[Which solution to functional somatic disorder: The ACSEPT program]. / Quelle réponse au trouble somatique fonctionnel : la filière ACSEPT.

BACKGROUND: Functional somatic disorder (FSD) is a prevalent disorder that can be severely disabling for the patient and is associated with major health costs. There are few formalized care programs for these disorders in the country, and their management encounters various difficulties, both in the diagnosis and its announcement and the treatment. Cognitive-behavioural and emotional therapy (CBT) is the standard on psychiatry care, and its efficacy has been demonstrated through several randomised controlled studies on the intensity of physical and psychological symptoms. INTERVENTION: At Lille's University Hospital Center, we have established the "ACSEPT" care pathway for TSF management which consists of a psychiatric consultation followed by an individual referral, including a treatment using repeated transcranial magnetic stimulation (rTMS) or the integration of a CBT-based psychoeducation group. This group had the particularity of caring for all patients presenting FSD regardless of the associated physical symptoms. Educating medical professionals and conducting FSD research were other goals of ACSEPT. DISCUSSION/CONCLUSION: ACSEPT allows an improvement in the care offered to these patients with a defined orientation and interdisciplinary, early, organized cares that are repeatable. Our goal is to study the effectiveness of these different interventions in subsequent studies, to continue the development of ACSEPT and to be able to distribute this intervention at the regional level to establish a clear care program allowing early management of these patients.

[Long-term results of plantar skin grafts versus skin grafts of hairy areas for covering loss of skin substances on the palmar surface of the fingers, palm of the hand and sole of the foot in patients with black skin. Prospective cohort study of 123 total skin grafts]. / Résultats à long terme des greffes de peau plantaire versus greffes de peau des zones velues pour la couverture des pertes de substances cutanées de la face palmaire des doigts, de la paume de main et de la plante du pied chez les patients à peau noire. Étude de cohorte prospective de 123 greffes de peau totale.

CONTEXT: Despite the use of total skin grafting in the treatment of loss of skin substances on the palmar surface of the fingers, the palm of the hand and the sole of the foot, the data published in the literature on long-term results in black-skinned patients are non-existent. METHODS: The present study, filling this gap, used data from a prospective cohort of 123 total skin grafts performed on 93 black African patients who benefited from plantar skin grafts versus skin grafts from hairy areas to cover loss of skin substances. of the palmar surface of the fingers, the palm of the hand and the sole of the foot. This study covers a period of 163 months. RESULTS: Sixty-four grafts of hairy areas were carried out in 52 patients, 29 of whom were male and 23 female, for a M/F sex ratio of 1.3; and 59 plantar skin grafts in 41 patients including 21 males and 20 females, M/F sex ratio of 1. The digital palmar surface was the most recipient of the plantar graft, i.e. 35.5% of cases. After a post-operative follow-up of at least 12 months, patients or their entourage judged the functional and aesthetic results of plantar skin grafts to be better and acceptable, unlike the results of hairy area grafts. The texture and color are even better if the total skin graft is taken from an identical histological area. CONCLUSION: In view of these results, we recommend a plantar skin graft for black-skinned patients to cover losses of skin substances on the palmar surface of the fingers, the palm of the hand and the sole of the foot, if indicated.

[Functional neurological disorders and forensic medicine: Clinical and practical characteristics]. / Troubles neurologiques fonctionnels et expertise médico-légale : aspects cliniques et pratiques.

Functional neurological disorders (FND) have long been a challenge for medicine, both on clinical and psychodynamic point of view. The medico-legal issue is often relegated to the background in medicine, and FND patients also suffer from such neglected topic. Nonetheless, despite the difficulty to properly diagnose FND and the numerous associated organic and/or psychiatric comorbidities, FND patients report a significant level of deficiency and a high alteration of quality of life when compared to other well-recognized chronic disorders such as Parkinson's disease or epilepsy. Whether it is for the estimation of a personal injury, a prejudice, after-effects following a medical accident or certain legal contexts requiring the elimination of a factitious disorder or a simulation, the uncertainty and imprecision in the medico-legal assessment can imply notable consequences on the patient. In this article, we propose to define the different medico-legal contexts in which FND can occur that of the legal expert, that of the consulting physician, that of the so-called recourse physician and finally that of the attending physician who can provide detailed medical files to the patient in order to help him/her in his/her procedures. We then explain how to use standardized objective evaluation tools validated by the learned societies and how to encourage multidisciplinary cross-evaluation. Finally, we specify how to differentiate FND from historically FND-associated disorders (factitious and simulated disorders), through the clinical criteria, considering the difficulties linked to the uncertainty in the clinical examination of these disorders in a medico-legal context. In addition to the rigorous completion of expertise missions, we aim to reduce two damaging consequences characterizing FND: diagnostic delay and the patients' suffering through stigma.

[Overview of care management principles in functional neurological disorders]. / Synthèse des principes et schémas de prise en charge dans les troubles neurologiques fonctionnels.

After more than twenty years of academic research on functional neurological disorders (FND) throughout the world, a standardized care management strategy has emerged to allow a more adapted care offer to patients with FND, as close as possible to their experience and their needs. With regard to this special issue on FND in collaboration with L'Encéphale and at the initiative of the Neuropsychiatry section of the AFPBN (French Association of Biological Psychiatry and Neuropsychopharmacology), we would like to suggest a summary of all topics discussed in more detail in each article of this special issue, in order to facilitate its reading. We therefore cover the following themes: the initial contact with a patient with FND, the diagnostic process in favor of a positive diagnosis, the physiological, neural and psychological basis of FND, the diagnostic announcement (and its intangibles), the therapeutic patient education in FND, the general principles of therapeutic management through a personalized and multidisciplinary care program, and the validated therapeutic tools available according to the symptoms identified. This article is designed to be of broad interest on FND, supported by tables and figures showing the key points of all these steps, to keep an educational purpose at most. We hope that through this special issue, each health professional will be able to grasp this knowledge and this framework of care as easily and quickly as possible, in order to participate in the standardization of the care offer.

[Understanding functional neurological disorders: From biological markers to pathophysiological models]. / Étiopathogénie des troubles neurologiques fonctionnels : marqueurs biologiques et modèles théoriques.

OBJECTIVES: Functional neurological disorders have witnessed intense research activity in the fields of structural and functional neuroimaging for more than twenty years. Thus, we propose a synthesis of recent research findings and etiological hypotheses that have been proposed so far. This work should help clinicians to better understand the nature of the mechanisms involved, but also help patients to increase their knowledge about the biological features underlying their functional symptoms. METHODS: We carried out a narrative review of international publications dealing with neuroimaging and biology of functional neurological disorders, from 1997 to 2023. RESULTS: Several brain networks underlie functional neurological symptoms. These networks play a role in the management of cognitive resources, in attentional control, emotion regulation, in agency and in the processing of interoceptive signals. The mechanisms of the stress response are also associated with the symptoms. The biopsychosocial model helps to better understand predisposing, precipitating, and perpetuating factors involved. The functional neurological phenotype results from the interaction between: i) a specific pre-existing vulnerability resulting from biological background and epigenetic modifications, and ii) exposure to stress factors, according to the stress-diathesis model. This interaction causes emotional disturbances including hypervigilance, lack of integration of sensations and affects, and emotional dysregulation. These characteristics in turn impact the cognitive, motor and affective control processes related with the functional neurological symptoms. CONCLUSIONS: A better knowledge of the biopsychosocial determinants of brain network dysfunctions is necessary. Understanding them would help developing targeted treatments, but is also critical for patients care.

[Diagnostic criteria, epidemiology and assessment of patients with functional neurological disorders]. / Définitions, épidémiologie et démarche diagnostique clinique dans les troubles neurologiques fonctionnels.

Functional neurological disorders (FND) are symptoms that can affect a variety of functions including motor, sensory and cognitive. These symptoms are genuinely experienced by the patient and are related to a functional disorder rather than a structural one. There is little epidemiological data on these disorders, but their frequency is well established in clinical practice, it is the second most frequent reason for consultation in Neurology. Despite of the frequency of the disorder, general practitioners and specialists are insufficiently trained in the disease, and patients often suffer from stigmatization and/or unnecessary investigations. It is therefore important to be aware of the diagnostic approach to FND, which mostly relies on positive clinical signs. Psychiatric evaluation can help with the characterization of predisposing, precipitating and perpetuating factors of the symptoms (according to the 3P biopsychosocial model related to FND), and guide their management. Finally, diagnosis explanation is a crucial step in the management of the disease, which can in itself have a therapeutic effect, and allow the patient to adhere to the treatments.

Overall comorbidities in functional neurological disorder: A narrative review.

INTRODUCTION: The importance to assess and include the frequent comorbidities in the personalised care management plan of patients with functional neurological disorders (FND) has arisen through the years. FND patients are not only complaining from motor and/or sensory symptoms. They also report some non-specific symptoms that participate to the burden of FND. In this narrative review, we aim to better describe these comorbidities in terms of prevalence, clinical characteristics and their variability depending on the subtype of FND. METHODS: The literature was searched for on Medline and PubMed. The search was narrowed to articles between 2000 and 2022. RESULTS: Fatigue is the most common symptom reported in relation to FND (from 47 to 93%), followed by cognitive symptoms (from 80 to 85%). Psychiatric disorders are reported in 40 to 100% FND patients, depending on the FND subtype (functional motor disorder [FMD], functional dissociative seizures [FDS]…) but also on the type of psychiatric disorder (anxiety disorders being the most frequent, followed by mood disorders and neurodevelopmental disorders). Stress factors such as childhood trauma exposure (emotional neglect and physical abuse predominantly) have also been identified in up to 75% of FND patients, along with maladaptive coping strategies. Organic disorders are commonly reported in FND, such as neurological disorders (including epilepsy in FDS [20%] and FMD in Parkinson's Disease [7%]). Somatic symptom disorders including chronic pain syndromes are frequently associated to FND (about 50%). To be noted, recent data also suggest a high comorbidity between FND and hypermobile Ehlers Danlos Syndrome (about 55%). CONCLUSION: Put together, this narrative review highlights the high burden of FND patients, not only due to somatosensory alterations but also by considering the frequent comorbidities reported. Thus, such comorbidities must be taken into consideration when defining the FND personalised care management strategy for the patients.

Total clipless laparoscopic nephrectomy carried out with the LigaSure device: Preliminary experience.

BACKGROUND: Total laparoscopic nephrectomy has become the standard method for the removal of diseased kidneys. OBJECTIVES: The purpose of this study was to evaluate the feasibility of the LigaSure vessel closure system during laparoscopic nephrectomy. METHODS: From January 2018 to June 2018, the LigaSure device was used in 5 patients undergoing laparoscopic nephrectomy for non functional kidney. Nephrectomy was carried out without the use of clips or sutures for vessel closure. We report intraoperative findings, conversion rates, blood loss, operative time, morbidity, and postoperative outcomes. RESULTS: Median operative time was 45minutes (range 25 to 60min). Median blood loss was 30mL (range 10 to 50mL). No conversions to open surgery were necessary. No patients experienced major bleeding intraoperatively or postoperatively. All patients left the hospital one day after the procedure. Histopathological examination of the removed kidneys was in favor of chronic non specific pyelonephritis. CONCLUSIONS: For the treatment of the renal pedicle during total laparoscopic nephrectomy of a destroyed kidney, the LigaSure device appears to be feasible and effective. Our experience is the first to demonstrate the advantages of LigaSure® in laparoscopic nephrectomy: reduction in operating time, blood loss, transfusions and length of stay in hospital.

[Augmented psychotherapy with rTMS in functional neurological disorder]. / Psychothérapie augmentée par rTMS pour les troubles neurologiques fonctionnels.

BACKGROUND: We report the observation of a 47-year-old woman with functional neurological disorder (tetraparesis, mixed tremors and non-epileptic seizures) treated with a protocol of augmented psychotherapy in combination with repeated transcranial magnetic stimulation (rTMS). INTERVENTION: We carried out a biofeedback psychotherapy protocol with rTMS (twenty sessions, two sessions per day for ten days; 1Hz, 150% of the motor threshold, twenty minute sessions, 300 pulses per session) in which the patient visualized the motor activity of her upper limbs during stimulation of the primary motor area (PMA). The evolution of neurological symptoms was assessed using the Medical Research Council Scale for Muscle Strength (MRC). RESULTS: Symptoms were improved between the 4th and 6th days of treatment (8th and 12th sessions) with first a relief of paresis, then a secondary cascade improvement of other functional symptoms. At two months the patient no longer presented any functional neurological symptoms. DISCUSSION & CONCLUSION: We propose several hypotheses concerning the effectiveness of this type of biofeedback protocol using rTMS. We also suggest that this type of protocol should be systematically associated with psychotherapeutic support on biographical elements for holistic management. This observation underlines the interest of potentiating cognitive-behavioral therapies using the principle of operant conditioning with the aid of brain stimulation in functional neurological disorders, and motivates the realization of future studies.

Survie des patients en oncologie traités par l'équipe de soins palliatifs d'un hôpital de São Paulo, au Brésil.

Introduction: L'échelle de l'indice fonctionnel de Karnofsky (Karnofsky Performance Status Scale) est un instrument d'évaluation pertinent et fonctionnel qui sert à déterminer quelles personnes devraient être suivies par des équipes multidisciplinaires de soins palliatifs. Objectif: Analyser les résultats cliniques de patients, suivis par une équipe de soins palliatifs, dont l'indice fonctionnel de Karnofsky est inférieur à 70 %, et les comparer aux résultats de personnes n'ayant pas bénéficié de ce type de soins. Méthodologie: Dans la présente étude de cohorte rétrospective, le suivi pendant 10 jours des patients par l'équipe de soins palliatifs constituait le facteur d'exposition et la survie, la variable dépendante. Des données ont été extraites des dossiers médicaux afin de réaliser des statistiques descriptives et des analyses des courbes de survie. Résultats: Parmi les 581 participants de l'échantillon, 42,5 % avaient des métastases. Le cancer gastro-intestinal était le diagnostic plus prévalent (29,1 %). Du groupe, 51 participants (8,7 %) étaient suivis par l'équipe de soins palliatifs. Le taux de mortalité pendant les 10 jours de suivi s'élevait à 10,8 %; il était plus élevé encore (15,7 %) chez les patients suivis par l'équipe de soins palliatifs. Conclusion: Les patients ayant un indice fonctionnel inférieur à 70 % qui étaient suivis par l'équipe de soins palliatifs présentaient un piètre état clinique et une période de survie plus réduite comparativement aux autres patients.

Variables affecting quality of life after Radical cystectomy and neobladder substitution: Egyptian National Cancer Institute experience.

INTRODUCTION: To evaluate the functional outcomes and quality of life beyond 1 year, in patients treated with radical cystectomy and orthotopic diversion for invasive bladder cancer. To investigate various potential contributing factors on patient's quality of life after radical cystectomy and urinary diversion via orthotopic neobladder. MATERIALS AND METHODS: This retrospective study was conducted at the National Cancer Institute (NCI), Cairo; including a total of 97 patients who underwent radical cystectomy and orthotopic diversion. Functional and sexual outcome and patient QoL were assessed by ICIQ-SF, IIEF-5 and QLQ-C30 questionnaires. Potential association of patient QoL with pre-and intraoperative variables was studied. RESULTS: Our results show that preoperative ECOG performance status 0 (P=0.0001), and nerve sparing surgery (P=0.001), were associated with high QoL and functional outcomes. On the contrary, ECOG performance status 2, preoperative comorbidities as ischemic heart diseases (P=0.01), recurrence (0.041), adjuvant chemotherapy (P=0.017) and radiotherapy (P=0.001) were associated with low QoL on univariate analysis. However, only ECOG performance status 2 (P<0.0001), incontinence (P<0.0001), non-nerve sparing surgery (P=0.001) and ureteric stricture (P=0.001) were independent predictors of worse QoL on multivariate analysis. CONCLUSION: Orthotopic bladder is associated with increased morbidity. Attention should be given to preoprative patient characteristics at the time of patient selection, and intraoperative quality of functional preservation.

Measuring mothers' representations of their infants: Psychometric properties of the clinical scales of the working model of the child interview in a low- to moderate-risk sample.

The Working Model of the Child Interview (WMCI) is frequently used to measure parents' representations. Beyond the global categories (balanced, disengaged, distorted), the reliability, factor structure, and validity of all the 15 clinical scales have not previously been studied. The WMCI was administered to 152 Norwegian mothers of infants (mean age = 7.3 months) recruited from community well-baby clinics. Interrater reliability was adequate for the global categories and moderate for the clinical scales. Exploratory factor analysis and confirmatory factor analysis yielded three factors with evidence of factorial validity: Factor 1 balanced; factor 2 resentful; factor 3 apprehensive. Factor 1 corresponded with the original category balanced, while factor 2 and factor 3 corresponded with the original category distorted. Concurrent validity was supported as mothers with balanced representation (factor 1) were less stressed and the mother-infant interaction was more positive than that of mothers with resentful representation. Mothers with resentful or apprehensive representations (factor 2 and factor 3) reported more stress. The extracted factors and demographic variables correlated weakly or not at all, confirming discriminant validity. Our findings show that the clinical scales of the WMCI can be used in research with low- to moderate-risk samples.

El Modelo de Trabajo de la Entrevista del Niño (WMCI) se usa frecuentemente para medir las representaciones de los progenitores. Más allá de las categorías globales (equilibradas, desconectadas, distorsionadas), la confiabilidad, la estructura de factores y la validez de todas las 15 escalas clínicas no han sido previamente estudiadas. Se les administró el WMCI a 152 madres noruegas de infantes (edad media = 7.3 meses) reclutadas de clínicas comunitarias para el bienestar del bebé. La confiabilidad entre los evaluadores fue adecuada para las categorías globales y moderada para las escalas clínicas. Los análisis exploratorios de factores (EFA) y los análisis confirmatorios de factores (CFA) produjeron tres factores con evidencia de validez factorial: Factor 1) equilibradas; factor 2) resentidas; factor 3) aprensivas. El factor 1 se correspondió con la categoría original de equilibradas, mientras que el factor 2 y el factor 3 se correspondieron con la categoría original de distorsionadas. La validez concurrente encontró apoyo en que las madres con una representación equilibrada (factor 1) estaban menos estresadas y la interacción madre-infante fue más positiva que la de las madres con representaciones resentidas. Las madres con representaciones resentidas o aprensivas (factor 2 y factor 3) reportaron más estrés. Los factores extraídos y las variables demográficas se correlacionaron débilmente o no se correlacionaron del todo, lo cual confirma la validez discriminante. Nuestros resultados muestran que las escalas clínicas del WMCI pueden usarse en la investigación con grupos muestras de bajo a moderado riesgo.

Le Modèle Fonctionnel de l'Entretien de l'Enfant (WMCI en anglais) est fréquemment utilisé pour mesurer les représentations des parents. Au-delà des catégories globales (équilibré, désengagé, déformé), la fiabilité, la structure de facteur et la validité de toutes les 15 échelles cliniques n'ont pas été étudiées jusqu'à présent. Le WMCI a été donné à 152 mères de nourrissons norvégiennes (âge moyen = 7,3 mois) recrutées dans des cliniques de bien-être du bébé communautaires. La fiabilité entre les évaluateurs était adéquate pour les catégories globales et modérée pour les échelles cliniques. L'Analyse Factorielle Exploratoire (AFE) et l'Analyse Factorielle de Confirmation (AFC) ont produit trois facteurs avec une preuve de validité factorielle: Facteur 1) équilibré; facteur 2) rancunier; facteur 3) appréhensif. Le facteur 1 correspondait à la catégorie originale balancé, alors que le facteur 2 et le facteur 3 correspondaient à la catégorie originale déformé. La validité simultanée a été confirmée puisque les mères avec une représentation équilibrée (facteur 1) étaient moins stressées et l'interaction mère-bébé était plus positive que celle des mères avec une représentation rancunière. Les mères avec des représentations rancunières ou appréhensives (facteur 2 et facteur 3) ont fait état de plus de stress. Les facteurs extraits et les variables démographiques se sont faiblement corrélés ou pas du tout, confirmant une validité discriminante. Nos résultats montrent que les échelles cliniques du WMCI peut être utilisée dans les recherches avec des échantillons à risque faible à modéré.

Ileal ureter replacement: Early morbidity and long-term results.

INTRODUCTION: Ileal ureter is a technique that consists of replacing the ureter by a segment of ileum to treat a long ureteric lesion or a lesion involving the lumbar ureter. The primary objective of our study was to assess the early perioperative morbidity of ileal ureter according to the Clavien-Dindo classification. The secondary objectives were to assess the morbidity and the medium- and long-term outcome of renal function. MATERIALS AND METHODS: Single-centre retrospective study, collecting data from patients operated between February 2005 and October 2019. All patients who underwent ileal ureter replacement surgery in our unit were included in this analysis. The ureteric defect was longer than five centimetres and involved the pelvic and/or iliac and/or lumbar ureter. All ileal ureter replacements were performed by open surgery using isoperistaltic ileal grafts. RESULTS: Twenty-one patients (11 women and 10 men) underwent total or subtotal, unilateral or bilateral ileal ureter replacement, corresponding to 25 kidneys. The grade III early postoperative complication rate was 9.5% (two cases) mainly consisting of bleeding. No grade IV or V complications were observed. With a mean follow-up of 85 months, long-term morbidity essentially consisted of infectious complications. No patients developed anastomotic strictures. Mean serum creatinine was 116.3µmol/L preoperatively, 105.6µmol/L one month postoperatively and 112.2µmol/L at last follow-up. Renal function was generally preserved or even improved, except for patients with preoperative renal failure. CONCLUSION: Ileal ureter replacement is a surgical alternative associated with low morbidity and satisfactory long-term functional results. LEVEL OF EVIDENCE: 3.

[Management of a patient with severe limb trauma]. / La prise en charge d'un patient victime d'un traumatisme sévère de membre.

The management of a patient with limb trauma begins with a rapid assessment of the lesions in order to prioritise the treatment of life-threatening lesions, primarily haemorrhage. Severe limb trauma is defined by the presence of specific severity criteria and requires the injured person to be referred to a specialised severe trauma centre. The prognosis is twofold, both vital and functional, based on the speed as well as the quality of immediate pre-hospital care, specific hospital care and the prevention of secondary complications.

[Limb necrotizing soft tissue infection (NSTI) and necrotising fasciitis: A bicentric study between 2000 and 2017 on the quality of life and functional impact]. / Atteinte des membres dans les DHBN-FN : étude bicentrique entre 2000 et 2017 sur la qualité de vie et impact fonctionnel.

INTRODUCTION: Limb necrotising soft tissue infection and necrotising fasciitis surgical debridement results in significant soft tissue losses. The purpose of this study was to evaluate the functional impact and the quality of life of survivors. PATIENTS AND METHODS: This bicentric retrospective study included 62 patients treated for limb necrotising soft tissue infection and necrotising fasciitis (NSTI-NF) between 2000 and 2017. Demographic, clinic, biologic and surgical data were found in Patients Medical Records. Survivors at the moment of data collection (2018) were met; their quality of life was assessed using SF-36, DLQI, BSHS-B scores and their active joints motions were measured using a goniometer. RESULTS: Twenty-one patients (87.1% of the living patients at this moment) were assessed. For the joint above the injury, mean loss of flexion was 9.19% and 5% for extension whereas for the joint under the injury, mean loss of flexion was 37.65% and 48.6% for extension compared to non-injured side. Mean quality of life scores were: SF-36p: 45.88, SF-36m: 51.31, DLQI: 10.48, BSHS-B: 105.81. The statistical analysis was not able to establish a correlation between loss of motion and quality of life. CONCLUSION: We have not found a relationship between loss of joints motions and long term quality of life for those patients. High excised body surface area and high length of stay are correlated with high DLQI and thus a lower quality of life.

[Severe burns, a long journey of care and rehabilitation]. / Le brûlé grave, un long parcours de soins et de réhabilitation.

At the patient's bedside 24 hours a day, the nurse is at the heart of the rehabilitation management of the severely burnt patient: installation, technical dressings, supervision of postures and placement of compressors, to limit the functional consequences to the type of retractable and hypertrophic scars. The nurse takes care of the patient in this long journey leading to social reintegration; from accompaniment to autonomy and acceptance of self-image.

Analyzing gene expression profiles with preliminary validations in cardiac hypertrophy induced by pressure overload.

The aim of this study was to identify the key genes involved in the cardiac hypertrophy (CH) induced by pressure overload. mRNA microarray data sets GSE5500 and GSE18801 were downloaded from the Gene Expression Omnibus database, and differentially expressed genes (DEGs) were screened using the Limma package; then, functional and pathway enrichment analysis were performed for common DEGs using the Database for Annotation, Visualization and Integrated Discovery database. Furthermore, the top DEGs were further validated using quantitative PCR in the hypertrophic heart tissue induced by isoprenaline. A total of 113 common DEGs with absolute fold change > 0.5, including 60 significantly upregulated DEGs and 53 downregulated DEGs, were obtained. Gene ontology term enrichment analysis suggested that common upregulated DEG were mainly enriched in neutrophil chemotaxis, extracellular fibril organization, and cell proliferation; and the common downregulated genes were significantly enriched in ion transport, endoplasmic reticulum, and dendritic spine. Kyoto Encyclopedia of Genes and Genomes pathway analysis found that the common DEGs were mainly enriched in extracellular matrix receptor interaction, phagosome, and focal adhesion. Additionally, the expression of Mfap4, Ltbp2, Aspn, Serpina3n, and Cnksr1 were upregulated in the model of CH, while the expression of Anp32a was downregulated. The current study identified the key deregulated genes and pathways involved in the CH, which could shed new light to understand the mechanism of CH.

Mechanisms of spontaneous pacing: sinoatrial nodal cells, neonatal cardiomyocytes, and human stem cell derived cardiomyocytes.

The sinoatrial (SA) node is the primary site from which the mammalian heart is paced, but the mechanisms underlying the pacemaking still remain clouded. It is generally believed that the hyperpolarization-activated current If, encoded by hyperpolarization-activated cyclic nucleotide-gated (HCN) genes, contributes significantly to pacing, which in tandem with inward current generated by efflux of Ca2+ via the Na+-Ca2+ exchanger (NCX), resulting from the released Ca2+, mediates the diastolic depolarization. Here, we review the data that implicate If as the "pacemaker current" and conclude that there is not only a significant discrepancy between the range of diastolic depolarization potential (-60 to -40 mV) and the activation potential of If (negative to -70 mV), but that also the kinetics of If and its pharmacology are incompatible with the frequency of a heartbeat in rodents and humans. We propose that If serves as a functional insulator, which protects the SA-nodal cells against the large negative electrical sink of atrial tissue connected to it with connexins. We also evaluate the role of If and calcium signaling in mediating the diastolic depolarization in rat neonatal cardiomyocytes (rN-CM), and human induced pluripotent stem-cell derived cardiomyocytes (hiPSC-CM), and provide evidence for a possible involvement of mitochondrial Ca2+ in initiating the oscillatory events required for the spontaneous pacing.

[Conversion disorder in an internal medicine department: A series of 37 cases]. / Le trouble de conversion en médecine interne: 37 observations.

OBJECTIVES: To describe the clinical characteristics of a series of patients presenting conversion disorder in a general internal medicine ward and outpatient clinic, the arguments retained by the physicians in favour of the diagnosis, the somatic and psychiatric co-morbidities, the management and the outcome of the disorder. METHODS: We report the study of 37 patients diagnosed with conversion disorder in an internal medicine department of a French university hospital over a period of 14 years. We retrospectively reviewed the charts of the patients and contacted their primary care physicians to obtain follow-up data. No structured instrument was used for the diagnosis of conversion disorder or for the assessment of psychiatric comorbidities. RESULTS: As expected, patients were mostly young females, although a great variety of age, gender, and socio-cultural background was observed. Motor symptoms predominated (62%). A relevant psychogenic factor was explicitly mentioned in only 43% of the cases. In many cases, organic disease was also present, and an organic cause for the symptom initially considered as conversion was suspected in 3 cases. Depressive and anxious disorders were present respectively in 38% and 35% of cases. A pain complaint was associated in half of the cases. Among patients for whom follow-up data is available, conversion symptoms persisted or recurred in 70% of cases and were associated with a poor quality of life. CONCLUSION: This case series confirms that the DSM-IV-TR criterion of "psychogenicity" (later abandoned in DSM-5) is highly problematic in clinical practice. It suggests a close relationship between conversion disorder and unexplained chronic pain.

[Ecthyma gangrenosum of the eyelid after chickenpox]. / Ecthyma gangreneux de la paupière compliquant une varicelle.

BACKGROUND: Ecthyma gangrenosum is an acute ulcer necrotic skin infection frequently caused by Pseudomonas aeruginosa. It is characterised by necrotic ulcerations circumscribed by an inflammatory halo. Lesions are normally found in the anal, genital and axillary regions. Ecthyma gangrenosum is most commonly seen in immunodepressed patients (cytotoxic chemotherapy, HIV infection, neutropenia or functional neutrophil deficiency, agammaglobulinemia). It is a rarely described complication in chicken pox. PATIENTS AND METHODS: Herein we report the case of a girl aged 2 ½ years presenting in our dermatology department with ecthyma gangrenosum on the right upper eyelid secondary to varicella. The disease course was marked by fibrous scarring of the inner canthus with ptosis of the right upper eyelid. The retractile scarring caused disability. DISCUSSION: There have been previous reports of the contribution of non-steroidal anti- inflammatory drugs (NSAIDs) to the appearance of necrotic cutaneous super infections during the course of chickenpox. The occurrence of such complications on an eyelid may be harmful not only for the function of the eye but it can also cause extensive aesthetic impairment. Subsequent aesthetic and functional impairment may be improved by corrective surgery.