Core body temperature varies according to the time of exercise without affecting orexin-A production in the dorsal hypothalamus in male rats.

Physical exercise differentially increases body temperature according to the time of day, which shows the importance of circadian rhythm in thermal regulation. Given its contribution in central pathways involved in thermoregulation, orexin A could play a role in the regulation of core body temperature during and after exercise. To test this hypothesis, we assessed the effect of exercise, performed at two times of day, on core temperature and on the amount of orexin A in the production zone, i.e., the dorsal hypothalamus. Forty-nine male Wistar rats underwent forced treadmill exercise during the HG phase and HL phase of core temperature. Basal core temperature was recorded continuously for 48 h by implanted telemetric sensors in 11 rats. Regulation of core temperature during exercise (20 min) and after each exercise (60 min) was modeled with a modified logistic-type function. During HG exercise, core temperature curve reached a significantly higher maximum (asymptote: +0.70 ± 0.10 °C) and took longer to attain the strongest inclination of the core temperature regulation curve (Xmid: 3.46 ± 0.72 min). After HG exercise, time of recovery was significantly longer than after HL exercise. In male rats, thermoregulatory response to acute physical exercise was influenced by the time of day. There was no effect of either physical activity or time of day on the level of orexin A in the dorsal hypothalamus. Our results suggest that orexin A in the dorsal hypothalamus is not involved in the effects of physical exercise on thermoregulation.

[Management of vascular anomalies in children]. / Prise en charge des anomalies vasculaires chez l'enfant.

Vascular anomalies, which are broadly identified as "angiomas", are rare entities and often unknown by the medical sphere. They are divided in two different categories which carry different prognosis and management: "vascular tumors" and "vascular malformations". Their precise identification is crucial and involves a good knowledge of the biological classification published by Mulliken and Glowacki and that has recently been updated by the International Society for the Study of Vascular Anomalies (ISSVA). Vascular tumors are benign, common, inborn or not and most of the time disappear with growth. Vascular malformations are always congenital and growth with the child. They can involve type of vessels solely or combined with others. A rheologic differentiation between slow and fast flow malformations is essential in order to characterize the seriousness of the lesion. Frequently, their diagnosis is clinically established and the anamnesis is conducted to answer three questions that are the time of revelation of the lesion ("When?"), its aspect ("What?") and its evolution ("How?"). Further investigations are usually not required but a non-invasive imaging technique such as Doppler ultrasound could be useful if a doubt exists. Surgery is not mandatory and must always be well thought because its consequences might be disastrous. It must be left to cosmetic sequelae of these lesions or to lesions that are totally resectable without causing any unacceptable deformation.

Ultrasonographic evaluation of gastric content during labour under epidural analgesia: a prospective cohort study.

BACKGROUND: Women in labour are considered at risk of gastric content aspiration partly because the stomach remains full before delivery. Ultrasonographic measurement of antral cross-sectional area (CSA) is a validated method of gastric content assessment. Our aim was to determine gastric content volume and its changes in parturients during labour under epidural analgesia using bedside ultrasonography. METHODS: The cut-off value corresponding to an increased gastric content was determined by ultrasound measurement of antral CSA in six pregnant women in late pregnancy before and after ingestion of 250 ml of non-clear liquid. Antral CSA was then measured twice in 60 parturients who presented in spontaneous labour: when the anaesthesiologist was called for epidural analgesia catheter placement, and at full cervical dilatation. Patient-controlled epidural analgesia was performed with a solution of ropivacaine and sufentanil. RESULTS: After liquid ingestion, antral CSA (mm(2)) increased from 90 (range, 80-151) to 409 (range, 317-463). A CSA of 320 was taken as cut-off value. The feasibility rate of antral CSA determination was 96%. CSA decreased from 319 [Q1 158-Q3 469] to 203 [Q1 123-Q3 261] during labour (P=2×10(-7)). CSA was >320 in 50% of parturients at the beginning of labour vs 13% at full cervical dilatation (P=0.006). CONCLUSIONS: Bedside ultrasonographic antral CSA measurement is feasible in pregnant women during labour and easy to perform. The observed decrease in antral CSA during labour suggests that gastric motility is preserved under epidural anaesthesia. The procedure could be used to assess individual risk of gastric content aspiration during labour.

Pleth variability index is a weak predictor of fluid responsiveness in patients receiving norepinephrine.

BACKGROUND: In patients receiving an infusion of norepinephrine, the relationship between the amplitude of the oximeter plethysmographic waveform and stroke volume may be variable and quality of the waveform might be reduced, compared with patients not receiving norepinephrine. We assessed the reliability of the pleth variability index (PVI), an automatic measurement of the respiratory variation of the plethysmographic waveform, for predicting fluid responsiveness in patients receiving norepinephrine infusions. METHODS: We measured the response of cardiac index (transpulmonary thermodilution) to i.v. fluid administration in 42 critically ill patients receiving norepinephrine. Patients with arrhythmias, spontaneous breathing, tidal volume <8 ml kg(-1), and respiratory system compliance <30 ml cm H(2)O(-1) were excluded. Before fluid administration, we recorded the arterial pulse pressure variation (PPV) and pulse contour analysis-derived stroke volume variation (SVV, PiCCO2) and PVI (Masimo Radical-7). RESULTS: In seven patients, the plethysmographic signal could not be obtained. Among the 35 remaining patients [mean SAPS II score=77 (sd=17)], i.v. fluid increased cardiac index ≥15% in 15 'responders'. A baseline PVI ≥16% predicted fluid responsiveness with a sensitivity of 47 (inter-quartile range=21-73)% and a specificity of 90 (68-99)%. The area under the receiver operating characteristic curve was significantly lower for PVI [0.68 (0.09)] than for PPV and SVV [0.93 (0.06) and 0.89 (0.07), respectively]. Considering all pairs of measurements, PVI was correlated with PPV (r(2)=0.27). The fluid-induced changes in PVI and PPV were not significantly correlated. CONCLUSIONS: PVI was less reliable than PPV and SVV for predicting fluid responsiveness in critically ill patients receiving norepinephrine. In addition, PVI could not be measured in a significant proportion of patients. This suggests that PVI is not useful in patients receiving norepinephrine.

Unravelling transmission trees of infectious diseases by combining genetic and epidemiological data.

Knowledge on the transmission tree of an epidemic can provide valuable insights into disease dynamics. The transmission tree can be reconstructed by analysing either detailed epidemiological data (e.g. contact tracing) or, if sufficient genetic diversity accumulates over the course of the epidemic, genetic data of the pathogen. We present a likelihood-based framework to integrate these two data types, estimating probabilities of infection by taking weighted averages over the set of possible transmission trees. We test the approach by applying it to temporal, geographical and genetic data on the 241 poultry farms infected in an epidemic of avian influenza A (H7N7) in The Netherlands in 2003. We show that the combined approach estimates the transmission tree with higher correctness and resolution than analyses based on genetic or epidemiological data alone. Furthermore, the estimated tree reveals the relative infectiousness of farms of different types and sizes.

[Cutaneous collagenous vasculopathy: a rare cause of generalized telangiectasia]. / La vasculopathie cutanée collagénique : une cause rare de télangiectasies généralisées.

BACKGROUND: Cutaneous collagenous vasculopathy (CCV) is an entity first described in 2000 by Salama and Rosenthal [1]. Because of its rarity, we felt it opportune to report the present case. PATIENTS AND METHODS: We describe the case of a 47-year-old woman presenting with widespread telangiectasia distributed symmetrically on the legs, thighs and lower abdomen. The histological and immunohistochemical profile was typical of cutaneous collagenous vasculopathy. DISCUSSION: Cutaneous collagenous vasculopathy is characterized by generalized cutaneous telangiectasia and unique histopathological features consisting of marked collagen deposition within the vascular wall of the post-capillary venules in the superficial dermis. Its cause remains unknown. The differential diagnosis consists mainly of generalized essential telangiectasia (GET) and telangiectasia macularis eruptiva perstans (TMEP).

A re-innervated in vitro skin model of non-histaminergic itch and skin neurogenic inflammation: PAR2-, TRPV1- and TRPA1-agonist induced functionality.

Background: Skin, and epidermis, is innervated by sensory nerve fibres. Interactions between them and signal transduction are only partially elucidated in physiological/pathological conditions, especially in pruritus. Objectives: To study the mechanisms involved in pruritus in vitro, we developed a skin explant model re-innervated by sensory neurons. Methods: This model is based on the co-culture of human skin explants and sensory neurons from dorsal root ganglia of rats. Innervation and the expression of protease activated receptor 2 (PAR2), transient receptor potential vanilloid 1 (TRPV1) and transient receptor potential ankyrin one (TRPA1) was analysed by immunostaining. The response of the model to TRPV1, PAR2 and TRPA1 agonists was analysed by patch-clamp, qPCR and enzyme-linked immunosorbent assay. Results: After 5 days of re-innervating nerve fibres was evidenced in the epidermis. Re-innervation was correlated with decrease of epidermal thickness and the number of apoptotic cells in the tissue. The major actors of non-histaminergic itch (PAR-2, thymic stromal lymphopoietin [TSLP], TSLP-R, TRPA1 and TRPV1) were expressed in neurons and/or epidermal cells of skin explants. After topical exposure of TRPV1-(Capsaicin), TRPA1-(Polygodial) and PAR2-agonist (SLIGKV-NH2) activation of reinnervating neurons could be shown in patch-clamp analysis. The release of TSLP was increased with capsaicin or SLIGKV but decreased with polygodial. Release of CGRP was increased by capsaicin and polygodial but decreased with SLIGKV. Activation by SLIGKV showed a decrease of VEGF; polygodial induced an increase of TSLP, Tumour necrosis factor (TNF) and nerve growth factor and capsaicin lead to a decrease of sema3 and TNF expression. Conclusion: The present model is suitable for studying itch and neurogenic inflammation pathways in vitro. We observed that activation of TRPV1, TRPA1 and PAR-2 leads to different response profiles in re-innervated skin explants.

[Occupational asthma: retrospective study of a series of 144 cases]. / Asthmes professionnels: analyse rétrospective d'une série de 144 cas.

The occupational origin of asthma is only found only late, from a diagnosis delay due to development. The aim of this work was to study the chronological characteristics of occupational asthma of different etiologies and to understand the occupational after-effects. A series of 144 cases were analysed (115 men and 29 women) who were seen in a consultation that specialised in occupational pathology, with the inclusion criteria those of the National Institute for Occupational Safety and Health (NIOSH). The analysis was based on: the causative allergen or work protocol; the role of atopy; length of the latency phase; length of symptom exposure; diagnosis delay; occupational consequences. Asthma from isocyanates and flour between them accounted for 62% in this series. These were followed by asthma from wood (8.3%) and persulphates (7.6%). The mean length of the latency period was 7.5 years and the mean diagnosis delay was 2.5 years. Clinical history of atopy and the existence of rhinitis were much more common for the "biological" than the "chemical" asthmas (respectively 69% and 95%, against 36% and 15%). Amongst the 64% of patients who benefited from complete removal of the allergen, 78.5% who were cured or improved, though for those who kept the same conditions of work there was a persistence or even aggravation of symptoms. In 74 cases a certificate of occupational illness was given to the patient.

[Skin tests in the exploration of perianesthetic complications]. / Intérêt du bilan cutané dans l'exploration des accidents per-anesthésiques.

Adverse reactions in anesthesia are more and more frequent. The favoring factors are multiple but the physiopathology of these reactions are not right known: non specific histamine-release, complement activation is anaphylaxis can occur. Skin tests are an very important data for the diagnosis of these accidents. Forty patients and ten healthy subjects were tested with systematic research of a cross-reactivity for curare family; myorelaxants, fluid gelatin, dextran are the tests the most frequently positive. Cross reactivity for curare family is sure and sensibilization by some medicine is possible. Then the behavior of the data is looked at; the research of the favoring factors, the non utilization of some substances and prophylactic treatment are recommended.

[Respiratory allergies among bakers and pastry cooks: epidemiologic survey done in 1991 by the occupational physicians of the Loire-Atlantique]. / Allergies respiratoires des boulangers et des pâtissiers: enquête épidémiologique réalisée en 1991 par des médecins du travail de Loire-Atlantique.

The aim was to study the prevalence of respiratory allergy (rhinitis and asthma) in a population of bakers and pastrycooks. In 1991, 485 bakers and pastry cooks were examined by 27 work-physicians of Loire-Atlantic. The investigation was composed of a standardised questionnaire (signs of respiratory function, atopic history, smoking of tobacco ...), a clinical examination, and tests of respiratory function. An allergy assessment was made of all subjects with symptoms. 14.4% of subjects had rhinitis and 6.4% asthma. Development of these pathologies was clearly job-related for 2/3 of those with rhinitis and more than half of the asthmatics (55%). Occupational rhinitis and asthma were significantly more frequent in bakers than in pastrycooks and were linked to atopic history. Occupational asthma was associated with length of exposure to flour and with occupational rhinitis. In conclusion, these findings are comparable with or a little less than those that have been reported in occupational literature. They under-estimate the importance of the problem because of the occupational selection effect that is associated with these pathologies. Rhinitis and asthma are 1.5 to 3 time more common in bakers than in pastrycooks.

[Respiratory allergies among symptomatic bakers and pastry cooks: initial results of a prevalence study]. / Allergies respiratoires des boulangers-pâtissiers symptomatiques: premiers résultats d'une étude de prévalence.

A survey was carried out on respiratory symptoms and skin prick response to common allergens, storage mite and occupational allergens. Among 178 symptomatics bakers and pastry workers from small businesses in western France, only 65 people underwent skin prick and specific-IgE. 12 (18%) workers were skin positive to at least one common or occupational allergens. The more often skin positive were D. Ptero. mite 36 (57%); Alpha amylase 23 (35%); wheat flour 17 (26%); saccharomyces cerevisiae 16 (25%); Ephestia 15 (24%). The sensitivity of skin test was better than specific IgE for D. Ptero. Mite 36 (57%); and Alpha amylase 23 (35%). The sensitivity of specific IgE was better than skin test for wheat flour 26 (45%) and rye flour 23 (40%). Occurrence of skin positive to occupational allergen among symptomatics with rhinitis and asthma is much more frequent in workers with skin positive to common allergens (40/36) than in workers with skin negative (8/20). Atopy must be regarded as an important predisposing factor for skin sensitisation to occupational allergens. We conclude in the necessity of a standardised allergologic exploration to be done in symptomatics bakers.

Nrf2: a potential target for new therapeutics in liver disease.

Nuclear erythroid 2-related factor 2 (Nrf2) is an oxidative stress-mediated transcription factor with a variety of downstream targets aimed at cytoprotection. Nrf2 has recently been implicated as a new therapeutic target for the treatment of liver disease. Here, we focus on the most common liver diseases-nonalcoholic fatty liver disease/steatohepatitis, alcoholic liver disease, and drug-induced liver injury-and highlight areas in the development of these conditions where activation of Nrf2 may alleviate disease progression.

Electric-field-induced spin flop in BiFeO3 single crystals at room temperature.

Bismuth ferrite, BiFeO3, is the only known room-temperature magnetic ferroelectric material. We demonstrate here, using neutron scattering measurements in high quality single crystals, that the antiferromagnetic and ferroelectric order parameters are intimately coupled. Initially in a single ferroelectric state, our crystals have a canted antiferromagnetic structure describing a unique cycloid. Under electrical poling, polarization reorientation induces a spin flop. We argue here that the coupling between the two orders may be stronger in the bulk than in thin films where the cycloid is absent.

[Clinical aspects of capillary malformations]. / Aspects cliniques des malformations capillaires.

Capillary malformations (CM) are defects of the dermal capillary bed. These slow-flow malformations can affect any part of the body and are always lateralized, despite Unna's naevus. Present at birth, they grow proportionally with the child. In rare instance, they can be part of a more complex syndrome such as Sturge-Weber syndrome. Ectatic CMs of telangiectatic types can be cutaneous, isolated, multiples, diffuse or generalized. In rare instance, they can be associated with epidermal modifications. They can also be part of a syndrome such as Fabry disease, Osler-Weber-Rendu disorder or Cutis marmorata telangiectatica congenita (CMTC). This chapter details the various clinical aspects of CMs.

[Medical treatment of juvenile hemangiomas]. / Traitement médical des hémangiomes immatures.

Infantile hemangioma always involute in 5 to 7 years. However, 10% of proliferating hemangiomas will necessitate a therapeutic approach, often medical, in order to avoid life or organ threatening, fonctional or esthetic sequelae. "Which hemangioma need to be treated, when and how" are important questions for the optimal management of infantile hemangiomas. Corticotherapy is still the treatment of choice for these lesions. Other anti-angiogenic molecules have also been successfully used such as interferon alfa-2a and vincristine. This chapter tries to answer these questions and detail the different medical modalities for the treatment of infantile hemangioma.

Pseudo-factitial dermatitis: a useful clinical and/or histopathological concept.

The concept of pseudo-factitial dermatitis can be defined as follows: any skin condition which, by its clinical or histopathological profile, can lead the clinician to an erroneous diagnosis of factitial dermatitis. Therefore, pseudo-factitial dermatitis does not exist as such; intellectually, it is of special interest for the practising dermatologist, in terms of differential diagnosis, either clinical or histopathological.

Effects of diluents on skin tests.

The role of diluents and preservatives on skin tests was examined in 41 allergic patients. The effect of glycerol in intradermal tests was studied. Concentrations of five percent glycerol were shown to induce a significant wheal which was not inhibited by clemastine fumarate, suggesting a direct toxic effect without the participation of histamine release. Twenty five Dermatophagoides pteronyssinus allergic patients were prick tested with standardized and lyophilized extracts reconstituted either in saline, 50% glycerol or human serum albumin. The wheal size induced by saline or HSA diluted extracts was very similar but greater than that elicited by extract dissolved in 50% glycerol. The correlation between prick tests induced by the three types of extracts tested was always significant.