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Introduction: Since 2017, the Regional Health Agency of ’Île-de-France’ has implemented an experiment to subsidize the recruitment of part-time doctors in nursing homes, so that residents without a primary care physician can benefit from regular medical follow-up., Purpose of Research: The purpose of the study is to estimate the effects of this experiment: how is it implemented? What are its effects on the perceived quality of care?, Method: The method used was based on a qualitative survey involving semi-structured individual or group interviews. On the whole, 20 professionals, one resident, and two daughters of residents were interviewed in four different nursing homes., Results: The investigation shows that this experiment addresses an unmet medical need. However, the recruiting of doctors appears to be difficult and significant delays have been noted. The experimentation is considered to be beneficial by professionals and recipients: It provides an opportunity to re-evaluate prescriptions in time, to prevent the deterioration of the residents’ health and to reduce the need for emergency services. These physicians are involved in the care for cognitive disorders and play an important role in the support of the end-of-life., Conclusions: The experimentation has a positive effect on the perceived quality of care, according to professionals as well as residents or their relatives, which could provide a rationale for its sustainability or even its extension.

Photodynamic therapy (PDT) can prevent visual loss and the risk of hemorrhage in exudative ARMD. Nevertheless, it can sometimes complicate with massive hemorrhage. We report the case of a massive macular hemorrhage 4 days after a first treatment with dynamic phototherapy (PDT) with Visudyne for rapidly progressive (6 months) exudative AMD with occult neovessels in an 86-year-old female. The rationale for PDT was a rapidly progressive lesion with preserved visual acuity (20/40). Four days after injection, a massive submacular hemorrhage of 6 disc diameter developed, with a dramatic decrease in visual acuity. This hemorrhage recovered within 6 months, producing large, fibroglial, submacular scarring with changes on the retinal pigment epithelium. This case highlights the possible side effects of this treatment.

The criteria to be satisfied for a valid quantitation and the physiopathological significance of results: nature, site-specificity and kinetics of glycosylation, finally theoretical consideration of glycosylation of other proteins are the problems discussed.

Using two-dimensional immuno-electrophoresis to study a morphological abnormality of the alpha 2-neuramino-glycoprotein (alpha 2-NGP) we have been able to observe allelic exclusion in patients afflicted by hereditary angioneurotic oedema [1]. With the aid of two-dimensional immuno-affino-electrophoresis, we have been able to show that in some cases, there exists a double abnormality of alpha 2-NGP associating a deficiency in post translating glycosylation with a loss of the inhibitory function of the C1 esterase.

In liver, L-type pyruvate kinase (LPK) was considered to be the major isozyme. Using an immunocytometric method, it was demonstrated that labeled LPK (LPK+) hepatocytes were largely influenced by the nutritional status of the Rat, as well as addition of glucagon in vitro. In the fed Rats, the percentage of LPK-hepatocytes remained stable for at least 90 min. This decreased to one half value in the fasted Rats. Addition of glucagon (114 nM) had no effect in fasted Rats, but decreased the percentage of LPK-hepatocytes to a half in the fed Rats. It was concluded that neoglucogenesis status (fasting or addition of glucagon in fed Rats liver cells) induced a fall in the percentage of LPK-hepatocytes.

A technique for the determination of free and esterified plasma cholesterol by gas-liquid chromatography is proposed as a reference method. After a critical examination of all the stages to prove its validity, the method is compared to the usual techniques. Such a comparison confirms that colorimetric methods are more accurate after a lipidic extraction and with a purification step by liquid-solid chromatography.

Seventy seven patients from 32 families suffereing from angioneurotic oedema were studied and a single theory of the disorder is suggested. The functional abnormality of alpha2 neuraminoglycoprotein (NGP) or of C1 esterase inhibitor is related involvement of the structure gene (s) controlling its synthesis. Particular immunochemical characteristics of the inhibitor seen in severals families and remaining constant through a number of generations would indicate the existence of a phenomenon of functional haploidism in these heterozygous patients. Treatment of the condition with androgens suggests the existence of two varieties of alpha2 NGP molecules which are differentiated on the basis of their complete or incomplete glycoconjugation in the hepatocyte.

Four individuals of the same family suffered from a functional deficiency in C1 esterase inhibitor. In three of them, the manifestations of hereditary angioneurotic oedema were abdominal, paroxystic and pseudo-surgical. They were related to the development of visceral or mucosal oedema. The measurement of total complement (and of its fractions) during the acute episode, as well as dynamic complement studies between attacks, represent a simple method for indicating the probable diagnosis. Only estimation of the functional activity of C1 esterase inhibitor provides definite evidence. Familiarity with the clinical and biological characteristics of these acute abdominal episodes makes it possible to avoid repeated, unnecessary operations in these patients. They should be treated medically, under surgical surveillance, since a patient with angioneurotic oedema may have nevertheless a specific lesion, in addition. In addition, the episode may spread at any time, resulting in oedema of the glottis requiring tracheotomy or immediate intubation.

By immunofluorescence and double labelled anti sera L and M pyruvate kinase, there is a double localization of isozymes. It is detected in basal state, in vitro, in isolated hepatocyte, in vivo in experimental or genetic (Zucker rat) hyperinsulinemia or in regenerating liver following partial hepatectomy. It is found in hepatology, in regenerative nodule of cirrhosis and in cancerous cells of liver. This double presence of L and MPK tallies with a specific double hormonodependence: induction of MPK by insulin, and inhibition of LPK by glucagon.

A total increase of blood complement components, particularly C4, is found in subjects with familial Mediterranean fever both before and after colchicine therapy. This effect differs from the serum haptoglobin and orosomucoïd concentration decreases detected after identical therapy, confering diagnostic value to this inflammatory syndrome. This could be of both hepatic and extrahepatic origin. For the latter, it is possible that up take of circulating monocytes, macrophage precursors, by the connective tissue of the serum sub-mesothelial layer is responsible for the lesion.

It was known that with dietary and hormonal conditions the level of hepatic L pyruvate kinase (LPK) varied greatly. By immunochemical method we demonstrate in vitro insulinodependence of MPK in isolated hepatocytes. In hepatocytes of fasted Rats this effect was time and concentration dependent, but proinsulin was ineffective.

A structural immunochemical study has shown that fixation of melatonin on bovine serum albumin by formaldehyde occurs via reaction of both an indole NH group and the side chain, allowing extremely specific antibody production. Isotopic in vitro investigations and radioimmunological estimation of this hormone in man and in the rat shows that it is transported by plasmatic albumin in a 1/10(6) ratio and is eliminated in the urine as native material, 6-hydroxy melatonin and as an as yet unidentified metabolite.

A comparative analysis of urine and serum THG is carried out using physico-chemical and radioimmunological methods. It demonstrates a real similarity in the antigenicity, the glycan structure and the polymerization-depolymerization. The presence of THG in various biological fluids and tissues is an extra argument in favor of such an identity. A multifocal synthesis of THG and not an exclusively renal one is admitted. Such a conception seems to be more consistent with the membrane function of THG towards some ions in various tissues.

The primary structural analysis of O- and N-linked carbohydrate chains of the C-1-esterase inhibitor purified from normal serum was carried out by 400-MHz 1H-NMR spectroscopy. C-1-esterase inhibitor protein of a molecular weight of 116,000 daltons contains 24 O-glycans: NeuAc (alpha 2-3) Gal (beta 1-3) GalNAc, 4 N-glycans: NeuAc (alpha 2-6) Gal (beta 1-4) (GlcNAc (beta 1-2) Man (alpha 1-3) [NeuAc (alpha 2-6) Gal (beta 1-4) GlcNAc (beta 1-2) Man (alpha 1-6)] Man (beta 1-4) GlcNAc (beta 1-4) GlcNAc and 2 N-glycans: NeuAc (alpha 2-3) Gal (beta 1-4) GlcNAc (beta 1-2) Man (alpha 1-3) [NeuAc (alpha 2-3) Gal (beta 1-4) GlcNAc (beta 1-2) Man (alpha 1-6)] Man (beta 1-4) GlcNAc (beta 1-4) GlcNAc. 30% of the N-glycans are fucosylated.

The study of 24-h urinary excretion proves to be quite interesting from a theoretical point of view on account of its topographic origin in the nephron and from a practical point of view to control renal transplant patients with favourable or unfavourable course. In both cases, the results we obtain are in accordance with that of blood creatinine assay and ratio N-acetyl-beta-D-glucosaminidase (NAG)/creatinine in urine. The prolonged study of serum THG concentration confirms the previous data regarding the outcome of renal grafts. Moreover, particularly low concentration rates probably imply the interference of factors such as: renal toxins or anti-THG autoantibodies.

Previously we have found that spirobutenolide synthetic derivatives show an inhibiting effect on C1 esterase activity. In contrast to these compounds some derivatives in the same series reveal an esterase activity when they are added to a C1 esterase preparation in presence of normal serum. The present work shows that this effect reflect an interaction with natural inhibitor C1 INH.

Coagulation contact factors were studied in 9 patients with hereditary angioneurotic oedema. After storage of the plasma at O degrees C for 20 hours, activation of prekallikrein and factor VII, together with prekallikrein consumption, were observed. The cold activation, due to deficiency of C1 esterase inhibitor, was not suppressed by polybren in vitro (factor XII activation inhibitor) but was prevented by aprotinins (kallikrein inhibitors). These findings would suggest that patients with hereditary angioneurotic oedema should be investigated for prekallikrein consumption and should be treated with aprotinin as soon as the attack begins.

A purification method for C1 esterase is described. The final product significantly improved the sensitivity and the specificity of the enzymatic measurement of its plasma inhibitor C1-INH or alpha 2-neuraminoglycoprotein (alpha 2-NGP) by esterolysis of a synthetic substrate N-acetyl-L-tyrosine ethyl ester (ALTEe). A comparative study was done between the chromatographed C1 esterase and the native serum euglobulins: qualitative and quantitative determination of the serum contaminants, enzymatic activity measurement of C1-INH in normal subjects and in patients suffering from hereditary angioneurotic oedema (OANH) as well as in therapeutical C1-inhibitor concentrates.

The correlation obtained between the electronic properties and the in vitro inhibiting effect on C1 esterase of synthetic derivatives from spirobutenolides series, lead to a synthetic compound. The molecule is especially hopeful in this enzymatic activity and so comparable to the natural inhibitor.

The M1 pyruvate kinase has been localized in macroneuron's cytoplasm of nervous tissue of adult Rat, in situ as well as in tissue culture. Three methods have been used: histoenzymology, immunoenzymology and immunofluorescence, combined with Nomarski optics. This enzymatic localization may suggest a metabolic or differenciated fonctionnal state of the nerve cell.

A quantitative and qualitative study of neutral and aminosaccharides in C 1-esterase inhibitor (C 1-INH), protein of the complement system, was performed. We observe a mixed glycosylation of the molecule with an N-glycosylated: O-glycosylated chain ratio of 1: 4. The loss of the inhibitory activity of the molecule in hereditary angioedema (O ANH) is associated with an O-glycosylation deficiency which differs according to the two molecular variants: C 1-INH (1 A) and C 1-INH (II) previously described.

The gas-liquid chromatographic measurement of serum creatinine is described in the present study. A preliminary concentration on cation exchange resin is used. The different steps of the operating procedure are analysed. A statistical comparison is undertaken between the results obtained with gas-liquid chromatography and kinetic colorimetry method using Jaffé assay.

The presence of lymphoid cells possessing both kappa and lambda specificities has been observed in the intestinal mucosa of normal subjects. The variability in the number of such cells in different sections of the same sample and in different subjects seems to be a characteristic of this cell population and may reflect the high activity of the immune system in the small intestine.

Abdominal manifestations are almost constantly present (85% of cases) in the current form of hereditary Quincke's disease. In some cases, these abdominal manifestations occur even when cutaneomucosal edema is not present which leads to unwarranted often repeated and sometimes dangerous surgery. Apart from a story of heredity diagnosis of such troubles is possible, provided the total complement has been assayed to note its sharp fall. It can be subsequently explained by a functional defect of the C1 esterase inhibitor or alpha2-neuraminoglycoprotein.

An original immunological two-dimensional technique with two different gels permits the protein analysis of 80 S cytoplasmic ribosomal murine particles and of their 60 S and 40 S subunits. The diagrams isolate and characterize a definite number of specific polypeptidic structures from each ribosomal particle.

The monosaccharides of proteic samples liberated by methanolysis and submitted to trimethylsilylation by the trimethylsilylimidazole (TSIM) are determined by gas-liquid chromatography. The neutral sugars are detected in simple flame ionization (FID) and the amino sugars identified separatively by the use of a thermoionic detector (TID) which responds selectively to nitrogenous and phosphorated compounds. The method described has been tested on standard mixtures of monosaccharides and on a well known glycoprotein : the uromucoid. Then it has been applied to a pyroglobulin IgM (mu2, chi2).