[Implementing new technology in radiation oncology: The French agency for nuclear safety (ASN) report]. / Conditions de mise en œuvre des « nouvelles techniques et pratiques ¼ en radiothérapie. Synthèse du rapport du groupe de travail issu du groupe permanent d'experts en radioprotection médicale de l'Autorité de sûreté nucléaire.

In August 2013, the French nuclear safety agency (ASN) requested the permanent group of experts in radiation protection in medicine (GPMED) to propose recommendations on the implementation of new technology and techniques in radiation oncology. These recommendations were finalized in February 2015 by the GPMED. In April 2015, the ASN sent a letter to the French ministry of health (DGS/DGOS), and its national health agencies (ANSM, INCa, HAS). In these letters, ASN proposed that, from the 12 recommendations made by the GPMED, an action plan should be established, whose control could be assigned to the French national cancer institute (INCa), as a pilot of the national committee for radiotherapy and that this proposal has to be considered at the next meeting of the national committee of radiotherapy.

Biodiversity and characterization of aerobic spore-forming bacteria in surimi seafood products.

The microbial quality and safety of surimi seafood products was assessed by studying the prevalence and biodiversity of aerobic spore-forming bacteria at the beginning and end of shelf life in 100 surimi samples. Low levels of total flora and sporulated flora were numerated at the beginning of storage, however, residual spores were detected in the majority of samples during storage. Furthermore, for 34 samples, total flora counts>10(4) CFU/g were observed at the end of shelf life which could lead to non-compliance with good practice recommendations or product spoilage. In total, 460 strains were isolated, fingerprinted by M13-PCR and grouped into 98 different clusters. Representative strains were then identified at the species level via 16S rRNA gene sequencing. Overall, dominant species belonged to Bacillus simplex, Bacillus subtilis and Bacillus licheniformis; while B. simplex, B. subtilis as well as Sporosarcina aquimarina were clearly the dominant species found in samples with higher total flora counts. Amylolytic and proteolytic activities were very frequent amongst tested strains (80 and 92.5%, respectively). Heat resistance parameters of 4 strains in a surimi-based medium were determined. B. simplex and B. subtilis strains were the most heat resistant (δ(96 °C)= 27.6 and 23.3 min and z(T)=8.6 and 7.9, respectively) which can explain their dominance in surimi samples exhibiting higher microbial counts. The heat resistance data obtained can now be used to model thermal destruction of strains using predictive microbiology tools (Sym'Previus).

Diagnosis and natural course of allergy to cooked potatoes in children.

BACKGROUND: Allergy to heat stable potato proteins can cause severe allergic disease in children. OBJECTIVE: To study diagnostic criteria for allergy to cooked potatoes and to describe its clinical characteristics and natural history. METHODS: Thirty-six children, aged 4-36 months, with atopic symptoms and having a positive potato-CAP and/or skin prick test (SPT) were included. Potato allergy was documented by means of provocation, or elimination and reintroduction or an unequivocal clinical history. Potato-CAP and SPT with a commercial extract were evaluated for diagnostic performance. RESULTS: Presenting symptoms in children with proven potato allergy (n = 17) were eczema (16 of 17), gastrointestinal complaints (eight of 17), urticaria and/or angioedema (five of 17), wheezing/rhinitis (three of 17) and anaphylaxis (two of 17). Fifteen children had previously diagnosed cow's milk protein allergy and were egg-sensitized. Potato-CAP at cut-off >2 kU/l provided a 100% sensitivity and a 62.5% specificity for diagnosis of potato allergy, while a SPT score >/= 3 had a 100% sensitivity and a score >/= 4 had a 100% specificity. Tolerance to cooked potato was achieved in 80% of subjects at age 16-102 months. Of 12 subjects having reached the age of 3 years during the study, 10 were re-evaluated at age 3-6 years: seven of 10 subjects had developed clinical pollen allergy, compared with four of 18 atopic controls (P < 0.05). CONCLUSIONS: Potato-CAP and SPT at specific cut-off are valuable tools in the diagnosis of allergy to cooked potato. Most children with potato allergy develop tolerance at mean age of 4 years. Allergy to cooked potatoes is a risk factor for the development of pollen allergy.

Involvement of 4-1BB (CD137)-4-1BBligand interaction in the modulation of CD4 T cell-mediated inflammatory colitis.

4-1BB ligand (4-1BBL) expressed on antigen-presenting cells interacts with 4-1BB on activated T cells (especially CD8+ cells) and co-stimulates the latter to secrete cytokines and to proliferate. The role of 4-1BB-4-1BBL interaction was studied here in a model of colitis based on naive CD4+ T cell transfer to SCID mice, a disease model in which CD8 cells do not take part. We found that CD4+ T cells from 4-1BB-deficient mice, after transfer in SCID mice, proliferated more rapidly compared to wild-type CD4+ T cells. Mice reconstituted with naive CD4+ T cells from 4-1BB-deficient mice developed colitis, however, with a mixed Th1/Th2 response, in contrast to the Th1-type response in mice reconstituted with wild-type naive CD4+ T cells. Importantly, this altered cytokine response did not temper colitis severity. Although it has been reported previously that 4-1BB co-stimulation may contribute to regulatory T cell functioning, we found that CD4+CD25+ regulatory T cells from 4-1BB-deficient mice were perfectly able to prevent naive CD4+ T cell-induced colitis. In conclusion, our data provide evidence that 4-1BB-4-1BBL interaction modulates the effector CD4+ T cell-driven immune response and cytokine production in experimental colitis without affecting regulatory T cell function.

Heat resistance of coliform species isolated from cooked ham, snail flesh, and 'bouchées à la reine'.

AIMS: In this study, the heat resistance of coliform species isolated from cooked ham and ready-made meals was determined. METHODS AND RESULTS: Thirteen coliform strains belonging to 12 different species were studied using laboratory medium in order to determine delta (first decimal reduction time) and z(T) values (temperature increase leading to a 10-fold reduction of delta) using the Weibull model. For seven strains, delta-values were determined at temperatures ranging from 55 to 60 degrees C, with, delta values between 0.52 and 2.98 min, at 59 degrees C. For the other six strains, lower temperature values were determined with delta-values ranging from 0.47 to 1.64 min at 54 degrees C. z(T) values calculated for the 13 strains were 3.1 to 7.5 degrees C. For eight strains, plotting of the log of survivors was not linear but rather showed shoulders or shoulders and tails. CONCLUSIONS: Coliform species were sensitive to heat treatment with a decimal reduction time under 2 min at 60 degrees C. SIGNIFICANCE AND IMPACT OF THE STUDY: The better knowledge of coliform heat resistance by determining thermal resistance parameters with confidence intervals will be useful for evaluating the efficiency of industrial thermal processes.

House dust mite-specific T cells in healthy non-atopic children.

BACKGROUND: T-helper type 2 (Th2) cells play an important role in the pathogenesis of allergic diseases. Recent studies have demonstrated that allergen-specific T cells can also be found in the blood of healthy individuals. Both IL-10 and IFN-gamma might modulate the induction and maintenance of allergen-specific tolerance. AIM: To study the phenotype and functional characteristics of allergen-specific T cells in healthy non-atopic children. METHODS: Peripheral blood mononuclear cells (PBMC) from 13 symptomatic house dust mite (HDM)-allergic children and from nine matched healthy control children were stimulated with recombinant (r)Der p 2, a major allergen from HDMs. RESULTS: Stimulation with rDer p 2 resulted in Th2 cytokine production in cultures of PBMC from allergic but not from healthy children. In contrast, IL-10 and IFN-gamma were induced in PBMC cultures from both healthy and HDM-allergic children. Intracellular staining revealed that IL-10 and IFN-gamma are largely produced by the same T cells. Stimulation of T cells from healthy children with rDer p 2 also induced expression of inducible costimulator (ICOS) on a small T cell subset. CONCLUSION: Allergen-specific memory T cells from healthy non-atopic children produce IL-10 and IFN-gamma (but not Th2 cytokines) and express ICOS upon stimulation. These cells might be responsible for a normal immune balance after allergen encounter in non-atopics.

Oral allergy syndrome to chicory associated with birch pollen allergy.

BACKGROUND: A few cases of IgE-mediated chicory allergy with oral, cutaneous, and/or respiratory symptoms are reported. We present 4 patients with inhalant birch pollen allergy and oral allergy syndrome to chicory. IgE-binding proteins in chicory and cross-reactivity with birch pollen were studied. METHODS: Chicory extract was prepared and immunoblotting was used to study IgE reactivity and cross-reactions with birch pollen. RESULTS: The pattern of IgE binding to chicory was variable among the patients, with protein bands recognized at 18, 21, 40, 52 and 71 kD. Bet v 1-like proteins were detected in chicory by monoclonal antibody binding. Chicory-birch pollen cross-reactivity, as studied in 2 patients from whom enough serum was available, could be demonstrated but did not involve the Bet v 1 protein family. In one of these cases, a 51-kD protein of birch pollen was found to be responsible for cross-reactivity. CONCLUSIONS: Chicory should be added to the list of foods that can cross-react with birch pollen and cause the birch pollen-associated oral allergy syndrome.

[Life-threatening cellulitis, or Fournier's gangrene of the perineum]. / Les cellulites graves, ou gangrène de Fournier du périnée.

The global mortality for Fournier's gangrene is one in five. In half the cases, the infection is polymicrobial with either anaerobes or gram negative bacilli. Factors which worsen prognosis include renal insufficiency, streptococcal infection, or need for hospital admission. Diagnosis must be prompt and treatment multidisciplinary involving the surgeon, intensivist, and infectious disease specialist; early and adequate surgical debridement must be accompanied by well-chosen antibiotics and hyperbaric oxygen therapy. Post-debridement therapy requires a long period of dressing changes and skin grafting to achieve final wound closure. This is an aggressive disease with a high mortality, but the depth and extent of invasive infection does not determine prognosis; the first priority is prompt and wide surgical excision/debridement of infected tissues to pre-empt the development of systemic sepsis; this should not be deferred while arranging transfer to a facility with a hyperbaric chamber.

[Black esophagus associated with hypothermia]. / Oesophage noir associé à une hypothermie.

The authors report a clinical case concerning a necrotizing esophagitis following severe hypothermic shock. They recall the usual aetiology of the "black esophagus", emphasize the importance of ischemia and the multispeciality management of this very unfrequent disease.

Purification and characterization of an 18-kd allergen of birch (Betula verrucosa) pollen: identification as a cyclophilin.

BACKGROUND: Five birch pollen allergens have been identified so far. In a previous study we detected new birch pollen allergens with an isoelectric point in the range 9.0 to 9.3, present only in extracts prepared at controlled basic pH. OBJECTIVE: The purpose of the current study was to purify and characterize those allergens. METHODS: The target allergens were purified by ion exchange and hydrophobic interaction chromatography. Analyses were carried out by SDS-PAGE, isoelectric focusing, immunoblotting, and amino acid sequencing. The in vivo reactivity of the allergens was evaluated by skin testing. RESULTS: An 18-kd protein, which we named Bet v 7, was purified. This 18-kd protein corresponded to 3 bands on isoelectric-focusing immunoblots that probably represent isoforms. On immunoblots up to 20.8% of birch pollen-allergic patients recognized those allergens. The clinical relevance of Bet v 7 was demonstrated by positive immediate-type skin testing on a patient allergic to birch pollen. Sequencing of an internal peptide yielded an amino acid sequence showing high homology with various plant cyclophilins. The rotamase activity of the protein, inhibited by cyclosporin A, further confirmed that Bet v 7 belongs to the group of cyclophilins. CONCLUSION: We have purified a novel allergen of birch pollen, Bet v 7, belonging to the cyclophilin family. Because cyclophilins are highly conserved proteins over the phylogeny, we may postulate that Bet v 7 is a member of a new family of panallergens.

Composition and stability of allergenic extracts made from gamma-irradiated rye grass (Lolium perenne) pollen.

BACKGROUND: Phenol is commonly added to allergenic extracts as a bacteriostatic agent, but it is poisonous and also detrimental to proteins, which accelerates extract degradation. Sterilization by gamma-irradiation of the source material could be an alternative to the use of phenol. OBJECTIVE: To analyse the potential effects of gamma-irradiation of pollen on the composition, potency, and stability of the resulting extract, and compare them with those of phenol. METHODS: Ryegrass (Lolium perenne) pollen was sterilized by gamma-irradiation at a dose of 25 kGy. Extracts prepared from the irradiated pollen were then compared by electrophoresis techniques and RAST inhibition to extracts, without or with 0.5% phenol, from nonirradiated pollen. In addition, proteolytic activity was compared in extracts from irradiated and nonirradiated pollen. To evaluate the stability of extracts on storage, they were analysed after forced degradation for up to 7 days at 37 degrees C. RESULTS: When fresh extracts were analysed, there were no noticeable differences between the three types, as judged by immunoblotting and RAST inhibition experiments. However, on storage, extracts from irradiated pollen appeared to be superior to extracts from nonirradiated pollen, as some proteins were more stable in the former. This could be related to the lower proteolytic activity we have also observed in extracts from irradiated pollen. In contrast, extracts containing phenol degraded much faster, as proven by all our methods of investigation. CONCLUSION: Gamma-irradiation of pollen did not influence the IgE-binding capacity of the resulting extracts, but did yield extracts with somewhat improved stability, probably by reducing the proteolytic activity. It may be concluded that gamma-irradiation of the source material represents a good alternative to the use of phenol for the preparation of allergenic extracts.

[Value of magnetic resonance cholangiography in the diagnosis of common bile duct cystic dilation]. / Intérêt de la cholangio-IRM dans le diagnostic de la dilatation kystique du cholédoque.

BACKGROUND: Magnetic resonance cholangiography is a noninvasive method for exploring the biliary and pancreatic ducts. Allergic risk is reduced as no contrast agent is required and there is no risk of infectious contamination due to catheterism. Unlike endoscopic retrograde cholangiography which requires anesthesia, there is no risk of morbidity. We report one observation of Todani type Ia cystic dilation of the main bile duct explored preoperatively with MR-cholangiography. CASE REPORT: A 39-year-old woman complained of acute abdominal pain. Physical examination revealed jaundice and fever. MR-cholangiography gave the diagnosis of angiocholitis with cystic dilatation of the main bile duct (type Ia). Surgery was indicated. The procedure included a Y-loop hepato-jejunal anastomosis and cholecystectomy. The postoperative period was uneventful. Pathology reported a cystic formation with no signs of malignancy. DISCUSSION: Common manifestations of congenital cystic dilatation of the main bile duct are biliary pain, fever and jaundice. The MR-cholangiogram provides a map of the bile duct system directly with a noninvasive procedure. The map may be obtained in several planes to guide surgery. Indeed, since cholangiocarcinoma is found in numerous cases, surgery is a formal indication in patients with angiocholitis.

Determination of independent risk factors and comparative analysis of diagnostic methods for immediate type latex allergy in spina bifida patients.

BACKGROUND: Development of allergy to natural rubber latex in spina bifida patients is determined by several risk factors, such as age, number of interventions and atopic disease that are, however, interdependent. Furthermore, several diagnostic procedures have been analysed, but a comprehensive analysis of their diagnostic significance is lacking. OBJECTIVE: To determine the independent major risk factor(s) for development of natural rubber latex allergy and the most valuable diagnostic procedure. METHODS: In aselectively collected spina bifida patients, we correlated existing natural rubber latex allergy with age, sex, atopy and the number of hospitalizations and of surgical interventions in appropriately matched subgroups. Allergy to natural rubber latex was established by application of a latex glove fragment on the skin. Skin-prick tests with glove eluate, a natural latex extract and a commercial latex extract were carried out as were specific IgE measurements by radioimmuno assay (RAST-CAP). The results of the latex application test are compared with the other diagnostic methods. RESULTS: Out of 74 fully evaluated patients, 17 had a positive application test. The number of surgical interventions correlates strongly with the presence of natural rubber latex allergy (P<0.0002), independent of age, sex and presence of atopy. Skin-prick tests with unstandardized allergens made from known high allergenic latex gloves represent the most sensitive diagnostic method, with the highest negative predictive value and a specificity of 0.95. RAST-CAP was the next best method with a specificity of 0.93, a sensitivity of 0.89 and a negative predictive value of 0.97. CONCLUSION: The number of surgical interventions is the major independent determining factor for allergy to natural rubber latex in spina bifida patients. Unstandardized skin-prick tests are the most sensitive and specific diagnostic tool, but RAST-CAP is almost equally performant and therefore a valid alternative.

Inhalative occupational and ingestive immediate-type allergy caused by chicory (Cichorium intybus).

We report a first case of occupational allergy to chicory (Cichorium intybus) in a vegetable wholesaler. Symptoms occurred after oral, cutaneous or inhalatory exposure. The patient also reported reactions after ingestion of botanically related endive (Cichorium endivia) and lettuce (Lactuca sativa). We identified the responsible allergen by SDS-PAGE and immunoblot to be a 48-kDa protein, confined to the non-illuminated parts of the plants. No cross-reactivity was found with mugwort (Artemisia vulgaris), ryegrass (Lolium perenne), and birch (Betula verrucosa) pollen, which suggests that the vegetable is the primary allergenic material.

The effect of sucrose on the quality of ryegrass (Lolium perenne) pollen extracts.

We studied the protein-stabilizing properties of sucrose, in the extraction medium, on the composition and stability of ryegrass (Lolium perenne) pollen extracts. The effect of 0.5 M and 1 M sucrose was assessed in the presence and absence of 0.5% phenol, which is commonly used as a disinfectant in industrially prepared allergenic extracts. In the absence of phenol, sucrose improves the stability of extracts during storage, but it has little influence on the extraction process. In the presence of 0.5% phenol, however, both the quality of fresh extracts and the stability are greatly improved by 0.5 M and by 1 M sucrose, as shown by electrophoresis, immunoblotting, and RAST-inhibition experiments. The protection afforded by sucrose against the degrading effect of phenol is particularly evident for the major allergen Lol p 1 and for a set of basic allergens. In this respect, sucrose has been found to be superior to glycerol, on an equimolar basis. One may envisage the use of 0.5 M sucrose in allergenic extracts for intradermal testing and immunotherapy.

Influence of the pH of the extraction medium on the composition of birch (Betula verrucosa) pollen extracts.

Extracts from birch (Betula verrucosa) pollen were prepared at different pH, with constant pH monitoring and adjustment to preset values in the range 5.5-8.5. The total protein content of these extracts was directly correlated with the pH. Coomassie brilliant blue-stained isoelectric focusing and SDS-PAGE gels and immunoblot analysis demonstrated qualitative differences: some proteins were lost while others appeared when pH was changed. At pH 8.5, formerly unknown birch pollen allergens were detected with pI 9, 9.10, and 9.30 by about 30% of birch pollen-sensitive sera. Birch pollen extracts prepared at a pH close to neutrality, namely, 6.5 and 7.5, showed the greatest protein and different allergen diversity. Thus, extraction pH values are necessary to analyze the whole pattern of allergenic components in an extract.

[Knee prosthesis in 1990. Apropos of a 15 years' experience]. / Les prothèses de genou en 1990. A propos d'une expérience de 15 ans.

Knee prostheses have been greatly refined over the past ten years. A range of prostheses with various designs are currently used. On the basis of their 15-year experience, the authors assess the role of the various prostheses. Among partial prostheses, the femoropatellar prosthesed have a restricted place and are reserved for isolate degenerative diseases of the femoropatellar joint without femorotibial involvement: 34 such prostheses have been used by the authors and the department of professor J.H. Aubriot in Caen. About 75% of the results are satisfactory, with a follow-up in time of more than 8 years in 6 of these cases. Single-compartment prostheses are used in degenerative disease on an angular deviation, condylar necrosis or post-traumatic lesions, as far as one compartment only is affected. The authors have inserted 115 "Lotus" uni-compartment prostheses at Saint-Louis hospital. 75.6% of these have very good or good results maintained in time, as 72% of the 32 prostheses still produce satisfactory results after 5 years or more. The greatest progress was made above all for total prostheses replacing all the compartments of the knee. Hinge prostheses now have only rare indications as first-intention prostheses due to the immediate vital risks and to the high percentage of suppuration and long-term loosening. Sliding prostheses have taken an increasingly dominant place. The authors used Insall's total condylar prostheses, which do not preserve the posterior cruciate ligament, until 1983. 45 prostheses were followed up for 1 to 10 years, showing 71% of very good or good results.(ABSTRACT TRUNCATED AT 250 WORDS)