosis Society (P13-4.006)

International audienceObjective: To establish recommendations on pregnancy in women with neuromyelitis optica spectrum disorders (NMOSD).Background: In 2020, the French Multiple Sclerosis (MS) Society (SFSEP) decided to develop a national evidence-based consensus on pregnancy in MS. As NMOSD and MOG-antibody associated disease (MOGAD) share a series of commonalities with MS, and some significant differences about that topic, specific recommendations had to be developed.Design/Methods: The French Group for Recommendations in Multiple Sclerosis (France4MS) reviewed articles from PubMed and universities databases (January 1975 through December 2020). The RAND/UCLA appropriateness method, which was developed to synthesize the scientific literature and expert opinions on health care topics, was used to reach a formal agreement. 58 MS experts worked on the full-text review and initial wording of recommendations. A sub-group of 9 NMOSD experts was dedicated to analyzing of available data on NMOSD and MOGAD. A group of multidisciplinary healthcare specialists validated the final proposal of summarized evidences.Results: A strong agreement was reached for all 66 proposed recommendations. They cover diverse topics, such as pregnancy planning, follow-up during pregnancy and in the post-partum, delivery routes, loco-regional analgesia or anesthesia, prevention of post-partum relapses, breastfeeding, vaccinations, reproductive assistance, management of relapses, and disease-modifying treatments. Details will be presented at the AAN congress.Conclusions: Physicians and patients should be aware of the new evidence-based recommendations of the French MS Society for pregnancy in women with NMOSD and MOGAD

Pregnancy in women with Neuromyelitis Optica Spectrum Disorders: Recommendations from the French Multiple Sclerosis Society (P13-4.006)

International audienceObjective: To establish recommendations on pregnancy in women with neuromyelitis optica spectrum disorders (NMOSD).Background: In 2020, the French Multiple Sclerosis (MS) Society (SFSEP) decided to develop a national evidence-based consensus on pregnancy in MS. As NMOSD and MOG-antibody associated disease (MOGAD) share a series of commonalities with MS, and some significant differences about that topic, specific recommendations had to be developed.Design/Methods: The French Group for Recommendations in Multiple Sclerosis (France4MS) reviewed articles from PubMed and universities databases (January 1975 through December 2020). The RAND/UCLA appropriateness method, which was developed to synthesize the scientific literature and expert opinions on health care topics, was used to reach a formal agreement. 58 MS experts worked on the full-text review and initial wording of recommendations. A sub-group of 9 NMOSD experts was dedicated to analyzing of available data on NMOSD and MOGAD. A group of multidisciplinary healthcare specialists validated the final proposal of summarized evidences.Results: A strong agreement was reached for all 66 proposed recommendations. They cover diverse topics, such as pregnancy planning, follow-up during pregnancy and in the post-partum, delivery routes, loco-regional analgesia or anesthesia, prevention of post-partum relapses, breastfeeding, vaccinations, reproductive assistance, management of relapses, and disease-modifying treatments. Details will be presented at the AAN congress.Conclusions: Physicians and patients should be aware of the new evidence-based recommendations of the French MS Society for pregnancy in women with NMOSD and MOGAD

Pregnancy and multiple sclerosis: 2022 recommendations from the French multiple sclerosis society

International audienceObjective: The objective of this study was to develop evidence-based recommendations on pregnancy management for persons with multiple sclerosis (MS). Background: MS typically affects young women in their childbearing years. Increasing evidence is available to inform questions raised by MS patients and health professionals about pregnancy issues. Methods: The French Group for Recommendations in Multiple Sclerosis (France4MS) reviewed PubMed and university databases (January 1975 through June 2021). The RAND/UCLA appropriateness method was developed to synthesise the scientific literature and expert opinions on healthcare topics; it was used to reach a formal agreement. Fifty-six MS experts worked on the full-text review and initial wording of recommendations. A group of 62 multidisciplinary healthcare specialists validated the final proposal of summarised evidence. Results: A strong agreement was reached for all 104 proposed recommendations. They cover diverse topics, such as pregnancy planning, follow-up during pregnancy and postpartum, delivery routes, locoregional analgesia or anaesthesia, prevention of postpartum relapses, breastfeeding, vaccinations, reproductive assistance, management of relapses and disease-modifying treatments. Conclusion: The 2022 recommendations of the French MS society should be helpful to harmonise counselling and treatment practice for pregnancy in persons with MS, allowing for better and individualised choices

Pregnancy and neuromyelitis optica spectrum disorders: 2022 recommendations from the French Multiple Sclerosis Society

International audienceBackground: In 2020, the French Multiple Sclerosis (MS) Society (SFSEP) decided to develop a national evidence-based consensus on pregnancy in MS. As neuromyelitis optica spectrum disorders (NMOSD) shares a series of commonalities with MS, but also some significant differences, specific recommendations had to be developed.Objectives: To establish recommendations on pregnancy in women with NMOSD.Methods: The French Group for Recommendations in Multiple Sclerosis (France4MS) reviewed PubMed and universities databases (January 1975 through June 2021). The RAND/UCLA appropriateness method, which was developed to synthesise the scientific literature and expert opinions on health care topics, was used to reach a formal agreement. Fifty-six MS experts worked on the full-text review and initial wording of recommendations. A sub-group of nine NMOSD experts was dedicated to analysing available data on NMOSD. A group of 62 multidisciplinary healthcare specialists validated the final proposal of summarised evidence.Results: A strong agreement was reached for all 66 proposed recommendations. They cover diverse topics, such as pregnancy planning, follow-up during pregnancy and postpartum, delivery routes, loco-regional analgesia or anaesthesia, prevention of postpartum relapses, breastfeeding, vaccinations, reproductive assistance, management of relapses, and disease-modifying treatments.Conclusion: Physicians and patients should be aware of the new and specific evidence-based recommendations of the French MS Society for pregnancy in women with NMOSD. They should help harmonise counselling and treatment practise, allowing for better individualised choices

Pregnancy and multiple sclerosis: 2022 recommendations from the French multiple sclerosis society

International audienceObjective: The objective of this study was to develop evidence-based recommendations on pregnancy management for persons with multiple sclerosis (MS). Background: MS typically affects young women in their childbearing years. Increasing evidence is available to inform questions raised by MS patients and health professionals about pregnancy issues. Methods: The French Group for Recommendations in Multiple Sclerosis (France4MS) reviewed PubMed and university databases (January 1975 through June 2021). The RAND/UCLA appropriateness method was developed to synthesise the scientific literature and expert opinions on healthcare topics; it was used to reach a formal agreement. Fifty-six MS experts worked on the full-text review and initial wording of recommendations. A group of 62 multidisciplinary healthcare specialists validated the final proposal of summarised evidence. Results: A strong agreement was reached for all 104 proposed recommendations. They cover diverse topics, such as pregnancy planning, follow-up during pregnancy and postpartum, delivery routes, locoregional analgesia or anaesthesia, prevention of postpartum relapses, breastfeeding, vaccinations, reproductive assistance, management of relapses and disease-modifying treatments. Conclusion: The 2022 recommendations of the French MS society should be helpful to harmonise counselling and treatment practice for pregnancy in persons with MS, allowing for better and individualised choices

Pregnancy and multiple sclerosis: 2022 recommendations from the French multiple sclerosis society

International audienceObjective: The objective of this study was to develop evidence-based recommendations on pregnancy management for persons with multiple sclerosis (MS). Background: MS typically affects young women in their childbearing years. Increasing evidence is available to inform questions raised by MS patients and health professionals about pregnancy issues. Methods: The French Group for Recommendations in Multiple Sclerosis (France4MS) reviewed PubMed and university databases (January 1975 through June 2021). The RAND/UCLA appropriateness method was developed to synthesise the scientific literature and expert opinions on healthcare topics; it was used to reach a formal agreement. Fifty-six MS experts worked on the full-text review and initial wording of recommendations. A group of 62 multidisciplinary healthcare specialists validated the final proposal of summarised evidence. Results: A strong agreement was reached for all 104 proposed recommendations. They cover diverse topics, such as pregnancy planning, follow-up during pregnancy and postpartum, delivery routes, locoregional analgesia or anaesthesia, prevention of postpartum relapses, breastfeeding, vaccinations, reproductive assistance, management of relapses and disease-modifying treatments. Conclusion: The 2022 recommendations of the French MS society should be helpful to harmonise counselling and treatment practice for pregnancy in persons with MS, allowing for better and individualised choices