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Background: the COVID-19 crisis has shown that we need to optimize sedation and analgesia management for patients treated with Neuro-Muscular Blocking Agents (NMBA) to ensure optimal patient’s comfort without wasting sedative and analgesic drugs in Intensive Care Units (ICU) in a context of drugs shortage. Also, optimizing sedation/analgesia management is mandatory to prevent drugs overuse, delayed awakening and prolonged utilization of ICU resources. There is no recommendation regarding the assessment of pain in ICU patients receiving NMBA. This study evaluated the validity of different physiological parameters to better assess pain in pharmacologically paralyzed ICU patients.Methods: four electrophysiological parameters (instant-Analgesia Nociception Index (ANI), Bispectralindex (BIS), Heart Rate (HR) and Mean Arterial Blood Pressure (MAP)) and one clinical physiological parameter (Behavioural Pain Scale (BPS)) were recorded before, during and after tracheal suctioning in all consecutive patients admitted in a medical-surgical ICU who required a sustained use of cisatracurium, as well as just after the complete paralysis recovery measured by the Train-of-Four ratio using an automatized accelometer. The validity of the five pain-related parameters was assessed comparing the values recorded during different situations (at rest before, during, and after thenociceptive procedure) (discriminant validation method), and the effect of paralysis was assessed comparing values obtained during and after paralysis (parameters’ reliability).Results: twenty patients were included for analysis. ANI, BIS and HR significantly changed during the nociceptive procedure in both paralyzed and non paralyzed patients, while BPS changed only in non paralyzed patients. ANI and HR were the only two parameters that were not significantly modified by paralysis, contrary to BIS and BPS (mixed effect model for repeated measurements). ANI showed the highest discriminant validity with values (min 0, max 100) decreasing from 71 [48-89] at rest to 41 [25-72] during the procedure in paralyzed patients and from 71 [53-85] at rest to 40 [31-52] in non paralyzed patients.Conclusions: ANI is the most accurate parameter to detect pain in both paralyzed and non paralyzed sedated ICU patients. Its decrease during tracheal suctioning is significant, clinically relevant, and not modified by the use of NMBA in ICU patients.; La crise du COVID-19 a montré que la gestion de la sédation/analgésie doit être optimisée chez les patients curarisés afin d'assurer un confort optimal des patients, tout en évitant de gaspiller les médicaments sédatifs et analgésiques en réanimation, dans un contexte de pénurie. En outre, l'optimisation de la sédation/analgésie est nécessaire pour prévenir la surconsommation de médicaments, le retard de réveil consécutif et l'utilisation prolongée des ressources de la réanimation. Il n'existe pas de recommandation concernant l'évaluation de la douleur chez les patients curarisés en réanimation. Cette étude a évalué la validité de différents paramètres physiologiques afin de mieux évaluer la douleur chez les patients curarisés en réanimation.Méthodes : quatre paramètres électrophysiologiques (l’Analgesia Nociception Index instantané (ANI), l'indice bispectral (BIS), la fréquence cardiaque (FC) et la pression artérielle moyenne (PAM)) et un paramètre physiologique clinique (Behavioural Pain Scale (BPS)) ont été enregistrés avant, pendant et après l'aspiration trachéale chez tous les patients admis dans une unité de réanimation médico-chirurgicale, nécessitant une perfusion continue de cisatracurium, ainsi que juste après la décurarisation complète, évaluée par le rapport du Train de Quatre à l'aide d'un accéléromètre automatisé. La validité des cinq paramètres liés à la douleur a été évaluée en comparant les valeurs enregistrées dans différentes situations (au repos avant, pendant, et après la procédure nociceptive) (méthode de validation discriminante), et l'effet de la curarisation a été évalué en comparant les valeurs obtenues avant et après décurarisation (reproductibilité).Résultats : vingt patients ont été inclus pour l'analyse. Les valeurs d’ANI, de BIS et de FC se sont modifiées de manière significative au cours de la procédure nociceptive, que les patients soient curarisés ou décurarisés, le BPS ne se modifiant que chez les patients décurarisés. L’ANI et la FC sont les deux seuls paramètres qui n'ont pas été modifiés de manière significative par la décurarisation, contrairement au BIS et au BPS (modèle statistique à effet mixte pour mesures répétées). L'ANI a montré la validité discriminante la plus élevée avec des valeurs (min 0, max 100) diminuant de 71 [48-89] au repos à 41 [25-72] pendant la procédure chez les patients curarisés, et de 71 [53-85] au repos à 40 [31-52] chez les patients décurarisés.Conclusion : l'ANI est le paramètre le plus approprié pour détecter la douleur chez les patients sous sédation en réanimation qu’ils soient curarisés ou non. Sa diminution lors de l'aspiration trachéale est significative, cliniquement pertinente, et non modifiée par l'utilisation de curares en réanimation.

Background: Poliomyelitis is a viral, nervous system disease that affects both the upper and the lower extremities. The treatment of severe coxarthrosis in these patients with total hip arthroplasty (THA) has been widely questioned because of the high risk of subsequent complications. The aim of the present study was to describe both radiological and medium term clinical results in a series of patients with post polio residual paralysis that underwent THA. Materials and Methods: We report a retrospective review of a series of 5 five patients diagnosed with severe coxarthrosis secondary to post polio residual paralysis who were operated between 2008 and 2012. Uncemented THA was performed in all cases by the same surgeon. Clinical evaluation was carried out using the Harris Hip Score (HHS) at the preoperative visit, at 6 months, and annually after surgery. Results: The median age was 47 years, and the median followup was 55 months (interquartile range P25–P75: range 31–72 months). According to the HHS, a significant clinical improvement was observed in all patients with a median score of 81 points (interquartile range P25–P75: range 74–89) at 1 year of followup. A case of relapsing dislocation that required revision surgery of the implant was recorded. No cases of component loosening were found. Conclusion: THA surgery in patients with post polio residual paralysis is a complex procedure with a significant complication rate, but a predictable clinical improvement may encourage surgeons to perform in patients with severe coxarthrosis and moderate functional expectations.

International audience; Detection of Chronic bee paralysis virus (CBPV) is reported for the first time in two species of ants (Camponotus vagus and Formica rufa) and in Varroa destructor. A quantitative real-time PCR (qPCR) method was used to detect and quantify CBPV in infected bees, ants and mites. A minus-strand-specific RT-PCR was used to assess viral replication. These results suggest a new way by which the infection may be spread and other sites of viral persistence in the close apiary environment.

International audience; BACKGROUND: Clinical outcomes and socioeconomic consequences after a stroke may differ between regions. METHODS: One cohort was established prospectively in Kunming (China) to compare with a cohort of 156 stroke patients included in Limoges (France). During 1 year, patients hospitalized within 48 hours for a first-ever hemispheric stroke were included. Demographic data and neurocardiovascular risk factors were registered. Hemiplegia was evaluated. Functional outcome was assessed using the Barthel Index (BI) after 3 months. RESULTS: One hundred and eighteen patients were included in Kunming. Patients of Kunming were younger (61.4 ± 13.4 vs 72.3 ± 14.6 years in Limoges, P70 years (HR=6.29, 95% CI [2.36, 16.59]). Despite a better baseline BI for patients of Kunming (50.0 ± 34.9 vs 37.4 ± 34.2, P=0.0031), after adjustment for confusing, patients in Limoges had a 2.11 OR 95% CI [1.03, 4.31]) to reach a BI>80 at 3 months. CONCLUSIONS: Functional recovery for patients of Kunming was not as good as expected. The socioeconomic consequences of stroke in Kunming are significant as they involved younger subjects who were still in work.

INTRODUCTION: Several neurological complications are associated with cerebral malaria (CM). However, few long-term data from childhood survivors have been published. METHODS: A cross-sectional study was carried out in Mali among children followed from 1999 to 2002 after serious and complicated malaria. Our aim was to evaluate the persistent neurological sequelae associated with CM. RESULTS: This study concerned 101 subjects who had had CM. Mean age was 5.6+/-3.6 years. Twenty-eight children presented persistent neurological sequelae (27.7p.cent). Among them eight (7.9p.cent) children had developed these sequelae just after CM and 20 (19.8p.cent) a few months later: headaches, mental retardation, speech delay, bucco-facial dyspraxia, diplegia and frontal syndrome (one case each), dystonia (two cases), epilepsy (five cases) and behavior and attention disorders (15 cases). CONCLUSIONS: In this study, we show that neurological signs due to CM can persist in the long run. Long-term follow-up and proper management after CM are essential.

International audience; Venous thromboembolism is predominantly a disease of older age. The average annual incidence rate of venous thromboembolism among Caucasians is 1 per 1,000 person-years. Common independent VTE risk factors include hospitalization, active cancer, neurological disease with extremity paresis and, among women, oral contraceptives, pregnancy and the puerperium, and hormone therapy. Inherited reductions in plasma natural anticoagulants (antithrombin, protein C, or protein S) have long been recognized as uncommon but potent risk factors for venous thromboembolism. Activated protein C resistance (factor V Leiden), G20210 variant in the prothrombin gene have been recently added to the list of inherited disorders predisposing to thrombosis. Those latter frequent inherited factors interact with environmental risk factors such as oral contraceptives, pregnancy, hormone therapy.

International audience; A two-step real-time RT-PCR assay, based on TaqMan technology using a fluorescent probe (FAM-TAMRA) was developed to quantify Chronic bee paralysis virus (CBPV) genome in bee samples. Standard curves obtained from a CBPV control RNA and from a plasmid containing a partial sequence of CBPV showed that this assay provided linear detection over a 7-log range (R(2)>0.99) with a limit of detection of 100 copies, and reliable inter-assay and intra-assay reproducibility. Standardisation including RNA purification and cDNAs synthesis was also validated. The CBPV TaqMan methodology was first evaluated by quantifying the CBPV genomic load in bee samples from an experimental infection obtained by topical application. Up to 1.9 x 10(10) CBPV copies per segment of insect body (head, thorax and abdomen) were revealed whereas a lower CBPV genomic load was detected in dissected organs such as mandibular and hypopharyngeal glands, brain and alimentary canal (up to 7.2 x 10(6) CBPV copies). The CBPV genomic loads in different categories of bees from a hive presenting the trembling symptoms typical of Chronic paralysis were then quantified. Significantly higher CBPV loads were found in guard, symptomatic and dead bees (up to 1.9 x 10(13) CBPV copies) than in forager, drones and house bees (up to 3.4 x 10(6) CBPV copies). The results obtained for symptomatic or dead bees support the correlation between high CBPV genomic load and pathology expression. Moreover, the high CBPV genomic load revealed in guard bees highlights the possible pivotal role played by this category of bees in CBPV infection.

This study aims to investigate how quadriplegic patients with a C6-C7 spinal lesion coordinate their upper limb to extend the elbow despite the paralysis or weakness of the triceps brachii, and what is the effect of a surgical musculotendinous transfer. For this purpose, aiming movements in a wide workspace were recorded in seven healthy subjects and in patients with incomplete (five cases) or complete (eight cases) triceps paralysis and after musculotendinous transfer (eight cases). We used four electromagnetic field sensors to quantify hand trajectory and to compute the angles describing the rotations at the scapula, glenohumeral joint, elbow and wrist (10 degrees of freedom). Extent and smoothness of the hand trajectories and hand velocity profiles were surprisingly similar between healthy subjects and quadriplegic patients. The reduction of elbow extension observed in patients was compensated by rotations distributed across several degrees of freedom including the scapula. Principal components analysis showed that the joint rotations could be summarized by an additive combination of two synergies, respectively orientating and stretching out the limb, which explained similar amounts of variance in healthy subjects and in patients. The participations of degrees of freedom in the synergies were roughly similar in the different groups of subjects, the main difference concerning scapular medial-lateral rotation, which seems to be critical in patients with a complete triceps paralysis. This demonstrates that elbow extension in quadriplegic patients is due to anticipated mechanical interaction coupling between upper limb segments. We propose that the persisting (incomplete paralysis) or restored (musculotendinous transfer) elbow extensor strength may act by stabilizing the elbow. This counterintuitive preservation of limb kinematics for horizontal aiming movements in quadriplegic patients despite the drastic changes in muscle action provoked by paralysis and/or by surgery strongly suggests that the motor system does not primarily control forces but the morphological aspects of movement, via joint rotation synergies.

Pretibial flexor motoneurons were recorded intracellularly in anesthetized cats during unfused isometric contractions of a subpopulation of motor units from either tibialis anterior (TA) or extensor digitorum longus (EDL) muscles. The contractions elicited excitatory postsynaptic potentials in 23 of 28 pretibial flexor motoneurons. No effect was observed in the remaining motoneurons. In control experiments, the effects of electrical stimulation of afferents within the TA nerve were investigated to help identify afferents responsible for the contraction-induced positive feedback. This feedback was ascribed to actions of Ia fibers because the pattern of the contraction-induced excitatory potentials was consistent with the known pattern of Ia discharge; in control experiments, electrical stimulation of group I fibers elicited only monosynaptic excitatory potentials; and the distribution of both the contraction-induced positive feedback among motor nuclei as well as the electrically evoked Ia excitatory monosynaptic potentials were restricted to homonymous and synergic motoneurons. Observation of the Ia contraction-induced positive feedback was facilitated by the absence of Ib autogenic inhibition. This contraction-induced Ia excitatory feedback in ankle flexors might either reinforce Ia-induced reflexes when these muscles are lengthened or help to lift the leg over an obstacle.

The threefold purpose of this report is to describe the epidemiology of acute flaccid paralysis (AFP), to determine the impact of the National Immunization Days (NID), and evaluate the quality of active surveillance in the Central African Republic (CAR) and Chad. The data in this study was obtained from the Enterovirus Division of the Pastear Institute in Bangui (National WHO Inter-country Reference Laboratory for the CAR and Chad and Regional Poliovirus Reference Laboratory in Africa). An increase in the number of AFP cases was observed in the CAR between 1995 and 2000 and in Chad between 1997 and 2000, mainly as a result of enhancement of the surveillance system. The goals set by the WHO in terms of the proportion of AFP cases with 2 specimens collected within 14 days of onset of paralysis and the number of cases with 60-day follow-up have not been reached in either country. The presence of 2 strains of wild poliovirus (types 1 and 3) and several genotypes (West African 13 and West African 7 for type 1 and Central African and Nigeria-P3 for type 3) not only show that Central Africa is still a significant reservoir for poliovirus transmission but also raise serious doubts about the quality of the NID organized over the last 3 years. The priority of the next NID round must be to reach unimmunized children who have been missed by routine immunization coverage., A partir des données du Laboratoire des Entérovirus de l’Institut Pasteur de Bangui (Laboratoire National OMS Inter pays de Référence pour la poliomyélite pour la République Centrafricaine (RCA) et le Tchad et Centre Régional OMS de référence pour la poliomyélite pour l’Afrique ), nous décrivons l’épidémiologie des paralysies flasques aiguës (PFA) dans ces deux pays entre 1995 et 2000, nous estimons l’impact des Journées Nationales de Vaccination (JNV) et nous évaluons la qualité de la surveillance active dans les deux pays. Une augmentation du nombre de cas PFA a été observée en RCA entre 1995 et 2000 et au Tchad entre 1997 et 2000, essentiellement en raison de l’amélioration du système de surveillance. La proportion des cas de PFA pour lesquels 2 échantillons de selles sont recueillis dans les 14 jours suivant l’apparition de la paralysie et le nombre de cas de PFA bénéficiant d’un suivi après 60 jours, n’ont jamais atteint les objectifs fixés par l’OMS dans les 2 pays. La présence de 2 types de poliovirus sauvages (types 1 et 3) et de plusieurs génotypes (West African 13 et West African 7 pour le type 1 , Central African et Nigeria - P3 pour le type 3) témoigne de l’intense circulation du poliovirus en Afrique Centrale, mettant en cause la qualité des JNV organisées au cours de ces 3 dernières années. De ce fait, l’objectif des prochaines JNV doit être avant tout d’atteindre les enfants non immunisés contre la poliomyélite ayant échappé à la vaccination de routine.

Between October 2001 and April 2002, five cases of acute flaccid paralysis (AFP) associated with type 2 vaccine-derived polioviruses (VDPVs) were reported in the southern province of the Republic of Madagascar. To determine viral factors that favor the emergence of these pathogenic VDPVs, we analyzed in detail their genomic and phenotypic characteristics and compared them with co-circulating enteroviruses. These VDPVs appeared to belong to two independent recombinant lineages with sequences from the type 2 strain of the oral poliovaccine (OPV) in the 5′-half of the genome and sequences derived from unidentified species C enteroviruses (HEV-C) in the 3′-half. VDPV strains showed characteristics similar to those of wild neurovirulent viruses including neurovirulence in poliovirus-receptor transgenic mice. We looked for other VDPVs and for circulating enteroviruses in 316 stools collected from healthy children living in the small area where most of the AFP cases occurred. We found vaccine PVs, two VDPVs similar to those found in AFP cases, some echoviruses, and above all, many serotypes of coxsackie A viruses belonging to HEV-C, with substantial genetic diversity. Several coxsackie viruses A17 and A13 carried nucleotide sequences closely related to the 2C and the 3Dpol coding regions of the VDPVs, respectively. There was also evidence of multiple genetic recombination events among the HEV-C resulting in numerous recombinant genotypes. This indicates that co-circulation of HEV-C and OPV strains is associated with evolution by recombination, resulting in unexpectedly extensive viral diversity in small human populations in some tropical regions. This probably contributed to the emergence of recombinant VDPVs. These findings give further insight into viral ecosystems and the evolutionary processes that shape viral biodiversity., Author Summary Following extensive vaccination campaigns using the attenuated oral polio vaccine, wild polioviruses remain endemic in only a few countries. Nevertheless, several poliomyelitis outbreaks associated with vaccine-derived polioviruses (VDPVs) were reported in different parts of the world in recent years, particularly in Madagascar in 2002. We analyzed the molecular characteristics of Madagascar VDPVs and compared them with those of co-circulating enteroviruses. These VDPVs appear to be recombinant viruses between vaccine polioviruses and human enteroviruses of species C (HEV-C) and to present phenotypic characteristics similar to those of wild polioviruses including pathogenicity. Similar VDPVs and other enteroviruses, including several HEV-C of different types, were found in the stools of healthy children living in neighboring villages to where most of the poliomyelitis cases occurred. Some HEV-Cs showed sequences closely related to those of VDPVs, indicating genetic recombination between these viruses and vaccine polioviruses. There was also evidence of multiple genetic recombination events among other HEV-C isolates resulting in numerous different genotypes. These findings indicate that co-circulation of HEV-C and vaccine polioviruses and their evolution by recombination results in unexpectedly extensive viral diversity, at least in some small human populations, probably contributing to the emergence of recombinant VDPVs. Results of this study give further insight into the world of viruses and their biodiversity.