Development and initial validation of the polyhandicap severity scale.

OBJECTIVES: Providing a new tool, based on the point of view of experts in polyhandicap, which assesses the global severity of the health status of polyhandicapped persons is necessary. We present herein the initial validation of the polyhandicap severity scale (PSS). METHODS: The initial development of the tool was undertaken in two steps: item selection and validation process. The final set included 10 items related to abilities and 17 items related to comorbidities and impairments. The patient selection criteria were as follows: age>3 years, age at onset of cerebral lesion under 3 years old, with a combination of motor deficiency and profound intellectual impairment, associated with restricted mobility and everyday life dependence. External validity, reproducibility (20 patients), responsiveness (38 patients), and acceptability were explored. RESULTS: During the 18-month study period, a total of 875 patients were included. Two scores were calculated: an abilities score and a comorbidities/impairments score (higher score, higher severity). The 2 scores were higher for: older patients, patients with a progressive etiology, patients with more devices and more medications, patients with higher dependency and lower mobility. Indicators of reproducibility and responsiveness were satisfactory. The mean time duration of fulfilling was 22minutes (standard deviation 5). CONCLUSIONS: Quantifying the health severity of polyhandicapped persons is necessary for both healthcare workers and health decision makers. The polyhandicap severity scale provides the first reliable and valid measure of the health severity status for children and adults.

Perpendicular magnetic anisotropy and interfacial Dzyaloshinskii-Moriya interaction in as grown and annealed X/Co/Y ultrathin systems.

The perpendicular magnetic anisotropy (PMA) and the interfacial Dzyaloshinskii-Moriya interaction (iDMI) are investigated in as grown and 300 °C annealed Co-based ultrathin systems. For this, Co films of various thicknesses (0.8 nm ⩽ t Co ⩽ 5.7 nm) were deposited by magnetron sputtering on thermally oxidized Si substrates using Pt, W, Ir, Ti, Ru and MgO buffer or/and capping layers. X-ray diffraction was used to investigate their structural properties and vibrating sample magnetometry (VSM) was used to determine the magnetic dead layer thickness and the magnetization at saturation (M s). VSM revealed that the M s for the Pt and the Ir buffered and capped films is the largest. Microstrip line ferromagnetic resonance (MS-FMR), used to extract the gyromagnetic ratio of the thicker Co films, revealed the existence of a second order PMA term, which is thickness dependent. Brillouin light scattering (BLS) in the Damon-Eshbach configuration was used to investigate the thickness dependence of the iDMI effective constant from the spin wave vector dependence of the frequency difference between Stokes and anti-Stokes lines. BLS and MS-FMR techniques were combined to measure the spin wave frequency variation as a function of the in-plane applied magnetic field (where the second order PMA contribution vanishes). The thickness dependence of the effective magnetization was then deduced and used to investigate PMA. For all the systems, PMA results from interface and volume contributions that we determined. The largest interface PMA constants were obtained for Pt- and Ir-based systems due to the electron hybridization of Co with these heavy metals having high spin orbit coupling. Annealing at 300 °C increases both the interface PMA and iDMI for the Pt/Co/MgO most probably due to de-mixing of interpenetrating oxygen atoms from the Co layer and the formation of a sharp Co/O interface.

Magnetic and magneto-optical properties of assembly of nanodots obtained from solid-state dewetting of ultrathin cobalt layer.

An assembly of randomly organized cobalt nanoparticles were obtained by solid-state dewetting of a 3 nm-thick cobalt layer. Vibrating sample magnetometry and Brillouin light scattering techniques were used to investigate both their static and dynamic behaviors with respect to the initial native cobalt layer. The measurements obtained from the assembly of the obtained nanodots were analyzed by means of shape anisotropy contribution. The Brillouin spectra revealed an unusual reversed Stokes/anti-Stokes line height asymmetry comparing to that observed on the native layer. The effective optical properties of the nanodots, combined with the relation between mean field and inside-dot field allowed explaining the observed reversed height asymmetry. The assembly of nanodots behave as an effective magnetic and optical medium where these properties can be tuned by the elaboration process.

The interfacial nature of proximity-induced magnetism and the Dzyaloshinskii-Moriya interaction at the Pt/Co interface.

The Dzyaloshinskii-Moriya interaction has been shown to stabilise Nèel domain walls in magnetic thin films, allowing high domain wall velocities driven by spin current effects. The interfacial Dzyaloshinskii-Moriya interaction (IDMI) occurs at the interface between ferromagnetic and heavy metal layers with strong spin-orbit coupling, but details of the interaction remain to be understood and the role of proximity induced magnetism (PIM) in the heavy metal is unknown. Here IDMI and PIM are reported in Pt determined as a function of Au and Ir spacer layers in Pt/Co/Au,Ir/Pt. Both interactions are found to be sensitive to sub-nanometre changes in the spacer thickness, correlating over sub-monolayer spacer thicknesses, but not for thicker spacers where IDMI continues to change even after PIM is lost.

Current-induced skyrmion generation and dynamics in symmetric bilayers.

Magnetic skyrmions are quasiparticle-like textures which are topologically different from other states. Their discovery in systems with broken inversion symmetry sparked the search for materials containing such magnetic phase at room temperature. Their topological properties combined with the chirality-related spin-orbit torques make them interesting objects to control the magnetization at nanoscale. Here we show that a pair of coupled skyrmions of opposite chiralities can be stabilized in a symmetric magnetic bilayer system by combining Dzyaloshinskii-Moriya interaction (DMI) and dipolar coupling effects. This opens a path for skyrmion stabilization with lower DMI. We demonstrate in a device with asymmetric electrodes that such skyrmions can be independently written and shifted by electric current at large velocities. The skyrmionic nature of the observed quasiparticles is confirmed by the gyrotropic force. These results set the ground for emerging spintronic technologies where issues concerning skyrmion stability, nucleation and propagation are paramount.

[Venous thrombosis, unrecognized complication of DRESS]. / Thrombose veineuse, complication méconnue du DRESS.

BACKGROUND: DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms) is a rare syndrome triggered by an immunological reaction to certain drugs and which may be life-threatening as a result of the onset of severe organ involvement. It is characterised by a long period from the time of drug therapy to the onset of actual signs. Herein, we report the case of 42-year-old female patient who developed DRESS one month after beginning allopurinol treatment. PATIENTS AND METHODS: A 42-year-old woman was hospitalised for febrile exanthema with facial oedema, polyadenopathy, mononucleosis syndrome, major hypereosinophilia and hepatic cytolysis. A diagnosis was made of DRESS with a RegiSCAR score of 5. The implicated drug was allopurinol, which had been initiated one month earlier. HHV-6 IgM serology was positive. Two days after the start of systemic corticosteroids, the patient developed thrombosis of the internal jugular vein. Other than major hypereosinophilia, no other factors favouring thrombosis were detected. A favourable outcome was achieved under effective anticoagulants and corticosteroids. DISCUSSION: They have been rare reports of venous thrombosis during DRESS. Hypereosinophilia can be involved in the onset of this condition. Prophylaxis with systemic anticoagulants may be necessary in DRESS involving major hypereosinophilia.

Unmasking immune reconstitution inflammatory syndrome: a report of tuberculous epididymo-orchitis mimicking a testicular tumour in a Caucasian AIDS patient.

Worldwide, it is estimated that 14.8% of all new tuberculosis cases in adults are attributable to HIV infection. Genitourinary tuberculosis is a known complication and is considered to be a severe form of extrapulmonary tuberculosis. Isolated tuberculous epididymo-orchitis is rare. We report a Caucasian HIV-positive heterosexual male with a clinical diagnosis of testicular tumour for which he underwent a right orchidectomy. Tuberculous epididymo-orchitis was confirmed by histology. In this case, all Immune Reconstitution Inflammatory Syndrome (IRIS) criteria were met. We want to convey the message that in HIV-positive patients presenting with testicular swelling, an infective aetiology should be considered. This will increase the possibility of early diagnosis and proper management.

Autonomic neuropathy resulting in recurrent laryngeal nerve palsy in an HIV patient with Hodgkin lymphoma receiving vinblastine and antiretroviral therapy.

Hoarseness of voice due to vocal cord paresis as a result of recurrent laryngeal nerve palsy has been well recognised. Recurrent laryngeal nerve palsy is commonly caused by compression due to tumour or lymph nodes or by surgical damage. Vinca alkaloids are well known to cause peripheral neuropathy. However, vinca alkaloids causing recurrent laryngeal nerve palsy has been reported rarely in children. We report a case of an adult patient with HIV who developed hoarseness of voice due to vocal cord paralysis during vinblastine treatment for Hodgkin lymphoma. Mediastinal and hilar lymph node enlargement in such patients may distract clinicians from considering alternative causes of recurrent laryngeal nerve palsy, with potential ensuing severe or even life-threatening stridor.

Magnetic properties of exchange biased and of unbiased oxide/permalloy thin layers: a ferromagnetic resonance and Brillouin scattering study.

Microstrip ferromagnetic resonance and Brillouin scattering are used to provide a comparative determination of the magnetic parameters of thin permalloy layers interfaced with a non-magnetic (Al(2)O(3)) or with an antiferromagnetic oxide (NiO). It results from our microstructural study that no preferential texture is favoured in the observed polycrystalline sublayers. It is shown that the perpendicular anisotropy can be monitored using an interfacial surface energy term which is practically independent of the nature of the interface. In the interval of thicknesses investigated (5-25 nm) the saturation magnetization does not significantly differ from the reported one in bulk permalloy. In-plane uniaxial anisotropy and exchange bias anisotropy are also derived from the study of the dynamic magnetic excitations and compared with our independent evaluations using conventional magnetometry.

[Chagas disease in chronic phase outside the endemic area. The diagnostic tools]. / Maladie de Chagas en phase chronique hors zone d'endémie. Les outils diagnostiques.

The diagnosis of Chagas disease during the chronic phase is based on serology. Outside South America the use of two methods is recommended by WHO. A third method must be available for inconclusive results but there is no gold standard. A pilot study of screening in 254 Bolivian people living in the Paris area (France) was made. Serological study was performed using IIF and three Elisa, Elisa Cruzi (BioMérieux Brésil), BioElisa Chagas (Bio-kit), and Chagatest Elisa recombinante v. 3.0 (Wiener Lab). 165 patients were negative, 69 positive and 20 inconclusive. PCR-based assays appear to have a better sensitivity than parasitological methods, but not more than 70% that do not justify their use for primary testing. There are no standardized and commercial assays. The primer pairs based on the nuclear sequence TCZ1-TCZ2 seems to be the more specific (no cross reaction with others Trypanosomatidae) and the most sensitive with the strains of the two lineage of Trypanosoma cruzi. PCR would have a role in inconclusive serological cases or in the evaluation of treatment failure.

Spin wave modelling in arrays of ferromagnetic thin stripes: application to Brillouin light scattering in permalloy.

The magnetic Brillouin scattering of arrays of permalloy stripes with rectangular 29 nm × L cross section (L = 500, 1000, 1500 nm) is studied versus the amplitude and the direction of the applied magnetic field and of the transferred wavevector. A simple model provides a satisfactory agreement of the full set of experimental results: each stripe is viewed as a continuous film showing an in-plane anisotropy due to the demagnetizing effects induced by lateral surfaces. We introduce an anisotropy field H(a) = aM, where M stands for the magnetization and where the coefficient a can be evaluated directly, at least approximately. In addition, we give an account of the previously studied magnetic mode quantization and of the observed variations in the Stokes/anti-Stokes asymmetry in patterned arrays as well as in continuous films.

The peroxisome proliferator activated receptorgamma2 (PPARgamma2) Pro12Ala variant: lack of association with type 2 diabetes in obese and non obese Tunisian patients.

OBJECTIVES: Peroxisome proliferator activated receptorgamma2 (PPARgamma2) is a nuclear receptor that regulates adipocyte differentiation, lipid metabolism and probably insulin sensitivity. There have been several reports on the relationship between the PPARgamma2 Pro12Ala genotype and the development of obesity or type 2 diabetes. We designed a case-controlled study to investigate the potential association of the genetic variation of the PPARgamma2 gene with type 2 diabetes in Tunisians. METHODS: We used the polymerase chain reaction and restriction enzyme digestion to characterize the variation of the Pro12Ala polymorphism of the PPARgamma2 gene in 242 unrelated Tunisian patients with type 2 diabetes and 246 healthy control subjects. RESULTS: Analysis of the Pro12Ala polymorphism of the PPARgamma2 gene in patients with type 2 diabetes and in control subjects revealed no significant differences in the PPARgamma2 allele frequencies between diabetic patients and control subjects. However the PPARgamma2 Ala12 allele was found significantly associated with a high level of systolic blood pressure in diabetic patients. Stratification of diabetic patients on obese and non obese subjects showed non significant differences in the PPARgamma2 Ala12 frequency between the two groups. CONCLUSION: These results suggest that the PPARgamma2 gene is unlikely a major gene for type 2 diabetes mellitus or obesity in Tunisian subjects.

Polymorphism of stress protein HSP70-2 gene in Tunisians: susceptibility implications in type 2 diabetes and obesity.

OBJECTIVES: Tumor necrosis factor alpha (TNFalpha) is expressed primarily in adipocytes and elevated levels of this cytokine have been linked to obesity and insulin resistance. Several studies have shown statistical evidence of linkage between obesity and the chromosomal region encompassing the TNFalpha gene, suggesting that TNF alpha and/or a nearby gene is involved in the pathogenesis of obesity. Recently we analyzed the -308 TNFalpha polymorphism and that of HSP70-2 gene in Tunisian patients with obesity and no significant difference in allele frequencies of the -308 TNFalpha polymorphism was found between obese patients and controls. In contrast, polymorphism in HSP70-2 gene was found to be highly associated with obesity. Both TNFalpha and HSP70-2 genes have been mapped within the major histocompatibility complex (MHC). We designated a case-controlled study to investigate a potential association of genetic variation of the TNFalpha and that of the heat shock protein 70-2 (HSP70-2) with type 2 diabetes. METHODS: We used the polymerase chain reaction and restriction enzyme to characterize the variation of the TNFalpha promoter region and that of the HSP70-2 gene in 280 unrelated Tunisian patients with type2 diabetes and 274 healthy control subjects. RESULTS: Analysis of the -308 TNFalpha polymorphism in patients with type 2 diabetes and in control subjects revealed that the heterozygous TNF1/TNF2 genotype was significantly less frequent in the patient group (p=0.003), suggesting that TNF1/TNF2 may be considered as a protective marker against type 2 diabetes (OR=0.58). In contrast, a significant relative risk of type 2 diabetes was found associated with the P2-HSP70-2 homozygous genotype in non obese diabetic subjects (OR=1.97; p=0.0012). CONCLUSION: These results along with those showing high frequency of P2-HSP70-2 genotype in obese Tunisians, suggest that HSP70-2 polymorphism has susceptibility implications in both obesity and diabetes.

Surface acoustic waves in the GHz range generated by periodically patterned metallic stripes illuminated by an ultrashort laser pulse.

The photoelastic response of periodic arrays of stripes attached to the surface of a substrate and illuminated by an ultrashort laser pulse were investigated. The samples were gold arrays on silicon and aluminum arrays either on crystalline quartz or on silicon. The metallic stripes had submicrometer lateral dimensions and the spatial periods ranged from about 1 microm up to 5 microm. The substrate being transparent (quartz) or slightly absorbing (silicon) at the laser wavelength (lambda = 750 nm), a laterally modulated thermal stress is generated near the surface of the substrate when a light pulse illuminates the structure. The studies of vibrations involved by the subsequent relaxation processes show that surface acoustic waves at frequency as high as about 5 GHz are excited with the samples consisting of aluminum stripes. In the case of the aluminum samples with the largest lateral spatial periods (aluminum on quartz), the surface acoustic wave propagates outside the illuminated area. In the case of the gold samples, a normal mode of individual bars is observed instead. Experimental evidence shows that these behaviors are mainly governed both by the lateral spatial period of the structure and by the density of the metal.

Factors determining the use of hormone replacement therapy in recent naturally postmenopausal women participating in the French SU.VI.MAX cohort.

The determinants of hormone replacement therapy (HRT) were studied in a cohort of recently postmenopausal women participating, in France, in a nutritional study (SU.VI.MAX Study). Analysis was performed-analysis on 592 women aged 45 years or more, who had undergone natural menopause which appeared in the 2 previous years. No differences were observed in education level, socio-professional categories, marital status, geographic residence, smoking habits, physical activity, or past contraceptive practice. Past regular gynecologic follow-up appeared to be the strongest determinant of HRT use (odds ratio [OR]: 3.18). Women who reported having had at least one of the studied pathologies (past history of breast cancer, phlebitis, anger, uterine fibroma, hypertension, diabetes or hypercholesterolemia), past abundant menstrual blood losses, and with body mass index (BMI) > or = 25 were less likely to be taking HRT than women free of pathology, with no history of past abundant menstrual blood losses and with low BMI (OR respectively of 0.40, 0.64, 0.62). Women over 51.3 years of age were less likely to use HRT than younger women (OR: 0.92). Finally, in our population, while socio-economic level was not a major determinant of HRT use, the regularity of gynecological follow-up before menopause, overweight, and the existence of a definite or possible contra-indication were strong determinants of HRT use.

[A clinical trial of a titrated Olea extract in the treatment of essential arterial hypertension]. / Essai clinique d'un extrait titré de feuilles d'Olivier dans le traitement de l'hyptension arterielle essentielle.

A clinical assay of Olea europaea L. aqueous extract was carried on two groups of patients suffering with essential hypertension. 12 patients consulting for the first time, 18 patients with antihypertensive treatment. Treatment based on Olea europeae L. leaf aqueous extract was given (400 ng x 4/24 h) during 3 months, after 15 days treatment based on placebo. We note for all patients a statistically significant decrease of blood pressure (p < 0.001), we didn't find any modification of biological parameters excepted a significant little decrease of glycemia and calcemia p < 0.01 and p < 0.01 respectively. We didn't find any side effect in the two groups.

Heterogeneity of rabbit muscle creatine kinase and limited proteolysis by proteinase K.

By using sodium dodecyl sulphage/polyacrylamide-gel electrophoresis it was shown that rabbit muscle creatine kinase, both in a homogenate and purified, appears to be composed of a mixture of two peptides (mol.wts. 42100 and 40300) differing in length by about 15 amino acids. It is found that low concentrations of proteinase K from the fungus Tritirachium album can cleave about 38 amino acids from each chain of creatine kinase, leaving two large fragments (mol.wts 37700 and 35500). Scission of the whole enzyme was found to be concomitant with complete loss of enzyme activity. MgADP in the presence of absence of creatine slowed the rate of proteolysis by about 50%, but the transition-state analogue complex creatine-NO3--MgADP appeared to protect completely. The time course for the proteolytic inactivation in the presence of this complex, but not in its absence, was biphasic.