Infective anoproctitis in men having sex with men: Don't forget Mycoplasma genitalium.

OBJECTIVES: The aim was to describe the clinical characteristics of symptomatic anoproctitis and the occurrence of Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Mycoplasma genitalium (MG) infections in a prospective cohort of MSM patients. METHODS: From February 2018 to January 2020, all consecutive patients presenting at the Leopold Bellan Proctology Institute of Saint-Joseph Hospital, Paris, France with symptoms of anoproctitis were tested on rectal samples for C. trachomatis (CT), N. gonorrhoeae (NG), M. genitalium (MG). Clinical, microbiological, biological data, STI risk factors, medical history and treatments were collected. RESULTS: Three hundred and sixty-five patients were included for suspected infective anoproctitis. CT was detected in 84/365 (23%) patients, NG in 45/365 (12%) and MG in 46/315 patients (15%), associated with macrolide resistance in 28/46 MG strains (61%). The most frequent symptoms were rectal pains, rectal bleeding, purulent discharge in 253 (79%), 191 (60%), and 164 (51%) of cases respectively. In comparison with MG infections, ulcerations, erythematous proctitis, rectorragia and false needs were more frequently described in CT infections, while purulent proctitis, functional pain and purulent discharge were more often observed in NG and CT anoproctitis. CONCLUSION: We found a high prevalence rate of STIs due to CT, NG, while MG detection was associated with a high rate of macrolide resistance in a cohort of MSM patients. Our results confirm that in cases of symptomatic anoproctitis, MG should be tested in association with other STI pathogens.

Morphological variation in the freshwater blenny Salaria fluviatilis from Corsican rivers: adaptive divergence, phenotypic plasticity or both?

The first goal of this study was to determine whether morphological variation in the freshwater blenny Salaria fluviatilis results in spatially structured populations distributed around Corsica, France, which would suggest genetically differentiated populations through reproductive isolation by distance. The second goal was to determine whether some morphological traits are related to water velocity, one of the most contrasting habitat characteristics in these rivers, which would suggest an adaptation to local conditions. The results showed that the morphology of S. fluviatilis differed among the three main geographic areas studied in Corsica and that geographically distant populations of S. fluviatilis were less similar morphologically and genetically than close ones. The results also indicated that the morphological differences among populations conformed to functional expectations. Overall, the results suggest that the morphological variation of S. fluviatilis from Corsican rivers is an adaptive response to water velocity and that these populations are in a process of reproductive isolation by distance.

Diagnosis and treatment of pulmonary arteriovenous malformations in hereditary hemorrhagic telangiectasia: An overview.

Hereditary hemorrhagic telangiectasia (HHT) or Rendu-Osler-Weber disease is an autosomic dominant disorder, which is characterized by the development of multiple arteriovenous malformations in either the skin, mucous membranes, and/or visceral organs. Pulmonary arteriovenous malformations (PAVMs) may either rupture, and lead to life-threatening hemoptysis/hemothorax or be responsible for a right-to-left shunting leading to paradoxical embolism, causing stroke or cerebral abscess. PAVMs patients should systematically be screened as the spontaneous complication rate is high, by reaching almost 50%. Neurological complications rate is considerably higher in patients presenting with diffuse pulmonary involvement. PAVM diagnosis is mainly based upon transthoracic contrast echocardiography and CT scanner examination. The latter also allows the planification of treatments to adopt, which consists of percutaneous embolization, having replaced surgery in most of the cases. The anchor technique consists of percutaneous coil embolization of the afferent pulmonary arteries of the PAVM, by firstly placing a coil into a small afferent arterial branch closely upstream the PAVM. Enhanced contrast CT scanner is the key follow-up examination that depicts the PAVM enlargement, indicating the various mechanisms of PAVM reperfusion. When performed by experienced operators as the prime treatment, percutaneous embolization of PAVMs, is a safe, efficient and sustained therapy in the great majority of HHT patients.

Testing for microevolution in body size in three blue tit populations.

Quantifying the genetic variation and selection acting on phenotypes is a prerequisite for understanding microevolutionary processes. Surprisingly, long-term comparisons across conspecific populations exposed to different environments are still lacking, hampering evolutionary studies of population differentiation in natural conditions. Here, we present analyses of additive genetic variation and selection using two body-size traits in three blue tit (Parus caeruleus) populations from distinct habitats. Chick tarsus length and body mass at fledging showed substantial levels of genetic variation in the three populations. Estimated heritabilities of body mass increased with habitat quality. The poorer habitats showed weak positive selection on tarsus length, and strong positive selection on body mass, but there was no significant selection on either trait in the good habitat. However, there was no evidence of any microevolutionary response to selection in any population during the study periods. Potential explanations for this absence of a response to selection are discussed, including the effects of spatial heterogeneity associated with gene flow between habitats.

[Retinal vein occlusion and hyperhomocysteinemia]. / Occlusions veineuses rétiniennes et hyperhomocystéinémie.

INTRODUCTION: Previous studies have reported that an elevated plasma homocysteine level is a risk factor for vascular disease. The aim of this study is to determine whether hyperhomocysteinemia is a risk factor for retinal vein occlusion (RVO) and whether it is a prognostic factor. PATIENTS AND METHODS: The plasma homocysteine level was measured in 101 patients and compared to the plasma homocysteine level of controls. The relation between plasma homocysteine level and the other known risk factors of retinal vein occlusion was studied, as well as the correlation between the clinical outcome of the RVO and the plasma homocysteine level. RESULTS: The mean plasma homocysteine level was significantly higher in the 101 RVO patients than in the 29 controls (11.9 mmol/l vs 8.6, p<0.001). We found no relation between plasma homocysteine and other risk factors of vascular disease except for the hematocrit level. Hyperhomocysteinemia was more frequent in the ischemic forms and in bilateral RVO, but the difference was not statistically significant. CONCLUSIONS: Hyperhomocysteinemia seems to be an independent risk factor for RVO and was more frequent in severe RVO, but our study did not evidence an association with a severe prognosis. Vitamin therapy can decrease homocysteinemia but its efficacy in the prevention and in the treatment of RVO remains to be demonstrated.

Energetic and fitness costs of mismatching resource supply and demand in seasonally breeding birds.

By advancing spring leaf flush and ensuing food availability, climatic warming results in a mismatch between the timing of peak food supply and nestling demand, shifting the optimal time for reproduction in birds. Two populations of blue tits (Parus caeruleus) that breed at different dates in similar, but spatially distinct, habitat types in Corsica and southern France provide a unique opportunity to quantify the energetic and fitness consequences when breeding is mismatched with local productivity. As food supply and demand become progressively mismatched, the increased cost of rearing young pushes the metabolic effort of adults beyond their apparent sustainable limit, drastically reducing the persistence of adults in the breeding population. We provide evidence that the economics of parental foraging and limits to sustainable metabolic effort are key selective forces underlying synchronized seasonal breeding and long-term shifts in breeding date in response to climatic change.

Physiological ecology of Mediterranean Blue Tits (Parus caeruleus). I. A test for inter-population differences in resting metabolic rate and thermal conductance as a response to hot climates.

Blue Tits (Parus caeruleus) are widely distributed throughout Europe, reaching the southern limit of their range on islands in the Mediterranean and in northern Africa. On Corsica, one population located at Pirio in the Fango Valley breeds roughly one month later than populations in adjacent valleys or on the continent, thus exposing nestlings to high ambient temperatures (T(a)). We tested the hypothesis that nestlings and possibly adult Blue Tits at Pirio would exhibit a reduction in resting metabolic rate (MR) and an increase in thermal conductance as a physiological response to high T(a). We compared the thermoregulatory response and evaporative water loss for nestlings from Pirio in Corsica and one continental site (Vic-le-Fesq) and for adults from two Corsican (Pirio and Muro) and one continental site (La Rouvière). At 12-14 days of age, nestlings from Pirio showed two distinct thermoregulatory patterns. Nestlings under 8.0 g behaved as heterotherms, whereby MR was correlated only with body temperature. At body masses above 8.0 g nestlings progressively acquired the ability to regulate T(b) and at masses >9.0 g they behaved as homeotherms. When considering homeothermic nestlings and adults, population of origin did not affect either thermal conductance or resting MR. For homeothermic nestlings, mass-specific resting MR (mW x g-(1)) was 15.5 +/- 2.6 and 17.5 +/- 2.5 for nestlings from Vic-le-Fesq and Pirio, respectively. For adults, mass-specific resting MR (mW x g-(1)) was 17.5 +/- 2.0, 17.8 +/- 1.6, and 17.9 +/- 1.0 for birds from Pirio, Muro, and La Rouvière, respectively. Although there was a weak but positive effect of T(a) on evaporative water loss for homeothermic nestlings, no such trend was evident for adults over the range of T(a) tested in this study. We thus find no evidence to indicate that either nestlings or adults exhibit the exponential increase in evaporative water loss associated with the non-convective regulation of T(b) within the range of T(a) tested (roughly

[Optic neuropathy after proton-beam therapy for malignant choroidal melanoma]. / Neuropathie optique après protonthérapie pour mélanome malin de la choroïde.

Proton-beam irradiation is a conservative therapy commonly used for the treatment of uveal malignant melanomas. Some adverse effects such as optic neuropathy can compromise the visual outcome. We were interested in determining the risk factors for radiation papillopathy. Since there is currently no effective therapy, this is an interesting way to improve prevention of optic neuropathy. Six hundred sixty-two eyes had more than 24 month follow-up after proton-beam irradiation for uveal melanoma. In five hundred twenty-two cases, the clinical examination of the optic nerve head by ophthalmoscopy was possible. One-hundred eleven optic discs were pathologic, whereas 411 remained disease-free. Retrospective study of these two groups allowed to quantify the risk factors for optic neuropathy. The irradiation of more than 2mm of optic nerve at 30 Grays-equivalents appeared to be the major risk factor for optic neuropathy. For a given irradiation dose, the observed pattern of clinical responses was heterogeneous. These results are discussed and compared to the previous published reports. Visual results and life prognosis are also discussed, considering the optic nerve head status. Proton-beam therapy can preserve the optic nerve when the tumor location allows to keep it away from the irradiation-field. Patients must be informed about the risk of optic neuropathy after proton-beam irradiation.

Selection-Based Biodiversity at a Small Spatial Scale in a Low-Dispersing Insular Bird.

The blue tit is a highly mobile small passerine found in deciduous and evergreen oaks. In mainland populations, gene flow results in local maladaptive timing of breeding in evergreen oak forests, the rarer habitat. However, on the island of Corsica, two populations only 25 kilometers apart are highly specialized and differ between the two habitat types in breeding and morphological traits. In contrast to theoretical predictions about the homogenizing effects of gene flow, this highlights evolutionary consequences of habitat diversification and isolation at a small spatial scale in insular organisms, which should be taken into account in conservation policies.

Evolution and history of the western Palaearctic avifauna.

Recent data accumulated from fields as varied as avian palaeontology, palaeobotany, historical biogeography and molecular phylogenetics provide a completely renewed picture of the origin, evolution and distribution of modern birds. Although the origin of birds is still controversial, their Tertiary history is now well known. The reconstruction of palaeoenvironments and the identification of shifts in major vegetation belts and habitats during the Pliocene-Pleistocene epochs have added to these recent developments. Together they provide a new perspective on speciation and extinction rates since the late Pliocene and the establishment of modern avifaunas in the western Palaearctic.

A single response mechanism is responsible for evolutionary adaptive variation in a bird's laying date.

Many proximate factors determine a bird's laying date, including environmental and social stimuli as well as individual responses to internal and external factors. However, the relative importance of these factors has not been experimentally demonstrated. Here we show that (i) large differences in the onset of first clutches between different populations result from variation in different responses to photoperiod and not from variation in responses to any other proximate factors and (ii) the same response mechanism causes maladaptive laying dates in habitats modified by humans. We present, to our knowledge, the first experimental demonstration that a single response mechanism is responsible for evolutionary adaptive intraspecific variation in a vertebrate life history trait.

[Ambulatory laser and turbinectomy in the treatment of nasal obstruction. Apropos of 68 cases]. / Analyse du laser ambulatoire et de la turbinectomie dans le traitement de l'obstruction nasale. A propos de 68 cas.

The purpose of this prospective study was to compare subjectively and objectively the efficiency of laser vaporisation against surgical procedure in treatment of nasal obstruction related to vasomotor rhinitis. 40 inferior nasal turbinates laser vaporisations were compared to 28 surgical inferior turbinectomies. This trial was based on rhinomanometric data before and after laser or surgical management and on appreciation of individual nasal comfort. The results obtained with conventional surgery were slightly better than laser vaporisation; however this new procedure succeed in 75% of cases with a mean of one year follow-up. The rhinomanometric++ findings appeared especially contributing when significant disorders exist before treatment.

Nosocomial pneumonia in mechanically ventilated patients receiving antacid, ranitidine, or sucralfate as prophylaxis for stress ulcer. A randomized controlled trial.

OBJECTIVE: To assess three anti-stress ulcer prophylaxis regimens in mechanically ventilated patients for bacterial colonization, early- and late-onset nosocomial pneumonia, and gastrointestinal bleeding. DESIGN: Randomized controlled trial. PATIENTS: Consecutive eligible patients with mechanical ventilation and a nasogastric tube. Of 258 eligible patients, 244 were assessable. SETTING: Medical and surgical intensive care units. INTERVENTION: At intubation, patients were randomly assigned to receive one of the following: antacid (a suspension of aluminum hydroxide and magnesium hydroxide), 20 mL every 2 hours; ranitidine, 150 mg as a continuous intravenous infusion; or sucralfate, 1 g every 4 hours. MEASUREMENTS: Using predetermined criteria, the incidence of gastric bleeding, gastric colonization, early-onset pneumonia, and late-onset pneumonia was assessed in patients intubated for more than 24 hours. RESULTS: Of 244 assessable patients, macroscopic gastric bleeding was observed in 10%, 4%, and 6% of patients assigned to receive sucralfate, antacid, and ranitidine, respectively (P > 0.2). The incidence of early-onset pneumonia was not statistically different among the three treatment groups (P > 0.2). Among the 213 patients observed for more than 4 days, late-onset pneumonia was observed in 5% of the patients who received sucralfate compared with 16% and 21% of the patients who received antacid or ranitidine, respectively (P = 0.022). Mortality was not statistically different among the three treatment groups. Patients who received sucralfate had a lower median gastric pH (P < 0.001) and less frequent gastric colonization compared with the other groups (P = 0.015). Using molecular typing, 84% of the patients with late-onset gram-negative bacillary pneumonia were found to have gastric colonization with the same bacteria before pneumonia developed. CONCLUSION: Stress ulcer prophylaxis with sucralfate reduces the risk for late-onset pneumonia in ventilated patients compared with antacid or ranitidine.

[Pneumological exercise test and pulmonary hypertension]. / Epreuve d'effort pneumologique et hypertension pulmonaire.

The aims of and indications for exercise testing as a noninvasive method in pneumology are described with special emphasis on the diagnosis of chronic thrombo-embolic disease and primary pulmonary hypertension. The methodology and the criteria of interpretation as well as the diagnostic value are exposed.