Cerebellar syndrome associated with legionellosis: A case report and literature review.

INTRODUCTION: Legionnaire's disease is a community-acquired pneumonia caused by the Gram-negative bacterium Legionella pneumophila. This disease is often associated with neurological symptoms, the clinical presentation of which can be very varied. CASE REPORT: We report a 47-year-old female patient who developed Legionnaires' disease with cerebellar symptoms (ataxia, dysarthria and hypermetria). Laboratory tests revealed a biological inflammatory syndrome. The cerebrospinal fluid was sterile. Urinary antigen test and serology were positive for L. pneumophila. An interstitial syndrome of the right upper lobe was detected on chest computed tomography (CT) scan. Brain imaging (magnetic resonance imaging and CT angiography) showed no abnormalities. The outcome was favourable after treatment with spiramycin, levofloxacin and corticosteroids. DISCUSSION: Few cases only (n=110) of Legionnaires' disease with cerebellar symptoms have been reported in the literature. The pathogenic mechanism behind neurological dysfunction in patients with Legionnaires' disease is unknown. Neurological symptoms improve with antibiotic therapy and corticosteroids. Extra-pulmonary forms of Legionnaires' disease are frequent, with neurological symptoms being the most common symptoms. Cerebellar dysfunction may be underestimated and requires appropriate management with antibiotic therapy and corticosteroid therapy. Recommendations for the management of Legionnaire's disease with severe extra-pulmonary symptoms are needed.

Azithromycin resistance in Treponema pallidum in Reunion Island: A cross-sectional study.

OBJECTIVE: Since the beginning of the 21st century, Reunion Island has experienced a syphilis epidemic. Infected patients are mostly heterosexual, with a high proportion of women, suggesting that congenital syphilis is present on the island. To determine whether azithromycin can be used for mass treatment of syphilis on Reunion Island, we assessed the prevalence of macrolide resistance in Treponema pallidum (TP). METHODS: This monocentric cross-sectional study was conducted at the Reunion Island University Hospital. Samples were collected from lesions suggestive of primary or secondary syphilis. Samples positive for TP by multiplex polymerase chain reaction (PCR) were sent to the French National Reference Centre (NRC) for further analysis. Nested PCR-tpp47 was performed on these samples for detection of TP-DNA; 23s rRNA was amplified by PCR in confirmed positive samples. The Restriction Fragment Length Polymorphism (RFLP) technique was performed on samples with amplified 23s rRNA for detection of the A2058G mutation. RESULTS: A total of 129 samples were collected from 119 patients. Of these, 18 tested positive for TP using multiplex PCR and were sent to the NRC. Fifteen (83.3%) of the 18 samples were confirmed positive by nested PCR-tpp47, and 23s rRNA was amplified in only 7 (38.9%) samples. Azithromycin resistance was detected in all TP strains with amplified 23s rRNA. CONCLUSION: Amplification of 23s rRNA was successful in only 7 TP strains, all of which displayed resistance to macrolides. Keeping in mind the small sample size of our study, this suggests that azithromycin should not be used for mass treatment of syphilis in Reunion Island.

[Efficacy and safety of flibanserin "new female Viagra®?": Literature review]. / Efficacité et sécurité de la flibansérine « nouveau Viagra® féminin ? ¼ : revue de la littérature.

INTRODUCTION: In August 2015, the US Food and Drug Administration (FDA) has approved Addyi® (flibanserin) for treatment of acquired, generalized hypoactive sexual desire disorder (HSDD) in pre-menopausal women. We carried out a systematic review and meta-analysis to assess the efficacy and safety of the drug in women with HSDD. PATIENTS AND METHODS: A systematic literature review from the PubMed database search was carried out until April 2016 using the following keywords: "HSDD", "flibanserin", "sexual desire" and "ransomised controlled trial". RESULTS: We found four randomized double-blind control studies and two meta-analyzes and literature reviews. For the comparison of flibanserin with placebo, the results were reported in standardized mean difference (SMD). Regarding the main criterion "Satisfactory Sexual Event" (SSE), SMD was ranged from 0.49 to 1 (P<0.05); "Desire Sexual Score" SMD was ranged from 1.63 to 2.20 (P<0.05). For the Female Sexual Function Index (FSFI) desire domain score SMD was ranged from 0.03 to 0.4 (P<0.05). Adverse effects were mostly minor: dizziness and drowsiness. CONCLUSION: Flibanserin showed a moderate benefit in terms of frequency of sex and patient satisfaction. The long-term safety of flibanserin is still poorly defined and scientific data concerning this drug are still few.

[Perinatal mortality and quality of clinical management in the Aurore network from 2005 to 2011. Implementation of morbidity and mortality conferences]. / Mortalité périnatale et qualité des prises en charge au sein du réseau Aurore de 2005 à 2011. Mise en place des réunions de morbi-mortalité au sein du réseau.

OBJECTIVES: Evaluate the incidence of perinatal mortality and evaluate the percentage of non optimal care management of fatal pregnancies between 2005 and 2011 in the Rhone-Alpes region in France, by the use of the Aurore network. Evaluate the development of morbi-mortality revues (MMR) in this region. METHODS: Retrospective study of perinatal mortality in the Aurore network, from 2005 to 2011. Systematic analysis of care management (adapted, non adapted, non evaluable), of each perinatal death that occurred in the Aurore network, by a multidisciplinary committee during regional MMR. RESULTS: The incidence of perinatal mortality has diminished from 2005 to 2011 (8,4‰ vs. 6,4‰, P<0.07) as well as the percentage of non adapted care management (13% vs. 5,6%, P<0.001). An underestimation of irregularities in the fetal heart rate was described in 34% of per partum deaths. The percentage of optimal care management was significantly higher when the obstetrician was in the maternity rather than on call at home (P<0.03) and in type 3 maternities compared to type 1 and 2 maternities (P<0.04). The attendance of the MMR organized in the AURORE network progressed between 2006 and 2011. CONCLUSION: Since 2005, a decrease in perinatal mortality and in non-adapted care management was observed. More studies are necessary to evaluate the link between the development of MMR in this network and the amelioration of these two indicators.

[Comparison of three models to predict non-sentinel lymph node status in breast cancer patients with metastatic sentinel lymph nodes: a retrospective study of 77 patients]. / Comparaison de trois modèles prédictifs d'envahissement des ganglions non sentinelles en cas de métastases des ganglions sentinelles dans le cancer du sein: une étude rétrospective sur 77 patientes.

UNLABELLED: Various statistic predictive models have been developed to predict the status of the non-sentinel lymph nodes (NSLN) when the sentinel one was invaded by tumor cells in the case of breast invasive carcinoma. The objective of this study was to compare the accuracy of three of these statistic models: the MSKCC nomogram, the Tenon score and the MDA score. The study was conducted at Croix Rousse Hospital, Lyon, France. OBJECTIVE: When sentinel lymph node is invaded by metastasis, complete lymph node dissection of the axilla can be avoided using statistic predictive models especially when talking about micrometastases and moreover about isolated tumor cells in the sentinel lymph node. Over the different existing models, we tested the three most used ones to determine the model that is most adapted to our everyday practice. METHOD: The study population consisted of 77 women with an invasive breast cancer treated by complete axillary lymph node dissection for metastatic sentinel lymph node. Over the nine models already published, we focused on three of them due to their ease to use as well as their good preliminary results: the Memorial Sloan-Kettering Cancer Center nomogram (MSKCC), the Tenon score and the M.D Anderson score (MDA). Different criteria are used by these models, but all of them take in consideration: tumor size, multifocality, tumor type, lymphovascular invasion, hormonal receptors, number of sentinel lymph node resected, degree of sentinel lymph node invasion (i.e. macrometastasis, micrometastasis or isolated tumor cells) and histologic method used to diagnose sentinel lymph node invasion. These scores are validated depending on their false negative ratio as well as the proportion of patient selected as having a low risk of non-sentinel lymph node invasion. The major criterion for the MSKCC score is the calibration that compares the predicted likelihood of invasion and the histologically proved one. RESULTS: The rate of non-sentinel lymph node invasion was 37.6%. The discrimination of the three models was good with an AUC of 0.74 for both MSKCC nomogram and Tenon score and of 0.72% for MDA score. MSKCC nomogram was well calibrated (P=0.23). The false negative ratio was 0 (CI 95%: 0-18.1%) for MSKCC nomogram, 16.7% (CI 95%: 8.6%-27.8%) for Tenon score and 16% (CI 95%: 6.8-31%) for MDA score. The percentage of patients considered as having a low risk of invasion of the non-sentinel lymph node was 20.5% for MSKCC nomogram, 34.7% for MDA score and 47.4% for Tenon score. CONCLUSION: MSKCC nomogram seems to be the statistic model that is most adapted to the population we studied. To validate the Tenon and MDA score, we should have a most important population.

Current-induced two-level fluctuations in pseudo-spin-valve (Co/Cu/Co) nanostructures.

Two-level fluctuations of the magnetization state of pseudo-spin-valve pillars Co(10 nm)/Cu(10 nm)/Co(30 nm) embedded in electrodeposited nanowires ( approximately 40 nm in diameter, 6000 nm in length) are triggered by spin-polarized currents of 10(7) A/cm(2) at room temperature. The statistical properties of the residence times in the parallel and antiparallel magnetization states reveal two effects with qualitatively different dependences on current intensity. The current appears to have the effect of a field determined as the bias field required to equalize these times. The bias field changes sign when the current polarity is reversed. At this field, the effect of a current density of 10(7) A/cm(2) is to lower the mean time for switching down to the microsecond range. This effect is independent of the sign of the current and is interpreted in terms of an effective temperature for the magnetization.

Echocardiography, color-coded Doppler imaging, and abdominal sonography, a non-invasive method for investigation of heart and aortic morphology and function in female gottingen minipigs: method and reference values for M-mode, B-mode, and flow parameters.

OBJECTIVE: The aim of the study reported here was to set up a method for echocardiography (EC) and abdominal sonography and to obtain EC reference values for left ventricular (LV) morphology and function and sonographic abdominal aortic morphology, function, and flow values in conscious, unsedated Gottingen minipigs. METHODS: Applying a standardized investigation procedure, the following parameters were measured by use of M-mode EC, color-coded Doppler imaging, and B-mode sonography, or were calculated, in 58 female minipigs: LV end-diastolic and end-systolic diameter, interventricular septum thickness, LV caudal wall thickness, LV end-diastolic volume and end-systolic volume, fractional shortening, ejection fraction, and percentage of thickening of interventricular septum and LV caudal wall. In addition, morphology, pulsatility, flow values, and flow patterns in the abdominal aorta were recorded or calculated during abdominal sonography and color-coded Doppler imaging. RESULTS: Variable EC values were obtained due to individual variations of motor activity. Variation could be reduced by accustoming the animals to a standardized investigation procedure. Reference values could be obtained for EC, partially indicating clear correlation with body weight. Color-coded Doppler and Doppler spectra did not indicate flow disturbances in large arterial abdominal vessels. CONCLUSIONS: Results indicate that handling during EC and sonography can cause discomfort in unsedated minipigs that may interfere with recording of valid reference values for functional cardiac parameters in young animals. Accustoming the animals to a standardized investigation procedure reduces stress to a satisfactory level and enables data recording. Thus the minipig is considered suitable for assessment of cardiovascular parameters in experimental or toxicologic studies.

Ultrastructural localization of endogenous hormones and receptors in bone tissue: an immunocytological approach in frozen samples.

In addition to their well-known mechanical role, bones are essential for the regulation of calcium phosphate metabolism. Most of the peptide and steroid hormones acting on bone tissue exert their cellular effects directly on bone cells after binding to cell receptors. A combined method using immunocytology on ultrathin frozen sections has been applied to bone tissue and made possible the ultrastructural localization of endogenous hormones and hormone receptors. There is immunocytological evidence, at the osteoblast level, for: (1) the presence of calcitonin, parathyroid hormone, growth hormone, 1,25 dihydroxyvitamin D3, aldosterone, corticosterone and progesterone; (2) the existence of 1,25 dihydroxyvitamin D3 and progesterone receptors; (3) the absence of estradiol and receptors, testosterone and gonadoliberin. Ultimate goals of future studies are to extend the ultrastructural localization of hormones at the osteoclast level, to assess the distribution of adhesive proteins and of their receptors in bone cells and matrix, and to use well-calcified human bone samples in order to evaluate better the role of therapeutic agents.

Arginine-vasopressin in anterior pituitary cells: in situ hybridization of mRNA and ultrastructural localization of immunoreactivity.

The hypothalamic nonapeptide arginine-vasopressin (AVP) exerts several distinct receptor-mediated actions on pituitary cells. Although hypothalamic AVP reaches the anterior pituitary via well-defined pathways, there is now accumulating evidence that AVP may also be produced endogenously in anterior pituitary cells. Using in situ hybridization, we demonstrate here the presence of AVP mRNA in the anterior pituitary of the rat. The observed grain density over pituitary cells was, however, greater than 10-fold lower than the one observed over AVP producing neurons present in the supraoptic and paraventricular nuclei of the hypothalamus. Immunoelectron microscopic analysis using two different AVP-specific antibodies revealed that the distribution of AVP-like immunoreactivity (AVP-LI) in the anterior pituitary is cell-specific. AVP-LI is most abundant in corticotrophs, followed by lactotrophs, gonadotrophs and thyrotrophs. On the other hand, there is complete absence of AVP-LI from somatotrophs. Interestingly, all pituitary cells in which AVP-LI is detected also represent potential target sites for AVP action. A minor fraction of AVP-LI was found to be membrane-associated and may originate, at least in part, from extrapituitary sources. This fraction likely represents receptor-bound peptide. The bulk of AVP-LI, however, was present in the cellular cytoplasm, not associated with any specific ultracellular structure. Specifically in corticotrophs, AVP-LI was excluded from secretory granules. However, our finding of AVP mRNA in anterior pituitary cells indicates that intracellular AVP-LI includes endogenously produced peptide, suggesting a paracrine and/or autocrine action.

[Effects of 1,25 dihydroxyvitamin d3 on the morphology and alkaline phosphatase activity of ROS 17/2,8 osteoblastic cells: influence of time and dose]. / Effets de la 1,25 dihydroxyvitamine D3 sur la morphologie et l'activité phosphatase alcaline des cellules ostéoblastiques ROS 17/2,8: influence du temps et de la dose.

Osteosarcoma-derived osteoblastic cells were exposed to 1,25 dihydroxyvitamin D3 (1,25(OH)2D3) either to 0.001-1,000 nmol.l-1 for 4 days or to 10 nmol.-1 for 1-21 days. Between 0.01 and 10 nmol.l-1, a dose-dependent increase in alkaline phosphatase (AP) activity was found, which rose to a maximum level at 10 nmol.l-1 (+55%). At higher doses (100 and 1,000 nmol.l-1), 1,25(OH)2D3 induced a decrease in AP activity of 40%. After 1 day at 10 nmol.l-1 a slight increase in AP activity was noted (+20%) which augmented with the duration of exposure. This stimulatory effect was highest after 8 days (+130%). In contrast, after 15 and 21 days, AP activity decreased by 30%. Under 1,25(OH)2D3, microtubules were observed mainly in the perinuclear region.

Localization of endogenous osteocalcin in neonatal rat bone and its absence in articular cartilage: effect of warfarin treatment.

Immunocytochemistry after cryoultramicrotomy was used to localize endogenous osteocalcin in bone (calvaria, femoral diaphysis) and epiphyseal femoral cartilage from 8-day-old rats treated (or mot) for 7 days with warfarin. Ultrathin frozen sections were incubated with goat antiserum against rat osteocalcin at high dilutions (2 x 10(-4) to 2 x 10(-6). In calvaria and femur of untreated rats, endogenous osteocalcin was observed in osteoblasts (cytoplasm and nucleus) and in the collagenous matrix. Osteocalcin appeared progressively in osteoblasts and bone matrix in the mineralization front, then increased in the regions of extended calcification. Osteocalcin was also detected in osteocytes but was not as abundant as in osteoblasts. In bone samples of warfarin-treated rats, endogenous osteocalcin was only detected in bone matrix but not in osteoblasts. Furthermore, osteocalcin was only observed if antiserum was not very dilute (2 x 10(-2). In cartilage (hypertrophied and degenerative zones), osteocalcin was not observed in matrix and chondrocytes. However, it was found in the vicinity of matrix vesicles at the initial loci of calcification. Osteocalcin was never detected in the cartilage of warfarin-treated rats. Our results provide ultrastructural immunocytological evidence for the localization of endogenous osteocalcin in osteoblasts, the presence of osteocalcin in bone matrix and a direct gradient between the presence of osteocalcin and the calcification process. Osteocalcin is absent from cartilage, except possibly close to calcifying matrix vesicles. Warfarin inhibits the formation of osteocalcin.

Effects of ammoniation on the 'carry-over' of aflatoxins into bovine milk.

Two experiments were performed using lactating cows fed various treated and non-treated commodities from AFB1 contaminated peanut cakes. Treatment with ammonia gas by an autoclaving process was used for detoxification. Two methods were used for AFM1 determination in every milk sample: a TLC procedure recognized by AOAC and IDF and an HPLC method with a detection limit of 0.100 and 0.010 microgram/l, respectively. In a first experiment, lactating cows were fed treated and untreated meals during periods separated by uncontaminated soya meals phases. The total excreted AFM1 was 2.6% of the total ingested AFB1 from untreated feed contaminated at 1100 micrograms/kg. During periods receiving treated meals in the diet, AFM1 contents in milk were below 0.1 microgram/l. However, by using AFM1 data obtained using the HPLC method, an AFM1/AFB1 ratio of 4.6% was found from treated feed contaminated at 40 micrograms AFB1/kg. In a second experiment, a herd of 50 lactating cows was used for a long term (16 months) feeding of mixed commodities containing 30% ammoniated peanut cakes. AFB1 residues in the treated diet were below 10 micrograms/kg, the EEC action level, and no AFM1 residue was found up to 0.1 microgram/l in collected milk throughout this experiment.