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Congenital adrenal hyperplasia (CAH) is a disease that is part of neonatal screening. There are many causes of false-positive results on neonatal screening, and maternal opioid consumption during pregnancy is suspected to increase 17-hydroxyprogesterone (17-OHP) levels at birth. The aim of this study was to determine the effect of maternal drug consumption on 17-OHP values on neonatal screening.We studied 17-OHP levels of term newborns with reported maternal drug consumption born at the Maternity Hospital of Nancy between 2002 and 2018. These infants were matched with newborns of mothers without drug addiction. The 17-OHP levels, withdrawal syndromes, birth parameters, and maternal characteristics were compared between the two groups.The study included 241 patients (121 in the drug-exposed group, 120 in the control group). The mean 17-OHP levels in newborns of mothers with substance addiction were 9.83 nmol/L compared to 4.90 nmol/L (p=0.0001) in the control group. Newborns exposed to drugs were smaller (p=0.0001), lighter (p=0.0001), had smaller head circumference (p=0.0001), and had lower Apgar scores (p=0.004 at 1 min and p=0.0001 at 5 min). The 17-OHP level did not differ in cases of withdrawal syndrome in drug-exposed newborn (p=0.911).A significant increase in 17-OHP levels was observed in newborns exposed to drugs, with no influence of withdrawal syndrome on 17-OHP levels. Maternal substance addiction may be associated with moderately increased 17-OHP levels during neonatal screening.

Anorexia nervosa (AN) is a serious mental illness. It is frequently accompanied by a history of childhood maltreatment (CM) that may constitute a specific ecophenotype in patients with eating disorders necessitating special assessment and management. This retrospective study tested whether in patients with AN, CM-related chronic stress may manifest through low-grade inflammation reflected by an increase in white blood cell ratios (neutrophil-to-lymphocyte ratio, NLR, platelet-to-lymphocyte ratio, and monocyte-to-lymphocyte ratio).Participants (N = 206) were enrolled at an eating disorder daycare unit in Montpellier, France, from March 2013 and January 2020. CM was assessed using the childhood trauma questionnaire (CTQ). The Eating Disorder Examination Questionnaire (EDE-Q) and the MINI were used to assess AN severity and the other clinical characteristics, respectively.NLR was higher in patients with AN and history of CM (p = 0.029) and in patients with AN and history of emotional abuse (p = 0.021), compared with patients with AN without history of CM. In multivariate analysis, emotional abuse (β = 0.17; p = 0.027) contributed significantly to NLR variability.In patients with AN, NLR is a low-grade inflammation marker that is influenced by various sociodemographic, clinical and biological factors. It is more directly affected by some CM types, especially emotional abuse, than by the presence/absence of CM history. Future studies should focus on mediators between CM and increased inflammation, such as interoceptive awareness, emotional dysregulation, food addiction, and stress sensitization.III. Evidence obtained from well-designed cohort or case-control analytic studies.

Bacterial symbioses are significant drivers of insect evolutionary ecology. However, despite recent findings that these associations can emerge from environmentally derived bacterial precursors, there is still little information on how these potential progenitors of insect symbionts circulates in the trophic systems. The aphid symbiont Serratia symbiotica represents a valuable model for deciphering evolutionary scenarios of bacterial acquisition by insects, as its diversity includes intracellular host-dependent strains as well as gut-associated strains that have retained some ability to live independently of their hosts and circulate in plant phloem sap. These strains represent a potential reservoir for the emergence of new and more intimate symbioses. Here, we conducted a field study to examine the distribution and diversity of S. symbiotica found in aphid populations, as well as in different compartments of their surrounding environment. A total of 250 aphid colonies, 203 associated insects, and 161 plant samples associated with aphid colonies were screened for S. symbiotica. Twenty percent of aphids were infected with S. symbiotica, and the symbiont includes a wide diversity of strains with varied tissue tropism corresponding to different lifestyle. We also showed that the prevalence of S. symbiotica is influenced by seasonal temperatures. For the first time, we found that S. symbiotica was present in non aphid species and in host plants, and that the prevalence of the bacterium in these samples was higher when associated aphid colonies were infected. Furthermore, phylogenetic analyses suggest the existence of horizontal transfers between the different trophic levels examined. These results provide a completely new picture of the ubiquity of an insect symbiont in nature. They suggest that ecological interactions promote the dissemination of strains that are still free-living and poorly specialized, and for which plants are a proabable reservoir for the acquisition of new bacterial partners in insects.

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Resume La mesure continue du glucose est une composante obligatoire d’un systeme de pancreas artificiel realisant une insulinotherapie en boucle fermee. Ce sont les donnees issues du capteur de glucose qui fournissent l’information de base pour que l’algorithme de controle calcule la quantite d’insuline que la pompe doit perfuser pour maintenir la glycemie a l’objectif, qu’il s’agisse d’un niveau glycemique-cible ou d’un intervalle de securite predefini. Le signal issu et recu du capteur par l’algorithme de controle est donc d’une importance capitale, car il va determiner la commande de perfusion d’insuline par la pompe. L’amelioration des composants structuraux et fonctionnels des capteurs de glucose au cours de la derniere decennie a permis des gains consistants en precision et en exactitude des capteurs couramment utilises, c’est-a-dire enzymatiques et mis en place dans le tissu sous-cutane. Lors de leur connexion au sein d’un systeme en boucle fermee, les elements-cles vont resider dans l’analyse et le traitement du signal du capteur afin de reduire le bruit de fond aleatoire, d’ameliorer la calibration par rapport a la glycemie, et d’anticiper par la prediction les variations glycemiques. L’identification d’evenements perturbateurs du signal revet une importance croissante avec l’evolution vers l’utilisation de la boucle fermee en vie reelle. Deux de ces evenements necessitent une attention particuliere : l’interruption du signal, et les artefacts de compression du capteur.

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Introduction Cardiac arrhythmias are an important cause of morbidity and mortality. Optical mapping using voltage-sensitive dyes (VSDs) allows to study these disorders in isolated perfused tissues. Until recently, this technique remained limited to the myocardial surface due to the short excitation wavelengths of common VSDs. Using red excitation light allows to by-pass this problem, but availability of such dyes remains limited. Objective To develop new families of red-shifted VSDs and to characterize both their spectral and potentiometric properties. Method Three families of VSDs were designed. The spectral properties of each VSD was assessed by spectrofluorometry in Langendorff perfused rat hearts. The potentiometric properties were assessed through optical mapping in Langendorff perfused rat hearts. For spectrofluorometry, hearts were freely beating and systolic and diastolic pressures were continuously monitored. In optical mapping experiments hearts were mechanically arrested by supplementation of blebbistatin (10 μM). Results Out of the three families, one showed a strong shift in excitation and emission wavelengths towards the near-infrared. Within this family, three VSDs, with variations in the hydrophilic tail and charged carrier, were tested. Results showed that these VSDs have peak excitation above 500 nm and peak emission around 730 nm. Although two of these dyes showed a low potentiometric sensitivity ( 5%) with a stable signal for over 2 hours after a bolus injection in the hearts. In mechanically arrested hearts, the VSDs had no impact on electrophysiological parameters. However, in beating hearts, the VSDs significantly increased diastolic pressure. Conclusion We have developed new red-shifted VSDs and validate their use in cardiac applications, which might allow optimizing optical mapping of cardiac arrhythmia dynamics in deeper tissue layers and/or in blood-perfused tissues.

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P.-Y. Benhamou, B. Catargi, B. Delenne, B. Guerci, H. Hanaire, N. Jeandidier, R. Leroy, L. Meyer, A. Penfornis, R.-P. Radermecker, E. Renard, S. Baillot-Rudoni, J.-P. Riveline, P. Schaepelynck, A. Sola-Gazagnes, V. Sulmont, N. Tubiana-Rufi, D. Durain, I. Mantovani Coordination: A. Sola-Gazagnes, J.-P. Riveline Societe Francophone du Diabete (SFD), Societe Francaise d’Endocrinologie (SFE) and EVADIAC group (EVAluation dans le Diabete des Implants ACtifs)

Resume Introduction Les hypoglycemies d’effort du diabetique insuline demeurent difficiles a predire. Nous avons voulu determiner lors d’un exercice a plateau de 30 minutes, le role des niveaux glycemiques et insulinemiques de depart, ainsi que celui de l’oxydation des glucides determinee par l’activite musculaire, dans la decroissance de la glycemie. Methodes Vingt-trois diabetiques de type 1 (âge 22–67 ans, poids moyen : 68,6 ± 2,03 kg ; taille moyenne : 168 ± 1,45) traites par basal-bolus ou pompe a insuline ont realise un exercice a plateau sur ergocycle a 50 % de leur Pmax (soit 30 a 120 watts) avec suivi de la glycemie, de l’insulinemie libre et calorimetrie d’effort. Synthese des faits La glycemie de depart G0 (comprise entre 1,11 et 4,22 g/L, soit en moyenne 2,23 ± 0,95 g/L) baisse en moyenne de –0,95 ± 0,26 g/L, baisse retrouvee dans chez 21 sujets (91 % des cas). L’oxydation des glucides est fortement correlee au travail total effectue (en kJ) (r = 0,875 p Conclusion Ces donnees confirment que lors de ces exercices prolonges a plateau, l’oxydation des glucides ne predit pas la baisse de glycemie. Cette baisse de la glycemie est d’autant plus marquee que la glycemie basale est elevee, et apparait determinee, en analyse multivariee, par le niveau d’insuline au debut du test.

Obstructive sleep apnea (OSA) impacts on macrovasculature and autonomic function and may therefore interfere with ocular microvascular regulation. We hypothesized that choroidal vascular reactivity to hyperoxia and hypercapnia was altered in patients with OSA compared with matched control subjects and would improve after treatment with continuous positive airway pressure (CPAP).Sixteen healthy men were matched 1:1 for body mass index, sex, and age with 16 men with newly diagnosed OSA without comorbidities. Subjects underwent sleep studies, 24-hour blood pressure monitoring, arterial stiffness measurements, and cardiac and carotid echography. Overall, patients were middle-aged, lean, and otherwise healthy except for having OSA with a limited amount of desaturation, with, at most, subclinical lesions of the cardiovascular system, stage 1 hypertension, or both. Choroidal laser Doppler flowmetry provides a unique opportunity to assess microvascular function by measuring velocity, (ChBVel), volume (ChBVol), and relative subfoveal choroidal blood flow (ChBF). Vascular choroidal reactivity was studied during hyperoxia and hypercapnia (8% CO2) challenges before and after treatment with nasal CPAP.Patients with OSA and control subjects exhibited similar choroidal reactivity during hyperoxia (stability of choroidal blood flow) and hypercapnia (significant increases in ChBVel of 13.5% and in ChBF of 16%). Choroidal vasoreactivity to CO2 was positively associated with arterial stiffness in patients with OSA. Gas choroidal vasoreactivity was unchanged after 6 to 9 months of CPAP treatment.This study showed unimpaired choroidal vascular reactivity in otherwise healthy men with OSA. This suggests that patients with OSA, without comorbidities, have long-term adaptive mechanisms active in ocular microcirculation.

A 30-year-old man with a history of skin and recurrent oral ulceration over 1 year developed loss of visual acuity in the right eye. The diagnosis of acute frosted branch angiitis was based on retinal vasculitis associated with retinal edema and hemorrhages, confirmed using fluorescein angiography (venous leakage and extensive staining of the vein walls). General examination revealed pseudofolliculitis and recurrent oral ulcers. The diagnosis of Behcet's disease was based on the international criteria. The patient was treated with prednisolone and colchicine, which were effective with a normalization of the fundus 1 month later. The initial presentation of Behcet's disease as frosted branch angiitis is exceptional, the main differential diagnosis being herpetic infections, which must be ruled out.

The TANTALUS system (MetaCure Ltd.) is a minimally invasive implantable gastric stimulation modality that does not exhibit malabsorptive or restrictive characteristics. The device applies gastric contractility modulation (GCM) signals to the stomach antrum. The signals are delivered in synchronization to the native electrical activity of the stomach during meals. Retrospective analysis of previous studies indicated that type 2 diabetes mellitus (T2DM) subjects on oral medication with hemoglobin A1c (HbA1c) between 7.5% and 9.5% are the population with most potential benefit from the treatment. The current study includes subjects enrolled prospectively within that range of HbA1c.To prospectively investigate the potential effect of the TANTALUS system on glycemic control and weight in overweight subjects with T2DM.In this European multicenter, open-label study, 13 T2DM obese (6 male, 7 female, BMI 37.2 +/- 1.0 kg/m(2), range 30.4-44.0 kg/m(2)) subjects treated with oral antidiabetic medications but with poor glycemic control (HbA1cor = 7%, range 7.3-9.5%) were implanted laparoscopically with the TANTALUS system.Thirteen subjects that had completed 3 months of treatment showed a significant reduction in HbA1c from 8.0 +/- 0.2% to 6.9 +/- 0.1% (p0.05), whereas fasting blood glucose decreased from 175 +/- 6 mg/dL to 127 +/- 8 mg/dL (p0.05). The glycemic improvement was accompanied by reduction in weight from 104.4 +/- 4.4 kg to 99.7 +/- 4.8 kg, and in waist circumference from 122.3 +/- 3.2 cm to 117.0 +/- 3.0 cm.Interim results with the TANTALUS system suggest that this stimulation regime can potentially improve glucose levels and induce moderate weight loss in obese T2DM subjects on oral antidiabetic therapy with poor glycemic control. Further evaluation is required to determine whether this effect is due to induced weight loss and/or due to direct signal-dependent mechanisms.

es tumeurs brunes sont des masses de tissu reactionnel non-neoplasique qui se developpent secondairement a une hyperparathyroidie primaire, secondaire ou tertiaire. Les sites classiques d’atteinte sont les os de la face, les cotes, le pelvis, le femur et les autres os longs (1). Elles ont rarement ete decrites sur le squelette axial (2), meme si des compressions du cordon medullaire ont ete decrites. Une fracture pathologique revelant ces tumeurs est rare (moins de 2 % des cas d’hyperparathyroidie primaire) (3). Dans les pays developpes, l’hyperparathyroidie est le plus souvent revelee par des desordres biologiques en particulier l’hypercalcemie (4), toutefois, les deficits en vitamine D et en calcium sont une cause potentielle d’hyperparathyroidie sans hypercalcemie (5). Nous rapportons ici un cas de tumeur brune revelee par une fracture pathologique de l’humerus gauche chez une femme de 50 ans qui presentait une hyperparathyroidie due a un adenome mediastinal associe a une insuffisance en vitamine D.

Zinc (Zn)-enriched yeast and gluconate are considered two of the more biologically available supplements. However, there have been few reports comparing the bioavailability of these supplements. The objective of this study was to demonstrate whether Zn was absorbed better by healthy male volunteers when given supplements where the mineral is found organically bound in yeast or as a salt gluconate form. The trial used a randomized, two-way crossover design. Urine, blood, and fecal samples were collected and analyzed over a 48-h period after a single dose of supplement. The net Zn balance and the relative bioavailability were calculated. No differences were observed in urine excretion of the two supplements. Zinc gluconate gave higher Zn concentrations in the blood in the first 6 h but also showed greater losses in the feces. Zinc yeast also increased in blood with time but showed significantly less loss in the feces. Thus, the net Zn balance after 48 h for Zn yeast was 9.46 but for Zn gluconate it was -2.00, indicating that Zn gluconate supplementation contributed to a net loss of Zn. It was concluded that organic Zn yeast supplements are more biologically available than Zn gluconate salts.

To evaluate newly diagnosed non-arteritic anterior ischaemic optic neuropathy (NAION) patients for the existence of an associated sleep apnoea syndrome.Newly identified NAION patient underwent polysomnography. The prevalence of sleep apnoea in NAION patients was compared to the prevalence previously found in the general population. Hypertension, diabetes, hyperlipidaemia, and atheromatous lesions of carotid vessels as classic risk factors associated with NAION were also identified.27 consecutive newly diagnosed NAION patients (18 men and nine women, mean age 65 (SD 8) years, body mass index 27.2 (3.8) kg/m2) were included in the study. 24 of these 27 NAION patients (89%) exhibited a sleep apnoea syndrome (respiratory disturbance index: 37.2/h (SD 18.3/h). Risk ratio for a NAION patient to have sleep apnoea was 4.9 compared to the general population (p0.001). Sleep apnoea was 1.5-2-fold more frequent than the rate of the other identified risk factors typically associated with NAION (hypertension, diabetes).Sleep apnoea is the most frequent disorder associated with NAION and should be screened in this population. At least a questionnaire related to obstructive sleep apnoea symptoms and assessment of sleepiness should be systematically proposed to patients with NAION.

International audience; Rare-earth zirconates (Re2Zr2O7, Re= rare element) have attracted particular interest in thermal barrier coating (TBC) applications due to suitable thermal properties such as low conductivity and efficient phase stability at elevated temperatures. Among them, lanthanum zirconate (La2Zr2O7 - LZ) with a pyrochlore structure has been proposed as potential candidate. Recently, rare-earth cerates, especially lanthanum cerate (La2Ce2O7-delta - LC) has been also developed and considered as new TBC ceramic material. This study is interested in synthesizing these compounds by soft chemistry processes: alkoxide and citrate synthesis route. X-ray diffraction (XRD) was used to analyze the powder after calcinations under air. Pyrochlore and fluorite structures were identified at relatively low temperature (1000 degrees C) for LZ and LC respectively. Chemical reactivity tests under reducing atmosphere were performed at 1400 degrees C and investigated by XRD analysis. The lanthanum zirconate is the most stable and interesting material under Ar-(g)/2%H-2(g) atmosphere.

Introduction La calciphylaxie non uremique est une pathologie rare, presentant une importante morbi-mortalite, dont la physiopathologie reste meconnue a ce jour. Observation clinique Une patiente de 56 ans, a ete hospitalisee dans notre unite, pour des ulcerations chroniques bilaterales et hyperalgiques du tablier abdominal. On retenait dans ses antecedents : une obesite severe, une denutrition protido-energetique, une intoxication ethylique et un diabete non insulinodependant. La patiente ne prenait ni anticoagulant ni corticoides. L’examen clinique, retrouvait des lesions cutanees necrotico-fibrineuses etendues, avec un aspect inflammatoire et une induration sous-cutanee perilesionnels. La biopsie cutanee profonde retrouvait une hypodermite chronique avec necrose adipeuse et calcifications des parois vasculaires, compatibles avec une calciphylaxie. La fonction renale etait normale, tout comme le bilan phosphocalcique, le bilan hepatique et les facteurs de coagulation. Le scanner TAP ne retrouvait aucune lesion neoplasique et confirmait la presence de calcifications arterielles abdominopelviennes superficielles sous-cutanees. La patiente a ete traitee par antibiotherapie large spectre, antalgique de palier 3 et thiosulfate de sodium a raison de 25 g 3 fois par semaine ; puis apres 6 semaines et devant l’absence d’amelioration clinique, une chirurgie d’abdomino-plastie a ete realisee, assortie d’une therapie par pression negative. Le thiosulfate a ete poursuivi pour eviter toute recidive precoce. L’evolution a ete favorable. Discussion Nous rapportons ici un des rares cas de calciphylaxie non uremique et non associe a un traitement anticoagulant ou une pathologie neoplasique, traite par antibiotherapie, thiosulfate de sodium et chirurgie d’abdomino-plastie.

Resume Objectifs Revisiter la pertinence de deux idees frequemment enoncees quant aux hypoglycemies a l’exercice chez le diabetique insuline : la premiere est qu’une glycemie avant exercice excedant 2,5 g/l doit contre-indiquer l’exercice car, dans ce cas, l’exercice aggraverait notoirement l’hyperglycemie ; la seconde est que la prediction de l’oxydation des glucides par le niveau d’exercice (glucose pulse) predit l’hypoglycemie. Materiels et methodes Vingt-quatre diabetiques de type 1 (12 hommes et 12 femmes, âge 19–71 ans) traites par basal-bolus ou pompe a insuline ont realise un exercice a plateau sur ergocycle a 50 % de leur Pmax (soit 40 a 200 W) avec suivi de la glycemie, de la lactatemie et calorimetrie d’effort. Ce protocole fait baisser la glycemie (p

This manuscript proposes a framework for conceptualizing the development of experienced counselors when they address unfamiliar tasks or client concerns. Implications for practice, theory, and research are presented.

A network of Burkard 7-day spore-recording traps was set up in the Walloon Region in Belgium to monitor the airborne inoculum of wheat pathogens. The relationship between the airborne inoculum of Puccinia striiformis f.sp. tritici, the causal agent of stripe rust, and the disease incidence on plants in untreated plots located near each spore traps was studied during the 2008-2009 season. The presence of airborne inoculum was tested in four locations on tapes collected from the Burkard spore traps from 1 April to 14 June 2009. Total DNA from each fragment of spore trap tape corresponding to 1 day sampling was extracted. P. striiformis f.sp. tritici was quantified by real-time polymerase chain reaction (PCR) assay using specific primers and SYBRGreen. The airborne inoculum of P. striiformis was first detected between 7 and 13 April 2009, depending on the location in the Walloon Region. The first symptoms of stripe rust were observed in the fields between 15 May and 2 June 2009. The onset of the disease symptoms was always preceded by a higher peak of airborne inoculum about 15 days earlier. When P. striiformis f.sp. tritici was detected, the daily quantities of spores, collected from a volume of air of 14.4 m3, fluctuated between 0.23 and 154.66. This study shows that spore traps coupled with real-time PCR could be used to assess the airborne inoculum of P. striiformis in order to understand and predict stripe rust outbreaks.

Modularity plays a key role in many engineering systems, allowing for plug-and-play integration of components, enhancing flexibility and adaptability, and facilitating standardization. In the control of diabetes, i.e., the so-called “artificial pancreas,” modularity allows for the step-wise introduction of (and regulatory approval for) algorithmic components, starting with subsystems for assured patient safety and followed by higher layer components that serve to modify the patient's basal rate in real time. In this paper, we introduce a three-layer modular architecture for the control of diabetes, consisting in a sensor/pump interface module (IM), a continuous safety module (CSM), and a real-time control module (RTCM), which separates the functions of insulin recommendation (postmeal insulin for mitigating hyperglycemia) and safety (prevention of hypoglycemia). In addition, we provide details of instances of all three layers of the architecture: the APS© serving as the IM, the safety supervision module (SSM) serving as the CSM, and the range correction module (RCM) serving as the RTCM. We evaluate the performance of the integrated system via in silico preclinical trials, demonstrating 1) the ability of the SSM to reduce the incidence of hypoglycemia under nonideal operating conditions and 2) the ability of the RCM to reduce glycemic variability.

International audience; PURPOSE: As the number of cases of Acanthamoeba spp. keratitis (AK) is constantly growing, new diagnostic tools are needed to confirm and guide ophthalmologists in this clinically problematic diagnosis. Molecular diagnosis is particularly well adapted, although only a few real-time PCR techniques have been described recently. The aim of this study was to develop a new PCR technique for the diagnosis of AK by combining the detection of Acanthamoeba DNA with human DNA, thus allowing an accurate interpretation of the PCR result. METHODS: Different DNA extraction procedures were compared to ensure an optimized amplification of one Acanthamoeba genome. The analytical parameters of this new multiplex Acanthamoeba beta-globin PCR (MAB-PCR) were evaluated. Fourteen eye drops were tested as potential PCR inhibitors. A prospective series of 28 corneal scrapings was subjected to MAB-PCR. RESULTS: The best extraction procedure associated thermal-shock pretreatment followed by a manual extraction procedure. The MAB-PCR parameters displayed excellent specificity and sensitivity, with a detection of 0.02 genome of Acanthamoeba. No eye drops were total PCR inhibitors. Of 28 corneal scrapings, 18 were considered true negatives. Seven could not be interpreted because of insufficient scraping material. Three were considered true positives: every patient progressed favorably on specific and reliable treatment. CONCLUSIONS: The MAB-PCR is a new tool to diagnose AK. It allows rapid diagnosis and prompt treatment of this probably underestimated etiology of infectious keratitis. This optimized real-time PCR outperforms the gold standard for Acanthamoeba keratitis diagnosis and it allows a concomitant evaluation of the quality of the corneal scraping, which is necessary for a precise interpretation of the results.

A network of 10 Burkard 7-day spore-recording traps was set up in the Walloon region in Belgium to monitor the airborne inoculum of wheat pathogens. Three spore traps were used to analyse the distribution of Mycosphaerella graminicola inoculum at the field scale, at 1 m above ground level. Two traps were set up in a wheat field 100 m apart. The third trap was placed 70 m away in a sugar beet field adjacent to the wheat field. Total DNA from each fragment of spore trap tape corresponding to 1 day sampling was extracted and the quantity of M. graminicola was assessed using real-time polymerase chain reaction (PCR) assay. The experiment was conducted from July to October 2009. Positive detections were obtained for between 33 and 36 days, depending on the spore traps. When detected, the daily quantities of cDNA, collected from a volume of 14.4 m3, fluctuated between 4.84E+00 and 6.10E+03. Correlation coefficients higher than 0,82 and no significant differences were observed between the quantities of M. graminicola collected by the three spore traps, indicating that, at 1 m above ground level, the distribution of inoculum can be considered as homogenous at the tested field scale. This study confirms that spore traps coupled with real-time PCR could be used to assess the airborne inoculum of M. graminicola and to understand the development of the disease at this scale.

Aim Glucagon-like peptide-1 (GLP-1) belongs to the incretin hormone family: in the presence of elevated blood glucose, it stimulates insulin secretion and inhibits glucagon production. In addition, GLP-1 slows gastric emptying. GLP-1 secretion has also been reported to potentially affect patients with type 2 diabetes (T2DM) compared with non-diabetics and, as enzymatic inactivation by dipeptidyl peptidase-4 (DPP-4) shortens the GLP-1 half-life to a few minutes, GLP-1 receptor agonists such as exenatide twice daily (BID) and liraglutide have been developed, and have become part of the management of patients with T2DM. This review focuses on the potential beneficial effects of these compounds beyond those associated with improvements in blood glucose control and weight loss, including changes in the cardiovascular and central nervous systems. Methods This was a state-of-the-art review of the literature to evaluate the relationships between GLP-1, GLP-1 receptor agonists, weight and the cardiovascular system. Results GLP-1 receptor agonists improve glucose control and do not significantly increase the risk of hypoglycaemia. Also, this new class of antidiabetic drugs was shown to favour weight loss. Mechanisms may involve central action, direct action by reduction of food intake and probably indirect action through slowing of gastric emptying. The relative importance of each activity remains unclear. Weight loss may improve cardiovascular outcomes in patients with T2DM, although GLP-1 receptor agonists may have other direct and indirect effects on the cardiovascular system. Reductions in myocardial infarct size and improvements in cardiac function have been seen in animal models. Beneficial changes in cardiac function were also demonstrated in patients with myocardial infarcts or heart failure. Indirect effects could involve a reduction in blood pressure and potential effects on oxidation. However, the mechanisms involved in the pleiotropic effects of GLP-1 receptor agonists have yet to be completely elucidated and require further study. Conclusion These compounds may play an important role in the treatment of patients with T2DM as their potential effects go beyond glucose-lowering (weight loss, potential improvement of cardiovascular risk factors). However, to better understand their place in the management of T2DM, further experimental and clinical prospective studies are required.

Purpose Obstructive sleep apnea syndrome (OSA) has been recently reported to be associated with ischemic and glaucomatous optic neuropathy. The physiopathology of these diseases includes an abnormal regulation in the optic nerve head vasculature. The aim of our study was to characterize the choroidal vascular reactivity to acute increase in ocular perfusion pressure due to exercise in OSA patients. Methods Fourteen newly diagnosed OSA patients were included in this prospective study. Control subjects were matched with OSA patients for body mass index (BMI), gender and age. At the screening visit, each subject underwent a general exam, cardiovascular, neurologic and ophthalmological examinations, and underwent complete overnight polysomnography. The LDF instrument used in this study to measure subfoveal choroidal blood flow (ChBF) measured the following parameters: ChBVel (kHz); volume, ChBVol (in arbitrary units, AU) and the relative flow, ChBF = ChBVel  ChBVol (in AU). Vascular choroidal reactivity was tested during squatting. Results OSA patients exhibited a similar choroidal reactivity during increase in OPP (i.e. stability of choroidal blood flow) than controls until an increase of OPP about 145%. We found a similar vascular resistance increase in both groups during increase of OPP. Conclusion This prospective comparative study explored for the first time the choroidal blood flow of OSA patients and showed that subfoveal ChBF reactivity to gas in OSA patients differed from that of healthy control subjects. These preliminary results suggest that choroidal vasculature of OSA patients remained vasoconstricted when OPP increased, due to a chronic sympathetic activation.

La grossesse diabetique est une grossesse a haut risque justifiant une prise en charge multidisciplinaire et un suivi intensif. Le nouveau-ne de mere diabetique est menace, en plus de la mort in utero, par la prematurite, les complications metaboliques et cardio-respiratoire, ainsi que par le risque malformatif. C'est grâce a une meilleure prise en charge de ces grossesses que le pronostic maternel et fœtal s'est ameliore durant ces dernieres annees. La mortalite reste cependant le double de celle observee dans la population non diabetique. La base du traitement est d'obtenir un equilibre glycemique optimum des avant la conception et durant tout le deroulement de la grossesse et d'assurer une surveillance rigoureuse en centre specialise.

Cowden syndrome (CS) is the prototypic PTEN hamartoma tumor syndromes (PHTS), rare clinical syndromes characterized by germline mutations of the tumor suppressor PTEN. CS is characterized by association of macrocephaly, facial trichilemmomas, acral keratoses, papillomatous papules, with increased risk for breast, thyroid and endometrial cancer. PTEN, which is located on chromosome 10q23, regulates negatively the prosurvival PI3K/Akt/mTOR pathway through a lipid phosphatase activity. Loss of PTEN activates this pathway and leads to increased cellular growth, migration, proliferation, and survival. CS diagnosis is clinical, based on the association of pathognomonic, major and minor criteria. The association in a patient with thyroid cancer, rarely with multinodular goiter, of typical dermatological manifestations, easily identifiable by clinical examination (papillomatous papules, acral keratoses, trichilemmomas), with a history of breast, endometrial, or renal cancer, or hamartomatous tumors presence, should alert the clinician. Clinical management of patients with CS is multidisciplinary, to include early and frequent screening, surveillance, and preventive care for associated malignancies. The development of antineoplastic agents targeting PI3K/Akt/mTOR pathway, such as rapamycin, may be the opportunity of treatment in PHTS and CS patients, for whom no specific medical treatment exist.

Continuous intraperitoneal insulin infusion (CIPII) with the DiaPort system using regular insulin was compared to continuous subcutaneous insulin infusion (CSII) using insulin Lispro, to investigate the frequency of hypoglycemia, blood glucose control, quality of life, and safety.In this open, randomized, controlled, cross-over, multinational, 12-month study, 60 type 1 diabetic patients with frequent hypoglycemia and/or HbA1c7.0% with CSII were randomized to CIPII or CSII. The aim was to obtain the best possible blood glucose while avoiding hypoglycemia.The frequency of any hypoglycemia was similar (CIPII 118.2 (SD 82.6) events / patient year, CSII 115.8 (SD 75.7) p = 0.910). The incidence of severe hypoglycemia with CSII was more than twice the one with CIPII (CIPII 34.8 events / 100 patient years, CSII 86.1, p = 0.013). HbA1c, mean blood glucose, and glucose fluctuations were not statistically different. Treatment-related severe complications occurred mainly during CIPII: port infections (0.47 events / patient year), abdominal pain (0.21 events / patient year), insulin underdelivery (0.14 events / patient year). Weight gain was greater with CSII (+ 1.5 kg vs. - 0.1 kg, p = 0.013), quality of life better with CIPII.In type 1 diabetes CIPII with DiaPort reduces the number of severe episodes of hypoglycemia and improves quality of life with no weight gain. Because of complications, indications for CIPII must be strictly controlled. CIPII with DiaPort is an alternative therapy when CSII is not fully successful and provides an easy method of intraperitoneal therapy.

Purpose Obstructive sleep apnea syndrome (OSA) is associated with ischemic and glaucomatous optic neuropathy. The physiopathology of these diseases includes an abnormal regulation in the optic nerve head vasculature. The aim of our study was to characterize the choroidal vascular reactivity to hyperoxia and 8% CO2 breathing in OSA patients, as compared with matched healthy control subjects. Methods Eighteen newly diagnosed OSA patients were included in this prospective study. Control subjects were matched with OSA patients for body mass index (BMI), gender and age. At the screening visit, each subject underwent a general exam, cardiovascular, neurologic and ophthalmological examinations, and underwent complete overnight polysomnography. The LDF instrument used in this study to measure subfoveal choroidal blood flow (ChBF) measured the following parameters: ChBVel (kHz); volume, ChBVol (in arbitrary units, AU) and the relative flow, ChBF = ChBVel ? ChBVol (in AU). Vascular choroidal reactivity was tested during hyperoxia and hypercapnia (8% CO2) inhalation. Results OSA patients exhibited a similar choroidal reactivity during hyperoxia (stability of choroidal blood flow) and hypercapnia (1.5% increase in choroidal blood flow per 1 mmHg PtCO2) than controls. Conclusion This prospective comparative study explored for the first time the choroidal blood flow of OSA patients and results showed that subfoveal ChBF reactivity to gas in OSA patients is similar to healthy control subjects. These preliminary results suggest that choroidal vasculature is protected against the inbalance between the vasodilation (NO) and vasoconstriction (endothelin) system.

PURPOSE To characterize the nyctohemeral rhythm of intraocular pressure (IOP) and ocular perfusion pressure (OPP) in patients with newly diagnosed, untreated normal tension glaucoma (NTG). METHODS Twenty-seven patients with suspected NTG were prospectively included and underwent 24-hour monitoring of IOP and blood pressure (BP), polysomnography, and nailfold capillaropathy. The nyctohemeral rhythms of IOP, BP, and OPP were modeled with a nonlinear least-squares, dual-harmonic regression procedure, studying the mean value, the acrophase, the nadir and the amplitude of each rhythm. Nonparametric tests were used to study the relationship between the rhythm of IOP and vascular, sleep, and visual field parameters. RESULTS Five patients were excluded from the analysis after the 24-hour curve of IOP, (IOP > 21 mm Hg during nighttime [n = 1] or daytime [n = 4]). Twenty-two (81%) patients received a diagnosis of NTG (IOP < 22 mm Hg over 24 hours). They exhibited a diurnal acrophase (54.5%), or a nocturnal acrophase (36.4%) of IOP. The remaining patients (9.1%) with NTG had no nyctohemeral rhythm. A significantly higher proportion of patients with capillaropathy and a higher nyctohemeral fluctuation of IOP characterized the IOP group with diurnal acrophase. A rhythm of OPP was found in all patients, (diurnal [58%] or nocturnal [42%]) acrophase) equally distributed between the two groups of IOP. Amplitude of OPP was not significantly associated with the severity or progression of glaucoma. CONCLUSIONS A nyctohemeral rhythm of IOP exists in most of the patients with NTG, either with a nocturnal acrophase or a diurnal acrophase. The rhythm of OPP did not correlate with the IOP rhythm.

A 30-year-old man with a history of skin and recurrent oral ulceration over 1 year developed loss of visual acuity in the right eye. The diagnosis of acute frosted branch angiitis was based on retinal vasculitis associated with retinal edema and hemorrhages, confirmed using fluorescein angiography (venous leakage and extensive staining of the vein walls). General examination revealed pseudofolliculitis and recurrent oral ulcers. The diagnosis of Behçet's disease was based on the international criteria. The patient was treated with prednisolone and colchicine, which were effective with a normalization of the fundus 1 month later. The initial presentation of Behçet's disease as frosted branch angiitis is exceptional, the main differential diagnosis being herpetic infections, which must be ruled out.