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Drawing on a multidisciplinary survey carried out in three contrasting areas of the Rhône-Alpes Region in France, this article investigates how the concept of multifunctionality has been understood and appropriated. After a retrospective look at French agricultural policy, the first part presents our analytical framework, which is inspired by the sociology of action. The second part analyses the socio-political issues of farming in each area and the compromises established around the various functions attributed to agriculture. The third part highlights the different ways of considering and practising farming, as well as the social expectations towards agriculture. This regional comparison shows that professional identities are constructed at local levels in different places: the farms and their neighbourhood, local groups and agricultural organisations. Local agreements on agriculture and the construction of professional identities take into account multifunctionality in specific ways, which depend on the social and economic relationships that the farmers have established with their fellow citizens. [ABSTRACT FROM AUTHOR]

The paper examines the determinants of the creation of high tech SMEs at a regional level. Relations between the scientific and technical profile of a region, the size of the local market for biotech products and services, and economic development are explored in the French biotech industry during the 1990's. Empirical analysis shows that a high level of scientific activity within a region is necessary to sustain a continuous flow of new business creation. The likelihood of firm creation depends on scientific and technological organizational factors like cooperation between academic and private organizations. Regional policies can have positive impact on firm creation, especially by promoting diversity and excellence in science. However, contrasting with the U.S. results, the size of the local market for biotech products and services matters in the industry development. [ABSTRACT FROM AUTHOR]

Abstract: In the last few years, a scientific consensus has emerged regarding the increasing frequency and severity of cyanobacterial blooms in freshwater environments. Consequently, recreational and drinking water bodies are now increasingly monitored by local authorities to prevent animal and human poisoning related to cyanobacteria and their toxins. A survey of a water body used for recreational activities (at Champs-sur-Marne, Paris suburb) was conducted from 2005 to 2008. The chlorophyll a concentrations, the occurrence of toxic cyanobacteria and of the cyanotoxins microcystins, anatoxin-a and saxitoxins were recorded. The potentially toxic genera Aphanizomenon, Planktothrix and Microcystis were observed throughout the monitoring period. Microcystis was the dominant genus during the first two years (2005–2007), whereas Aphanizomenon became the dominant genus towards the end of the survey (2007–2008). As a consequence, microcystins were initially detected at high concentrations (max.=89μgequivMC-LRL−1 in raw water), and were later superceded by saxitoxins (STXs) in 2008. Using LC–MS/MS and the Neuro-2a cell-based assay, we confirmed that the STX and neoSTX variants were present in the natural samples at concentrations higher than 3μgequivSTXL−1 in raw water. To attribute STXs production to the appropriate cyanobacterial taxa, monoclonal cultures were obtained after an isolation procedure then screened for the presence of the sxtA gene. SxtA-positive strains were analyzed for their STX content using the Neuro-2a cell-based assay and LC–MS/MS. The results led to consider Aphanizomenon gracile as the most likely producer of STXs. The first description of STXs in a French recreational water body lead to discuss the health risks associated with the presence of STXs alone or with its co-occurrence with other known cyanotoxins in recreational water bodies. [ABSTRACT FROM AUTHOR]

Hyalomma marginatum is an invasive tick species recently established in mainland southern France. This tick is known to host a diverse range of human and animal pathogens. While information about the dynamics of these pathogens is crucial to assess disease risk and develop effective monitoring strategies, few data on the spatial dynamics of these pathogens are currently available. We collected ticks in 27 sites in the Occitanie region to characterize spatial patterns of H. marginatum -borne pathogens. Several pathogens have been detected: Theileria equi (9.2%), Theileria orientalis (0.2%), Anaplasma phagocytophilum (1.6%), Anaplasma marginale (0.8%), and Rickettsia aeschlimannii (87.3%). Interestingly, we found a spatial clustered distribution for the pathogen R. aeschlimannii between two geographically isolated areas with infection rates and bacterial loads significantly lower in Hérault/Gard departments (infection rate 78.6% in average) compared to Aude/Pyrénées-Orientales departments (infection rate 92.3% in average). At a smaller scale, R. aeschlimannii infection rates varied from one site to another, ranging from 29% to 100%. Overall, such high infection rates (87.3% on average) and the effective maternal transmission of R. aeschlimannii might suggest a role as a tick symbiont in H. marginatum . Further studies are thus needed to understand both the status and the role of R. aeschlimannii in H. marginatum ticks.IMPORTANCETicks are obligatory hematophagous arthropods that transmit pathogens of medical and veterinary importance. Pathogen infections cause serious health issues in humans and considerable economic loss in domestic animals. Information about the presence of pathogens in ticks and their dynamics is crucial to assess disease risk for public and animal health. Analyzing tick-borne pathogens in ticks collected in 27 sites in the Occitanie region, our results highlight clear spatial patterns in the Hyalomma marginatum -borne pathogen distribution and strengthen the postulate that it is essential to develop effective monitoring strategies and consider the spatial scale to better characterize the circulation of tick-borne pathogens., Competing Interests: The authors declare no conflict of interest.

Crimean-Congo haemorrhagic fever (CCHF), a potentially severe zoonotic viral disease causing fever and haemorrhagic manifestations in humans. As the Crimean-Congo haemorrhagic fever virus (CCHFV) has been detected in ticks in Spain and antibodies against the virus in ruminant sera in Corsica, it was necessary to know more about the situation in France. In 2022-2023, CCHFV was detected in 155 ticks collected from horses and cattle in southern France.

To better prevent and control multi-host pathogen circulation over large areas, it is essential to identify patterns of disease persistence within host communities involved in pathogen circulation at a macroscale. The aim of this study was to design and calculate "BACACIX", a spatial index of indirect contacts between cattle and badgers, two species involved in the circulation of Mycobacterium bovis, one of the main causative agents of bovine tuberculosis (bTB), in some areas of France. The index combined spatial models of land use distribution (the probable distribution defining animal use of space) based on pasture location for cattle, and based on land cover for badgers, with proxies for animal density for both species. For badgers, we used two series of census data of badger setts in two regions of France to evaluate our model of badger space use distribution (also known as utilization distribution), and analyzed the relationship between BACACIX and the upsurge of bovine tuberculosis observed in several regions of France during the decade after the country obtained the officially bTB-free status in 2001. We observed high values of BACACIX from the southwest to the northeast of France and from Brittany to the Channel coast. Conversely, in two areas (north-central area and Mediterranean coast), index values were low, suggesting that indirect cattle-badger contacts were unlikely. In the two series of census data of badger setts that we analyzed, 96.5% and 87% of the global positioning system (GPS) locations of badger setts, respectively were located in the calculated badger space use distribution. A logistic regression model showed that after controlling bTB over the previous decade, the value of the index was positively associated with the risk of cattle outbreaks between 2001 and 2010 (OR = 1.57). In addition, the risk of bTB occurrence in cattle decreased when the pasture area outside the badger space use distribution increased. In the future, the spatial index of indirect cattle-badger contacts we propose could help to better target bTB surveillance and control in France., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Background: The Balaruc-les-Bains' thermal mud was found to be colonized predominantly by microorganisms, with cyanobacteria constituting the primary organism in the microbial biofilm observed on the mud surface. The success of cyanobacteria in colonizing this specific ecological niche can be explained in part by their taxa-specific adaptation capacities, and also the diversity of bioactive natural products that they synthesize. This array of components has physiological and ecological properties that may be exploited for various applications. Methods: Nine cyanobacterial strains were isolated from Balaruc thermal mud and maintained in the Paris Museum Collection (PMC). Full genome sequencing was performed coupled with targeted and untargeted metabolomic analyses (HPLC-DAD and LC-MS/MS). Bioassays were performed to determine antioxidant, anti-inflammatory, and wound-healing properties. Results: Biosynthetic pathways for phycobiliproteins, scytonemin, and carotenoid pigments and 124 metabolite biosynthetic gene clusters (BGCs) were characterized. Several compounds with known antioxidant or anti-inflammatory properties, such as carotenoids, phycobilins, mycosporine-like amino acids, and aeruginosins, and other bioactive metabolites like microginins, microviridins, and anabaenolysins were identified. Secretion of the proinflammatory cytokines TNF-α, IL-1β, IL-6, and IL-8 appeared to be inhibited by crude extracts of Planktothricoides raciborskii PMC 877.14, Nostoc sp. PMC 881.14, and Pseudo-chroococcus couteii PMC 885.14. The extract of the Aliinostoc sp. PMC 882.14 strain was able to slightly enhance migration of HaCat cells that may be helpful in wound healing. Several antioxidant compounds were detected, but no significant effects on nitric oxide secretion were observed. There was no cytotoxicity on the three cell types tested, indicating that cyanobacterial extracts may have anti-inflammatory therapeutic potential without harming body cells. These data open up promising uses for these extracts and their respective molecules in drugs or thermal therapies.

Objective: This study aimed to describe end-of-life (EOL) care in individuals with bipolar disorder (BD) who died of cancer compared with mentally healthy individuals., Methods: This was a nationwide cohort study of all adult individuals who died of cancer in hospitals in France between 2013 and 2016. Outcomes were compared between individuals with BD and mentally healthy individuals in the last month of life including palliative care and high-intensity EOL care (chemotherapy, artificial nutrition, and other interventions). A subanalysis explored differences between patients with BD and patients with schizophrenia., Results: The study included 2015 individuals with BD and 222,477 mentally healthy controls. Compared with the controls, individuals with BD died 5 years earlier, more often had comorbidities and thoracic cancer, and had fewer metastases, but did not have shorter delays from cancer diagnosis to death. After matching and adjustment for covariates, individuals with BD more often received palliative care in the last 3 days of life (25% versus 13%, p < .001) and less high-intensity care (e.g., chemotherapy 12% versus 15%, p = .004), but more artificial nutrition (6% versus 4.6%, p = .003). Compared with the schizophrenia comparison group, chemotherapy was received more by individuals with BD in the last 14 days of life (12.5% for BD versus 9.4%, p < .001)., Conclusions: Individuals with BD were more likely to receive palliative care and less likely to receive high-intensity EOL care, except for artificial nutrition. These results may not be specific to BD, as no difference was found between patients with BD and schizophrenia except for chemotherapy.

Co-infection by a type 1 modified live vaccine-like strain (MLV1-like) of porcine reproductive and respiratory syndrome virus (PRRSV) and a type 2 porcine circovirus (PCV2) was identified on a French pig farm with post-weaning multisystemic wasting syndrome (PMWS). An in vivo experiment was set up to characterize the virulence level of the MLV1-like strain compared with the parental MLV1 strain, and to assess the impact of PCV2 co-infection on the pathogenicity of both PRRSV strains. Six groups of six pigs each were inoculated only with either one of the two PRRSV strains or with PCV2, or co-inoculated with PCV2 and MLV1 or PCV2 and MLV1-like strains. Six contact pigs were added to each inoculated group to assess viral transmission. The animals were monitored daily for 35 days post-inoculation for clinical symptoms. Blood and nasal swabs were sampled twice a week, and tissue samples were collected during necropsy for viral quantification. Compared to MLV1-infected pigs, animals infected with the MLV1-like strain had increased PRRSV viremia and nasal shedding, a higher viral load in the tonsils, and lymph node hypertrophy at microscopic level. PCV2 co-infection did not influence clinical, virologic or transmission parameters for MLV1, but co-infected MLV1-like/PCV2 pigs had the most severe lung lesions, the highest viremia in contact animals and the highest transmission rate. Our study demonstrated that the MLV1 strain tested was safe when co-inoculated with PCV2 in piglets. However, co-infection by the MLV1-like strain and PCV2 resulted in increased virulence compared with that due to a single infection., Competing Interests: Declaration of Competing Interest The authors declare that they have no conflict of interests., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Objective: We still don't know if recurrent major depressive disorder (RMDD) may impact the quality of the end-of-life (EOL) cancer care in France. To tackle this knowledge gap, we explored EOL care in RMDD subjects who died from cancer compared to subjects without psychiatric disorder in a 4-year nationwide cohort study., Design: Nationwide cohort study., Setting: National hospital database, France., Participants: All patients aged ≥15 years who died from cancer in hospital: 4070 RMDD subjects and 222,477 controls, 2013-2016, France., Main Outcome Measures: Palliative care in the last 31 days of life and high-intensity EOL care including chemotherapy in the last 14 days of life, artificial nutrition, tracheal intubation, mechanical ventilation, gastrostomy, cardiopulmonary resuscitation, dialysis, transfusion, surgery, endoscopy, imaging, intensive care unit and emergency department admission in the last 31 days of life. Multivariate generalized mixed models with log-normal distribution was used to compare RMDD subjects and controls., Results: Compared to the controls, the RMDD subjects died 3 years younger, had more comorbidities, more thoracic cancers, less metastases and longer time from cancer diagnosis to death. After matching and adjustment, subjects with RMDD were found to receive more palliative care and less high-intensity EOL care, had fewer iterative admissions to acute care unit, and died less often in the intensive care unit and emergency department., Conclusions: RMDD subjects were more likely to receive palliative care associated with less high-intensity EOL care. Yet the interpretation may be discussed, resulting from either patients'/families' wishes or difficulties for providers in offering personalized care to RMDD., Competing Interests: Declaration of Competing Interest None declared., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: Patients with schizophrenia represent a vulnerable, underserved, and undertreated population who have been neglected in health disparities work. Understanding of end-of-life care in patients with schizophrenia and cancer is poor. We aimed to establish whether end-of-life care delivered to patients with schizophrenia and cancer differed from that delivered to patients with cancer who do not have diagnosed mental illness., Methods: We did a population-based cohort study of all patients older than 15 years who had a diagnosis of advanced cancer and who died in hospital in France between Jan 1, 2013, and Dec 31, 2016. We divided this population into cases (ie, patients with schizophrenia) and controls (ie, patients without a diagnosis of mental illness) and compared access to palliative care and indicators of high-intensity end-of-life care between groups. In addition to unmatched analyses, we also did matched analyses (matched in terms of age at death, sex, and site of primary cancer) between patients with schizophrenia and matched controls (1:4). Multivariable generalised linear models were done with adjustment for social deprivation, year of death, time from cancer diagnosis to death, metastases, comorbidity, and hospital type (ie, specialist cancer centre vs non-specialist centre)., Findings: The main analysis included 2481 patients with schizophrenia and 222 477 controls. The matched analyses included 2477 patients with schizophrenia and 9896 controls. Patients with schizophrenia were more likely to receive palliative care in the last 31 days of life (adjusted odds ratio 1·61 [95% CI 1·45-1·80]; p<0·0001) and less likely to receive high-intensity end-of-life care-such as chemotherapy and surgery-than were matched controls without a diagnosis of mental illness. Patients with schizophrenia were also more likely to die younger, had a shorter duration between cancer diagnosis and death, and were more likely to have thoracic cancers and comorbidities than were controls., Interpretation: Our findings suggest the existence of disparities in health and health care between patients with schizophrenia and patients without a diagnosis of mental illness. These findings underscore the need for better understanding of health inequalities so that effective interventions can be developed for this vulnerable population., Funding: Assistance Publique des Hôpitaux de Marseille and Aix-Marseille University., (Copyright © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Evaluating the causes and consequences of dominance by a limited number of taxa in phytoplankton communities is of huge importance in the current context of increasing anthropogenic pressures on natural ecosystems. This is of particular concern in densely populated urban areas where usages and impacts of human populations on water ecosystems are strongly interconnected. Microbial biodiversity is commonly used as a bioindicator of environmental quality and ecosystem functioning, but there are few studies at the regional scale that integrate the drivers of dominance in phytoplankton communities and their consequences on the structure and functioning of these communities. Here, we studied the causes and consequences of phytoplankton dominance in 50 environmentally contrasted waterbodies, sampled over four summer campaigns in the highly-populated Île-de-France region (IDF). Phytoplankton dominance was observed in 32-52% of the communities and most cases were attributed to Chlorophyta (35.5-40.6% of cases) and Cyanobacteria (30.3-36.5%). The best predictors of dominance were identified using multinomial logistic regression and included waterbody features (surface, depth and connection to the hydrological network) and water column characteristics (total N, TN:TP ratio, water temperature and stratification). The consequences of dominance were dependent on the identity of the dominant organisms and included modifications of biological attributes (richness, cohesion) and functioning (biomass, RUE) of phytoplankton communities. We constructed co-occurrence networks using high resolution phytoplankton biomass and demonstrated that networks under dominance by Chlorophyta and Cyanobacteria exhibited significantly different structure compared with networks without dominance. Furthermore, dominance by Cyanobacteria was associated with more profound network modifications (e.g. cohesion, size, density, efficiency and proportion of negative links), suggesting a stronger disruption of the structure and functioning of phytoplankton communities in the conditions in which this group dominates. Finally, we provide a synthesis on the relationships between environmental drivers, dominance status, community attributes and network structure., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

SETTING: The World Health Organization (WHO) recommends that multidrug-resistant tuberculosis (MDR-TB) treatment should be managed in collaboration with multidisciplinary advisory committees (consilia). A formal national Consilium has been established in France since 2005 to provide a centralised advisory service for clinicians managing MDR-TB and extensively drug-resistant (XDR-TB) cases. OBJECTIVE: Review the activity of the French TB Consilium since its establishment. DESIGN: Retrospective description and analysis of the activity of the French TB Consilium. RESULTS: Between 2005 and 2016, 786 TB cases or contacts of TB cases were presented at the French TB Consilium, including respectively 42% and 79% of all the MDR-TB and XDR-TB cases notified in France during this period. Treatment regimens including bedaquiline and/or delamanid were recommended for 42% of the cases presented at the French TB Consilium since 2009. Patients were more likely to be presented at the French TB Consilium if they were born in the WHO Europe Region, had XDR-TB, were diagnosed in the Paris region, or had resistance to additional drugs than those defining XDR-TB. CONCLUSION: The French TB Consilium helped supervise appropriate management of MDR/XDR-TB cases and facilitated implementation of new drugs for MDR/XDR-TB treatment.

With the increasing impact of the global warming, occurrences of cyanobacterial blooms in aquatic ecosystems are becoming a main worldwide ecological concern. Due to their capacity to produce potential toxic metabolites, interactions between the cyanobacteria, their cyanotoxins and the surrounding freshwater organisms have been investigated during the last past years. Non-targeted metabolomic analyses have the powerful capacity to study simultaneously a high number of metabolites and thus to investigate in depth the molecular signatures between various organisms encountering different environmental scenario, and potentially facing cyanobacterial blooms. In this way, the liver metabolomes of two fish species (Perca fluviatilis and Lepomis gibbosus) colonizing various peri-urban lakes of the Île-de-France region displaying high biomass of cyanobacteria, or not, were investigated. The fish metabolome hydrophilic fraction was analyzed by 1 H NMR analysis coupled with Batman peak treatment for the quantification and the annotation attempt of the metabolites. The results suggest that similar metabolome profiles occur in both fish species, for individuals collected from cyanobacterial blooming lakes compared to organism from non-cyanobacterial dominant environments. Overall, such environmental metabolomic pilot study provides new research perspectives in ecology and ecotoxicology fields, and may notably provide new information concerning the cyanobacteria/fish ecotoxicological interactions., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Efforts to improve the quality of end-of-life (EOL) care depend on better knowledge of the care that children, adolescents, and young adults with cancer receive, including high-intensity EOL (HI-EOL) care. The objective was to assess the rates of HI-EOL care in this population and to determine patient- and hospital-related predictors of HI-EOL from the French national hospital database., Methods: This was a population-based, retrospective study of a cohort of patients aged 0 to 25 years at the time of death who died at hospital as a result of cancer in France between 2014 and 2016. The primary outcome was HI-EOL care, defined as the occurrence of ≥1 chemotherapy session <14 days from death, receiving care in an intensive care unit ≥1 time, >1 emergency room admission, and >1 hospitalization in an acute care unit in the last 30 days of life., Results: The study included 1899 individuals from 345 hospitals; 61.4% experienced HI-EOL care. HI-EOL was increased with social disadvantage (adjusted odds ratio [AOR], 1.30; 95% confidence interval [CI], 1.03-1.65; P = .028), hematological malignancies (AOR, 2.09; 95% CI, 1.57-2.77; P < .001), complex chronic conditions (AOR, 1.60; 95% CI, 1.23-2.09; P = .001) and care delivered in a specialty center (AOR, 1.70; 95% CI, 1.22-2.36; P = .001). HI-EOL was reduced in cases of palliative care (AOR, 0.31; 95% CI, 0.24-0.41; P < .001)., Conclusion: A majority of children, adolescents, and young adults experience HI-EOL care. Several features (eg, social disadvantage, cancer diagnosis, complex chronic conditions, and specialty center care) were associated with HI-EOL care. These findings should now be discussed with patients, families, and professionals to define the optimal EOL., (© 2019 American Cancer Society.)

Background: Studies using health administrative databases (HAD) may lead to biased results since information on potential confounders is often missing. Methods that integrate confounder data from cohort studies, such as multivariate imputation by chained equations (MICE) and two-stage calibration (TSC), aim to reduce confounding bias. We provide new insights into their behavior under different deviations from representativeness of the cohort., Methods: We conducted an extensive simulation study to assess the performance of these two methods under different deviations from representativeness of the cohort. We illustrate these approaches by studying the association between benzodiazepine use and fractures in the elderly using the general sample of French health insurance beneficiaries (EGB) as main database and two French cohorts (Paquid and 3C) as validation samples., Results: When the cohort was representative from the same population as the HAD, the two methods are unbiased. TSC was more efficient and faster but its variance could be slightly underestimated when confounders were non-Gaussian. If the cohort was a subsample of the HAD (internal validation) with the probability of the subject being included in the cohort depending on both exposure and outcome, MICE was unbiased while TSC was biased. The two methods appeared biased when the inclusion probability in the cohort depended on unobserved confounders., Conclusion: When choosing the most appropriate method, epidemiologists should consider the origin of the cohort (internal or external validation) as well as the (anticipated or observed) selection biases of the validation sample., Competing Interests: The authors have declared that no competing interests exist.

An acute epidemic of porcine epidemic diarrhea (PED) has affected the USA since 2013 and spread all around the world. In France, the immune status of the pig population against PED virus (PEDV) was expected to be low due to the absence of circulation of the virus since the 80's and a compulsory notification of PED was set up in 2014. Here, we reported the first case of a PED outbreak in December 2014 in the North of France after a long absence of the disease, the monitoring of the excretion and the control measure implementation. The isolated strain in France in December 2014 was a PEDV "S-InDel" strain which was close to the "S-InDel" German PEDV strain isolated in May 2014. The individual shedding duration of PEDV in feces was estimated around 20 days for pigs of different ages. Biosecurity measures implemented allowed the limitation of PEDV spread to fattening and farrowing rooms without dissemination to the nursery block. Using strict biosecurity measures, direct shipment of infected fatteners to the slaughterhouse, strict decontamination protocols with a quarantine of 6 weeks for replacement gilts without voluntary contamination helped PEDV fade out within the herd and avoided the spread to other herds. PEDV presence in manure was investigated as well as the inactivation treatment of the virus present in the liquid manure. An increase to a pH 12 of liquid manure by liming led to the absence of PEDV detection by RT-PCR after seven days., (Copyright © 2018. Published by Elsevier B.V.)

Drawing on her hospital expertise in pulmonology, a currently private practice nurse describes her work supporting patients with chronic obstructive pulmonary disease in their home. In collaboration with hospital- and community-based teams, she uses a support tool to formalise therapeutic education sessions., (Copyright © 2018. Publié par Elsevier Masson SAS.)

Settings: Identification of extensively drug-resistant tuberculosis (XDR-TB) may be delayed because of the lack of availability of molecular testing for second-line drugs (SLDs). Early suspicion of XDR-TB is therefore necessary to avoid developing further drug resistance., Objective: To identify the characteristics associated with XDR-TB among multidrug-resistant TB (MDR-TB) cases before the availability of second-line drug susceptibility testing (DST) results., Methods: All MDR-TB cases with available second-line DST results recorded in France from 1998 to 2013 were classified as simple MDR-TB (no resistance to fluoroquinolones [FQs] or second-line injectable drugs [SLIDs]), pre-XDR-TB (resistance to FQs or SLIDs) and XDR-TB cases (resistance to both)., Results: A total of 833 MDR-TB cases were analysed, including 168 (20%) pre-XDR and 62 (7%) XDR-TB cases. A previous history of treatment was acknowledged among 41% of the cases; 12% were human immunodeficiency virus-positive. Characteristics independently associated with XDR-TB were foreign birth (OR 9.5), previous anti-tuberculosis treatment (OR 2.6), smear positivity (OR 4.5) and ethambutol (EMB) resistance (OR 9.1). Characteristics independently associated with pre-XDR-TB compared to simple MDR-TB cases were male sex (OR 1.6), birth in Europe (OR 2.6) and EMB resistance (OR 1.9)., Conclusion: The presence of clinical or bacteriological characteristics associated with XDR-TB should lead to rapid molecular testing for resistance to SLDs before starting tailored treatment.

Background: Human endogenous retroviruses HERV-W encode a pro-inflammatory protein, named MSRV-Env from its original identification in Multiple Sclerosis. Though not detected in various neurological controls, MSRV-Env was found in patients with chronic inflammatory demyelinating polyradiculoneuropathies (CIDPs). This study investigated the expression of MSRV in CIDP and evaluated relevant MSRV-Env pathogenic effects., Methods: 50 CIDP patients, 19 other neurological controls (ONDs) and 65 healthy blood donors (HBDs) were recruited from two different countries. MSRV-env and -pol transcripts, IL6 and CXCL10 levels were quantified from blood samples. MSRV-Env immunohistology was performed in distal sensory nerves from CIDP and neurological controls biopsies. MSRV-Env pathogenic effects and mode of action were assayed in cultured primary human Schwann cells (HSCs)., Findings: In both cohorts, MSRV-env and -pol transcripts, IL6 positivity prevalence and CXCL10 levels were significantly elevated in CIDP patients when compared to HBDs and ONDs (statistically significant in all comparisons). MSRV-Env protein was detected in Schwann cells in 5/7 CIDP biopsies. HSC exposed to or transfected with MSRV-env presented a strong increase of IL6 and CXCL10 transcripts and protein secretion. These pathogenic effects on HSC were inhibited by GNbAC1, a highly specific and neutralizing humanized monoclonal antibody targeting MSRV-Env., Interpretation: The present study showed that MSRV-Env may trigger the release of critical immune mediators proposed as instrumental factors involved in the pathophysiology of CIDP. Significant MSRV-Env expression was detected in a significant proportion of patients with CIDP, in which it may play a role according to its presently observed effects on Schwann cells along with previously known effects on immune cells. Experimental results also suggest that a biomarker-driven therapeutic strategy targeting this protein with a neutralizing antibody such as GNbAC1 may offer new perspectives for treating CIDP patients with positive detection of MSRV-Env expression., Funding: Geneuro-Innovation, France., (Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.)

In high-altitude summer pastures, horseflies (Diptera: Tabanidae) can be a serious nuisance to livestock, as well as mechanical vectors of animal diseases such as besnoitiosis, an enzootic disease in the Pyrenees. However, the activity of horseflies in mountainous environments is poorly documented. To study the seasonality and distribution of tabanids in the Pyrenees Mountains, a sampling design was set up in two valleys on opposite sides of the mountain, one north-facing and one south-facing, along high-elevation gradients and at different distances from a water body between May and October 2011. The influence of the landscape on species richness and abundance was assessed by taking into account forested and unforested areas in 200 m radii around the trapping sites. Our findings indicated that: (1) The slope, the altitude and the size of unforested patches significantly influenced community composition of tabanids. (2) Altitude had a positive or a negative effect, depending on the species. (3) Species richness and abundance were negatively correlated with large open habitats and positively correlated with patch-shape complexity. (4) Seasonal succession of the most abundant species was observed in both valleys, with a maximum of catches at the beginning of August; however, tabanid activity ended earlier in the southern valley, which was more exposed to sunlight. (5) Philipomyia aprica, Tabanus bromius, Tabanus glaucopis and Hybomitra auripila were active from 9:00 to 19:00 h (GMT+1), with a peak of activity at midday. This paper also discusses the implications of these findings in relation to changes in horsefly distribution and their control in mountainous environments.

Purpose: Since 2011, the French medical students ranked after a national ranking exam (NRE) are making their career choice among 11 disciplines detailing the chosen one. Before 2011, this precise choice was unknown. Our work is the first descriptive study of French medical students choice of career after the NRE, precising the medical specialty chosen and the city of practical formation., Methods: We analyzed the Excel(®) file transmitted by the 'Agence régionale de santé d'Aquitaine' once students choice done after the 2012 NRE. A median range analysis was made for disciplines and city formation choices. For medical and surgery specialties, the analysis was compared to regional medical densities., Results: According to the median national choice, the first sixth disciplines chosen are ophthalmology, nephrology, internal medicine, radiology, cardiology and dermatology. Women are more attracted by medical gynecology, obstetrics, pediatrics, or dermatology; men mostly by neurosurgery, general surgery, nuclear medicine or cardiology. The most rated cities of formation according to their national median range of choice are Lyon, Montpellier and Paris. A majority of students (59 %) moved to another city to obtain the desired specialty. Among general practitioners, 56 % of students stayed in the city where they had been trained., Perspectives: Our study may provide concrete objectives for French medical students accomplishing their second cycle of medical studies, as well as supplemental data for French medical demographic management., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Aquatic ecosystems are facing increasing environmental pressures, leading to an increasing frequency of cyanobacterial Harmful Algal Blooms (cHABs) that have emerged as a worldwide concern due to their growing frequency and their potential toxicity to the fauna that threatens the functioning of ecosystems. Cyanobacterial blooms raise concerns due to the fact that several strains produce potent bioactive or toxic secondary metabolites, such as the microcystins (MCs), which are hepatotoxic to vertebrates. These strains of cyanobacteria may be potentially toxic to fish via gastrointestinal ingestion and also by direct absorption of the toxin MC from the water. The purpose of our study was to investigate toxic effects observed in fish taken from several lakes in the Ile-de-France region, where MCs-producing blooms occur. This study comprises histological studies and the measurement of MC concentrations in various organs. The histological findings are similar to those obtained following laboratory exposure of medaka fish to MCs: hepatic lesions predominate and include cell lysis and cell detachment. MC concentrations in the organs revealed that accumulation was particularly high in the digestive tract and the liver, which are known to be classical targets of MCs. In contrast concentrations were very low in the muscles. Differences in the accumulation of MC variants produced by blooms indicate that in order to more precisely evaluate the toxic potential of a specific bloom it is necessary not only to consider the concentration of toxins, but also the variants produced., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

A marked increase in the number of multidrug-resistant (MDR) tuberculosis (TB) cases entirely related to patients born in the Former Soviet Union was observed in France in the last two years. Very few cases were clustered, suggesting it is a consequence of recent immigration of patients already infected in their country of origin. This major increase challenges the existing structures for management of MDR and extensively drug-resistant TB (XDR-TB).

The respective roles of predisposing genetic factors and environmental factors in the development of type 2 diabetes (T2D) in obese subjects is poorly documented. Rodent models have been set up in an attempt to better understand of the differential effect of a prolonged metabolic stress induced by a high fat diet on glycaemic control according to the genetic background. In utero growth retardation resulting from a hypocaloric diet in pregnant rats induces a dramatic alteration of the development of islet cells leading to diabetes and insulin secretory defects in adult age. Experimentally induced diabetes in rodents results in hyperglycaemia and hyperinsulinemia in the fetus related to accelerated endocrine pancreas maturation responsible for the onset of diabetes in the adult. Deranged metabolic environment during fetal life may therefore further contribute to the onset of diabetes in the adult. Normal mouse strains with different genetic backgrounds show a wide range of responses to a high fat diet, with strains resistant to the diet and other more or less sensitive to the diet, the most sensitive exhibiting obesity diabetes and, insulin deficiency. The inability of the β cell to respond to the increased insulin demand related to insulin resistance seems to be pivotal in the pathophysiologic process and a new notion is emerging: "nutritional genetics" which studies the influence of nutrients on gene expression., (© 2013 médecine/sciences – Inserm.)

Objectives: Large unselected studies on representative samples of HIV-infected patients with a whole battery of neuropsychological tests and cerebral MRI scan are required to assess the frequency of neurocognitive impairment (NCI), the determinants of mild neurocognitive disorders (MNDs), or HIV-associated dementia (HAD) and the relationship between NCI and MRI scan findings., Methods: Investigation of 400 consecutively enrolled HIV-1-infected adults from the ANRS CO3 Aquitaine Cohort, using standardized neurocognitive tests chosen to achieve consistency with Frascati's criteria. Half of the patients had a cerebral MRI scan allowing gray and white matter volume measurement. Factors associated with NCI were studied by logistic regression models., Results: Median age of participants was 47 years, 79% were male and 89% received combination antiretroviral treatment (cART), of whom 93% had plasma HIV RNA below 500 copies/ml. Median CD4 cell count was 515 cells/μl. Prevalence of NCI was 59%, including 21% of asymptomatic NCI, 31% of MND, and 7% of HAD. A low level of education, prior neurologic AIDS-defining disorders event, anxiety, depressive symptoms, and prior history of brain damage were independently associated with MND or HAD, but neither HIV nor cART-related variables. The presence of NCI was significantly associated with lower gray matter fraction., Interpretation: In this large unselected cohort, a high prevalence of symptomatic neurocognitive disorders was mainly related to its traditional determinants and associated with gray matter atrophy at early stages of the disease.

Objectives: This study explored the associations between biomechanical and psychosocial work factors and musculoskeletal symptoms in vineyard workers., Methods: This cross-sectional study was based on a random sample of 2,824 male and 1,123 female vineyard workers in France. Data were collected using a self-administered questionnaire. Neck/shoulder, back and upper and lower extremity symptoms were evaluated using the Nordic questionnaire. Biomechanical exposures included 15 tasks related to vineyard activities. Psychosocial work factors included effort-reward imbalance and overcommitment, measured using the effort-reward imbalance model, and low job control and insufficient material means. Statistical analysis was performed using logistic regression analysis, and the results were adjusted for age, body mass index, educational level, work status and years in vineyard., Results: Pruning-related factors increased the risk of upper extremity pain for both genders, of back pain for men and of neck/shoulder and lower extremity pain for women. Driving increased the risk of neck/shoulder and back pain among men. Psychosocial work factors, which were insufficient material means, overcommitment (both genders), effort-reward imbalance (men) and low job control (women), were associated with musculoskeletal symptoms, back and upper extremity pain for both genders and neck/shoulder and lower extremity pain for men., Conclusions: These results underlined that both biomechanical and psychosocial work factors may play a role in musculoskeletal pain among vineyard workers. Prevention policies focusing on both biomechanical and psychosocial work exposures may be useful to prevent musculoskeletal symptoms.

Planktothrix agardhii dynamics, microcystin concentration and limnological variables were monitored every 2 weeks for 2 years (2004-2006) in a shallow hypereutrophic artificial lake (BNV, Viry-Châtillon, France). Time-series analysis identified two components in the P. agardhii biomass dynamics: (1) a significant decreasing trend in P. agardhii biomass (65% of the overall variance) and (2) a residual component without significant seasonal periodicity. A path-analysis model was built to determine the main factors controlling the P. agardhii dynamics over the period studied. The model explained 66% of P. agardhii biomass changes. The decreasing trend in P. agardhii biomass was significantly related to a decrease in the PO4(3-) concentration resulting from an improved treatment of the incoming watershed surface water. The residual component was related to zooplankton dynamics (cyclopoid abundances), supporting the hypothesis of a top-down control of P. agardhii, but only when the biomass was low. Forty-nine percent of the variability in the microcystin (MC) concentration (min:<0.1 microg equivalent MC-LR L(-1); max: 7.4 microg equivalent MC-LR L(-1)) could be explained by changes in the P. agardhii biomass. The highest toxin content was observed when P. agardhii biomass was the lowest, which suggests changes in the proportion of microcystin-producing and -nonproducing subpopulations and/or the physiological status of cells.

The Agricultural Social Mutual Insurance System (MSA) has been mobilised to support a corporate approach in the perspective to decrease mortal acts of violence or aggression. The plan brought together the skills of all the companies' actors (management, hygiene committees, safety and working conditions committee, occupational health and safety at work, and salaried workers). The MSA occupational health departments carried out a situational inventory (through a survey of salaried workers exposed to the risk of aggression). An intervention methodology was addressed to the occupational medical practitioners (PECVAT Protocol). A corporate framework agreement has specified the plan that was developed by company and the actors concerned. Finally, an evaluation enabled them to define the level at which this prevention intervention should be implemented.

One view of adaptation is that it proceeds by the slow and steady accumulation of beneficial mutations with small effects. It is difficult to test this model, since in most cases the genetic basis of adaptation can only be studied a posteriori with traits that have evolved for a long period of time through an unknown sequence of steps. In this paper, we show how ace-1, a gene involved in resistance to organophosphorous insecticide in the mosquito Culex pipiens, has evolved during 40 years of an insecticide control program. Initially, a major resistance allele with strong deleterious side effects spread through the population. Later, a duplication combining a susceptible and a resistance ace-1 allele began to spread but did not replace the original resistance allele, as it is sublethal when homozygous. Last, a second duplication, (also sublethal when homozygous) began to spread because heterozygotes for the two duplications do not exhibit deleterious pleiotropic effects. Double overdominance now maintains these four alleles across treated and nontreated areas. Thus, ace-1 evolution does not proceed via the steady accumulation of beneficial mutations. Instead, resistance evolution has been an erratic combination of mutation, positive selection, and the rearrangement of existing variation leading to complex genetic architecture., Competing Interests: Competing interests. The authors have declared that no competing interests exist.

Musculoskeletal disorders (MSD) are a major area of concern in the occupational world. The agricultural industry is particularly affected: 93 percent of occupational diseases in agriculture are MSD. Carpal tunnel syndrome occurs in one third of the cases. Shoulder is the second most common location. The most affected occupational areas are meat production, viticulture, market gardening, horticulture and small animal farming. This MSD phenomenon, of multifactorial origin, which has been amplifying for two decades, has led to some consensus in terms of definition and prevention strategy. The aim is to identify, limit or even suppress risk factors through worker training as well as through actions related to work organization. Regarding occupational health and safety in agriculture, two fronts of progress have been mentioned: the creation of a statistic observatory of MSD (disease, occupational area and cost) and the assessment of prevention activities. Finally, a new issue is being discussed: sustainable prevention of MSD.

The first identification of anatoxin-a in a French lotic system is reported. Rapid deaths of dogs occurred in 2003 after the animals drank water from the shoreline of the La Loue River in eastern France. Sediments, stones and macrophytes surfaces at the margin of the river were covered by a thick biofilm containing large quantities of several benthic species of filamentous, non-heterocystous cyanobacteria. Known cyanotoxins, such as microcystins, saxitoxins and anatoxins were screened from biofilm samples by biochemical and analytical assays. A compound with similar UV spectra to the anatoxin-a standard was detected by high-performance liquid chromatography (HPLC) coupled with photo-diode array detector. This toxin was further identified by HPLC coupled with a UV detector and by electrospray ionisation-Quadrupole-Time-Of-Flight mass spectrometer, and confirmed by tandem mass spectrometry. These two techniques were necessary to discriminate anatoxin-a in phenylalanine-containing matrices such as liver samples of poisoned dogs. The toxin and the aromatic amino acid, phenylalanine, present the same pseudomolecular ion at m/z 166, but have differing fragmentation patterns, retention times and UV spectra. Finally, several cyanobacterial strains were isolated from the green biofilm and tested for anatoxin-a production. Phormidium favosum was identified as a new anatoxin-a producing species.

Cylindrospermopsis raciborskii, a potentially toxic blooming cyanobacterium (blue-green alga), responsible for public health problems in Australia, was identified in France in 1994 in a shallow pond south of Paris. A program monitoring the occurrence of C. raciborskii in this pond was conducted from July 1998 to October 1999. The phytoplankton assemblages were studied, and limnological parameters (water temperature, dissolved oxygen, pH, conductivity, and dissolved inorganic nutrients) were measured. By multivariate analysis (principal component analysis), we showed that sufficiently high temperatures to allow the germination of akinetes, relatively low nutrient concentrations (soluble reactive phosphorus with a mean concentration of 1 microM and nitrate between 0 and 5 microM, except in February 1999 (21 microM)) and a characteristic high and constant sulfate concentration (8981+/-471 microM) seemed to be the main factors involved in the proliferation of C. raciborskii in the "Francs-Pêcheurs" (FP) pond. In the light of these findings and of bibliographic data, C. raciborskii would seem to be characterized by good adaptability, but also by low competitiveness with other phytoplanktonic species in the temperate study area.

In southern France, failure to control Culex pipiens L. with Bacillus sphaericus Neide toxin (Bs) was first detected in 1994, at the extreme east of the Languedoc-Roussillon coast. This failure was due to a single recessive mutant, sp-1R. Two complementary strategies were used to test whether sp-1R had invaded the Bs-controlled area by 1998. First, a strain (BP) was selected from resistant larvae sampled in the western part of the Bs-controlled area. In BP strain, resistance involved a single recessive gene, sp-2R, distinct from sp-1R, that conferred a similarly high resistance in the homozygous state (approximately 6,000-fold). Combining one copy of sp-1R and one of sp-2R conferred a > 100-fold resistance. Second, Bs-resistance was monitored among the offspring of field females crossed to sp-1RR homozygous males. Females were sampled in 20 localities of southern France and three localities of the Llobregat delta (Barcelona, Spain) where C. pipiens control is also intensive. The 537 females in the study produced enough larvae to infer their genotype: 462 progenies were susceptible and the survival rate of 51 others was explained by the presence of sp-1R and/or sp-2R. The remaining 24 cases indicated that other factors could confer resistance when combined with sp-1R. The current data showed that, even when recessive, resistant mutants can rapidly increase in frequency, providing some interactions that protect them from disappearance. We discuss the consequences of this finding on the current strategies aimed to avoid or delay resistance in the pests controlled with B. sphaericus or B. thuringiensis Berliner toxins.

Purpose: To evaluate the occurrence and inheritance of various types of pigmentary retinopathy in patients followed at the outpatient clinic in the university hospital, Montpellier, France. To characterize genes and mutations causing these conditions., Methods: Ophthalmic examination and various visual tests were performed. Mutations were sought from genomic DNA by PCR amplification of exons associated with single-strand conformation analysis and/or direct sequencing., Results: Among 315 patients over an 8-year period, cases of retinitis pigmentosa (63.2%), Usher's syndrome (10.2%), Stargardt's disease (5.4%), choroideremia (3.2%), Leber's congenital amaurosis (3.2%), congenital stationary night blindness (2.9%), cone dystrophy (2.5%), dominant optic atrophy (1.9%), X-linked juvenile retinoschisis (1.6%), Best's disease (1.6%), and others (4.3%) were diagnosed. In retinitis pigmentosa, inheritance could be determined in 54.2% of the cases including dominant autosomic (26.6%), recessive autosomic (22.6%), and X-linked cases (5%) while it could not be confirmed in 45.7% of the cases (simplex cases in the majority). For the 6 examined genes, mutations were found in 22 out of 182 propositus (12.1%). Analysis of phenotype-genotype correlations indicates that in retinitis pigmentosa, RDS is more frequently associated with macular involvement and retinal flecks, RHO with regional disease, and RPE65 with the great severity of the disease with some cases of Leber's congenital amaurosis., Conclusions: Identification of genes may help in diagnosis and in genetic counseling, especially in simplex cases with retinitis pigmentosa. In this latter condition, molecular diagnosis will be necessary to rationalize future treatments.

The cause of high resistance to chlorpyrifos observed in Tunisian Culex pipiens (L.) was investigated by comparing a Tunisian strain G (> 10,000-fold resistance), a French strain T (approximately 50-fold resistance), and a susceptible reference strain S. Strains G and T had the same level of propoxur resistance (approximately 1,000-fold) and were homozygous for an autosomal propoux-insensitive acetylcholinesterase (AChE-1). In G and T strains, as well as in the offspring of different F1s and backcrosses using these F1s and the S strain, the effect of DEF and Pb synergists on chlorpyrifos resistance was low or absent, indicating that increased detoxification by enzymes inhibited by these chemicals had a minor role. Chlorpyrifos resistance in the G strain was caused by a major gene (or group of genes) tightly linked to the Ace-1 gene (coding AChE-1 enzyme). The possibility of allelism between this gene and the Ace-1R allele present in the T strain was rejected by showing that AChE-1 inhibition by chlorpyrifos-oxon was not different between G and T mosquitoes.

The authors describe the advantages and the pitfalls of the first mobile MR unit in metropolitan France. For the last year, this unit has been providing services to five hospitals and a private clinic. The greatest distance between 2 hospitals was 230 km (144 miles).

In the context of a transational study, 404 sexual active 17-21 years-old students living in Lyon (France), Montreal (Quebec) and Salamanque and Madrid (Spain) have answered a questionnaire dealing with their contraceptive patterns, their perceptions of AIDS and their risky sexual behaviors. Results show that each group uses a different contraceptive strategy. In France and in Quebec those who had their first intercourse before 17 years of age used oral contraceptive rather than the condom. As for AIDS girls from Quebec had a higher index of risky sexual behaviors (CASH) than French, but the opposite was true among boys, while both girls and boys from Spain adopted safer sexual behaviors. Multiple regression analysis shows that the CASH rests on different predictors according to each national context.

Sexual behaviors and attitudes were surveyed among 787, 17-21 years-old students in Lyon (France), Montreal (Quebec) and Salamanque and Madrid (Spain). Near 55% have had intercourse and oral sex in France, while this was the case of almost 80% in Quebec and only about 30% in Spain. Students from France and Quebec were younger at first intercourse, have had more sexual partners, and higher frequencies of intercourse and oral sex than those from Spain. Girls from Quebec have shown higher sexual permissiveness than other girls. Spanish students, particularly girls, consider their parents' sexual attitudes as far less permissive. Religiosity and church attendance seem to still put a strong damper, in Spain, on young people's sexual behaviors.