Lactobacillus endocarditis: a case report in France and literature review.

Lactobacilli are commensal bacteria in the normal flora of the oral cavity, gastrointestinal and genital tract. However, few cases of lactobacilli-induced bacteremia or endocarditis have been reported, particularly in immunocompromised patients. We reported a rare case of a 57-year-old man with a Lactobacillus rhamnosus endocarditis without immunodeficiency in his medical history. He received a dental scaling one year before. Clinical presentation included weight loss, heart murmur, ankle arthritis and splinter hemorrhage. Echocardiography showed a mitral prolapse and a 16 mm vegetation associated with a valvular perforation. All blood cultures were positive for Lactobacillus rhamnosus. Antibacterial regimen with amoxicillin and gentamicin led to recovery without surgery. We present a literature review of the lactobacillary endocarditis cases published since 1992. Valvulopathy, dental or invasive procedures and probiotics use were the main underlying conditions, in contrary to immunodeficiency. Diagnosis of lactobacillary endocarditis should be more considered and a treatment with penicillin and aminoglycoside should be promptly introduced in life-threatening cases.

[Suggestion for recommendations for the wise use of social media in French internal medicine - take control of online reputation]. / Utilisation avisée des réseaux sociaux pour la gestion de la e-réputation des médecins internistes français ­ proposition de recommandations.

Social networks (or SoMe) expanded exponentially over the last ten years, including healthcare. SoMe have changed the doctor's daily life and the relationship with patients. Poor management of SoMe can impact on "e-reputation". On the other hand, the proper use of SoMe allows the opening up of new functionalities in both clinical and research settings. Several scientific societies have made recommendations for the proper handling of SoMe in order to protect the personal information and privacy of physicians. Professionals are advised to differentiate between a professional account and a personal account. Confidentiality settings and certain "codes" for managing publications must be followed. Physicians must be aware that their publications are indelible and can damage their "e-reputation". The proper handling of SoMe will allow internists to organize their bibliographic monitoring, increase the altmetric of their articles, facilitate communication between researchers and modify the relationship with their patients.

Concomitant association of giant cell arteritis and malignancy: a multicenter retrospective case-control study.

INTRODUCTION: Some studies suggest that there is an increased risk of malignancies in giant cell arteritis (GCA). We aimed to describe the clinical characteristics and outcomes of GCA patients with concomitant malignancy and compare them to a GCA control group. METHOD: Patients with a diagnosis of GCA and malignancy and with a maximal delay of 12 months between both diagnoses were retrospectively included in this study and compared to a control group of age-matched (3:1) patients from a multicenter cohort of GCA patients. RESULTS: Forty-nine observations were collected (median age 76 years). Malignancies comprised 33 (67%) solid neoplasms and 16 (33%) clonal hematologic disorders. No over-representation of a particular type of malignancy was observed. Diagnosis of GCA and malignancy was synchronous in 7 (14%) patients, while malignancy succeeded GCA in 29 (59%) patients. Malignancy was fortuitously diagnosed based on abnormalities observed in laboratory tests in 26 patients, based on imaging in 14 patients, and based on symptoms or clinical examination in the nine remaining patients. Two patients had a concomitant relapse of both conditions. When compared to the control group, patients with concomitant GCA and malignancy were more frequently male (p < 0.001), with an altered general state (p < 0.001), and polymyalgia rheumatica (p < 0.01). CONCLUSIONS: This study does not indicate an over-representation of any particular type of malignancy in GCA patients. Initial follow-up dictated by vasculitis may have led to an early identification of malignancy. Nevertheless, GCA male patients with an altered general state and polymyalgia rheumatica might more frequently show concomitant malignancies.

[Use of Twitter(®) in a congress: First experience for French internal medicine]. / Utilisation de Twitter(MD) en congrès : une première pour la médecine interne française.

INTRODUCTION: Twitter(®) is a social "microblogging" network in which users can send and receive updates of up to 140 characters. Nowadays its use in medicine has become common in the United Kingdom and in the USA, particularly in scientific meetings where attendees tweet relevant information from the various lectures. Then, the tweeted information is relayed by followers who may be present or not at the lectures. RESULTS: Using Twitter(®) on the 70th Congress of French Society of Internal Medicine with @MielLorraine and @secretaireMIEL accounts was the first time in internal medicine in France. In total, 825 tweets were posted by both accounts and 59% were original. The two accounts were followed by respectively 12 and 10 followers. People outside the congress were able to get information and to start discussion on many topics. CONCLUSION: This experience emphasizes the fact that Twitter(®) improves interactions during congresses. Therefore, we should continue on a going forward basis to develop this tool.

Fluorinated enol ethers: their synthesis and reactivity.

Thanks to the beneficial effect of fluorine substitution on the pharmacokinetic properties of molecules, an ever increasing number of marketed drugs incorporate a fluorine atom into their structure. As a consequence, the synthesis of fluorinated molecules has become a very active research field. Among the numerous approaches, fluorinated enol ethers are valuable building blocks that allow the introduction of a fluoro- or difluoromethyl group through a wide variety of reactions. The present review lists different methods for their preparation and sums up their numerous synthetic applications.

Understand, elucidate and rationalize the coordination mode of pyrimidylmethylamines: an intertwined study combining NMR and DFT methods.

Conception of new pyrimidylmethylamine (pyrma) ligands and their corresponding Pd(II) complexes has been described. Both symmetrical and non-symmetrical ligands were prepared and subjected to complexation. Two different coordination modes, Pd(N,N)- or Pd(C,N,N)-pyrma, have been evidenced depending on the substitution of the pyrimidine ring and the nature or the shape of the additional pendant arm. In a non-symmetrical pyrimidine series, the substituent-induced discrimination of each heterocyclic nitrogen atom provoked regio-controlled coordination to the metal center. The molecular structure of pyrma-Pd(II) complexes in the solution state has been elucidated thanks to combined NMR experiments and DFT calculations. This study highlights the potency of (15)N and (13)C NMR spectroscopy for the elucidation of the regio-selective coordination to the Pd(II) in the pyrma-based complex series. DFT calculations were highly relevant to the identification of crucial factors that govern the regio-selectivity and the complexation modes. Close predicted and experimental chemical shift values put into relief the reliability of coordination modes for the most stable complexes in solution, depicted by DFT approaches.

Rate of intravenous thrombolysis for acute ischaemic stroke in the North-of-France region and evolution over time.

The proportion of patients with ischaemic stroke treated by intravenous (i.v.) recombinant tissue plasminogen activator (rt-PA) is an indicator of quality of stroke care. The objective of the study is to evaluate the rate of i.v. thrombolysis in the North-of-France region and its evolution over time. We determined the proportion of inhabitants treated by i.v. rt-PA in 2009-2010 (period A; 8 stroke units, no telemedicine) and 2012 (period B; population campaigns, 12 stroke units with telemedicine in 5). We used hospital registries from the 12 stroke units, and population-based data were collected in a subpopulation of 226,827 inhabitants (5.6% of the whole population). 1,563 inhabitants received i.v. rt-PA for stroke (period A: 835 in 24 months; period B: 728 in 12 months). Hospital and population data were similar. Annual rates of thrombolysis increased from 103 per million inhabitants [95% confidence interval (CI) 85-125] to 181 (95% CI 157-209; relative increase 76%, 95% CI 67-83%). This rate increased in 12 districts (significantly in 6), but the increase was greater in districts where new stroke units, telemedicine, or both were implemented. In conclusion, although the proportion of patients treated was already high in period A, there was still place for improvement. Implementation of new stroke units, extension of the telemedicine network and new population campaigns are necessary to improve the rate of thrombolysis in several areas, to ensure an equal access to treatment over the whole territory. The next step is now to determine whether this high rate of i.v. rt-PA delivery at the population level translates into clinical results.

Catalytic asymmetric access to alpha,beta unsaturated delta-lactones through a vinylogous aldol reaction: application to the total synthesis of the Prelog-Djerassi lactone.

[reaction--see text] A one-step catalytic asymmetric access to alpha,beta unsaturated delta-lactones is described, using a vinylogous Mukaiyama-aldol reaction between a gamma-substituted dienolate and various aldehydes in the presence of Carreira catalyst CuF.(S)-tolBinap. This methodology has been further applied to a straightforward access to the Prelog-Djerassi lactone.

Catalytic Asymmetric Vinylogous Mukaiyama-aldol (CAVM) reactions: the enolate activation.

The Catalytic Asymmetric Vinylogous Mukaiyama (CAVM) reactions of various aldehydes with dienolate 1 using different enolate activations (CuF*(S)-TolBinap, t-BuOCu*(S)-Tol-Binap, and various chiral nonracemic ammonium fluorides derived from cinchona alkaloids) are described. These reactions proved to be highly regioselective leading exclusively to the alpha-aldol products in good yields and poor to good enantioselectivities.

Colour vision at very high altitude.

The goal of our study was to evaluate colour vision during high-altitude mountain climbing without supplemental oxygen. Two Himalayan expeditions were invited to test their colour perception at both the highest possible altitude and on the largest possible number of subjects. The panel desaturated D15 was used, because only a simple test could be transported to those altitudes. There were 2 evaluations (i.e., 4 eyes) at 7,000 m during the first expedition in 1997, and 3 evaluations (i.e., 6 eyes) at 6,500 m during the second expedition in 1998. The results were in perfect agreement and can be considered practically normal for all 5 mountain climbers.

New sucrose phenylpropanoid esters from Polygonum perfoliatum.

Five diferuloyl esters of sucrose, 6'-acetyl-3,6-diferuloylsucrose (helonioside B) (1); 2',4',6'-triacetyl-3,6-diferuloylsucrose (2); 1, 2',4',6'-tetraacetyl-3,6-diferuloylsucro se (3); 1,2',6'-triacetyl-3, 6-diferuloylsucrose (4); and 2',6'-diacetyl-3,6-diferuloylsucrose (5), were isolated, along with the 1,3,6-tri-p-coumaroyl-6'-feruloylsucroses, vanicoside A and vanicoside B, from the whole plant of Polygonum perfoliatum by various chromatographic methods. The structures of these phenylpropanoid glycosides were determined on the basis of their NMR and mass spectroscopic data. Compound 1 is a known compound, but 2-5 are new members of this class.

Tetrasomy 9p due to an intrachromosomal triplication of 9p13-p22.

To date, approximately 30 patients have been described with a tetrasomy 9p, all being caused by the presence of an isochromosome 9p. We now report on a 3-year-old boy with a de novo intrachromosomal triplication of 9p13-p22, resulting in partial tetrasomy 9p. We compared his phenotype with cases of tetrasomy 9p caused by the presence of an extra isochromosome 9p. He has facial anomalies similar to those of cases of tetrasomy 9p, central nervous system abnormalities, and severe psychomotor retardation but no other major congenital anomalies. Fluorescence in situ hybridization with region-specific probes showed that the middle repeat of the triplicated part is inverted. Microsatellite analysis demonstrated an involvement of both paternal chromosome 9 homologues in the triplication. This is compatible with either unequal crossing over of three of the four chromatids in paternal meiosis I or with a double crossing over in meiosis I and II (or an early mitotic division).

5-Benzoyl-5-deacetylwilforidine: a new sesquiterpene nicotinoyl alkaloid from Maytenus buchananii.

A new sesquiterpene nicotinoyl alkaloid has been isolated from Maytenus buchananii (Loes.) R. Wilczek and identified as 5-benzoyl-5-deacetylwilforidine (1). This appears to be the first sesquiterpene nicotinoyl alkaloid based on hydroxywilfordic acid with a benzoyl group at C-5.

[Transient erythroblastopenia in children; a harmless form of anemia]. / Voorbijgaande erytroblastopenie bij kinderen; een onschuldige vorm van anemie.

In three children presenting with anaemia, transient erythroblastopenia of childhood (TEC) was diagnosed. This is a harmless disorder in which erythropoiesis is temporarily suppressed by some unknown cause. TEC mostly affects young children between the age of 1 and 4 years. Apart from the anaemia symptoms are rare. Children with TEC recover spontaneously but sometimes one or more packed red cell transfusions may be necessary. It is easy to distinguish TEC from other causes of anaemia by history, physical examination and limited blood testing. Awareness of the existence of TEC can prevent unnecessary diagnostic procedures and treatment.

Characterization of a monoclonal antibody produced in an attempt to mimic the active site of HIV aspartyl protease using haptens based on inhibitor models.

The high binding affinity and specificity of antibodies for a great variety of ligands has been widely exploited in structure-activity relationship studies of biomolecules and more recently in the development of new catalysts for several chemical reactions. It is assumed that antibodies generated against haptenic protease inhibitors would recognize both these haptens and the substrate of the model proteolytic reaction. We have produced antibodies against HIV PRp12 aspartyl protease substrate analogues, chemically modified at the scissile bond, Phe-Pro. Identical chemical modifications have been reported for related HIV protease inhibitors. We finally selected an anti-hapten monoclonal antibody that specifically recognized the substrate and those haptens with both the phenylalanyl side chain and the prolyl pyrrolidine ring. This selectivity of recognition suggests that such an antibody might mimic the catalytic site of the model protease.