Different peripheral expression patterns of the nicotinic acetylcholine receptor in dementia with Lewy bodies and Alzheimer's disease.

BACKGROUND: The diffuse distribution of nicotinic cholinergic receptors (nAChRs) in both brain and peripheral immune cells points out their involvement in several pathological conditions. Indeed, the deregulated function of the nAChR was previously correlated with cognitive decline and neuropsychiatric symptoms in Alzheimer's disease (AD) and Dementia with Lewy bodies (DLB). The evaluation in peripheral immune cells of nAChR subtypes, which could reflect their expression in brain regions, is a prominent investigation area. OBJECTIVES: This study aims to evaluate the expression levels of both the nAChR subunits and the main known inflammatory cytokines in peripheral blood mononuclear cells (PBMCs) of patients with DLB and AD to better characterize their involvement in these two diseases. RESULTS: Higher gene expression levels of TNFα, IL6 and IL1ß were observed in DLB and AD patients in comparison with healthy controls (HC). In our cohort, a reduction of nAChRα4, nAChRß2 and nAChRß4 was detected in both DLB and AD with respect to HC. Considering nAChR gene expressions in DLB and AD, significant differences were observed for nAChRα3, nAChRα4, nAChRß2 and nAChRß4 between the two groups. Moreover, the acetylcholine esterase (AChE) gene expression was significantly higher in DLB than in AD. Correlation analysis points out the relation between different nAChR subtype expressions in DLB (nAChRß2 vs nAChRα3; nAChRα4 vs nAChRα3) and AD (nAChRα4 vs nAChRα3; nAChRα4 vs nAChRß4; nAChRα7 vs nAChRα3; nAChRα7 vs nAChRα4). CONCLUSIONS: Different gene expressions of both pro-inflammatory cytokines and nAChR subtypes may represent a peripheral link between inflammation and neurodegeneration. Inflammatory cytokines and different nAChRs should be valid and accurate peripheral markers for the clinical diagnosis of DLB and AD. However, although nAChRs show a great biological role in the regulation of inflammation, no significant correlation was detected between nAChR subtypes and the examined cytokines in our cohort of patients.

Psychological and professional impact of COVID-19 lockdown on French dermatologists: Data from a large survey.

AIM: To evaluate the extent to which COVID-19-related lockdown affected dermatologists. METHODS: An anonymous online survey was proposed to all French dermatologists and dermatology residents to assess the impact of COVID-19 lockdown on their professional activity, their level of stress and their psychological state, as well as their coping strategies. RESULTS: Exactly 800 dermatologists completed the survey. The respondents noted changes in behaviour in their professional and personal environment. The number of cancelled or rescheduled appointments was very high, with a huge financial impact for private practitioners. Stigmatisation was also reported. Anxiety and a feeling of increased stress were very frequent. Increased substance use was also reported. CONCLUSION: The impact of the COVID-19 pandemic and lockdown was significant for French dermatologists, with risks to their own health, profound changes in their practice, and financial and psychological impact, but also the development of new consultation and evaluation strategies to improve their work-life balance.

On the performance of a pilot hybrid constructed wetland for stormwater recovery in Mediterranean climate.

The overall efficiency of a pilot-scale hybrid constructed wetland (H-CW), located on a retail store's parking area in Eastern Sicily, for alternative treatment of stormwater runoff and of sequential batch reactor (SBR) effluent was evaluated. Experimental activities were focused on system performances, including wastewater (WW) quality and hydraulic monitoring. System design, macrophyte growth and seasonal factors influenced the pilot plant performance. Very high removal efficiency for microbial indicators were reported within the subsurface horizontal flow unit (HF), playing a strategic role for Clostridium perfringens. The algal growth occurred in the free water surface (FWS) unit and inhibited removal efficiencies of total suspended solids (TSS), biochemical oxygen demand (BOD5) and chemical oxygen demand (COD), impairing water quality. The whole H-CW showed good efficiency in trace metals removal, especially for Pb, Zn, and Cu. Preliminary results suggested the reliability of the H-CW technology in decentralised water treatment facilities for enhancing water recovery and reuse.

Assessing environmental impacts of constructed wetland effluents for vegetable crop irrigation.

The objective of this study was to monitor and assess environmental impacts of reclaimed wastewater (RW), used for irrigation of vegetable crops, on soil, crop quality and irrigation equipment. During 2013, effluents of a horizontal sub-surface flow constructed treatment wetland (TW) system, used for tertiary treatment of sanitary wastewater from a small rural municipality located in Eastern Sicily (Italy), were reused by micro-irrigation techniques to irrigate vegetable crops. Monitoring programs, based on in situ and laboratory analyses were performed for assessing possible adverse effects on water-soil-plant systems caused by reclaimed wastewater reuse. In particular, experimental results evidenced that Escherichia coli content found in RW would not present a risk for rotavirus infection following WHO (2006) standards. Irrigated soil was characterized by a certain persistence of microbial contamination and among the studied vegetable crops, lettuce responds better, than zucchini and eggplants, to the irrigation with low quality water, evidencing a bettering of nutraceutical properties and production parameters.

Excess non-psychiatric hospitalizations among employees with mental disorders: a 10-year prospective study of the GAZEL cohort.

OBJECTIVE: To examine whether non-psychiatric hospitalizations rates were higher in those with mental disorders. METHOD: In a cohort of 15,811 employees, aged 35-50 years in 1989, mental disorder status was defined from 1989 to 2000. Hospitalizations for all-causes, myocardial infarction (MI), stroke, and cancer, were recorded yearly from 2001 to 2011. Negative binomial regression models were used to estimate hospitalization rates over the follow-up. RESULTS: After controlling for baseline sociodemographic factors, health-related behaviors, self-rated health, and self-reported medical conditions, participants with a mental disorder had significantly higher rates of all-cause hospitalization [incidence rate ratio, IRR=1.20 (95%, 1.14-1.26)], as well as hospitalization due to MI [IRR=1.44 (95%, 1.12-1.85)]. For stroke, the IRR did not reach statistical significance [IRR=1.37 (95%, 0.95-1.99)] and there was no association with cancer [IRR=1.01 (95%, 0.86-1.19)]. A similar trend was observed when mental disorders groups were considered (no mental disorder, depressive disorder, mental disorders due to psychoactive substance use, other mental disorders, mixed mental disorders, and severe mental disorder). CONCLUSION: In this prospective cohort of employees with stable employment as well as universal access to healthcare, we found participants with mental disorders to have higher rates of non-psychiatric hospitalizations.

Analysis of small-scale soil CO2 fluxes in an orange orchard under irrigation and soil conservative practices.

The quantification of soil carbon dioxide (CO2) flux represents an indicator of the agro-ecosystems sustainability. However, the monitoring of these fluxes is quite challenging due to their high spatially-temporally variability and dependence on environmental variables and soil management practices.In this study, soil CO2 fluxes were measured using a low-cost accumulation chamber, that was realized ad hoc for the surveys, in an orange orchard managed under different soil management (SM, bare versus mulched soils) and water regime (WR, full irrigation versus regulated deficit irrigation) strategies. In particular, the soil CO2 flux measurements were acquired in discontinuous and continuous modes, together with ancillary agrometeorological and soil-related information, and then compared to the agrosystem scale CO2 fluxes measured by the eddy covariance (EC) technique.Overall significant differences were obtained for the soil CO2 discontinuous fluxes as function of the WR (0.16 ± 0.01 and 0.14 ± 0.01 mg m-2 s-1 under full irrigation and regulated deficit irrigation, respectively). For the continuous soil CO2 measurements, the response observed for the SM factor varied from year to year, indicating for the overall reference period 2022-23 higher soil CO2 flux under the mulched soils (0.24 ± 0.01 mg m-2 s-1) than under bare soil conditions (0.15 ± 0.00 mg m-2 s-1). Inter-annual variations were also observed as function of the day-of-year (DOY), the SM and their interactions, resulting in higher soil CO2 flux under the mulched soils (0.24 ± 0.02 mg m-2 s-1) than under bare soil (0.15 ± 0.01 mg m-2 s-1) in certain periods of the years, according to the environmental conditions. Results: suggest the importance of integrating soil CO2 flux measurements with ancillary variables that explain the variability of the agrosystem and the need to conduct the measurements using different operational modalities, also providing for night-time monitoring of CO2. In addition, the study underlines that the small-scale chamber measurements can be used to estimate soil CO2 fluxes at orchard scale if fluxes are properly scaled.

Progesterone and its derivatives for the treatment of catamenial epilepsy: A systematic review.

OBJECTIVE: Catamenial epilepsy (CE) is defined as an increase in seizure frequency during specific phases of the menstrual cycle in women with epilepsy. The treatment usually includes a combination of non-hormonal and hormonal therapies. This systematic review summarizes the available data on the efficacy of progesterone and its derivates to treat CE. METHODS: We performed a systematic search of the literature to identify studies reporting data on the use of progesterone and its derivatives (any type and dose) for the treatment of CE. The main outcome included the efficacy of progesterone and its derivatives on seizure frequency. RESULTS: Nineteen articles (457 patients) were included; four were randomized controlled trials (two comparing progesterone vs placebo and two comparing norethisterone vs placebo). Progesterone was generally administered during the luteal phase (from day 15 to 25) or during perimenstrual exacerbations (from day 23 to 25), with an average dose of 10-30 mg/day to a maximum of 300 mg/day. The therapy, usually well tolerated, was ineffective in the randomized controlled trials; conversely, it was associated with an overall reduction in seizure frequency in case reports and uncontrolled studies. CONCLUSIONS: Although data from uncontrolled studies suggest that hormone therapy with progesterone may be useful in the treatment of CE, its efficacy has not been demonstrated in controlled trials. The possible antiseizure effect of progesterone could be mediated by its active metabolite allopregnanolone, making the plasmatic measurement of these hormones mandatory to evaluate efficacy. Further randomized controlled trials should investigate the efficacy of progesterone and its derivatives, addressing these pharmacological issues.

Presymptomatic genetic testing in minors at risk of paraganglioma and pheochromocytoma: our experience of oncogenetic multidisciplinary consultation.

The aim of the work was to define quality criteria for presymptomatic genetic testing in minors at risk of paraganglioma/pheochromocytoma. A 3-step multidisciplinary procedure was developed: 1) preparatory consultations for parents, providing decision support and advice concerning the way of informing the children; 2) consultation with the minor and blood sampling; and 3) announcement of the result of the genetic test to the minor and his/her parents. Twenty-three minors (mean age=9.22) were tested. The result was positive in 16 cases (presence of the familial mutation) and negative in 7. The 23 procedures were classified according to emotional reactions at the announcement of the result: calm (18/23) or tense (5/23). In parallel, 4 criteria for a good testing procedure was defined: 1) both parents agreeing to have their child tested when they felt ready; 2) parents being given advice concerning the way to inform their child; 3) the most appropriate time for testing being discussed for each child; and 4) avoidance of testing during medical examination periods for the carrier parent. The frequencies of the above criteria were as follows: 1 (17/23); 2 (19/23); 3 (17/23); and 4 (17/23). The overall quality of the testing procedure, calculated as the sum of the four criteria, differed significantly between calm and tense announcements (p<0.01). This study highlights the important role of careful preparation with the parents in emotional acceptance of the result of testing. The 4 criteria identified should be evaluated in further prospective studies.

[Reflections about non compliance]. / Réflexions sur la non-observance.

Throughout the follow up of a patient suffering from a chronic cutaneous disease, non compliance is rarely avoidable. It is provoked by numerous factors, which have to be looked for in the patient and the doctor, as well, and in the external reality, as in the internal, psychic, reality, both of the patient and the doctor. Being aware of these factors is fundamental for resolving the non compliance conflict. Thus, non compliance can become a chance to seize for avoiding patients' wandering and building a more dynamic, authentic and stronger doctor-patient relationship.

[Isotretinoin and adolescent depression]. / Isotrétinoïne et dépression à l'adolescence.

BACKGROUND: Isotretinoin, indicated in France in the treatment of severe acne (e.g. nodular acne, acne conglobata or acne likely to result in permanent scarring) resistant to adequate cure by standard systemic antibiotic therapy and topical treatments, has on occasion been suspected of being associated with suicide. A study involving collective reflection on this issue is presented herein. METHODS: The Psychodermatology Group of the French Dermatology Society, made up of dermatologists, psychiatrists, paediatric psychiatrists, psychoanalysts and clinical psychologists, met several times and views were exchanged by e-mail. The first two authors drafted the present article, which was then re-read, modified and approved by the members of the Psychodermatology Group, in particular by the co-authors. The article was then modified at the request of the proofreaders of the Annales de Dermatologie and re-read once more by members of the Psychodermatology Group. RESULTS: Psychological disturbances, including depression and other suicidal tendencies, are extremely common during adolescence and are clearly increased by acne, particularly where it is severe. Isotretinoin does not appear to increase this risk. CONCLUSION: Routine screening should be performed for psychological disturbance in adolescents, particularly among those presenting acne. Prescription of isotretinoin is not contraindicated in subjects presenting depression.

Cognitive hostility and suicide.

OBJECTIVE: To determine whether a specific component of hostility (i.e. cognitive or behavioural) may predict suicide in a prospective design, controlling for depressive mood. METHOD: In 1993, 14,752 members of the 'GAZ et ELectricité' (GAZEL) cohort (10,819 men, mean age=49.0 years; 3933 women, mean age=46.2 years) completed the Center for Epidemiologic Studies Depression Scale and at least one subscale (i.e. cognitive or behavioural hostility) of the Buss and Durkee Hostility Inventory. Dates and causes of death were obtained annually. RESULTS: During a mean follow-up of 15.7 years, 28 participants completed suicide (24 men, four women). Suicide was predicted by depressive mood [relative index of inequality (RII) (95% CI)=8.16 (1.97-33.85)] and cognitive hostility [RII (95% CI)=10.76 (2.50-46.42)], but not behavioural hostility [RII (95% CI)=1.37 (0.38-4.97)]. These associations remained significant after adjustment for potential confounders. After mutual adjustment, however, suicide remained significantly associated with cognitive hostility [RII (95% CI)=8.87 (1.52-51.71)] (RII reduction: 34.6%), but no longer with depressive mood [RII (95% CI)=2.03 (0.41-10.07)] (RII reduction: 79.1%). CONCLUSION: Cognitive rather than behavioural hostility is associated with an increased risk of suicide, independently of baseline depressive mood.

Characterization of the main land processes occurring in Europe (2000-2018) through a MODIS NDVI seasonal parameter-based procedure.

The identification and recognition of the land processes are of vital importance for a proper management of the ecosystem functions and services. However, on-ground land uses/land covers (LULC) characterization is a time-consuming task, often limited to small land areas, which can be solved using remote sensing technologies. The objective of this work is to investigate how the different MODIS NDVI seasonal parameters responded to the main land processes observed in Europe in the 2000-2018 period; characterizing their temporal trend; and evaluating which one reflected better each specific land process. NDVI time-series were evaluated using TIMESAT software, which extracted eight seasonality parameters: amplitude, base value, length of season, maximum value, left and right derivative values and small and large integrated values. These parameters were correlated with the LULC changes derived from COoRdination of INformation on the Environment Land Cover (CLC) for assessing which parameter better characterized each land process. The temporal evolution of the maximum seasonal NDVI was the parameter that better characterized the occurrence of most of the land processes evaluated (afforestation, agriculturalization, degradation, land abandonment, land restoration, urbanization; R2 from 0.67-0.97). Large integrated value also presented significant relationships but they were restricted to two of the three evaluated periods. On the contrary, land processes involving CLC categories with similar NDVI patterns were not well captured with the proposed methodology. These results evidenced that this methodology could be combined with other classification methods for improving LULC identification accuracy or for identifying LULC processes in locations where no LULC maps are available. Such information can be used by policy-makers to draw LULC management actions associated with sustainable development goals. This is especially relevant for areas where food security is at stake and where terrestrial ecosystems are threatened by severe biodiversity loss.

[Addiction and brief-systemic therapy: working with compulsion]. / Addictions et thérapie systémique brève : un travail sous contrainte.

In our daily practice in public hospitals, we are regularly confronted with the paradox of helping patients, who do not ask for help. Although the French law is clearly defined to allow us to treat patients suffering from psychiatric conditions, who are unable to give their consent, it is not the case for those with addictive disorders. In fact, their disorder does not always (or does not yet) justify treatment without their consent, according to the 1990 law (psychiatric treatment without the patient's consent). However, many of them are referred to us because a third party has forced them (spouse, general practitioner, treatment order) and even though some patients consult spontaneously, they often do so more "for others" than for themselves. Because of this, the therapist (doctor, psychologist or nurse), in addition to the paradox of treating patients who do not ask for treatment, find themselves in a situation with two-fold compulsion, fixed by the social (or family) setting, both as a helper and as a coercive agent, thus, putting the fundamental concepts of treatment into question. A therapeutic agreement, free-will and motivation are in jeopardy when the pressure is strong, which removes the therapist from his mission of treating. Although we would not question the necessity for psychiatric treatment in patients who do not ask for it (addictions are a major public-health problem), we should not forget that motivation is one of the essential elements for making any changes in behavior. Although compulsion (external or internal) is recognized by everyone as a limiting factor, we would like to show here how much it can be a lever for change, as long as this compulsion is identified right from the first meeting with the patient, who consults in an addiction centre. Brief systemic therapy may be of interest for these patients, since it reinforces the motivating approach, which is recommended today and since the compulsive nature of the request for treatment is not an obstacle for such treatment to be started. We try to outline here how the therapist can get out of this two-fold compulsion and help the patient to become the instigator of this change, often imposed on him. Two elements are fundamental to understand the function of brief systemic therapy. First of all, "systemic" means "interaction". A systemic approach to treatment requires working in clinical situations, particular attention being paid to interactions. Second, brief therapy does not mean short therapy, but rather therapy with an objective in view. The objective is determined by the patient together with the therapist and they work out together how to reach it, with or without the family's help. Because of this, we use a five-point assessment to offer a concrete response to the patients in these psychotherapeutic consultations. Firstly, is the patient the one who has asked for treatment? We know that in addictive behavior, it is not always the one with symptoms who asks for help (many couples consult who are persuaded that the other one needs to change). Once we know who has asked for treatment, we clarify (with the patient's help) that his/her objectives are not the same as someone who asks for treatment and we can then redefine them (first step in the therapeutic agreement). Once the request for treatment is clarified, we can clearly define what the problem is, the objectives that the patient fixes for him/herself and how to reach them. A large proportion of therapeutic failures result from the request for treatment being unclear. In this way, we define the problem in concrete terms, without using classifications and the previous attempts to solve it (third point). In fact, we often find that the problem itself is the solution, which is chosen to try to resolve it. Knowing which solutions have been tried (and failed) allows the patient to realize what is effective and what is not. The role of the therapist is to help the family and the patient to find other types of solution to their problem. The therapist only offers concrete tasks, which can be done in the near future (minimal changes). Finally, the therapist takes into account the patient's beliefs, values and personal priorities, to which they are attached and which have determined up to now, how they react to the problem. To work with a patient suffering from addiction, it is important, first of all, to find the elements of compulsion, which are hiding behind each request for treatment. This is because, if the patient does not follow the initial therapeutic objectives, there is always the underlying complaint, which should motivate the patient to improve the situation. An individual patient only has a few possibilities for adapting to this type of situation (agreeing, refusal or negotiation) and the role of the therapist is first of all to help him to realize this. This helps to avoid resistance developing, by underlying the compulsive aspect, which originates from the family's request for treatment. We offer a way for setting up the first meeting: working on the role of the patient in the treatment. Three types of patients consult: patients who are "not concerned" (sent by a third party; their main problem is with the person who asked for them to be treated), "victims" (they complain and consult because they put the responsibility of their problem on someone else) and "clients" (they consult because they consider that their problem depends on themselves and they want help to solve it actively). In fact, changing is not easy and does not happen without making an effort. Change comes from a complex cycle of interactions, for which it is often impossible to find a single origin for the situation in question. The psychological world tends towards homeostasis, just like all human systems, and so, suggesting making changes can only be experienced as an intrusion. Pathology begins when an individual can no longer choose what he/she needs to do. We do not consider that a brief-concrete approach is better than any other approach, but its pragmatic nature seems to fit in with the new conception of addiction therapy, with earlier intervention. However, is it possible to make changes outside of a crisis situation? We are unable to answer this question, except to say that the best time for change is that chosen by the patient.

[Psychosocial distress and communication about cancer in ill partners and their spouses]. / Détresse psychosociale et communication à propos du cancer chez le partenaire malade et son conjoint.

INTRODUCTION: Each cancer can have a psychological impact not only on the patient himself/herself, but also on his/her spouse. OBJECTIVE: Our study concerned 30 couples encompassing a member treated for a cancer, non related to gender. It was aimed at determining the links between the levels of psychosocial distress measured in both members of each couple, patients' sociodemographic and clinical characteristics, as well as communication skills about cancer in both members of the couples. METHODS: Psychosocial distress and communication about cancer were measured by the general health questionnaire (GHQ-28) and the openness to discuss cancer in the nuclear family (ODCF), with an additional version adapted for the spouse on the occasion of this study. RESULTS: A positive correlation was found between the respective scores of the two members of the couples, for the GHQ-28 (r=0.53; p=0.005) as well as for the ODCF (r=0.44; p=0.024). GHQ-28 scores were not associated with the sociodemographic characteristics of the patients, nor with the stage of cancer, the number of months elapsed since the diagnosis of cancer, or the ODCF personal or spouse's score. On the other hand, when the communication within each couple was classified into concordant (insufficient or, on the contrary, open for both members) or discordant (insufficient for one of the two members and open for the other), and after controlling for gender, higher levels of psychosocial distress were found in patients (p=0.038) as well in spouses (p=0.052) belonging to discordant compared with concordant couples. CONCLUSION: These results suggest an effect of contamination or a mutual reinforcement of the distress of each member of such couples, as well as the presence of relatively similar styles of communication in the two partners of each couple. They also underline the possible adaptive function of a restricted style of communication about cancer, if such a restriction is shared by both the members of the couple, and incites particular attention to be paid to couples where one of the partners, but not the other, adopt an open style of communication about cancer.

Directed forgetting in depression.

Subjects with depression exhibit deficits in prefrontal function. We posited that as a result, in a supraspan memory test, they would be impaired in their ability to inhibit recall of irrelevant words, and because of consequent overload of working and episodic memory capacity, would be impaired in their ability to recall relevant words. We tested this hypothesis in 30 inpatients and outpatients with a diagnosis of major depressive disorder and 30 controls subjects using a form of the Directed Forgetting Paradigm using exclusively neutral words. The depressed subjects did exhibit deficits in prefrontal function. All subjects were given four lists of 24 items each, in which half the words were followed by the instruction and half by the instruction Our hypothesis found support in a significant group by item type interaction effect exhibited when subjects were instructed to recall only those items followed by the instruction: depressed subjects recalled relatively more words to be forgotten and relatively fewer words to be remembered. A control experiment suggested that these results could not be accounted for by a differential effect of depression on memory encoding.

[Influence of the communication about one parent's cancer on children's suffering]. / Influence de la communication à propos du cancer d'un parent sur la souffrance des enfants.

INTRODUCTION: Factors contributing to children's distress when a parent is affected with a cancer are still insufficiently known. This study aimed at searching for associations between psychosocial distress in children living with a parent suffering from cancer, the severity of parental cancer, the levels of psychosocial distress in both parents and the openness to discuss cancer in the family. METHODS: Thirty families encompassing a parent treated for cancer and 54 children aged four to 16 were examined. Each parent's psychosocial distress was assessed by the General Health Questionnaire (GHQ-28) and the distress of the children living within the family by the Child Behavior Check List (CBCL) filled out by both parents. Each parent's communication ability about cancer was assessed by the Openness to Discuss Cancer in the nuclear Family questionnaire (ODCF). RESULTS: No association was found between children's distress and objective cancer characteristics. Higher externalized disorders scores at CBCL (aggression) were found when the ill parent was the mother (P=0.018). After controlling for cancer parent's gender, CBCL total score and internalized disorders (anxiety, depression) score were higher in families characterized by an "open" style of communication, defined on the parental couple as a whole (respectively p=0.007 and 0.024), such an effect being present only when the ill parent was the mother (interaction effect: p<0.001). CONCLUSION: These results underline the importance of family characteristics for understanding the suffering observed in children living with a parent affected with a cancer in comparison with objective cancer characteristics.