[Recommendations for a gradual and controlled resumption of electroconvulsive therapy in France during the period of lifting of the containment and of the COVID-19 pandemic linked to SARS-CoV-2]. / Recommandations pour une reprise progressive et contrôlée de l'électroconvulsivothérapie en France en période de levée du confinement et de pandémie COVID-19 liée au SARS-CoV-2.

The COVID-19 pandemic has had major consequences for the organization of care. In France and around the world, centers practicing electroconvulsive therapy (ECT) have seen their activity decrease, or even stop for many reasons. In this context, maintaining or resuming this essential therapeutic activity for many patients suffering from psychiatric disorders requires material, human and logistical adaptations that should be supervised. The objective of this collective and national work is to offer simple recommendations that can be applied immediately by any healthcare establishment, public or private, practicing ECT. They are the result of feedback from multiprofessional and inter-establishment experiences. Declined in three stages, these recommendations are accompanied by a practical sheet which describes in detail the necessary conditions and prerequisites for any resumption of ECT activity.

Effects of smoking status and MADRS retardation factor on response to low frequency repetitive transcranial magnetic stimulation for depression.

BACKGROUND: Despite growing evidence supporting the clinical interest of repetitive transcranial magnetic stimulation (rTMS) in treatment-resistant depression (TRD), little is known regarding the effects of clinical and sociodemographic factors on the clinical outcome in patients. METHODS: We retrospectively investigated the effects of clinical (using the 3-factor model of the Montgomery-Åsberg depression rating scale [MADRS] encompassing dysphoria, retardation and vegetative symptoms) and sociodemographic characteristics of participants on clinical outcome in a sample of 54 TRD patients receiving low frequency rTMS (1Hz, 360 pulses) applied over the right dorsolateral prefrontal cortex combined with sham venlafaxine. RESULTS: Responders (n=29) displayed lower retardation baseline scores (13.6±2.9) than non-responders (15.6±2.9; n=25; P=0.02). We also observed a significant difference between the numbers of ex-smokers in responders and non-responders groups; all ex-smokers (n=8) were responders to rTMS (P=0.005). CONCLUSION: Low MADRS retardation factor and ex-smoker status is highly prevalent in responders to low frequency rTMS. Further studies are needed to investigate the predictive value of these factors.

[Investigation of the venodilatory effect of vascular endothelial growth factor (VEGF) in rat gingiva]. / A vaszkularis endoteliális növekedési faktor (VEGF) venulákra kifejtett hatásának vizsgálata patkány fogínyben.

VEGF induces proliferation of endothelial cells, stimulates angiogenesis, and increases vascular permeability in many organs. Nevertheless, we have only limited information about its role on gingival hemodynamics, especially in venules. Therefor the aim of this study was to assess the acute circulatory effects of VEGF on rat gingival venules by means of the following protocol. Wister rats (n=63) were devided into five study groups after anesthesia; each animal received 10 microl of experimental solution dripped onto the lower interincisal gingiva. The groups included: 1) saline control (after the experiment, gingiva was excised for VEGF receptor 2 [VEGFR2] immunohistochemistry); 2) VEGF (0.1, 1, 10, or 50 microg/ml); 3) VEGF2 receptor antagonist 5-((7-benzyloxyquinazolin-4-yl)amino)-4-fluoro-2-methyl-phenol-hydrochloride (ZM323881; 20 microg/ml); 4) ZM323881 (20 microg/ml) followed by VEGF application (50 microg/ml after 15 minutes); and 5) VEGF (10 microg/ml), these rats were premedicated with nitric oxide (NO) synthase blocker (NG-nitro-L-arginine-methyl-ester [L-NAME]; 1 mg/ml in drinking water) for 1 week before the experiment. Changes in gingival superficial venule diameter were measured by vital microscopy prior to and 1, 5, 15, 30, and 60 minutes after the administration of the experimental solutions. According to our findings, VEGF dose-dependently increased the venular diameter compared to saline. ZM323881 alone did not cause any alteration. Premedication with ZM323881 or L-NAME decreased the dilatory effects of VEGF. Occassionally moderate VEGFR2 immunohistochemical labeling was observed in the wall components of the venules. Concluding our results we can say, that there is no remarkable VEGF production under physiologic circumstances in rat gingiva, but VEGF is able to increase gingival blood flow through the activation of VEGF2 receptors and consequent NO release.

Distribution and seasonality of Phlebotomus sand flies in cutaneous leishmaniasis foci, Judean Desert, Israel.

The ecology of Phlebotomus sand flies in cutaneous leishmaniasis foci as a result of Leishmania tropica in the Judean Desert was studied. Between 2005 and 2007, >265,000 specimens were trapped outdoors and 1,233 specimens were collected indoors. The catches included Phlebotomus sergenti Parrot, Phlebotomus papatasi (Scopoli), Phlebotomus syriacus Adler & Theodor, and Phlebotomus tobbi Adler & Theodor. P. sergenti, the local vector of Leishmania tropica, comprised 90% of outdoor catches, and relatively few were caught indoors. Conversely, P. papatasi were > 90% of the indoor collections, and only a few were caught outdoors. The efficiency of trapping methods varied, but species composition and sex ratio remained constant irrespective of method. Sand flies were abundant on slopes facing east where wind velocity was low, and scarce on slopes facing west and residential areas. Large numbers and high proportion of males that occur near breeding sites were found in man-made rock walls and in rock crevices on slopes of uncultivated hills. Population increase began in April, was more intensive between May and November, peaked in August-September, and significantly decreased in December. Indoors, most of the P. sergenti (< 80%) were collected from September to November. A few sand flies were found between January and March. The effects of climatic factors and human activities on sand fly populations and the risk of Leishmania infections are discussed.

[Usefulness of repetitive transcranial magnetic stimulation in psychiatric disorders]. / Applications thérapeutiques actuelles de la stimulation magnétique transcrânienne répétée en psychiatrie.

Mental disorders represent a concern for the public health because of their prevalence in the general population. Despite progress in psychopharmacology, 20-30 % of the patients suffering of depressive disorders are responding only partially to different pharmacological and psychological therapeutic strategies. Until recently, the therapeutic alternative in refractory depression was the electroconvulsive therapy. New therapeutic approaches should be therefore explored. In October 2008 repetitive transcranial magnetic stimulation was approved as an antidepressive monotherapy by the FDA, opening the way to a routine application of this technique, which will supplement the body of our therapeutic armamentarium for mood disorders. We review this new therapeutic approach, which is rapidly developing for treating depression and schizophrenia.

[Psychopathologies encountered on the island of Mayotte between 1998 and 2004]. / Psychopathologies rencontrées sur l'île de Mayotte entre 1998 et 2004.

Before 2001, psychiatric care on the island of Mayotte was ensured by missionaries from the Reunion Island. A mental health system has since been gradually installed, although the culture in Mayotte, mixing practicing Muslim women and traditional animists, still leaves a broad place for traditional healers. This paper presents a retrospective study of 1212 psychiatric case reports, aimed at indexing the various psychopathologies according to the CIM 10, on the island of Mayotte between 1998 and 2004. The files, before and after the opening of the mental health centre, were compared with those of the psychiatric diagnoses of the Comorians. The results show an evolution in the chronic pathologies treated in the Comorians: delirious disorders, and the organic, major, mental disorders in the first psychiatric files have given way to depressive episodes and somatoform disorders. Nevertheless, an underlying prevalence of depression and addiction persist. It is interesting to note the reduced number of suicide attempts, far lower than in western countries: one suicide attempt per annum for 375 inhabitants in metropolitan France, whereas, in this study, one suicide attempt in Mayotte was reported for 2504 inhabitants. The cultural characteristics are also taken into account in the discussion of these results. Thus, if there are more demonstrations with somatic expression in the Comorians, related to a stronger implication of the body in situations of psychological faintness: 1.75% of hysterical conversion in the Comorians versus 0.99% in Mayotte, this does not mean a more histrionic personality in this population: 1.8% of Comorians, against 1.98% in Mayotte. The results of this study consolidate the impressions felt by the experts and show the effects of the mental health policy on the island. Thus, the assumption of responsibility of chronic psychotics made it possible to improve their quality of life, and to decrease the number of medical evacuations that decreased from 17 to three, between 2001 and 2004. However, this study also underlined the possible axes of development in this field, namely the assumption of responsibility of psychiatric emergencies with a crisis centre, and the development of a specialized pedopsychiatric assumption of responsibility. Indeed, in the first six months of 2004, 35% of the patients were 0-20 year-old.

Modelling Staphylococcus aureus-induced septicemia using NMR.

We present a novel NMR-based study of the molecular aspects of the "attack" on human red blood cells (RBCs) by growing bacteria. Staphylococcus aureus expresses virulence factors, including alpha-hemolysin, which contribute to the clinical condition known as septic shock. alpha-Hemolysin is a pore-forming toxin and its secretion increases the permeability of a range of mammalian cell types infected with S. aureus. (31)P NMR spectra of the probe molecules dimethyl methylphosphonate (DMMP) and hypophosphite (HPA) in RBC suspensions show separate intra- and extracellular resonances. These resonances coalesced over time in RBC suspensions inoculated with S. aureus or pure alpha-hemolysin, due to increasing permeability of the RBC membrane. Increased RBC permeability resulted in leakage of intracellular proteins, plus an increase in the exchange rate of the solutes between the intra- and extracellular compartments, both effects contributing to the coalescence of the split peaks. The addition of antibiotics prevented peak coalescence and enabled the minimal inhibitory concentration (MIC) for eight strains of S. aureus to be determined for oxacillin and erythromycin. The MIC values obtained by using (31)P NMR spectroscopy were within one dilution of the MICs obtained using the standard National Committee for Clinical Laboratory Standards (NCCLS) method. The results are encouraging for the use of NMR spectroscopy in clinical microbiology.

Legal issues of the electronic dental record: security and confidentiality.

Computer-based, electronic dental record keeping involves complex issues of patient privacy and the dental practitioner's ethical duty of confidentiality. Federal and state law is responding to the new legal issues presented by computer technology. Authenticating the electronic record in terms of ensuring its reliability and accuracy is essential in order to protect its admissibility as evidence in legal actions. Security systems must be carefully planned to limit access and provide for back-up and storage of dental records. Carefully planned security systems protect the patient from disclosure without the patient's consent and also protect the practitioner from the liability that would arise from such disclosure. Human errors account for the majority of data security problems. Personnel security is assured through pre-employment screening, employment contracts, policies, and staff education. Contracts for health information systems should include provisions for indemnification and ensure the confidentiality of the system by the vendor.

Oestrogens and endometrial cancer: effect of other risk factors on the association.

We analyzed data from a case-control study of endometrial cancer to determine whether, in a woman's menstrual and medical history, factors could be identified that modify the increased risk resulting from menopausal oestrogen use. Overweight, hypertension, low parity, non-smoking, late age at menopause, and a history of cholecystectomy were all associated with endometrial cancer, but oestrogen use produced large increases in risk both in the presence and absence of these characteristics. We conclude that information on other known risk factors for endometrial cancer provides little or no guidance as to which patients to select in the perimenopause.

PIP: Using a population-based tumor registry serving western Washington state, all female residents of King County aged 50-74 years with a new diagnosis of endometrial cancer were identified. Then a comparable group of controls was found, and a case-control study of endometrial cancer was done to determine whether, in a woman's menstrual cycle and medical history, factors that modify the increased risk of endometrial cancer from estrogen use for menopausal symtoms could be identified. Endometrial cancer was found to be associated with overweight, hypertension, low parity, nonsmoking, late onset of menopause, and history of cholecystectomy. Use of estrogen produced large increases in risk both in the presence and absence of these characteristics, however. Because of this lack of association, it was concluded that information on other known risk factors for endometrial cancer gives little or no help as to selection for estrogen treatment in perimenopause.

Endometrial cancer in relation to patterns of menopausal estrogen use.

Female residents of King County, Washington, in whom endometrial cancer developed between January 1975 and April 1976 were interviewed concerning prior use of menopausal estrogens. Their responses were compared with those of a random sample of women from the same population. Among current estrogen users, endometrial cancer risk was strongly related to duration of use; although only a minimal elevation of risk was present during the first two years, there was a rapid rise to a 20-fold excess after about ten to 15 years. Cessation of estrogen use led to a decline in incidence of endometrial cancer within several years, but the risk remained higher than in nonusers through the first decade after administration of the drug was stopped. Risk was elevated whether or not the regimen was cyclic and whether conjugated or other types of estrogens had been used. Dosages of less than 0.625 mg/day of conjugated estrogens produced a smaller increase in risk than did other dosages.

Incidence of endometrial carcinoma in King County, Washington: a standardized histologic review.

Previously diagnosed tumor specimens from 35- to 74-year-old female patients with endometrial cancer who were residents of King County, Washington, during the first 6 months of 1975 were reviewed by a single pathologist using uniform criteria for the assessment of cancer. Routinely reported incidence of this tumor in this population was judged to be inflated, the annual incidence rate (excluding carcinoma in situ) falling from 108.2 to 88.5 per 100,000 women after the exclusion of cases found not to be unequivocally malignant. This rate nonetheless represented a large increase over the rate of 47.3 per 100,000 observed in the U.S. Third National Cancer Survey just 5 years earlier. We concluded that U.S. pathologists in the 1970's may have been using more liberal criteria by which to diagnose endometrial cancer, but that such a change could only account for a small part of the rising incidence of the disease.

Age-related differences in the trends of fatal Hodgkin's disease as a consequence of immune experience.

It has been proposed by MacMahon, on the basis of the variations among populations in the age distribution of fatal Hodgkin's disease, that there are two etiological factors, one important in young adults and the other important in middle-aged and elderly people. Correa has extended this by suggesting that those who died of the disease as young adults in developed countries would have succumbed to the disease as children under less favorable circumstances. In England and Wales, the mortality rate from Hodgkin's disease doubled from 1911 to 1970. If there were two etiologies, it seems unlikely that they would remain in step with one another over such a long period, when it was clear that some factor of major etiological importance was changing. Examination of the trends with time of the age-specific rates confirmed the previously reported decline in children and rise in elderly people and revealed a rapid rise in the mortality of young adults of both sexes. These changes were not compatible with any reasonable variations in the diagnosis or classification of Hodgkin's disease. Our data are compatible with the hypotheses that the etiology of the disease in young adults in different from that in elderly people and that the rise in the mortality of young adults is due to a transfer of deaths from the disease in childhood.

Increasing incidence of endometrial cancer in the United States.

Data from eight areas in the United States served by population-based cancer reporting systems indicate that, after many years of relative stability, incidence rates of endometrial cancer have risen sharply in the 1970's. In some areas the amount of the increase has exceeded 10 per cent per year. The incidence among middle-aged women has changed most (by 40 to 150 per cent between 1969 and 1973, depending on the area), but rates have increased in younger women and the elderly as well.