Development and initial validation of a screening tool for visual ability/performance of people with polyhandicap.

BACKGROUND: Visual impairments are common in people with polyhandicap although they are poorly assessed. However, evaluation of the visual abilities of these people is critical to determining treatment for impairments. OBJECTIVES: To develop and validate an easy-to-use visual-behavioural scale for assessing the visual abilities of people with polyhandicap. METHODS: The development of the Visual Assessment for People with Polyhandicap (VA-PLH) involved 2 steps: i) construction of the scale and ii) field validation. Participant selection criteria were aged > 3 years, age at onset of cerebral lesion < 3 years, a combination of motor impairment and profound intellectual impairment associated with restricted mobility (Gross Motor Function Classification System levels [GMFCS] III, IV or V), and everyday life dependence (Functional Independency Measure [FIM] <55). Vision assessment by both an orthoptist and an ophthalmologist was the reference against which were analysed the items of the scale completed by local health care workers. Acceptability, validity, and reliability were analysed. RESULTS: Amongst the 232 participants included, 217 had a complete assessment, and 33% were < 18 years of age. Ocular abnormalities were reported in 83% of participants. Visual ability was altered or insufficient in 60% of participants. The final version of the VA-PLH included 3 items related to visual reaction (Area Under Curve Receiver Operating Characteristic = 0.83). Participants were considered at-risk if they had at ≥ 1 of 3 signs present (sensitivity 83% and specificity 73%). The scale's reliability was satisfactory CONCLUSION: The VA-PLH scale provides an easy-to-use, reliable and valid measure of visual status for people with polyhandicap and may be used both in clinical practice and clinical research. In addition, this study provides an overview of the diversity of visual impairments in a large population of people with polyhandicap, showing that most experience visual challenges.

Pharmacological targeting of netrin-1 inhibits EMT in cancer.

Epithelial-to-mesenchymal transition (EMT) regulates tumour initiation, progression, metastasis and resistance to anti-cancer therapy1-7. Although great progress has been made in understanding the role of EMT and its regulatory mechanisms in cancer, no therapeutic strategy to pharmacologically target EMT has been identified. Here we found that netrin-1 is upregulated in a primary mouse model of skin squamous cell carcinoma (SCC) exhibiting spontaneous EMT. Pharmacological inhibition of netrin-1 by administration of NP137, a netrin-1-blocking monoclonal antibody currently used in clinical trials in human cancer (ClinicalTrials.gov identifier NCT02977195 ), decreased the proportion of EMT tumour cells in skin SCC, decreased the number of metastases and increased the sensitivity of tumour cells to chemotherapy. Single-cell RNA sequencing revealed the presence of different EMT states, including epithelial, early and late hybrid EMT, and full EMT states, in control SCC. By contrast, administration of NP137 prevented the progression of cancer cells towards a late EMT state and sustained tumour epithelial states. Short hairpin RNA knockdown of netrin-1 and its receptor UNC5B in EPCAM+ tumour cells inhibited EMT in vitro in the absence of stromal cells and regulated a common gene signature that promotes tumour epithelial state and restricts EMT. To assess the relevance of these findings to human cancers, we treated mice transplanted with the A549 human cancer cell line-which undergoes EMT following TGFß1 administration8,9-with NP137. Netrin-1 inhibition decreased EMT in these transplanted A549 cells. Together, our results identify a pharmacological strategy for targeting EMT in cancer, opening up novel therapeutic interventions for anti-cancer therapy.

Fat1 deletion promotes hybrid EMT state, tumour stemness and metastasis.

FAT1, which encodes a protocadherin, is one of the most frequently mutated genes in human cancers1-5. However, the role and the molecular mechanisms by which FAT1 mutations control tumour initiation and progression are poorly understood. Here, using mouse models of skin squamous cell carcinoma and lung tumours, we found that deletion of Fat1 accelerates tumour initiation and malignant progression and promotes a hybrid epithelial-to-mesenchymal transition (EMT) phenotype. We also found this hybrid EMT state in FAT1-mutated human squamous cell carcinomas. Skin squamous cell carcinomas in which Fat1 was deleted presented increased tumour stemness and spontaneous metastasis. We performed transcriptional and chromatin profiling combined with proteomic analyses and mechanistic studies, which revealed that loss of function of FAT1 activates a CAMK2-CD44-SRC axis that promotes YAP1 nuclear translocation and ZEB1 expression that stimulates the mesenchymal state. This loss of function also inactivates EZH2, promoting SOX2 expression, which sustains the epithelial state. Our comprehensive analysis identified drug resistance and vulnerabilities in FAT1-deficient tumours, which have important implications for cancer therapy. Our studies reveal that, in mouse and human squamous cell carcinoma, loss of function of FAT1 promotes tumour initiation, progression, invasiveness, stemness and metastasis through the induction of a hybrid EMT state.

Context Dependency of Epithelial-to-Mesenchymal Transition for Metastasis.

Epithelial-to-mesenchymal transition (EMT) has been proposed to be important for metastatic dissemination. However, recent studies have challenged the requirement of EMT for metastasis. Here, we assessed in different models of primary skin squamous cell carcinomas (SCCs) whether EMT is associated with metastasis. The incidence of metastasis was much higher in SCCs presenting EMT compared to SCCs without EMT, supporting the notion that a certain degree of EMT is required to initiate the metastatic cascade in primary skin SCCs. Most circulating tumor cells presented EMT, whereas most lung metastasis did not present EMT, showing that mesenchymal-to-epithelial transition is important for metastatic colonization. In contrast, immunodeficient mice transplanted with SCCs, whether displaying EMT or not, presented metastasis. Altogether, our data demonstrate that the association of EMT and metastasis is model dependent, and metastasis of primary skin SCCs is associated with EMT.

Identification of the tumour transition states occurring during EMT.

In cancer, the epithelial-to-mesenchymal transition (EMT) is associated with tumour stemness, metastasis and resistance to therapy. It has recently been proposed that, rather than being a binary process, EMT occurs through distinct intermediate states. However, there is no direct in vivo evidence for this idea. Here we screen a large panel of cell surface markers in skin and mammary primary tumours, and identify the existence of multiple tumour subpopulations associated with different EMT stages: from epithelial to completely mesenchymal states, passing through intermediate hybrid states. Although all EMT subpopulations presented similar tumour-propagating cell capacity, they displayed differences in cellular plasticity, invasiveness and metastatic potential. Their transcriptional and epigenetic landscapes identify the underlying gene regulatory networks, transcription factors and signalling pathways that control these different EMT transition states. Finally, these tumour subpopulations are localized in different niches that differentially regulate EMT transition states.

[Screening by general practitioners in smoking among young people aged 12 to 16 years]. / Dépistage par les médecins généralistes de la consommation de tabac chez les jeunes de 12 à 16ans.

OBJECTIVE: To know whether general practitioners in the Nord-Pas-de-Calais realize screened for tobacco use among youth aged 12 to 16years. METHOD: This is a cross-sectional study of 300 general practitioners in the region Nord-Pas-de-Calais (150 in each department). These physicians were randomly selected according to the quota method (with XLSTAT(©) software). Upon agreement, we send them, by various means (e-mail, fax or mail their choice), the questionnaire. RESULTS: One hundred and fifty-seven (68%) questionnaires were returned. Thirty-seven percent (58) of physicians routinely asked their young patients, during questioning, if they smoke, 58.5% (92) sometimes and 4.5% (7) do not ask. Information on smoking was issued by 86% of physicians surveyed. CONCLUSION: General practitioners perform a screening for tobacco use among young patients aged 12 to 16years. They face certain obstacles which the presence of parents during the consultation.

The positive adjuvant effect of chitosan on antigen-specific cell-mediated immunity after chickens vaccination with live Newcastle disease vaccine.

The development of safe, novel strong adjuvants is necessary to maximize the efficacy of and the immune response induced by new and/or available vaccines administered through the mucosal route to chickens. Chitosan is a non-toxic, biocompatible, biodegradable and natural polysaccharide derived from the exoskeleton of crustaceans and insects. It has been demonstrated to be an effective absorption enhancer to improve mucosal delivery of peptide and protein drugs in human and mice. In poultry, mucosal administration of live vaccine has been already explored with success. However, the effects of the use of the chitosan as adjuvant for mucosal vaccination in birds have not been investigated yet. To this aim, we explored its potential as adjuvant given by oculo-nasal route to one-day-old chickens with live Newcastle disease (ND) vaccine. The immune response has been evaluated during three independent vaccination experiments on specific pathogen free (SPF) chickens. It was shown that chitosan enhanced the antigen-specific cell-mediated immune response in the spleen. New protocols were developed to measure the chicken IFNgamma production after ex vivo antigen-stimulation of peripheral blood and duodenal lamina propria lymphocytes. It was then observed than the peripheral cellular immune response was earlier and stronger, while the local cellular immune response in digestive tract as shorter when chitosan was used as adjuvant. On the other hand, the chitosan had no effect on the systemic, lachrymal and digestive antibody-mediated immunity. This study indicates thus that the chitosan is a cell-promising adjuvant for the mucosal delivery of live vaccine in poultry, by enhancing the Th1 pathway of immunity. However, further investigations are required to explore its mechanism of action and to evaluate the inferred protection.

Improved vaccination against Newcastle disease by an in ovo recombinant HVT-ND combined with an adjuvanted live vaccine at day-old.

The continuous outbreaks of fatal Newcastle disease (ND) in commercial poultry flocks demonstrate that current vaccination strategies are not fully efficacious and should be improved by new generation of vaccines. In this context, maternally immune conventional layer chickens were vaccinated in ovo with a turkey herpesvirus recombinant expressing the fusion (F) gene of NDV (rHVT-ND) and/or at day-old with an apathogenic enterotropic live ND vaccine co-administrated or not with chitosan by oculo-nasal route. The induced vaccinal immune responses and conferred protection against a challenge with a circulating NDV velogenic viscerotropic strain were evaluated. The innovative rHVT-ND/live ND-chitosan vaccination regimen provided the best protection against mortality and morbidity as well as the strongest reduction of virus shedding that could be related to the higher measured cellular immune response and digestive antibody-mediated immunity.

Humoral, cell-mediated and mucosal immunity induced by oculo-nasal vaccination of one-day-old SPF and conventional layer chicks with two different live Newcastle disease vaccines.

To further characterize the immune response elicited by two live Newcastle disease vaccines, humoral, cellular and mucosal immunity was evaluated after oculo-nasal vaccination of day-old chickens. The preferential replication sites for each vaccine strain were investigated by screening different tissues using quantitative real-time reverse transcription-polymerase chain reaction (QRRT-PCR). The interference of maternally derived antibody with vaccination was also considered in conventional layer chickens. In SPF chickens, similar humoral immune-response was measured in blood and tears but a differential profile of cell-mediated immunity was observed according to the vaccine strain. The lung-associated humoral immunity was higher with the tracheotropic strain while the enterotropic vaccine induced a more important specific immunity in the digestive tract. The presence of maternally derived antibody in conventional layer chickens limited, if not completely abrogated, their immune responses to vaccination. This study increases our understanding of the protective immune response against Newcastle disease virus (NDV) and provides new useful informations for the development and evaluation of new types of vaccines.

Prevention of volatile fatty acids production and limitation of odours from winery wastewaters by denitrification.

The effect of the addition of nitrate to winery wastewaters to control the formation of VFA in order to prevent odours during storage and treatment was studied in batch bioreactors at different NO(3)/chemical oxygen demand (COD) ratios and at full scale in natural evaporation ponds (2 x 7000 m(2)) by measuring olfactory intensity. In the absence of nitrate, butyric acid (2304 mgL(-1)), acetic acid (1633 mgL(-1)), propionic acid (1558 mgL(-1)), caproic acid (499 mgL(-1)) and valeric acid (298 mgL(-1)) were produced from reconstituted winery wastewater. For a ratio of NO(3)/COD=0.4 gg(-1), caproic and valeric acids were not formed. The production of butyric and propionic acids was reduced by 93.3% and 72.5%, respectively, at a ratio of NO(3)/COD=0.8, and by 97.4% and 100% at a ratio of NO(3)/COD=1.2 gg(-1). Nitrate delayed and decreased butyric acid formation in relation to the oxidoreduction potential. Studies in ponds showed that the addition of concentrated calcium nitrate (NITCAL) to winery wastewaters (3526 m(3)) in a ratio of NO(3)/COD=0.8 inhibited VFA production, with COD elimination (94%) and total nitrate degradation, and no final nitrite accumulation. On the contrary, in ponds not treated with nitrate, malodorous VFA (from propionic to heptanoïc acids) represented up to 60% of the COD. Olfactory intensity measurements in relation to the butanol scale of VFA solutions and the ponds revealed the pervasive role of VFA in the odour of the untreated pond as well as the clear decrease in the intensity and not unpleasant odour of the winery wastewater pond enriched in nitrates. The results obtained at full scale underscored the feasibility and safety of the calcium nitrate treatment as opposed to concentrated nitric acid.