Search

STUDY OBJECTIVES: To determine the prevalence of obstructive sleep apnea (OSA) in a cohort of women with class III obesity, and a comparator lean group, in the second and third trimesters of pregnancy. Secondary objectives were to compare characteristics of women with obesity with and without OSA and to assess factors that were predictive of OSA. METHODS: We performed a prospective cohort study involving 33 women with class III obesity (mean body mass index 43.5 ± 3.9 kg/m(2)) and 39 lean women (body mass index 22.0 ± 1.7 kg/m(2)) with singleton pregnancies. Participants completed 2 level 3 sleep studies between 12–22 weeks and 32–38 weeks gestation. OSA was defined as a respiratory event index ≥ 5 events/h (≥ 3% desaturation criteria). Levels of interleukin-6, glucose, and C-peptide were quantified in maternal blood. Logistic regression analysis was performed to determine predictors of OSA. RESULTS: OSA was identified in 12 (37.5%) and 14 (50.0%) women with obesity and in 1 (2.6%) and 3 (9.1%) lean women in the second and third trimesters, respectively. Women with obesity with OSA were older than those with no OSA but otherwise had similar characteristics. In unadjusted analysis of women with obesity, increased age, body mass index, homeostatic model assessment of insulin resistance, and history of nonsmoking were associated with increased odds of OSA. In multivariable analysis, only increased age remained significantly associated with OSA. CONCLUSIONS: OSA is highly prevalent in pregnant women with class III obesity. Further research is required to establish effective management strategies for the growing number of women in this high-risk group. CITATION: Johns EC, Hill EA, Williams S, et al. High prevalence of obstructive sleep apnea in pregnant women with class III obesity: a prospective cohort study. J Clin Sleep Med. 2022;18(2):423–432.

Adherence is a critical issue in the treatment of obstructive sleep apnea with continuous positive airway pressure (CPAP). Approximately 40% of patients treated with CPAP are at risk of discontinuation or insufficient use (< 4 h/night). Assuming that the first few days on CPAP are critical for continued treatment, we tested the predictive value at day 14 (D14) of the Philips Adherence Profiler™ (AP) algorithm for adherence at 3 months (D90). The AP™ algorithm uses CPAP machine data hosted in the database of EncoreAnywhere™. This retrospective study involved 457 patients (66% men, 60.0 ± 11.9 years; BMI = 31.2 ± 5.9 kg/m2; AHI = 37.8 ± 19.2; Epworth score = 10.0 ± 4.8) from the Pays de la Loire Sleep Cohort. At D90, 88% of the patients were adherent as defined by a mean daily CPAP use of ≥ 4 h. In a univariate analysis, the factors significantly associated with CPAP adherence at D90 were older age, lower BMI, CPAP adherence (≥ 4 h/night) at D14, and AP™ prediction at D14. In a multivariate analysis, only older age (OR 2.10 [1.29–3.41], p = 0.003) and the AP™ prediction at D14 (OR 16.99 [7.26–39.75], p < 0.0001) were significant predictors. CPAP adherence at D90 was not associated with device-derived residual events, nor with the levels of pressure or leakage except in the case of very significant leakage when it persisted for 90 days. Automatic telemonitoring algorithms are relevant tools for early prediction of CPAP therapy adherence and may make it possible to focus therapeutic follow-up efforts on patients who are at risk of non-adherence.

STUDY OBJECTIVES: Thermistors, nasal cannulas, and respiratory inductance plethysmography (RIP) are the recommended reference sensors of the American Academy of Sleep Medicine (AASM) for the detection and characterization of apneas and hypopneas; however, these sensors are not well tolerated by patients and have poor scorability. We evaluated the performance of an alternative method using a combination of tracheal sounds (TSs) and RIP signals. METHODS: Consecutive recordings of 70 adult patients from the Pays de la Loire Sleep Cohort were manually scored in random order using the AASM standard signals and the combination TS and RIP signals, without respiratory sensors placed on the patient’s face. The TS-RIP scoring used the TS and RIP-flow signals for detection of apneas and hypopneas, respectively, and the suprasternal pressure and RIP belt signals for the characterization of apneas. RESULTS: Sensitivity and specificity of the TS-RIP combination were 96.21% and 91.34% for apnea detection and 89.94% and 93.25% for detecting hypopneas, respectively, with a kappa coefficient of 0.87. For the characterization of apneas, sensitivity and specificity were 98.67% and 96.17% for obstructive apneas, 92.66% and 99.36% for mixed apneas, and 96.14% and 98.89% for central apneas, respectively, with a kappa coefficient of 0.94. The TS-RIP scoring revealed a high agreement for classifying obstructive sleep apnea into severity classes (none, mild, moderate, and severe obstructive sleep apnea) with a Cohen’s kappa coefficient of 0.96. CONCLUSIONS: Compared with the AASM reference sensors, the TS-RIP combination allows reliable noninvasive detection and characterization of respiratory events with a high degree of sensitivity and specificity. TS-RIP combination could be used for diagnosis of obstructive sleep apnea in adults, either as an alternative to the AASM sensors or in combination with the recommended AASM sensors. CITATION: Sabil AK, Marien C, LeVaillant M, Baffet G, Meslier N, Gagnadpix F. Diagnosis of sleep apnea without sensors on the patient’s face. J Clin Sleep Med. 2020;16(7):1161–1169.

International audience; Rationale: Data from population-based cohorts suggest that symptom subtypes and obstructive sleep apnea (OSA)-specific hypoxic burden (HB) could help to better identify patients with OSA at high cardiovascular (CV) risk. Objectives: We aimed to evaluate whether those new markers are associated with the risk of major adverse CV events (MACE) in clinical setting. Methods: Data from the Pays de la Loire cohort were linked to health administrative data to identify the occurrence of MACE (a composite outcome including all-cause mortality, acute myocardial infarction, stroke, and unplanned coronary revascularization) in patients with newly diagnosed OSA and no overt CV disease. Latent class analysis was used to identify subtypes based on eight clinically relevant variables. HB was defined as the total area under the respiratory event-related desaturation curve. Cox proportional hazards models were used to evaluate the association of symptom subtypes and HB with MACE. Measurements and Main Results: Four symptom subtypes were identified (minimally symptomatic [22.0%], disturbed sleep [17.5%], excessively sleepy [49.8%], and moderately sleepy [10.6%]). After a median follow-up of 78 months (interquartile range, 52-109), 592 (11.05%) of 5,358 patients experienced MACE. In a fully adjusted model, HB and overall nocturnal hypoxemia assessed by sleep time with oxygen saturation,90% were the only predictors ofMACE (hazard ratio, 1.21; 95% confidence interval, 1.07-1.38; and hazard ratio, 1.34; 95% confidence interval, 1.16-1.55, respectively). The association appeared stronger toward younger patients and women. Conclusion: In clinical setting, patients with OSA who demonstrate elevated OSA-specific HB are at higher risk of a CV event and all-cause mortality. Symptom subtypes were not associated with MACE after adjustment for confounders.

AbdelKebir Sabil,1 Remi Bignard,2 Chloé Gervès-Pinquié,3 Pierre Philip,4 Marc Le Vaillant,3 Wojciech Trzepizur,2 Nicole Meslier,2 Frédéric Gagnadoux2 1Clinical Research Department, Cloud Sleep Lab, Paris, France; 2Department of Respiratory and Sleep Medicine, University Hospital of Angers, Angers, France; 3Biostatistics Department, Pays de la Loire Respiratory Health Research Institute, Beaucouzé, France; 4Sleep, Attention and Neuropsychiatry Unit, University of Bordeaux, CNRS, SANPSY USR 3413, and CHU Pellegrin, Bordeaux, FranceCorrespondence: AbdelKebir SabilClinical Research Department, Cloud Sleep Lab, 29 rue Louis Braille, Paris, FranceTel +33 648 01 00 21Email kebir.sabil@cloudsleeplab.comPurpose: We aimed to determine the risk factors of sleepiness at the wheel among patients with obstructive sleep apnea (OSA) and to determine factors that were independently associated with reported sleep-related near-miss accidents or car accidents.Patients and Methods: This retrospective study was conducted on 843 OSA patients from the French Pays de la Loire sleep cohort database. Each patient completed surveys including anthropometric data, medical history, professional status, and data on alcohol and tobacco use. Epworth sleepiness scale (ESS) and sleep quality questionnaires were administered. Regarding driving, data were collected on occurrence of sleepiness-related near-misses or car accidents, and on distance driven per year. The primary dependent variable of interest was reported sleepiness at the wheel.Results: On multivariable regression analysis, reported sleepiness at the wheel (n=298) was independently associated with younger age (p=0.02), male gender (p=0.009), marked nocturnal hypoxemia (p=0.006), lower BMI (p=0.03), absence of cardiovascular disease (p=0.022), executives or high degree jobs (p=0.003) and reported difficulty-maintaining sleep (p=0.03). Only past experience of sleepiness at the wheel (OR 12.18, [6.38– 23.25]) and an ESS ≥ 11 (OR 4.75 [2.73– 8.27]) were independently associated with reported car accidents (n=30) or near-miss accidents (n=137).Conclusion: In patients newly diagnosed with OSA, the risk of car accident seems multifactorial, and its evaluation should include multiple parameters such as patient self-reported sleepiness at the wheel, occurrence of sleepiness-related accidents, anthropometry, professional status, and insomnia complaints. Thus, it is possible to evaluate this risk and advise patients as early as the first visit at the sleep medicine clinic without waiting for the results of the sleep study.Keywords: sleepiness, accidents, near-miss accidents, French drivers, OSA, early risk prediction

In Morocco, Leishmania infantum species is the main causative agents of visceral leishmaniasis (VL). However, cutaneous leishmaniasis (CL) due to L. infantum has been reported sporadically. Moreover, the recent geographical expansion of L. infantum in the Mediterranean subregion leads us to suggest whether the nonsporadic cases of CL due to this species are present. In this context, this review is written to establish a retrospective study of cutaneous and visceral leishmaniasis in northern Morocco between 1997 and 2018 and also to conduct a molecular study to identify the circulating species responsible for the recent cases of leishmaniases in this region. Data concerning leishmaniases cases were collected from the Epidemiology and Disease Control Directorate from 1997 to 2018. Human samples obtained from peripheral laboratories were examined using PCR-ITS1 method. The ITS1 products were subjected to digestion with the restriction endonuclease Mn1-I. Between 1997 and 2018, a total of 1,255 cases of cutaneous and visceral leishmaniasis were recorded in Tangier-Tetouan-Al Hoceima Region, i.e., 1.56% of the reported cases in Morocco (1,255/80,299). Concerning the geographical study covering the period 2007-2018, 79.5% (105/132) of the sectors were affected by leishmaniases. The molecular results showed that Humans were found to be infected with the L. infantum species with a high infection rate compared to L. tropica infection. Moreover, molecular characterization using ITS1 PCR-RFLP showed that the density of L. infantum was significantly higher (n = 68/81; 84%) than that of L. tropica (n = 13/81; 16%) (P-value 9.894e-10). While regarding visceral leishmaniasis, L. infantum was the only species responsible of this form. These findings of this study showed the emergence of L. infantum in Morocco and suggest that this species might be more prevalent than previously thought. Furthermore, the molecular determination of L. infantum will be helpful for control strategies by taking into consideration the reservoir of this species.

This study aimed to investigate whether the combination of tracheal sounds and nasal pressure sensor (TS-NP) allows the same detection of apneas and hypopneas as the recommended American Academy of Sleep Medicine (AASM) method for obstructive sleep apnea (OSA) diagnosis, i.e., the combination of an oronasal thermistor and nasal pressure sensor (Therm-NP). Polysomnographic recordings of 33 patients (6 females; mean age 52.9 ± 10.3 years; mean body mass index, BMI, 30.0 ± 5.2 kg/m2) were analyzed to compare detection of apneas by two different methods of combined airflow signals: a) Therm-NP and b) TS-NP. The two scoring methods were performed randomly and independently of each other. Respiratory event detection results and apnea–hypopnea index (AHI) obtained using Therm-NP signals as a reference were compared to those obtained by TS-NP signals. The number of respiratory events scored using Therm-NP was 7268, while it was 7329 with TS-NP. The sensitivity and positive predictive value of TS-NP with respect to Therm-NP were 93.0 and 90.6, respectively. The average AHI for all patients was 29.8 ± 22.9 for Therm-NP and 30.0 ± 22.6/h for TS-NP. With the Therm-NP as a reference detection, a kappa statistic value of 0.86 for TS-NP revealed a high agreement for classifying OSA into the severity classes mild, moderate, and severe. However, 55% of total events scored by Therm-NP were hypopneas while 59% of events scored by TS-NP were apneas. These results show that TS-NP reliably detects the same number of respiratory events as Therm-NP, despite a difference in the apnea to hypopnea ratio between the two methods. The use of TS does not modify AHI calculations and guarantees accurate sleep apnea diagnosis and severity assessment. Thus, TS can be used as a substitute for an oronasal thermistor in sleep recording systems.

Erodium glaucophyllum is a common Mediterranean herb known for its health benefits. In this study, Erodium extracts obtained from different extraction methods (conventional vs ultrasound-assisted extraction) and extraction solvents (aqueous and hydroethanolic) were evaluated in microbiological media to determine their effects on bacteria (Salmonella enterica, Staphylococcus aureus, Listeria innocua, Bifidobacterium lactis and Lactobacillus casei) and antiviral activity (hepatitis A virus and murine norovirus). Both, the extraction method and solvent were found to be important contributing factors. Ultrasound-assisted extraction yielded the highest level of desirable Erodium-extracted phenolic compounds. Hydroethanolic extracts exhibited the highest level of bioactivity on the tested bacteria and also showed the highest antiviral activity against hepatitis A virus and murine norovirus. Erodium glaucophyllum extracts may have potential use as a food or dietary supplement.

To determine if recording of suprasternal pressure (SSP) can classify apneas and hypopneas as reliably as respiratory inductance plethysmography (RIP) belts and to compare the two methods to classification with esophageal pressure (Pes), the reference method for assessing respiratory effort. In addition to polysomnographic recordings that included Pes, SSP was recorded. Recordings from 32 patients (25 males, mean age 66.7 ± 15.3 years, and mean BMI 30.1 ± 4.5 kg/m2) were used to compare the classification of detected apneas and hypopneas by three methods of respiratory effort evaluation (Pes, RIP belts, and SSP). Signals were analyzed randomly and independently from each other. All recordings were analyzed according to AASM guidelines. Using Pes as a reference for apnea characterization, the Cohen kappa (κ) was 0.93 for SSP and 0.87 for the RIP. The sensitivity/specificity of SSP was 97.0%/96.9% for obstructive, 93.9%/98.3% for central, and 94.9%/97.9% for mixed apneas. The sensitivity/specificity of the RIP was 97.4%/91.9% for obstructive, 87.5%/97.9% for central, and 85.6%/96.6% for mixed apneas. For hypopnea characterization using the Pes as a reference, κ was 0.92 for SSP and 0.86 for the RIP. The sensitivity/specificity of SSP was 99.7%/97.6% for obstructive and 97.6%/99.7% for central. The sensitivity/specificity of the RIP was 99.8%/81.1% for obstructive and 81.1%/99.8% for central. These results confirm the excellent agreement in the detection of respiratory effort between SSP, RIP belts, and Pes signals. Thus, we conclude that apnea and hypopnea characterization in adults with SSP is a reliable method.

International audience

International audience; Manuscript word count: 1,374 "take home" message: Indices of sleep apnoea-related hypoxic burden and heart rate variability derived from full-night polysomnography might be useful for identifying sleep apnoea patients at risk for stroke.

STUDY OBJECTIVES: To assess, in a large cohort of patients with obstructive sleep apnea, the factors that are independently associated with positional obstructive sleep apnea (POSA) and exclusive POSA (e-POSA) and determine their prevalence. The secondary objective was to evaluate the outcome of positive airway pressure (PAP) therapy for patients with POSA and e-POSA. METHODS: This retrospective study included 6,437 patients with typical mild‐to‐severe OSA from the Pays de la Loire sleep cohort. Patients with POSA and e-POSA were compared to those with non-POSA for clinical and polysomnographic characteristics. In a subgroup of patients (n = 3,000) included in a PAP follow-up analysis, we determined whether POSA and e-POSA phenotypes were associated with treatment outcomes at 6 months. RESULTS: POSA and e-POSA had a prevalence of 53.5% and 20.1%, respectively, and were independently associated with time in supine position, male sex, younger age, lower apnea-hypopnea index and lower body mass index. After adjustment for confounding factors, patients with POSA and e-POSA had a significantly lower likelihood of treatment adherence (PAP daily use ≥ 4 h) at 6 months and were at higher risk of PAP treatment withdrawal compared to those with non-POSA. CONCLUSIONS: The prevalence and independent predictors of POSA and e-POSA were determined in this large clinical population. Patients with POSA and e-POSA have lower PAP therapy adherence, and this choice of treatment may not be optimal. Thus, there is a need to offer these patients an alternative therapy. CITATION: Sabil A, Blanchard M, Trzepizur W, et al. Positional obstructive sleep apnea within a large multicenter French cohort: prevalence, characteristics, and treatment outcomes. J Clin Sleep Med. 2020;16(12):2037–2046.

© 2020 by the authors., Mediterranean plants, such as fig and olive leaves, are well-known to exert beneficial effects in humans because of the presence of a wide range of bioactive compounds. However, scarce information regarding the impact of extraction methods, such as ultrasound and types of solvents, on their profile of antioxidant and anti-inflammatory compounds is provided. In addition, no information is available on the effects of extraction methods and solvents on the inhibition of pathogenic bacteria or promoting probiotic growth. In this scenario, this study was aimed to study the effects of ultrasound-assisted extraction (UAE) and solvent on the phenolic profile (Triple TOF-LC-MS/MS), antioxidant and anti-inflammatory compounds of olive and fig leaves. Results showed that UAE extracted more carotenoids compared to conventional extraction, while the conventional extraction impacted on higher flavonoids (olive leaves) and total phenolics (fig leaves). The antioxidant capacity of aqueous extract of fig leaves was three times higher than the extract obtained with ethanol for conventional extraction and four times higher for UAE. In general terms, hydroethanolic extracts presented the highest bacterial growth inhibition, and showed the highest anti-inflammatory activity. In conclusion, these side streams can be used as sources of bioactive compounds for further development of high-added-value products., J.V.G.-P. acknowledges the financial support from the Spanish National Research Agency through the MEFPROC project (PCI2018-093161, Era-NET SUSFOOD2). F.J.B. and A.R.J. would like to thank Croatian Science Foundation for project: “High voltage discharges for green solvent extraction of bioactive compounds from Mediterranean herbs (IP-2016-06-1913)”.

The paper presents experimental results concerning the ultrasonically-assisted extraction of bioactive compounds from Erodium glaucophyllum roots. A comparison with conventional methodology is presented, and thereby the phytochemical composition and the antioxidant and anti-inflammatory activities of extracts are evaluated. The phenolic profile of Erodium extracts was analyzed by TOF&ndash, LC&ndash, MS&ndash, MS. The identification of phenolic compounds revealed that the major component was (+)-gallocatechin in the aqueous extracts obtained for the different extraction methodologies. The highest quantity of phenolic compounds and antioxidant capacity was found in the hydroethanolic extract obtained by conventional extraction (29.22&ndash, 25.50 mg GAE/g DM, 21.174 mM Trolox equivalent). The highest content of carotenoids, varying from 0.035 to 0.114 mg/g dry matter, was reached by ultrasonic-assisted extraction. Furthermore, Erodium extracts showed a potent inhibition of the inflammatory reaction by means of the inhibition of tumor necrosis factor-alpha (TNF-&alpha, ). The extracts obtained when ultrasound extraction was combined with ethanol:water (50:50, v/v) presented the greatest inhibition (92%).

STUDY OBJECTIVES: Oronasal thermistor and nasal cannula are recommended for the scoring of respiratory events (RE) but these sensors are poorly tolerated in children. The aim of the study was to evaluate tracheal sounds (TS) and suprasternal pressure (SSP) for the scoring of RE during sleep in children. METHODS: We compared the detection and characterization of RE by AASM-recommended sensors (“AASM” scoring), with the detection and characterization of RE by the combination of TS and SSP with respiratory inductance plethysmography-sum (TS-RIP scoring), and TS and SSP only (TS scoring). RESULTS: The recordings of 17 patients were analyzed. The TS, SSP, and RIP flow signals were present during 95%, 95%, and 99% of the validated recording time, respectively, as compared to 79% and 86% for nasal cannula and oronasal thermistor. A total of 1,456 RE were scored with the “AASM” scoring, 1,335 with the TS-RIP scoring, and 1,311 with the TS scoring. Sensitivity for apnea and hypopnea detection was 88% and 84% for the TS-RIP scoring, and 86% and 77% for the TS scoring. For apnea characterization, the TS-RIP scoring sensitivities and specificities were 97% and 100%, 76% and 98%, and 95% and 97%, for obstructive, mixed, and central apnea, respectively. For the TS scoring, they were 95% and 100%, 95% and 97%, and 91% and 97%, respectively. CONCLUSIONS: TS and SSP + RIP-sum has a good sensitivity and specificity for the detection and characterization of apnea and hypopnea in children. TS and SSP alone have good sensitivity and specificity for apnea detection and characterization but lower sensitivity for hypopnea detection. CITATION: Amaddeo A, Sabil A, Arroyo JO et al. Tracheal sounds for the scoring of sleep respiratory events in children. J Clin Sleep Med. 2020;16(3):361–369.

Summary Introduction Retention during both the active and passive phases of treatment has given rise to numerous publications concerning its efficacy, the range of systems available and its variability over time. There are currently many different retention protocols regularly used by orthodontists; however, their efficacy and duration are still subject to debate. There is as yet no consensus as to which retention protocol is the most effective or for how long the retention device needs to be worn. The aim of this research was to perform a systematic review of the scientific literature in order to evaluate the efficacy of the different retention systems and clinical protocols among those most widely used, so as to make recommendations beneficial to both patient and practitioner. Materials and methods A search of the literature was performed in the following databases: PubMed (MEDLINE), ScienceDirect and Cochrane Library. The search was limited to publications in English and French during the period 2006–2016. Results Out of 1952 references initially identified, 17 articles corresponded to our inclusion criteria. The results show that: fixed retention is more effective than removable retainers for the maintenance of incisor alignment during the first six months of retention; there is no significant difference in efficacy between the different fixed retention systems; there is no significant difference in efficacy between the vacuum-formed systems and the Hawley retainer; part-time use of removable retainers (between 8–10 h/day) is sufficient; the most widely used retention protocol combines a vacuum-formed splint or Hawley retainer in the upper arch with mandibular fixed retention. Conclusion Despite the large number of studies devoted to orthodontic retention only a few articles corresponded to the methodological criteria of bio statistical analysis. Also, on account of the variations in experimental protocols, the levels of proof relating to the efficacy of different systems are very weak. Research into this topic should first seek to normalize methods of analysis and then perform randomized controlled long-term trials to shed light on this problem.

Tracheal sounds have been the subject of many research studies. In this review, we describe the state of the art, original work relevant to upper airways obstruction during sleep, and ongoing research concerning the methods used when analysing tracheal sounds. Tracheal sound sensors are a simple and noninvasive means of measurement and are more reliable than other breathing sensors. Developments in acoustic processing techniques and enhancements in tracheal sound signals over the past decade have led to improvements in the accuracy and clinical relevance of diagnoses based on this technology. Past and current research suggests that they may have a significant role in the diagnosis of obstructive sleep apnoea. Key points Tracheal sounds are currently a topic of significant interest but are not yet used in most routine sleep study systems. Measured at the suprasternal notch, tracheal sounds can provide reliable information on breathing sounds, snoring sounds and respiratory efforts. Tracheal sounds may be used as a noninvasive method of studying abnormalities of the upper airways during wakefulness. Educational aims To understand the principles of tracheal sound measurement and analysis. To highlight the importance of tracheal sounds for the diagnosis of sleep apnoea–hypopnoea syndrome. To present the most relevant clinical studies that have validated the use of tracheal sound sensors and to make future clinical validation studies possible., Tracheal sounds analysis may have a significant role in the diagnosis of obstructive sleep apnoea http://ow.ly/f7ax30cAcnP

Introduction: The AASM recommends the use of oronasal thermistor and nasal cannulas to detect respiratory events and respiratory inductance plethysmography (RIP) to characterise apnoeas. However nasal cannulas have a poor scorability. The aim of the study was to evaluate the use of tracheal sounds (TS) and suprasternal pressure (SSP) as an alternative of oronasal thermistor and nasal cannulas for the diagnosis of sleep apnoea in children. Materials and methods: Polysomnographic recordings of 17 children were used. We compared the detection and characterisation of apnoeas by 3 methods: AASM using standard signals (AASM scoring), combination of TS and SSP with RIPflow and pulse oximetry (SpO2) without nasal cannulas (scoring 2) and TS and SSP combined with SpO2 (scoring 3). Results: AASM scoring identified 1149 apnoeas, scoring 2 and 3 identified 1054 and 1049 apnoeas respectively. Sensitivity for apnoeas detection was 92% (scoring 2) and 91% (scoring 3). For apnoea characterisation, scoring 2 sensitivity and specificity were 97% and 100%, 77% and 99% and 98% and 98% for obstructive, mixed and central apnoeas respectively. For scoring 3, they were 96% and 100%, 90% and 96% and 88% and 98% for obstructive, mixed and central apnoeas respectively. Conclusions: The combination of TS and SSP with RIP flow and SpO2 without oronasal thermistor and nasal cannulas can be used for the detection and characterisation of apnoeas in children, and may be used as an alternative when these signals are not available.

Introduction: Childhood sleep disordered breathing (SDB) is associated with neurodevelopmental disorders and structural brain abnormalities. Near infrared spectroscopy (NIRS) allows a continuous noninvasive measurement of cerebral tissue oxygenation. Objectives: To analyze changes in cerebral oxygenation during respiratory events in children with SDB, and to evaluate the impact of the type of respiratory events, the severity of SDB and age. Methods: Children with suspected SDB underwent a respiratory polygraphy with simultaneous recording of cerebral oxygenation indexes with NIRS. Respiratory events were analyzed according to their type (obstructive-mixed apneas (OMA), central apneas (CA), and hypopneas (H)), duration, and simultaneous changes in pulse oximetry (SpO2) and tissue oxygenation index (TOI). The data were categorized according to SDB severity and age. Results: Five hundred forty OMA, 172 CA and 393 H were analyzed. Mean SpO2 and TOI decreases were 4.1±3.1% and 3.4±2.8%, respectively. TOI decrease correlated with SpO2 decrease, duration of the respiratory event and age for the 3 types of respiratory events. TOI decrease was significantly smaller in patients with mild SDB, and in children = 7 years old. In a model of multivariate regression, predictive factors of TOI decrease were the type of respiratory event, SpO2 decrease, apnea-hypopnea index and age. Conclusion: Changes in cerebral oxygenation are determined by the type of respiratory events, SDB severity and patient9s age.

Objective: To show whether the combination of tracheal sounds and nasal pressure sensors (TS/NP). allows the same detection of apneas and hypopneas as the combination of oronasal thermistor and nasal pressure sensors (Therm/NP), the recommended AASM method. Materials and methods: Polysomnographic recordings of 34 patients (6 females, mean age 52.9 ± 10.3 years, and mean BMI 30.0 ± 5.2kg/m2) were analyzed to compare the detection of apneas by 2 different methods of combined airflow signals: a) Therm/NP and b) TS/NP. The two scoring methods were performed randomly and independently form each other. Results of respiratory event detection and AHI using Therm/NP signals as a reference were compared to those obtained by TS/NP signals. Results: The number of respiratory events scored using Therm/NP was 7268 while it was 7329 with TS/NP. The average AHI for all patients were 29.8 ± 22.9 for Therm/NP and 30.0 ± 22.6 /hour for TS/NP. However, 55.3 % of total events scored by Therm/NP were hypopneas while 59.3 % of events scored by TS/NP were apneas. Conclusions: These results show that the association TS/NP reliably detects the same number of respiratory events as Therm/NP despite the difference of apnea to hypopnea ratio between the two methods. The use of TS does not modify AHI calculations and it guarantees accurate sleep apnea diagnosis. Thus, TS can be used as a substitute for oronasal thermistors in sleep recording systems.

Objectives To evaluate changes in cerebral oxygenation by means of near-infrared spectroscopy during respiratory events in children with sleep-disordered breathing (SDB) and associated disorders. Study design Sixty-five children suspected of having SDB underwent a respiratory polygraphy with simultaneous recording of cerebral oxygenation indices. Respiratory events were analyzed by type of event, duration, variations of pulse oximetry (oxygen saturation [SpO2]), cerebral tissue oxygenation index (TOI), and heart rate. Data were categorized according to the severity of SDB and age. Results There were 540 obstructive and mixed apneas, 172 central apneas, and 393 obstructive hypopneas analyzed. The mean decreases in SpO2 and TOI were 4.1 ± 3.1% and 3.4 ± 2.8%, respectively. The mean TOI decrease was significantly smaller for obstructive hypopnea compared with apneas. The TOI decrease was significantly less in children with mild SDB as compared with those with moderate-to-severe SDB and in children >7 years as compared with those Conclusions In children with SDB and associated disorders, cerebral oxygenation variations depend on the type of respiratory event, severity of SDB, and age.

Mediterranean herbs, specially thyme and rosemary, are important ingredients in food preparation and more recently have been studied as natural sources of bioactive compounds. This study aimed to study the effect of matrix (thyme vs. rosemary), and extraction protocol (conventional extraction vs. ultrasound assisted extraction) solvent composition (water vs. 50:50 ethanol:water solution) on the extraction of high value compounds (phenolic compounds, flavonoids and carotenoids) and also explore the antioxidant, antimicrobial (Listeria innocua, Staphylococcus aureus, and Salmonella enterica), probiotic (Lactobacillus casei and Bifidobacterium lactis), and anti-inflammatory activities. The phenolic, flavonoid and carotenoid content of extracts was greatly influenced by extraction conditions wherein the ultrasound pre-treatment improved the extraction of carotenoids but induced the opposite effect for polyphenols and flavonoids in both herbs. Only the aqueous extract of thyme obtained from ultrasound pre-treatment was the only extract that inhibited the growth of potentially pathogenic bacteria, stimulated the probiotic bacteria and achieved high anti-inflammatory and antioxidant activity. Moreover, this extract also was rich on phenolic compounds (such as p-coumaric acid 4-O-glucoside, kaempferol 3-O-rutinoside, feruloyl glucose, and 4-vinylguaiacol) and carotenoids. Therefore, ultrasound extraction of bioactive compounds with water as solvent could be explored in food and pharmaceutical applications.

Polysomnography (PSG) is necessary for the accurate estimation of total sleep time (TST) and the calculation of the apnea-hypopnea index (AHI). In type III home sleep apnea testing (HSAT), TST is overestimated because of the lack of electrophysiological sleep recordings. The aim of this study was to evaluate the accuracy and reliability of a novel automated sleep/wake scoring algorithm combining a single electroencephalogram (EEG) channel with actimetry and HSAT signals. The study included 160 patients investigated by PSG for suspected obstructive sleep apnea (OSA). Each PSG was recorded and scored manually using American Academy of Sleep Medicine (AASM) rules. The automatic sleep/wake-scoring algorithm was based on a single-channel EEG (FP2-A1) and the variability analysis of HSAT signals (airflow, snoring, actimetry, light and respiratory inductive plethysmography). Optimal detection thresholds were derived for each signal using a training set. Automatic and manual scorings were then compared epoch by epoch considering two states (sleep and wake). Cohen's kappa coefficient between the manual scoring and the proposed automatic algorithm was substantial, 0.74 ± 0.18, in separating wakefulness and sleep. The sensitivity, specificity and the positive and negative predictive values for the detection of wakefulness were 76.51% ± 21.67%, 95.48% ± 5.27%, 81.84% ± 15.42% and 93.85% ± 6.23% respectively. Compared with HSAT signals alone, AHI increased by 22.12% and 27 patients changed categories of OSA severity with the automatic sleep/wake-scoring algorithm. Automatic sleep/wake detection using a single-channel EEG combined with HSAT signals was a reliable method for TST estimation and improved AHI calculation compared with HSAT.

Objectives: In type III home polygraphy (HPG), Apnea Hypopnea Index (AHI) is calculated over the total recording time rather than the total sleep time (TST) as in polysomnography (PSG) and it is, therefore, underestimated. The aim of this study is to assess the impact of an automatic sleep/wake estimation algorithm on the AHI calculation. Methods: The study included 176 patients admitted to the sleep laboratory for a PSG recording. The sleep/wake estimation algorithm used a single lead EEG (FP2-A1) associated to HPG signals (tracheal sounds, nasal airflow, actimetry, light, respiratory inductive plethysmography and suprasternal pressure). AHI using the enhanced HPG (AHIHPG+) scoring was compared with manual AASM scoring of both HPG (AHIHPG) and PSG (AHIPSG). Based on the AHI, patients were diagnosed with mild, moderate or severe sleep apnea. Results: Cohen’s Kappa coefficient, sensitivity, specificity and the positive predictive value for the detection of wakefulness were 0.72, 78%, 94% and 78% respectively. TST estimation resulted in a better AHI assessment (Figure 1). In comparison to AHIPSG, a total of 54 patients were misclassified, using AHIHPG, as mild or moderate instead of moderate or severe. One third (18/54) of these patients would have been diagnosed properly based on AHIHPG+. Conclusions: Enhanced HPG using single lead EEG is an efficient and cost-effective method for TST estimation and AHI calculation.

Objectives: Respiratory inductance plethysmography (RIP) is a common approach for respiratory effort measurement in sleep-disordered breathing (SDB). Nevertheless, the use of RIP could have limited precision, e.g. due to sensor displacement. That is why suprasternal pressure (SSP) monitoring might be an alternative in diagnosis of SDB. The aim of the study was to use SSP for the visual characterization of respiratory events during sleep and to compare results to those found by RIP. Methods: In OSA patients, one-night SSP recording using the PneaVoX sensor (Cidelec, France) was done in parallel to polysomnography (PSG). Apneas were classified visually as obstructive (OA), central (CA), and mixed (MA) based on SSP and on RIP by two trained scores (S1/S2). The sensitivity and specificity of results from SSP compared to RIP were calculated. Results: Synchronous recordings of SSP and PSG were analyzed from n=34 SDB patients (BMI 30±5kg/m²; AHI 34±24/h). AHI based on PSG was correlated with those from SSP (r=0.94, p˂0.01). Respiratory events were scored by scorers S1/S2 mostly as OA or MA with SSP (92.7/93.1%) and with RIP (92.3/92.1%). Sensitivity of SSP in apnea characterization with reference to RIP was 91.5/92.3% (S1/S2) for OA, 82.7/76.2% (S1/S2) for CA, and 87.4/79.9% (S1/S2) for MA. Discussion: Results: reveal that apnea characterization using SSP and using RIP belts are highly concordant. These findings were independently found by two scorers. In summary, it seems that the PneaVoX sensor provides a reliable SSP signal for the classification of respiratory events in SDB patients and could become an additional tool in clinical practice.

Advances in technology have made it possible to reliably and not invasively record physiological parameters to diagnose sleep disorders. The most common sleep-related breathing disorder is sleep apnea. Complete cessation of airflow, apneas, or reduction of airflow, hypopneas occurs during sleep [1]. Based on the underlying pathophysiology, these respiratory events are classified as obstructive or central, with or without respiratory efforts. Accurate and reliable detection and classification of apneas and hypopneas are critical for the diagnosis and quantifying of the disease severity, morbidity, or mortality, as well as for appropriate therapy selection.

This study deals with the phytochemical analyses, antioxidant and antimicrobial activities screening of Erodium glaucophyllum root bark. Organic extracts (Chloroformic Acid and Ethyl acetate) were screened for their biochemical composition as well as antioxidant and antibacterial activities. Phytochemical screening of Erodium glaucophyllum root bark showed the presence of flavonoids, coumarins, saponins, tannins, antracenosides, phenolics compounds and mucilage. Biochemical screening of the two organic extracts show a highest total polyphenolic content of the two solvent (78.022 ± 0.28 mg GAE/g DM in Chloroform extract and 95.468 ± 0.078 mg GAE/g methyl acetate extract). These values were recorded in the proportion of 70% MeOH. The antioxidant activity was evaluated using DPPH tests, chelation, and the total antioxidant capacity. The antibacterial activity was evaluated by the diffusion test agar vis-a-vis of six bacterial strains. The results show that the levels of polyphenolic content influenced these activities.

In obstructive sleep apnea (OSA) esophageal pressure (Pes) is the gold standard for measurement of respiratory effort, and respiratory inductance plethysmography (RIP) is considered an accepted measurement technique. However, the use of RIP could lead to limited accuracy in certain cases and therefore suprasternal pressure (SSP) monitoring might improve the reliability of OSA diagnosis. We aimed to use SSP for the visual characterization of respiratory events in adults and compared results to those obtained by RIP from polysomnography (PSG).In patients with OSA, a 1-night SSP recording using the PneaVoX sensor (Cidelec, Sainte-Gemmes-sur-Loire, France) was done. In parallel, PSG was performed according to American Academy of Sleep Medicine criteria. A subgroup of patients agreed to have Pes measurement in addition. Characterizations of apneas as obstructive, central, and mixed as well as hypopneas as central and obstructive were done by visual evaluation of SSP, RIP, and Pes in random order by two independent scores (S1 and S2). The sensitivity and specificity of characterization by SSP compared to RIP and to Pes were calculated.Synchronous recordings of SSP and PSG were analyzed from n = 34 patients with OSA (AHI 34.1 ± 24.2 events/h); 9 of them had synchronized Pes monitoring as well. Interscorer agreement for apnea characterization as obstructive, central, and mixed based on SSP, RIP, and Pes were found, with RThis study demonstrated a good agreement in the detection of respiratory effort with the SSP signal using the PneaVoX sensor compared to the RIP belts signals as well as to the Pes signal. These findings were consistently found by two independent scorers. In summary, results suggest that SSP is a reliable signal for the classification of respiratory events and could be used as an additional tool for OSA characterization in clinical practice.

Even if the airflow in the upper airway is insignificant, tracheal sounds emitted during apnea and just at the resumption of ventilation have their origin in the inspiratory depression created around the pharyngeal collapse. We aimed to establish a link between the characteristics of chocking sounds (CS) and the nature of the apnea characterized using polysomnography (PSG) with AASM 2012 criteria. Tracheal sounds were sampled at 4 kHz with 16 bits. The PSG recordings used for this study have a signal-to-noise ratio high enough to recognize the pulse signal. We studied the last 10 seconds of apneas and the resumption of ventilation. We characterize mixed or obstructive apneas by the presence of CS and central apnea by the absence of CS. The CS are characterized by their mid-inspiration snoring spectrum that can occur in any hyperventilation following an apnea. The detection of CS from the intermittent (during apnea) or permanent (at the end of apnea) clearing of the temporary obstacle is optimized using ROC curves. The study was conducted on 12 PSG recordings containing 342 obstructive, 240 mixed and 137 central apneas. The optimization criteria require a minimum CS above the background noise of 32 dB during apnea and 34 dB at the end of apnea. Mixed and obstructive sleep apneas are recognized with a sensitivity of 95.5% and a specificity of 95.5%. CS at the end of apneas correctly characterize obstructive events. Their absence indicates that the apneas are central. This study confirms the role of efforts that generate CS during arousal. Finally, compared to qualitative assessment of respiratory efforts using the thoracoabdominal movements, this method introduces a quantitative assessment of respiratory efforts.

Background During noninvasive ventilation, nonintentional leaks have a detrimental effect on the efficacy of ventilation. A wide range of industrial masks are available, with intentional leaks of different importance. The potential impact of this variability in intentional leaks on performances of bilevel ventilators has not been assessed. Objective To measure intentional leaks in seven different industrial masks and determine whether higher leaks modify ventilator performance and quality of ventilation. Methods Seven interfaces connected to four ventilators, the VPAP III ST (ResMed; NorthRyde, Australia), the BiPAP Harmony (Respironics; Monroeville, PA), the SmartAir ST (Covidien/Airox; Pau, France), and the GoodKnight 425 ST Bilevel (Covidien/Tyco-Nellcor/Puritan Bennett; Pleasanton, CA), were adapted on a mannequin connected to a lung model (ASL5000, IngMar Medical; Pittsburgh, PA). Inspiratory positive airway pressure (IPAP) and expiratory positive airway pressure were 14 and 4 cm H2O, respectively. The lung model was set with a respiratory rate of 15 cycles per min and a duration of inspiration of 1 s in three simulated conditions (normal, restrictive, and obstructive). Inspiratory trigger delay and effort, capacity to achieve and maintain IPAP, expiratory cycling and tidal volume were analyzed for all masks and ventilators in the three simulated lung conditions. Results The level of intentional leaks in the seven masks ranged from 30 to 45 L/min for an IPAP of 14 cm H2O. Importance of leaks did not influence trigger performances. However, capacity to achieve and maintain IPAP was significantly decreased with all ventilators and in all simulated lung conditions when intentional leaks increased. This led to a maximum reduction in delivered tidal volume of 48 mL. Expiratory cycling was not affected by the level of intentional leaks except in obstructive lung conditions. Conclusion Mask intentional leaks can impair efficacy of ventilation, especially when > 40 L/min.

Objective Air leakage is a major problem in long-term assisted ventilation both invasive and non-invasive that becomes even more important during sleep. The objective of this work was to provide a method for continuous estimation of tidal volume changes in patients under ventilatory support during sleep. Materials and methods Recordings were from 14 patients with neuromuscular disorders admitted to hospital for a routine evaluation of assisted ventilation during sleep. Air leakage was continuously evaluated from: 1) the difference between the insufflated and expired volume using a flow meter; 2) the changes in lung volume using inductance plethysmography. Results Both methods showed presence of air leaks in all patients and also variations in their amount throughout the night. However, inductance plethysmography provided more rigorous measurement of air leaks than flow meters as it measures the amount of air actually entering the lungs. The magnitude of leakage does not appear to be related to the method of assisted ventilation (invasive or non-invasive) or to the characteristic of the assistance mode (volume control or volume assist control). Conclusion The proposed method offers a reliable, non-invasive, continuous, bedside evaluation of air leak changes in ventilated patients. On-line analysis can be performed to find optimal ventilator settings in order to compensate for leakage while providing patient comfort.

A previously developed competitive enzyme-linked immunosorbent assay (cELISA) based on a species-specific, broadly conserved, and tandemly repeated B-cell epitope within the C terminus of rhoptry-associated protein 1 of Babesia bovis was refined and validated for use internationally. Receiver operating characteristic analysis revealed an assay with a specificity and positive predictive value of 100% and a sensitivity of 91.1%, with various negative predictive values depending on the level of disease prevalence. The cELISA was distributed to four different laboratories, along with a reference set of 100 defined bovine sera, including known-positive, known-negative, and field samples. Pairwise concordances among the four laboratories ranged from 94% to 88%. Analysis of variance of the resulting optical densities and a test of homogeneity indicated no significant difference among the laboratories. Overall, the cELISA appears to have the attributes necessary for international application.

Rationale: Among respiratory events which may occur during nocturnal non-invasive ventilation (NIV), differentiating between central and obstructive events requires appropriate indicators of respiratory effort. Objective: To assess pulse transit time (PTT) as an indicator of respiratory effort under NIV in comparison with esophageal pressure (Pes). Methods: 1: During wake period, PTT was compared to Pes during spontaneous breathing and under NIV with or without induced leaks in 11 healthy individuals. 2: To evaluate the contribution of PTT vs Pes for differentiating central from obstructive respiratory events occurring under NIV during sleep in 10 patients with obesity hypoventilation syndrome (OHS). Results: 1: From spontaneous breathing to NIV without leaks, respiratory effort decreased significantly and with increasing level of leaks, there was a significant increase in respiratory effort. In both situations changes in PTT accurately reflected changes in Pes. 2: In OHS patients during nocturnal NIV, intraclass correlation coefficients between Pes and PTT were 0.970 for total number of events and 0.970 for percentage of central events. Conclusion: PTT accurately reflects the unloading of respiratory muscles induced by NIV and the increase in respiratory effort during NIV. PTT during sleep is also useful to differentiate central from obstructive respiratory events occurring under NIV. Clinical trial registration number: [NCT00983411][1]. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT00983411&atom=%2Ferj%2F40%2FSuppl_56%2F2850.atom

A highly specific and sensitive competitive enzyme-linked immunosorbent assay for detection of specific antibody to Babesia equi in serum from equids was validated for use in Morocco. The assay is based on the specific inhibition of binding of a monoclonal antibody to a conserved epitope within a recombinant parasite peptide by serum from infected animals. The assay was compared to an established indirect immunofluorescence assay, with a concordance of 91%. The assay was used to determine seroprevalence for B. equi infections in donkeys and horses throughout Morocco. A total of 578 sera (163 horses and 415 donkeys) from 6 locations representing different bioclimatic regions were assayed. An analysis of variance, indicated no significant effect of location; however, donkeys were significantly more likely than horses to be seropositive. Management conditions contribute to greater tick infestations and thus Babesia exposure in donkeys than in horses.

It is essential to have a user-friendly, noninvasive bedside procedure at our disposal in order to study swallowing and swallowing disorders in the elderly in view of the frailty of this age group. In the present work, respiratory inductance plethysmography (RIP) is proposed as an appropriate clinical tool for such studies. An automated process for the detection of swallowing is used involving the derivative of the respiratory volume signal. The accuracy of the automated detection is given by the area under the Receiver Operating Characteristic (ROC) curve and is found to be greater than 0.9. At the optimal threshold, RIP constitutes a reliable and objective bedside clinical tool for studying swallowing in the elderly, as well as being user-friendly and noninvasive. In addition, RIP can be used to monitor swallowing in order to analyze swallowing disorders and put in place medical supervision of swallowing for individuals who might aspirate.

The obstructive syndrome of sleep apnea/hypopnea is characterized by repeated partial or total obstructions of the upper airways (UA) [1] resulting in intermittent asphyxia and repeated micro-arousals. Sleep disordered breathing affects about 9% of males and 4.5% of females between the ages of 30 and 60 years [2], 15% to 20% of elderly people [3] and 5% to 10% of children [4]. Sleep apnea and hypopnea events are easily identified while more subtle events, such as inspiratory flow limitation episodes, are difficult to detect. Flow limitation is the result of a partial occlusion of the upper airway during sleep.

International audience; Abstract - Canine leishmaniasis (canL) is widespread in the north of Morocco and the Leishmania infantum local strains are highly virulent. An epidemiological survey was carried out in 1993-1995 in the Khemisset province. In this region, the severity of the disease was assessed during regular visits to the identified foci by clinical examination of 323 dogs. Clinical signs were protean and occurred in various combinations. Biopsies were made on available sick dogs; the main histological changes were severe infiltration of the spleen, lymph nodes and bone marrow by mononuclear cells and hyperplasia of macrophage cells with amastigotes in their cytoplasm. The seroprevalence among 323 dog sera tested by ELISA showed a rate of 16.71% . The highest prevalence of the disease was 23.6% in the Sid El Ghandour hamlet. A comparison of the results of this study with those from the year following the first examination on the same site (Sid El Ghandour) of 67 dogs showed that the disease prevalence had not increased significantly (23.6% to 25.33% ).; La leishmaniose canine : étude sérologique, clinique et histopathologique dans la province de Khemisset, Maroc. La leishmaniose canine (L.can) est largement répandue dans la partie Nord du Maroc et les souches de Leishmania infantum sont très virulentes. Dans la présente étude, nous rapportons les résultats d'une enquête sur la leishmaniose canine au Maroc dans la province de Khemisset de 1993 à 1995. La gravité de la maladie a été évaluée par l'examen clinique minutieux de 323 chiens lors de visites régulières dans les foyers identifiés. Les signes cliniques ont révélé un caractère protéiforme et un manque de constance des symptômes. Les biopsies des ganglions, rate et moelle osseuse ont montré une infiltration massive par les cellules mononucléaires et une hyperplasie de macrophages avec des amastigotes dans leur cytoplasme. La recherche des anticorps anti-Leishmania effectuée par la technique ELISA a révélé une séro-prévalence moyenne de 16,71 % avec 23,63 % dans la localité de Sid El Ghandour seule. La comparaison des résultats de cette étude avec ceux d'une année après la première visite dans cette dernière localité sur 67 chiens a montré que la prévalence n'a pas augmenté significativement (23,6 % à 25,33 % ).

Proteins extracted from salivary glands of unfed, three days and five days fed adult Hyalomma marginatum marginatum were analyzed by sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE). We have noticed changes during the three feeding steps. Some proteins disappeared during feeding process (23, 38, 39, 40 to 50, 95 and 112 kDa), they might be proteins which were converted in other substances and are secreted. Other antigens (13 to 14, 20, 25, 29, 165 and 210 kDa) were synthesized as a result of tick attachment and feeding. They may be related to growth and development or are the ciment which fixed the adult. Also, three Holstein calves were infested five times with 100 pairs of adult ticks of the same species. The five infestations were performed two weeks from the previous infestation. The sera before infestations and after each infestation were used in western-blot analyses to identify antigens from five days salivary gland extracts of the primary infestation of ticks. Three antigens (18.7, 50 and 80 kDa) were revealed weakly after the first and the second infestations by sera samples but not at infestation onward. Others (13.5, 17 to 18.5, 25, 30, 70, 133, 176 and 193 kDa) were revealed only by sera taken after manifestation of resistance (third infestation). A 13.5 kDa antigen was particularly revealed when resistance had appeared and became more evident after the fourth and fifth infestations. The late antigens recognized might be associated with establishment of calves resistance against ticks.

The incidence of canine visceral leishmaniasis (CVL) is increasing in the Mediterranean region. Many drugs have been tested for treatment of CVL, but little is known regarding their effect on test immune responses. In our study, three dogs naturally infected with Leishmania infantum and five dogs experimentally infected with the same strain, were treated with dimethasulfonate pentamidine (Lomidine) and the immune response evaluated before, and after, treatment. After the last injection, animals began to gain weight and the major clinical signs disappeared. Antibody titers gradually decreased to low levels, six months after treatment. At the same time, antigen specific lymphoproliferation reappeared in the sampled animals. This study shows that, after treatment, immune cellular responses to leishmanial antigens, involved in protection against Leishmania infection, were established.

Cell-mediated and humoral immune response in naturally and experimentally infected dogs was studied using crude and pure antigens. Both types of infections induced severe signs of visceral disease, but the symptoms observed in natural infections were more pronounced than in experimental infections. In addition, asymptomatic infections were not observed in experimentally infected animals. Disease evolution in laboratory infections was rapid and an increase in antibody titer to crude parasite antigen was correlated with the appearance and aggravation of clinical symptoms. Peripheral blood lymphocyte proliferation to crude antigen and pure gp63 was observed early following experimental infection, but was abolished once the infected dogs began to exhibit clinical signs. A similar pattern was observed in naturally infected dogs. Serum from all patent dogs showed high antibody titers to rK39 in enzyme-linked immunosorbent assays (ELISA), and reacted by western blotting with several antigens, 12 to 120 KDa, including gp63 and gp70. In the case of asymptomatic dogs, antibody titers to crude antigen were low and only a few antigens were identified by western blotting. None of the pure proteins examined, gp63, gp70, and rK39 were recognized by western blotting or ELISA. However, asymptomatic dogs exhibited specific lymphocyte proliferation to both crude antigen and the potential vaccine candidate gp63.

Three Holstein calves were infested with low numbers of ticks, two or three pairs of adults Hyalomma marginatum marginatum in cloth bag daily for 21 days. Infestation was carried out during tick proliferation periods. Two months later, cattle leads were challenged with 100 pairs of ticks. Another group of three Holstein calves were infested five times with 100 pairs of adult ticks of the same species. The five infestations were performed two weeks from the previous infestation. Three tick characteristics were recorded for each experiment: survival to detachment, females weight at detachment and egg mass weight. Light continuous infestations did not cause a significant change in this parameter, but every parameter declined gradually in the heavy infestations. Female and egg mass weight reached a significant difference from the first infestation by the fourth infestation. The circulating antibodies anti-salivary glands of Hyalomma m. marginatum showed that light infestation may induce like immuno-suppression. However, there is an inverse relationship between these antibodies and manifestation of resistance when calves were heavily infested. This is discussed in relation to a fraction of produced antibodies against protective antigens, and participation of another effector mechanism.

Les auteurs rapportent les resultats preliminaires d'une enquete epidemiologique autour d'un cas de leishmaniose viscerale infantile de la localite de Ouled Hcein, province de Taounate (Nord du Maroc). la souche isolee a partir de l'enfant a ete identifiee par trois methodes comme Leishmania infantum et l'analyse isoenzymatique montre une similitude totale avec le zymodeme MON-1. Au cours de l'enquete humaine menee dans la localite d'origine du cas index, aucun autre cas n'a ete diagnostique, et la serologie s'est averee negative pour toutes les personnes testees. L'enquete canine menee dans cette meme localite et dans quatre autres voisines a montre que la plus forte seroprevalence (27,1 %) etait retrouvee dans celle du cas index. L'enquete entomologique a montre que Phlebotomus longicuspis est l'espece predominante parmi celles deja demontrees comme vecteur de L. infantum autour de la Mediterranee. Par ailleurs, l'identification d'une femelle de P. ariasi naturellement infestee par L. infantum suggere que cette espece est au moins l'un des vecteurs du parasite. Cette etude confirme donc que le cycle de transmission de L. infantum dans le Nord du Maroc est similaire a celui du reste du Bassin Mediterraneen.

The development of Muellerius capillaris in the lung of goats was associated with marked tissue damage and pronounced a cellular reaction. Using broncho-alveolar lavage, the time course of the cellular responses was studied following primary and secondary infection. During the primary infection, there was a biphasic increase in total broncho-alveolar leucocytes (an average of 294.0 +/- 137.0 cells microl[-1]) and in the absolute number of macrophages (182.0 +/- 82.0 cells ul[-1]), lymphocytes (68.5 +/- 35.0 cells microl[-1]), eosinophils (35.3 +/- 16.4 cells microl[-1]) and neutrophils (10.9 +/- 8.7 cell microl[-1]). The lung tissue reaction against worms consisted of a mild infiltration of inflammatory cells. The secondary infection resulted in significant changes in the pulmonary tissue characterised by severe inflammation, leading to widespread granulomatous formation throughout the parenchyma, hyperplasia of cells Type II and a leucocytosis in the broncho-alveolar fluids, with an anamnestic-like response by all cell types. The overall average of the total leucocytes, macrophages, lymphocytes, eosinophils and neutrophils was 529.3 +/- 347.4; 265.4 +/- 148.1; 127.3 +/- 100; 125.4 +/- 100.1 and 14.0 +/- 8.7 cells microl(-1), respectively. Secondary infection also resulted in 56% reduction of worms established in the lungs and 72.3% of L1 larval production. These data suggest that the broncho-alveolar leucocyte response to infection has an immunological basis and that the alveolar macrophages, neutrophils, eosinophils, and lymphocytes may play a significant role in lung resistance against protostrongylid nematodes.

Monoclonal antibodies (mAbs) were obtained against the surface antigens of the Eimeria falciformis sporozoite by immunizing mice with whole homogenized sporozoite. The hybridomas were selected by their reactivities against oocyst extracts, then against glutaraldehyde-treated sporozoites. Three mAbs recognized both the surface of E. falciformis, E. tenella, and E. acervulina and their refractile bodies, whereas a fourth mAb recognized only one epitope on the refractile bodies. All mAbs bound to the same immunoaffinity-purified antigens in Western-blot analysis (P27 for E. falciformis and P25 for E. tenella and E. acervulina). Thus, the mAbs define at least two shared epitopes between sporozoite antigens from different eimerian species. Two of these mAbs are involved in the in vitro phagocytosis of E. falciformis sporozoites by macrophages and also in their lysis by neutrophils. Altogether, these properties showed that the four mAbs came from different activated B-cells. The P27 antigen recognized by our mAbs represents a major target of the in vitro destructive immune response.