Description of an outbreak of hemorrhagic fever with renal syndrome in the southern Jura Mountains, France, in 2021.

OBJECTIVE: The aim of our study was to describe the 2021 Hemorrhagic Fever with Renal Syndrome (HFRS) outbreak in the southern Jura Mountains. PATIENTS AND METHODS: We included all laboratory-confirmed cases of HFRS reported between April and September 2021 in the three local hospitals. RESULTS: A total of 90 patients were enrolled in the study: 73 hospitalized and 17 non-hospitalized patients. Transient myopia was only reported in non-hospitalized patients. Forty (44.4 %) patients underwent medical imaging before hantavirus diagnosis. Twenty-one patients (28.8 %) had a plasma creatinine level > 353.6 µmol/L, no patient developed severe metabolic disorder. Only one patient was dialyzed. A pacemaker was implanted before diagnosis of HFRS due to severe bradycardia in one patient. Sudden death was reported in one patient. CONCLUSION: This hantavirus epidemic led to numerous hospitalizations, one dialysis treatment, and one death. Early diagnosis by rapid test could avoid unnecessary investigations.

Guidelines for May-Grünwald-Giemsa staining in haematology and non-gynaecological cytopathology: recommendations of the French Society of Clinical Cytology (SFCC) and of the French Association for Quality Assurance in Anatomic and Cytologic Pathology (AFAQAP).

OBJECTIVE: Since the guidelines of the International Committee for Standardisation in Haematology (ICSH) in 1984 and those of the European Committee for External Quality Assessment Programmes in Laboratory Medicine (EQALM) in 2004, no leading organisation has published technical recommendations for the preparation of air-dried cytological specimens using May-Grünwald-Giemsa (MGG) staining. DATA SOURCES: Literature data were retrieved using reference books, baseline-published studies, articles extracted from PubMed/Medline and Google Scholar, and online-available industry datasheets. RATIONALE: The present review addresses all pre-analytical issues concerning the use of Romanowsky's stains (including MGG) in haematology and non-gynaecological cytopathology. It aims at serving as actualised, best practice recommendations for the proper handling of air-dried cytological specimens. It, therefore, appears complementary to the staining criteria of the non-gynaecological diagnostic cytology handbook edited by the United Kingdom National External Quality Assessment Service (UK-NEQAS) in February 2015.

[Radiological trap and oncological precautions in a patient who has undergone a permanent withdrawal of PIP breast implants]. / Piège radiologique et précautions carcinologiques chez une patiente ayant subi un retrait définitif de prothèses mammaires PIP.

We report the case of a 57-year-old patient who presented radiological images similar to ruptured breast implants one year after the supposed withdrawal of the latter. This woman had benefited for the first time from cosmetic PIP breast implants in 2000. Early in 2014, she requested the removal of the implants without renewal because she was feeling pain and functional discomfort. A few months after the operation, she consulted for breast swelling in the upper pole of the breast. Radiological assessment showed liquid formations compatible with the presence of implants. At our request, the rereading of the MRI by the radiologist definitively concluded on a bilateral seroma within the persistent fibrous capsule. In the absence of symptoms, clinical monitoring had been decided. But at the recrudescence of anaplastic large cell lymphoma cases associated with breast implants, a cytological sampling was intended. In case of cytological abnormality or recurrence of the seroma, a surgical procedure should be performed. In conclusion, the removal of a breast implant without capsulectomy may result in the formation of a seroma whose images resemble those of an implant. It is always worthwhile to provide precise clinical data to the radiologist in order to help him to make informed interpretations. Every serous effusion in a breast lodge having contained a silicone implant must evoke the diagnosis of anaplastic large cell lymphoma.

[Indoor tanning: motivations and beliefs among users and non-users in the population of Lille (Northern France)]. / Cabines de bronzage : étude des motivations et croyances des utilisateurs et non-utilisateurs dans la population lilloise.

BACKGROUND: Uncontrolled use of tanning beds is a major public health problem. The role of UV in skin carcinogenesis has in fact been clearly demonstrated. AIMS: The main purpose of the study was to assess the motivations and beliefs of the population concerning the use of indoor tanning. The secondary objectives were to compare the knowledge of users and non-users and to screen for addiction criteria among users. PATIENTS AND METHODS: This was a transversal descriptive study conducted between April and June 2013 in Lille town center. The motivations of the participants were determined using a multiple-choice questionnaire. A Likert scale was used to assess beliefs and an m-CAGE questionnaire was used to screen for addiction. RESULTS: Of the 200 respondents, 30% (n=60) had used tanning beds in a non-medical setting. The median age of first use was 23 years (15-59). 11.7% of respondents had started before the authorised age of 18 years. "To prepare the skin for exposure to the sun" was the main reason given (68.3%) for use of tanning beds. The population was aware that use of such apparatus favours onset of skin cancer and ageing of the skin. Users were more convinced than non-users that UV cabins "prepare the skin for exposure to the sun" (75% vs. 49.6%, P=0.0009) and that they "favour skin cancer" (56.9% against 36.2%, P=0.0444). Addictive behaviour was detected in 3.3% (2/60) of users. CONCLUSION: Users are aware of the carcinogenic risk of UV cabins but expose themselves to such risk, as they believe it prepares their skin for sun exposure.

[Unilateral gigantomastia of pregnancy: case-report of a giant breast hamartoma]. / Gigantomastie unilatérale gravidique: à propos d'un cas d'hamartome géant.

Breast hamartoma is a benign tumour consisting of fat, fibrous and glandular tissue. A young woman in her 19th week of pregnancy underwent exceptional surgery for a unilateral gigantomastia secondary to a rapid-growth giant hamartoma during her second pregnancy. Rigourous clinical and ultrasonographic examinations were performed followed by multiple biopsies. The decision to perform surgery was guided by the risk to skin integrity and of tumour infarct. Our report provides detailed information on gestational benign breast tumours, on the specificities of medical imaging and breast surgery in pregnant patients.

[MRI-guided breast microbiospy or macrobiopsy: which is the best option for a small tumor?]. / Micro- ou macrobiopsie mammaire guidée par IRM : quel est le meilleur choix pour une petite tumeur ?

The choice of the optimum therapeutic strategy for breast cancer depends on the histological diagnosis of the sample obtained by biopsy. The microbiopsy is the preferred method as it provides an accurate diagnosis of the histological type as well as the main prognostic factors, whilst being simple, fast and inexepensive. However, some infraclinic breast tumors are not accessible by conventional guidance due to excessive depth inside the breast, their small size or technical inability to image them by mammography or ultrasonography. In those cases, the MRI guidance may help to perform the biopsy. Most MRI biopsies are made by large-core needle that are known to alter the histological structure of the tumor and to disturb the anatomopatholgical analysis (size and surgical margin). Those are very important elements to know before treatment. Our case report details an original technique of MRI microbiopsy of a deep 4mm opacity found on the occasion of a patient's mammography. The operative specimen revealed an invasive ductal carcinoma of 4mm diameter which scored III on the Elston and Ellis scale (oestrogen and progesterone receptors tested negative and HER-2 was over-expressed). It was associated with a high grade in situ ductal carcinoma. No systemic treatment was prescribed due to the small size of the carcinoma. The development of partially or totally amagnetic microbiopsy pistols would help perform microbiopses guided by MRI.

[Diabetic mastopathy: a recurrent benign breast disease]. / La mastopathie diabétique : une lésion mammaire bénigne sujette à récidive.

Diabetic mastopathy is an uncommon benign entity occurring in young women with type 1 diabetes. Its clinical and radiological signs are not specific and often mimic a breast carcinoma. However, the benign nature of this lesion is easily recognized on histological examination, visualizing dense keloid-like fibrosis, lymphocytic lobulitis and ductitis with lymphocytic perivascular inflammation, with or without epithelioid-like fibroblasts. Surgery can generally be avoided. The evolution of this entity is characterized by the risk of local growth, bilateralisation or recurrence after surgical treatment. We present a case in which the core biopsy allowed the diagnosis of a diabetic mastopathy and we discuss its clinical, diagnostic, pathological and therapeutic particularities.

[Most common benign epithelial breast diseases: diagnosis, treatment and cancer risk]. / Les principales lésions mammaires épithéliales bénignes et à risque. Prise en charge diagnostique et thérapeutique.

As a consequence of breast imaging development and increased interventional radiology, benign epithelial breast diseases (BEBD) represent a growing percentage of breast pathology diagnoses. BEBD include numerous entities such as cysts, fibrosis, adenosis, duct ectasia, which require neither surgery nor follow-up. Some BEBD have to be individualized (radial scars, papillomas, complex sclerosing adenosis, lobular intraepithelial neoplasia, flat epithelial atypia, atypical hyperplasia), being preinvasive lesions or markers of increased breast cancer risk, or being associated with suspect radiological aspect. BEBD should be managed in a pluridisciplinar way and correctly diagnosed by percutaneous biopsies or surgical specimens. The goals of surgery vary according to lesions. It always allows a complete surgical specimen analysis and therefore a search for atypical or cancerous cells. Surgery can also have a preventive role by reducing the risk of potential malignant transformation. Finally, it enables in some cases the excision of a radiologically suspect mass. So the aim of this review is to give a clinical and morphological description of most common BEBD, underlying their cancer risk, specific diagnosis, therapeutic, follow-up and psychological repercussions.

Stereotactic vacuum biopsy of calcifications with a handheld portable biopsy system: a validation study.

To prospectively evaluate a compact portable 10-gauge handheld battery-operated biopsy system for stereotactic biopsy of microcalcifications. The ethics committee of the hospital approved this prospective multicentric study, and informed consent was obtained. Biopsy under stereotactic guidance was performed in 215 patients for 219 lesions consisting of microcalcifications without mass. The feasibility and the tolerance of the procedure were evaluated. The mean weight of the specimen was calculated. In patients with surgical diagnoses, the underestimation rate in biopsy diagnoses of atypical ductal hyperplasia and ductal carcinoma in situ were evaluated. The sampled specimens were separated according to the presence of calcifications on magnified specimen radiographs and to the probe the rotation number in order to evaluate the contribution of each rotation and the contribution of the specimen with and without calcifications on the radiographs. The macrobiopsy was feasible in 98.5% of the patients and was well tolerated in 82% of patients. It identified 4.6% invasive carcinomas, 18.5% ductal carcinomas in situ, 14.8% atypical ductal hyperplasias, 22.2% benign proliferative mastopathies and 39.8% benign non-proliferative mastopathies. The underestimation rate was 26.6% when an atypical ductal hyperplasia was diagnosed at biopsy, and 7.7% when a ductal carcinoma in situ was diagnosed. In the 77 patients with surgical correlation, the accurate diagnosis was obtained in specimens sampled during the first, second, and third in 69%, 9%, and 4% of the biopsies, respectively, and the analysis of specimens without microcalcification had an added value in 8% of patients. The compact portable battery-operated biopsy system can be used successfully for stereotactic biopsy of microcalcifications and constitutes a valid alternative to current systems.

Rapid population growth of a critically endangered carnivore.

Reintroductions of endangered species are controversial because of high costs and frequent failures. However, the population of black-footed ferrets descended from animals released in Shirley Basin, Wyoming, from 1991 to 1994 has grown rapidly after a decline to a low of five animals in 1997. Beginning around 2000, the population grew rapidly to an estimated 223 (95% confidence interval is 192 to 401) individuals in 2006. Matrix population modeling shows the importance of survival and reproduction during the first year of life, reflecting an uncommon life history for an endangered mammalian carnivore. Recovery of the species may benefit from more opportunistic and widespread releases.

A prospective evaluation of nesiritide in the treatment of pediatric heart failure.

This study sought to determine the potential of recombinant B-type natriuretic peptide (nesiritide) for the treatment of pediatric decompensated heart failure. Nesiritide is a widely used and effective treatment for decompensated heart failure (HF) in adults, but its safety and efficacy in pediatric patients is unclear. Outcomes of 55 separate nesiritide infusions of varying durations in 32 patients (13 males and 19 females; mean age, 8.01 years; range, 0.01-20.4) were evaluated prospectively. All patients received nesiritide in the intensive care unit. The starting dose (0.01 microg/kg/min) was titrated to a maximum of 0.03 microg/kg/min. All patients were monitored for clinical signs and symptoms, hemodynamics, urine output, electrolytes, oxygen requirements, and oral intake. Functional status was assessed by patients and/or their parents. All patients successfully underwent initiation and titration of nesiritide infusion. No hypotension or arrhythmias were noted during 478 cumulative days of therapy. Nesiritide was given safely with vasoactive medications. Mean urine output improved from 2.35 +/- 1.71 cc/kg/hr on the day before nesiritide initiation (baseline) to 3.10 +/- 1.94 cc/kg/hr on day 4 of treatment (p < 0.01). Serum creatinine decreased from 1.04 to 0.92 mg/dl (p = 0.096), mean central venous pressure from 13 to 7 mmHg (p = 0.018), and mean weight from 30.4 to 29.7 kg (p < 0.001) with therapy. Thirst, as subjectively assessed by patients old enough to respond, decreased with infusion in 31 of 42 cases (74%). Mean New York Heart Association functional class improved significantly (p < 0.001). Nesiritide infusion, alone or in combination, is a safe treatment for decompensated HF in pediatric patients. It is associated with decreased thirst and improved urine output and functional status, and it may be efficacious in the treatment of pediatric HF.

Cognitive structure of executive deficits in patients with frontal lesions performing activities of daily living.

OBJECTIVE: Executive function in activities of daily living (ADL) were investigated in 10 patients with excised frontal lobe tumours. METHOD: The patients with frontal lesions were compared to 10 normal controls with a neuropsychological test battery, a script generation task and a realistic implementation of complex multi-task ADL (planning and preparing a meal). RESULTS: The patients manifested numerous basic executive deficits on the paper-pencil tests, were unimpaired on the script generation task despite an aberrant semantic structure and manifested marked anomalies in the meal preparation task. CONCLUSION: Frontal lobe deficits in lengthy complex multi-task ADL can be explained by impairment of several executive functions, generalized slowness of performance and paucity of behaviour.

Early transference interventions with male patients in psychotherapy.

Transcripts of early sessions for 7 personality-disordered male subjects participating in an ongoing naturalistic long-term dynamic psychotherapy project were rated for therapist interventions and alliance. Early transference interpretations were followed by increased defensiveness even when there was a solid alliance. Omitting transference interpretations in the face of an early negative transference was equally problematic. However, the rapid sequence of early transference and defense interpretations, or early defense interpretations alone, enhanced therapeutic work without increasing defensiveness. Caretaking of the alliance after early interpretive work was also investigated. Two different styles of handling affect emerged from the sample.

Task-specific resistance training to improve the ability of activities of daily living-impaired older adults to rise from a bed and from a chair.

OBJECTIVES: To determine the effect of a 12-week intervention to improve the ability of disabled older adults to rise from a bed and from a chair. DESIGN: Subjects were randomly allocated to either a 12-week task-specific resistance-training intervention (training in bed- and chair-rise subtasks, such as sliding forward to the edge of a chair with the addition of weights) or a control flexibility intervention. SETTING: Seven congregate housing facilities. PARTICIPANTS: Congregate housing residents age 65 and older (n = 161, mean age 82) who reported requiring assistance (such as from a person, equipment, or device) in performing at least one of the following mobility-related activities of daily living: transferring, walking, bathing, and toileting. MEASUREMENTS: At baseline, 6 weeks, and 12 weeks, subjects performed a series of bed- and chair-rise tasks where the rise task demand varied according to height of the head of the bed, chair seat height, and use of hands. Outcomes were able or unable to rise and, if able, the time taken to rise. Logistic regression for repeated measures was used to test for differences between tasks in the ability to rise. Following log transformation of rise time, a linear effects model was used to compare rise time between tasks. RESULTS: Regarding the maximum total number of bed- and chair-rise tasks that could be successfully completed, a significant training effect was seen at 12 weeks (P = .03); the training effect decreased as the total number of tasks increased. No statistically significant training effects were noted for rise ability according to individual tasks. Bed- and chair-rise time showed a significant training effect for each rise task, with analytic models suggesting a range of approximately 11% to 20% rise-time (up to 1.5 seconds) improvement in the training group over controls. Training effects were also noted in musculoskeletal capacities, particularly in trunk range of motion, strength, and balance. CONCLUSIONS: Task-specific resistance training increased the overall ability and decreased the rise time required to perform a series of bed- and chair-rise tasks. The actual rise-time improvement was clinically small but may be useful over the long term. Future studies might consider adapting this exercise program and the focus on trunk function to a frailer cohort, such as in rehabilitation settings. In these settings, the less challenging rise tasks (such as rising from an elevated chair) and the ability to perform intermediate tasks (such as hip bridging) may become important intermediate rehabilitation goals.

Liposomal mediated transfection of mature rat astrocytes in vitro: a comparison of ten reagents.

Ten cationic liposomes were tested for their ability to transfect mature, astrocyte monolayers in vitro using the eucaryotic expression vector plasmid p cytomegalovirus (CMV)-beta. Liposomal agents were examined for optimum length of exposure and optimum cDNA/lipid ratios. Lipofectin demonstrated the highest transfection efficiencies of all agents tested (3.3%). When examined at 3 days following transfection, 24-h exposures yielded higher efficiencies compared to 6 h exposures (1.9%, P=0.07). Although expression appeared to decline by up to 80%, positive cells were still detected up to 2 weeks after transfection with all reagents. Lipofectin represents a useful tool for transfecting mature astrocytes for investigation of gene transfer in vitro.

Phosphorylation at tyrosine-524 influences nuclear accumulation of HSP72 with heat stress.

Nuclear accumulation of heat shock protein (HSP) 72 occurs after cardiac ischemia. This nuclear accumulation of HSP72 with stress occurs in other tissues and species. We postulated that nuclear accumulation of HSP72 was important for the protective effect of HSP72 and that phosphorylation of a single tyrosine (Y(524)) regulated nuclear accumulation of HSP72. Western blots of immunoprecipitated HSP72 from Cos-1 cells demonstrated that tyrosine becomes phosphorylated after heat shock. Treatment with the tyrosine kinase inhibitor geldanamycin blocked nuclear accumulation of HSP72 with heat shock. Two epitope-tagged constructs were made: M17 converting Y(524) to aspartic acid (pseudophosphorylation) and M18 converting Y(524) to phenylalanine. When transfected into Cos-1 cells, M17 accumulates more rapidly and M18 less rapidly than wild-type (WT) HSP72 in the nucleus following heat shock. Cells expressing M18 had less viability after heat shock at 43.5 degrees C than other constructs. After heat shock at 45 degrees C, cells expressing M17 had superior survival compared with WT and M18. These data suggest that phosphorylation at Y(524) facilitates nuclear accumulation of HSP72 following heat stress, and substitution of aspartic acid at Y(524) enhances resistance to heat-shock injury.