Dramatic Increase in Incidence of Ulcerative Colitis and Crohn's Disease (1988-2011): A Population-Based Study of French Adolescents.

OBJECTIVES: Few data are available to describe the changes in incidence of pediatric-onset inflammatory bowel disease (IBD). The aim of this study was to describe changes in incidence and phenotypic presentation of pediatric-onset IBD in northern France during a 24-year period. METHODS: Pediatric-onset IBD (<17 years) was issued from a population-based IBD study in France between 1988 and 2011. Age groups and digestive location were defined according to the Paris classification. RESULTS: 1,350 incident cases were recorded (8.3% of all IBD) including 990 Crohn's disease (CD), 326 ulcerative colitis (UC) and 34 IBD unclassified (IBDU). Median age at diagnosis was similar in CD (14.4 years (Q1=11.8-Q3=16.0)) and UC (14.0 years (11.0-16.0)) and did not change over time. There were significantly more males with CD (females/males=0.82) than UC (females/males=1.25) (P=0.0042). Median time between onset of symptoms and IBD diagnosis was consistently 3 months (1-6). Mean incidence was 4.4/105 for IBD overall (3.2 for CD, 1.1 for UC and 0.1 for IBDU). From 1988-1990 to 2009-2011, a dramatic increase in incidences of both CD and UC were observed in adolescents (10-16 years): for CD from 4.2 to 9.5/105 (+126%; P<0.001) and for UC, from 1.6 to 4.1/105 (+156%; P<0.001). No modification in age or location at diagnosis was observed in either CD or UC. CONCLUSIONS: In this population-based study, CD and UC incidences increased dramatically in adolescents across a 24-year span, suggesting that one or more strong environmental factors may predispose this population to IBD.

Spatiotemporal gait parameters during dual task walking in need of care elderly and young adults. A cross-sectional study.

BACKGROUND: Up to now there have only been marginal data in the elderly in need of care regarding spatiotemporal gait parameters during single (ST) and dual tasking (DT). AIM: The aim of this study was to allocate data for gait speed, cadence and stride length cycle variability in the elderly in need of care and in young adults during ST and DT, to compare the two groups and to demonstrate the impact of ST and DT on gait parameters. MATERIAL AND METHODS: This cross-sectional study investigated a group of 16 young healthy adults (mean age 23.0 ± 2.5 years) and a group of 16 elderly persons in need of care (mean age 85.5 ± 0.6 years). The RehaWatch system was used to collect the spatiotemporal gait parameters cadence, speed and stride length. The participants completed four different measurements during normal walking and fast walking during ST and DT over a walking distance of 20 m. The Wilcoxon rank sum test and Whitney-U test were used for statistical analysis. RESULTS: Gait speed (ST and DT: p < 0.001), cadence (ST and DT: p < 0.001) and gait variability (ST: p = 0.007, DT: p = 0.003) were significantly reduced in the elderly in need of care group compared to the young group. The gait speed in the elderly in need of care group decreased from normal to fast walking (ST = - 2.8%, DT = - 12.2%) compared to the young group (ST = 31.5%, DT = 25.2%). CONCLUSION: The results of this study are comparable with the results of existing studies, which investigated falling and non-falling participants. Elderly people in need of care cannot increase the normal gait speed.

[Uncommon manifestation revealing sarcoidosis]. / Un mode de révélation inhabituel de la sarcoïdose.

INTRODUCTION: Bilateral hilar lymphadenopathy, with or without lung parenchymal infiltrates, is the most common radiographic finding in patients with sarcoidosis. Atypical pulmonary findings have been uncommonly reported and include multiple large lung nodules, cavitation, lobar collapse, pleural effusions or pneumothorax. OBSERVATION: We report a 21-year-old non caucasian patient who presented with pulmonary nodular infiltration and sinonasal involvement revealing sarcoidosis. Thoracic and sinus computed tomographic scan showed both multiple excavated large lung nodules and micronodules, hilar lymphadenopathy and sinus thickening. Laboratory studies disclosed elevated angiotensin converting enzyme serum level (120UI/L). Outcome was favorable after institution of corticosteroids (at an initial dose of prednisone of 1mg/kg/day); at eight-month-follow-up, the patient was asymptomatic, while receiving prednisone 22.5mg/day. CONCLUSION: In patients exhibiting unusual pulmonary manifestations, diagnosis of sarcoidosis relies on compatible clinical signs, evidence of non-caseating granulomas, and exclusion of underlying conditions including infections, malignancy and other granulomatous diseases (Wegener disease, pneumoconiosis).

[A double-faced myocarditis: Whipple's disease or sarcoidosis?]. / Une myocardite à deux visages : maladie de Whipple ou sarcoïdose?

INTRODUCTION: Whipple's disease is a systemic infection that may mimic sarcoidosis in its initial presentation. The heart involvement is not uncommon and consists generally in an endocarditis. Myocarditis is less common and is usually accompanied by impairment of heart conduction. CASE REPORT: We report a 56-year-old man with Whipple's disease associated with a myocarditis, initially diagnosed as having a sarcoidosis with cardiac injury. The contribution of the histology and molecular biology on intestinal sampling made it possible to rectify the diagnosis. CONCLUSION: The diagnosis of Whipple's disease should be considered in the presence of a systemic granulomatosis with or without heart involvement. Early diagnosis is important because of effectiveness of antibiotic therapy.

[Mesenteric artery involvement in giant cell arteritis: two cases and literature review]. / Artérite inflammatoire mésentérique au cours de la maladie de Horton : à propos de deux observations et revue de la littérature.

INTRODUCTION: Mesenteric involvement has been rarely reported in giant cell arteritis (GCA). Our literature search using the Medline database (1966-2008), reviewing all articles in English and French languages identified only 31 cases of mesenteric ischemia related to GCA. We report two additional cases. CASE REPORTS: We report two men with GCA. At diagnosis of GCA-associated mesenteric involvement, patients exhibited: fever/fatigue (n=2), abdominal complaints (n=1), clinical signs of GCA (n=1). In both patients, abdominal CT-scan showed circumferential halo around the superior mesenteric artery. At systematic follow-up, CT-scan revealed improvement of mesenteric damage in both patients. CONCLUSION: Our study indicates that CT-scan is a useful technique in diagnosis of GCA-associated mesenteric involvement. Furthermore, we suggest that CT-scan may also be helpful in both the monitoring and the medical management of GCA-related mesenteric artery involvement.

[Cutaneous leishmaniasis in polymyositis]. / Leishmaniose cutanée au cours d'une polymyosite.

INTRODUCTION: The prevalence of cutaneous leishmaniasis is increasing, especially in immunocompromized subjects. CASE RECORD: We report a case of particular interest, where a patient with steroid refractory polymyositis developed cutaneous leishmaniasis. Clinical outcome was favorable after institution of intralesional antimony therapy. DISCUSSION: Cutaneous leishmaniasis is still recognized to be an opportunistic infection. Its frequency is indeed higher in immunocompromized subjects, mainly HIV-infected patients. In our patient, both polymyositis and steroid therapy were predisposing factors of cutaneous leishmaniasis onset; prednisone therapy has been postulated to be associated with immune dysfunction leading to: reduced blood T cells' levels (CD4 et CD8) as well as decreased cytokine synthesis (e.g. interferon gamma).

Polypeptide synthesis during protoplasmic incompatibility in the fungus Podospora anserina.

In Podospora anserina, self-lysis resulting from the combination of the R and V incompatibility genes is accompanied by the appearance, in lysing cells, of specific enzyme activities, among which is a laccase exoenzyme, and by a quenching of ribonucleic acid synthesis. Present results show that the occurrence of the laccase is the result of de novo synthesis. By means of two-dimensional gel electrophoresis it was shown that the onset of self-lysis is accompanied by the immediate shut-off of more than 60% of the pre-existing normal polypeptide synthesis and the occurrence of at least 20 new polypeptides. The synthesis of these new polypeptides is active for several hours after the cessation of RNA synthesis, concurrently with the synthesis of about 30 normal polypeptides which is maintained. These modifications of protein synthesis are not accompanied by a concomitant variation in the level of polysomes. It is deduced that incompatibility genes are involved in the control of both transcription and translation.

Protoplasmic Incompatibility in PODOSPORA ANSERINA: a Possible Function for Incompatibility Genes.

The suppression of protoplasmic incompatibility resulting from nonallelic gene interactions has been obtained by the coupled effect of mutations in the modA and modB genes (Bernet 1971). Due to their female sterility, modA modB strains provide an experimental tool to determine whether or not the mod and incompatibility loci are involved in a function other than protoplasmic incompatibility. Present results show that modA modB female sterility is a nonautonomous trait since heterokaryotic mycelia that include a modA modB nucleus and a female fertile nucleus (wild-type, modA or modB) produce modA modB protoperithecia, which are also formed by culture on medium supplemented with specific amino acids. Using modA modB strains, which are sterile at 32 degrees and fertile at 26 degrees , we have shown that the mod genes have no specific sequential timing. Indeed, the mod mutations may prevent the achievement of the female sexual cycle at any developmental stage from before early differentiation of protoperithecia until ascospore maturation. Employing different modA and modB mutations, we have shown that protoperithecia in modA modB cultures are generally distributed in female fertile rings; this result indicates that protoperithecia occur only in mycelial areas that have a restricted range of age at the time that modA modB thalli complete growth. Furthermore, nonsense mutations of incompatibility genes suppress the modA modB female fertile rings or restrict their width, suggesting that incompatibility loci, like the mod loci, are involved in protoperithecium formation. Taken together, these results lead to the postulate that mod and incompatibility genes do not determine, sensu stricto, protoperithecial function, as previously supposed (Boucherie and Bernet 1974), but may be involved in the homeostatic control of stationary cell functions essential for the complete development of the female sexual cycle.

Protoplasmic Incompatibility in PODOSPORA ANSERINA: A Possible Role for Its Associated Proteolytic Activity.

A mutation (modD) was selected in a gene involved in the control of protoplasmic incompatibility. Previous results (Labarere and Bernet 1979) showed that modD decreased the density of protoperithecia and caused a defect in ascospore germination. In addition, modD has a third defect: when modD stationary cells were isolated in order to obtain further development, renewal of growth rarely ensued. Instead, the modD cells lysed or produced microthalli from which normal growth never occurred. These defects were suppressed by beta-phenyl pyruvic acid, a protease inhibitor, and by the presence of a mutation (modC) that suppresses the proteases associated with protoplasmic incompatibility. The stationary wild-type cells' regeneration was inhibited by beta-phenyl pyruvic acid at levels that maintained modD cells' regeneration. These results suggest a biological role for the proteases associated with protoplasmic incompatibility.

Protoplasmic Incompatibility and Cell Lysis in PODOSPORA ANSERINA. I. Genetic Investigations on Mutations of a Novel Modifier Gene That Suppresses Cell Destruction.

In Podospora anserina, protoplasmic incompatibility (a phenomenon that prevents heterokaryon formation because of the destruction of the fused cells) can be studied in homokaryotic strains that combine nonallelic incompatibility genes or carry mutations at the lys loci. In these strains cell destruction occurs early in development and is associated with an arrest of growth.-From the self-lysing strains lysA(1) and RV (R and V are nonallelic incompatibility genes) mutations have been selected that suppress the self-lysing trait, i.e., that prevent cell destruction and remove growth inhibition. Some of them were derived from a novel modifier locus, modC, located near the mating-type locus.-In C/D and C/E incompatibility systems, modC mutations, which per se have no obvious effect, were considered in addition to mutations in the previously identified modifier loci, modA and modB. The demonstration of a functional interdependence among the three mod genes suggested that modC is not the structural gene for the protease associated with cell lysis, but is involved, like modA and modB, in its control.-All three modC mutant strains investigated exhibit defects in the formation of protoperithecia, suggesting that the modC gene function is essential to the occurrence or development of the female organs. This is the third argument that supports the hypothesis ( Boucherie, Bégueret and Bernet 1976) that protoplasmic incompatibility and female organ formation might be related phenomena.

Temporal Action of Mutations Inhibiting the Accomplishment of Quiescence or Disrupting Development in the Fungus PODOSPORA ANSERINA.

Two Podospora mutants carrying mutations modE and modF were persumed to be quiescent defective, because, when grown under glucose limitation, they differed from the wild-type strain in an excess of dry weight production and a reduction of cell survival. New insight on the action of modE and modF mutations was provided by the study of double mutants resulting from the association of modE or modF mutations with unrelated developmental mutations.-ModE and modF were first coupled to three allelic mutations ( modC) that inhibit production of all hyphal cell derivatives (late ramifications, aerial hyphae and protoperithecia). Suppression in the double mutants of the excess of proliferation associated with modE and modF and restoration of normal cell survival indicated that modE and modF result in an uncontrolled production of hyphal cell derivatives in which deregulation is presumed to be responsible for the reduction of cell survival following glucose exhaustion.-ModE and modF were associated with mutations of two genes (modD and modG) which abolish production of hyphal cell derivatives (like modC mutations) but also inhibit the renewal of growth of cells situated in the center of colonies. Investigations of eight of these double mutants showed that modE and modF mutations suppress the inhibitory action of modD and modG on production of hyphal cell derivatives and on growth renewal.-Taken together these results lead to the suggestion that the accomplishment of a quiescent state for cell survival under glucose starvation is the final stage in the differentiation of hyphal cells and prerequisite for the production of derivatives of hyphal cells and for a control of their development.

Dental hygienists' knowledge, opinions, and use of pit and fissure sealants: a comparison of two states.

This article reports results of a study of 563 practicing Minnesota and Wisconsin dental hygienists' knowledge, opinions, and use of pit and fissure sealants. The study was carried out six months prior to the 1983 NIH Consensus Development Conference on Dental Sealants in the Prevention of Tooth Decay. It therefore provides baseline information for two states prior to the initiation of widespread public information about the positive value of sealants that occurred as a result of that conference. Such baseline information is relevant for future studies of the diffusion of adoption of this caries-preventive technology by dental hygienists. Two independent samples were selected randomly from the populations of licensed dental hygienists residing in the two states. Data were collected using a 42-item mailed questionnaire, with an 84 percent response. Data were analyzed for both interstate and intrastate comparisons. Respondents were generally knowledgeable and had favorable opinions about sealants, although they had low levels of training in their use. Sealants were being used in 54 percent of the offices in which respondents practiced, with the dentist placing them most often. Among hygienists who applied sealants at all, more than two-thirds did so three or fewer times per week. Eighty-four percent indicated they would like to apply sealants more often. The most frequent reasons given for nonuse were lack of acceptance by the dentist-employer and nondelegation.

Dental hygienists' knowledge and opinions about fluorides and fluoridation.

This article reports results of a study of 563 practicing Minnesota and Wisconsin dental hygienists' knowledge and opinions about fluorides and water fluoridation. Two independent samples were selected randomly from the populations of licensed dental hygienists residing in the two states. Data were collected using a pretested, 42-item, mailed questionnaire. An 84 percent response was achieved with two followup reminders. These data provide baseline information about the caries prevention knowledge and attitudes of practicing dental hygienists in two states. Respondents from both states held similar levels of knowledge about fluorides and opinions about decision making on fluoridation. Fluoride topics, especially water fluoridation, were not receiving high priority in patient education, although nearly all believed that dental hygienists should promote water fluoridation actively. Two-thirds of respondents from both states believed fluoridation decisions should be made by health authorities, rather than by elected officials or through public vote. Greater attention to patient education about fluoride and community water fluoridation is needed by dental hygienists.

[Optochiasmatic tuberculoma and MRI. 2 cases]. / Tuberculomes opto-chiasmatiques et IRM. Deux observations.

Two cases are reported of optochiasmatic tuberculoma, an exceptional complication difficult to diagnose in the absence of any tuberculous context. Although diagnosis of the optochiasmatic occupying process is simple by scan or NMR imaging, it is generally difficult to identify the chiasma in a process of this type. It is therefore impossible to recognize the two forms of these tuberculomas: intra- and peri-chiasmatic histologic types, and yet these have an incidence on therapy and prognosis. Surgical exploration is justified when the diagnosis remains in doubt or when the functional prognosis is implicated.