Development and psychometric validation of the REFlective evaLuation of psoriasis Efficacy of Treatment and Severity (REFLETS) questionnaire: a common measure of plaque-type psoriasis severity and treatment efficacy for patients and clinicians.

BACKGROUND: To date, there is no global consensus on the definition of the severity of psoriasis. The REFlective evaLuation of psoriasis Efficacy of Treatment and Severity (REFLETS) questionnaire has recently been developed to provide a better understanding of plaque-type psoriasis severity and treatment efficacy from both patient and clinician perspectives. OBJECTIVE: This study aimed to develop and psychometrically validate the new REFLETS questionnaire to evaluate patient and clinician perceptions of plaque-type psoriasis severity and treatment efficacy. METHODS: Two similar versions of the REFLETS questionnaire were developed following a rigorous methodology for clinicians and patients, referring to 'the psoriasis of your patient' or to 'your psoriasis', respectively. An observational, longitudinal, multicentre study was conducted in France with 34 dermatologists and 430 mild to severe plaque-type psoriasis patients to finalize the questionnaire and evaluate its psychometric properties. RESULTS: Two dimensions were defined--severity and treatment efficacy--with three subdimensions within severity (impact of psoriasis, symptoms and disease course), and two individual items on joint pain. The questionnaire was well accepted by clinicians and patients. Excellent internal consistency (Cronbach's alpha = 0.66-0.98) and test-retest reliability (intraclass correlation coefficients = 0.83-0.94) were demonstrated. REFLETS scores were moderately to highly correlated to Psoriasis Area and Severity Index (r = 0.35-0.70), Skindex-29 (r = 0.46-0.82) and DLQI scores (r = 0.36-0.82). Patients with decreased psoriasis severity and those with increased treatment efficacy, according to patient global evaluations, had lower severity and higher treatment efficacy REFLETS scores, respectively. CONCLUSION: REFlective evaLuation of psoriasis Efficacy of Treatment and Severity is a promising tool for assessing plaque-type psoriasis severity and treatment efficacy from patient and clinician perspectives. It may help to improve patient and clinician communication in treatment decision making.

Performances of the Assessment of SpondyloArthritis International Society axial spondyloarthritis criteria for diagnostic and classification purposes in patients visiting a rheumatologist because of chronic back pain: results from a multicenter, cross-sectional study.

OBJECTIVE: To evaluate the performances (sensitivity, specificity, and positive and negative predictive values) at diagnosis and study visit of the Assessment of SpondyloArthritis international Society (ASAS) criteria in axial spondyloarthritis in patients with chronic back pain (CBP). A secondary objective was to identify the most contributory item to diagnosis/classify spondyloarthritis. METHODS: We conducted a multicenter, cross-sectional study. Patients were ages <45 years with a history of CBP and seeing a rheumatologist in France. Data included items from the different sets of criteria, checking if present at diagnosis ("diagnosis")/after diagnosis, but at study visit ("classification"), and the rheumatologist's diagnosis at study visit. Statistical analysis included descriptive characteristics and performances for diagnosis and classification. The diagnosis of the rheumatologist was considered the "gold standard." RESULTS: A total of 1,210 patients were eligible for our analysis. Sensitivity and specificity for ASAS axial criteria were 0.76 and 0.94, respectively, and 0.87 and 0.92 for diagnostic and classification purposes, respectively. The positive likelihood ratio of the ASAS axial criteria was 13.6 and 10.30 for diagnostic and classification purposes, respectively. The most contributory items to diagnosis and classification were radiographic sacroiliitis, followed by magnetic resonance imaging sacroiliitis for diagnosis and history of uveitis for classification. CONCLUSION: We confirm the validity of the ASAS criteria for both diagnostic and classification purposes in a clinical setting of patients with CBP.

Prevalence and factors associated with uveitis in spondylarthritis patients in France: results from an observational survey.

OBJECTIVE: To accurately estimate the prevalence of and the factors associated with uveitis in spondylarthritis (SpA) patients in France. METHODS: In an observational survey of SpA patients (diagnosis confirmed by the European Spondylarthropathy Study Group and/or Amor's criteria) consulting their rheumatologist for routine followup, we collected information regarding present/past history of uveitis, as well as detailed characteristics of the disease. Factors independently associated with uveitis were determined. RESULTS: From September 2008 to January 2009, 202 rheumatologists participated in the survey and recruited 902 patients (61% men) with a mean ± SD age of 45.3 ± 13.4 years and a mean ± SD disease duration of 10.4 ± 9.6 years. The SpA diagnoses were ankylosing spondylitis (71%), psoriatic arthritis (18%), or other SpA (11%). The HLA-B27 positivity rate was 76%. Uveitis prevalence was 32.2% (95% confidence interval [95% CI] 29.1-35.3%) since psoriasis and inflammatory bowel disease were 22.3% (95% CI 19.5-25.0%) and 8.6% (95% CI 6.7-10.5%), respectively. Recurrence of uveitis occurred in 52.3% and complications occurred in 11.7% of patients. Factors independently associated with uveitis were HLA-B27 positivity (adjusted odds ratio [OR(adj) ] 2.97 [95% CI 1.83-4.81], P < 0.0001) and disease duration (OR(adj) 1.28 [95% CI 1.16-1.41], P < 0.0001 for ≥10 years). CONCLUSION: Results indicate that uveitis is the most common extraarticular feature of SpA, occurring preferentially in HLA-B27-positive patients over the entire course of the disease.

Host-plant finding by the asparagus fly, Plioreocepta poeciloptera (Diptera: Tephritidae), a monophagous, monovoltine tephritid.

The role of various olfactory and visual stimuli was studied in host-plant finding by the asparagus fly Plioreocepta poeciloptera (Schrank), a monophagous monovoltine tephritid causing serious damage to asparagus spears. Volatiles released by asparagus plants were extracted by diethyl ether after cryotrapping concentration, and identified by gas chromatography-mass spectrometry. Twelve of the 13 compounds identified were tested using electroantennography to measure the response of the fly. Behavioural response was analysed using two different flight tunnels according to circadian rhythm, age and sex of adults, presence of the plant and of different coloured lures, presence of a male congener, or exposure to four pure asparagus odour compounds that elicited responses in electroantennography, i.e. hexanal, (E)-2-hexenal, (Z)-2-hexen-1-ol and decanal. Data showed that males locate the host plant more quickly than females. Females are attracted mainly by the blend of plant odour and male pheromone. Both sexes respond to a complex of stimuli only during the afternoon. These findings will be helpful in developing new and effective approaches to control this pest insect.

Characterization of a behaviorally active, gender-specific volatile compound from the male asparagus fly Plioreocepta poeciloptera.

Adult male asparagus flies exhibit typical calling behaviors (suggestive of pheromone production) during which they emit a single volatile compound that was identified as isopropyl (S)-5-hydroxyhexanoate. In laboratory bioassays, synthetic samples elicited an arrestant response in females, but did not appear to attract females. On the other hand, the synthetic material attracted conspecific males in olfactometer bioassays.

[Prevention of recurrences of atrial fibrillation by cardiologists established in general office practice: data from the FAUVE observatory]. / Traitement préventif des récidives de fibrillation atriale en médecine cardiologique de ville: données de l'observatoire FAUVE.

OBJECTIVES: Analyse the modalities of preventive therapy of recurrences of paroxysmal or persistent atrial fibrillation (AF) with Vaughan-Williams (VW) type IC antiarrhythmics. METHODS: Observational study conducted with 326 French cardiologists established in general office practice, involving on the one hand an opinion survey among the cardiologists and on the other hand a cross-sectional observatory of usual medical practice. Each cardiologist was asked to include two patients aged less than 65 with non-permanent (paroxysmal or persistent) AF without left ventricle dysfunction (LVD) and initiated on treatment with a VW type IC antiarrhythmic after cardioversion to sinus rhythm. RESULTS: The opinion survey among the cardiologists indicates that non-permanent AF constitutes 36.1% of AF cases, of which 57.8% concern LVD-free patients. Most cardiologists (85%) declare to institute a preventive therapy of AF recurrences in 70-100% of these patients after cardioversion to sinus rhythm, with a VW type IC antiarrhythmic in more than 50% of cases. Of the 633 patients included in the FAUVE observatory, mainly men, 409 (64.6%) had paroxysmal AF and 224 (35.4%) had persistent AF. Analysis of therapeutic management shows that both alteration of the previous treatment and the choice of a VW type IC antiarrhythmic are based chiefly on efficacy and on tolerability of the antiarrhythmic therapy. CONCLUSION: VW type IC antiarrhythmics constitute a therapy of choice for the maintenance of sinus rhythm in non-aged and LVD-free patients with non-permanent AF.

Gustatory sensilla sensitive to protein kairomones trigger host acceptance by an endoparasitoid.

Proteins isolated from the host cocoon of Acrolepiopsis assectella (Lepidoptera: Yponomeutoidea) act as kairomones for host acceptance by the endoparasitoid wasp Diadromus pulchellus Wesmael (Hymenoptera: Ichneumonidae). In this study, morphological, ultrastructural and electrophysiological studies were carried out in order to identify the contact chemoreceptive sensilla on the parasitoid antennae that perceive the protein kairomones. Three types of sensillum on the antennae of the females were found to have a chemosensory function. The receptor cell(s) of one sensillar type were shown to give a positive electrophysiological response to protein kairomones. This sensillar type is apically multiporous and female specific. Consequently, this sensillum could be the one implicated in the perception of the protein kairomone that triggers the host-acceptance behaviour of D. pulchellus females.

Food experience on the predatory behavior of the ant Myrmica rubra towards a specialist moth, Acrolepiopsis assectella.

Entomophagous insects are often repelled by the secondary compounds of the plants eaten by their prey. These compounds, therefore, take on a defensive role for the phytophagous species that sequester them. Given that numerous entomophagous species are capable of learning, the effects on the foraging behavior of a repeated experience were investigated in the predatory ant Myrmica rubra. The sulfur amino acids methyl-cysteine sulfoxide (MCSO) and propyl-cysteine sulfoxide (PCSO) produced by Allium plants were identified in caterpillars of the leek moth Acrolepiopsis assectella. Three behavioral studies were carried out, with or without prior familiarization with caterpillars reared either on leek or on an artificial diet containing no Allium compounds. In choice tests with the two types of caterpillars, unfamiliarized ants displayed a preference for caterpillars reared on the artificial diet, but this preference disappeared or was reversed in both young and old ants after familiarization.

Identification and synthesis of a kairomone mediating host location by two parasitoid species of the cassava mealybug Phenacoccus herreni.

Two encyrtid species, Acerophagus coccois and Aenasius vexans, parasitoids of the cassava mealybug Phenacoccus herreni use a contact kairomone from the body surface of their host as a host-location stimulant. The kairomone was synthesized and identified as O-caffeoylserine based on a combination of chromatographic methods. The synthetic compound was determined to be active.

Polypeptides of Acrolepiopsis assectella cocoon (Lepidoptera: Yponomeutoidea): an external host-acceptance kairomone for the parasitoid Diadromus pulchellus (Hymenoptera: Ichneumonidae).

Contact kairomones are essential for host-acceptance behaviour by female parasitoids. In the solitary endoparasitoid wasp, Diadromus pulchellus, this behaviour depends mainly on compound(s) in the cocoon of their host, Acrolepiopsis assectella pupae. Extracts of empty cocoons and polypeptides extracted from cocoons were tested in acceptance behaviour assays using cotton fibre lures bearing extracts. Extractions with solvents of increasing polarity indicated that the active compounds were polar, while SDS-PAGE showed that four glycopolypeptides contained enough information to trigger host-acceptance behaviour in female wasps. This kairomonal activity was found to be due to the protein moieties, and was independent of any glycosylation. These four glycopolypeptides might be two variants of two soluble sericin-like polypeptides differing in their degree of glycosylation.

Early versus delayed angiotensin-converting enzyme inhibition in experimental chronic heart failure. Effects on survival, hemodynamics, and cardiovascular remodeling.

BACKGROUND: The efficacy of ACE inhibitors in congestive heart failure (CHF) might be affected by the pathophysiological status present at the onset of treatment. We compared in a rat model the effects of ACE inhibition (lisinopril, 10 mg.kg-1.d-1) initiated early (1 week) or late (3 months) after myocardial infarction (i.e., at time points corresponding to moderate or severe CHF without or with established cardiac remodeling). METHODS AND RESULTS: Survival was improved by early treatment at 3 months (from 76% to 95%) and by both early and delayed treatment at 9 months (placebo, 28%; early, 90%; delayed, 61%). Delayed treatment was initiated in a more severe pathophysiological context of CHF than early treatment, illustrated in untreated rats by higher left ventricular (LV) end-diastolic and central venous pressures and by increased LV weight and LV cavity circumference. After 9 months, early and delayed treatments reduced systolic, LV end-diastolic, and central venous pressures. Both treatments also similarly decreased LV weight, LV cavity circumference, and LV collagen density. CONCLUSIONS: In this rat model of CHF, early and delayed ACE inhibitor treatments both increase survival and exert similar beneficial effects on cardiac hemodynamics and remodeling. Although early treatment prevents the development of ventricular dysfunction and remodeling, delayed treatment is capable of reversing cardiac hypertrophy and remodeling, as well as ventricular dysfunction. Thus, ACE inhibitors exert marked beneficial effects even when treatment is initiated late into the evolution of heart failure (ie, at a time of established ventricular dysfunction and remodeling).

Response of large and small vessels to alpha and beta adrenoceptor stimulation in heart failure: effect of angiotensin converting enzyme inhibition.

The increased sympathetic drive in chronic heart failure (CHF) might provoke vascular adrenoceptor desensitization, which, together with endothelial dysfunction, could contribute to the altered vasomotor tone seen in CHF. We investigated 1) whether CHF alters the responses mediated by alpha and beta adrenoceptors in small and large peripheral arteries, and 2) the effect of angiotensin-converting enzyme (ACE) inhibition. Rats with CHF (coronary artery ligation) were treated with placebo or the ACE inhibitor lisinopril (10 mg/kg/d) starting 7 days after ligation. Responses to phenylephrine (alpha 1 agonist), salbutamol (beta 2 agonist) as well as acetylcholine (endothelium-dependent), were assessed after 3 months in isolated and pressurized segments of the abdominal aorta, the femoral and the mesenteric arteries. In animals with hemodynamic signs of CHF, neither the vasoconstrictor responses to phenylephrine nor the vasodilator response to salbutamol were affected. In contrast, the dilator response to acetylcholine of both small arteries, but not that of the aorta, was impaired. Furthermore, CHF did not modify vessel structure. While lisinopril did not modify the responses to adrenergic agonists, it normalized the response to acetylcholine. Furthermore, ACE inhibition reduced vascular media cross sectional area and collagen density. Thus, the unchanged arterial responsiveness to adrenoceptor agonists does not indicate any vascular adrenoceptor desensitization, while endothelial dependent vasodilation of small arteries is impaired in CHF. ACE inhibition does not modify the response to adrenergic stimuli, prevents endothelial dysfunction and induces both cardiac and vascular remodeling, which probably contribute to the effect ACE inhibitors have on exercise tolerance and survival.

Origin and identification of bacteria which produce kairomones in the frass of Acrolepiopsis assectella (Lep., Hyponomeutoidea).

The volatiles used by the parasitoid Diadromus pulchellus to find its host, the leek moth, are produced by the bacteria developing in the frass of the host larvae. The origin and the nature of these bacteria were investigated. Samples were taken from healthy leeks and from infested leeks in the field, as well as from the frass of larvae reared in the laboratory either on the host plant or on an artificial diet. The various species of bacteria identified were cultured in the presence of precursors of leek sulphur volatiles and their volatile emissions were analysed. Klebsiella oxytoca and various Bacillus, common decomposers of plant matter, were the principal species producing active volatiles which were alkyl disulphides.

[Combination therapy in cardiovascular diseases other than hypertension]. / Les bithérapies dans les pathologies cardiovasculaires autres que l'hypertension.

As in hypertension, the addition of a second active drug is believed to enhance treatment efficacy; however, the extent to which a combination of two low-dose drugs outperforms conventional monotherapy remains uncertain. Established treatments of angina comprises nitrates compounds, beta-blockers and calcium antagonists, which are often given in combination. Beta-blockers are major players in this field as they inhibit the tachycardia induced by nitrates and calcium antagonists; there is therefore a pathophysiological justification for their use in combination therapy, supported by repeated confirmation of positive clinical effect. The most widely chosen calcium antagonists are dihydropyridines; verapamil may impair conduction. However, it is not clear whether combination enhances the effects of the individual antianginal substances. Diuretics are for most clinicians the keystone treatment of heart failure; diuretics are often combined with other drugs, e.g. amiloride and spironolactone. The latter also have a beneficial effect on myocardial structure (myocardium/collagen ratio). ACE-inhibitors are of proven clinical efficacy, and, in addition, have a beneficial effect on survival. They combine well with diuretics: because the diuretic stimulates renin release, the ACE-inhibitor can be given at a lower dose (enhancement of effect). There are, however, certain drawbacks (hypotension, hyperkalemia with antialdosterones). The results of combining ACE-inhibitors with calcium antagonists and beta-blockers await investigation. The ISIS studies demonstrated the advantages of combining beta-blockers, thrombolysis and aspirin in acute infarction. ACE-inhibitors have recently been added to the regimen with a positive effect (extended survival), especially in the presence of a decreased ejection fraction (SAVE, AIRE, GISSI 3 and ISIS 4 studies).(ABSTRACT TRUNCATED AT 250 WORDS)

[The ATLAS study (Assessment of Treatment with Lisinopril and Survival); justification and objectives]. / L'étude ATLAS (assessment of treatment with lisinopril and survival); justification et objectifs.

Treatment with ACE inhibitors has improved the prognosis of cardiac failure (CF). The results of CONSENSUS I, SOLVD and V HEFT II show clinical improvement and longer survival with this therapeutic class of drugs. However, the search for the optimal dosage was not undertaken in these trials (a standard dose was fixed at the onset, average dose of enalapril from 15 to 20 mg/day). In clinical practice, patients are prescribed lower doses of ACE inhibitors (enalapril: 7.5 mg/day) than the averages used in large scale trials. In order to optimise the use of ACE inhibitors, the ATLAS study (Assessment of Treatment with Lisinopril and Survival) was undertaken with the precise objective of comparing two dosages (2.5 to 5 mg/day vs 32.5 to 35 mg/day) of lisinopril on the morbidity and mortality of patients with CF. This international, multicenter, randomised, double-blind parallel group trial aims to include 3,000 patients over 18 years of age with NYHA Classes II, III and IV, and an ejection fraction < or = 30% and to follow them up for 3 to 4.5 years. Nearly 30 French centres will participate in this trial. After an initial, open period of evaluation of tolerance (5 mg to 15 mg/day of lisinopril in France), the patients will be randomised to two groups. After randomisation, all patients will receive 5 mg per day of lisinopril. The "high dose" group will receive 20 mg/day for two weeks, then 30 mg/day in addition to the "open dosage". In cases of intolerance, the dosage may be reduced to 20 mg/day or 10 mg/day, or the drug may be withdrawn.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of lisinopril on stress-induced peak blood pressure and sodium excretion: a double-blind controlled study.

A stress test was performed before (S1) and after a 1-month treatment period (S2) in patients with essential hypertension, randomly allocated to receive either an angiotensin-converting enzyme inhibitor (ACEI), lisinopril (n = 10), or placebo (n = 10). The two groups were similar with regard to systolic and diastolic blood pressure (SBP, DBP), body weight, renal function, and 24-h sodium excretion. At S1, stress induced a significant increase in SBP of 18 +/- 9 mm Hg and in DBP of 10 +/- 6 mm Hg and a significant reduction in sodium excretion from 258 +/- 105 to 204 +/- 72 mumol/min. Stress-induced sympathetic stimulation was assessed by a significant increase in urinary norepinephrine (NE) excretion from 21 +/- 10 to 26 +/- 10 micrograms/g creatinine. One-month treatment by placebo did not change stress-induced BP reactivity, sodium retention, or urinary NE excretion. In the lisinopril group, rest and stress BP were significantly reduced by the treatment. Stress-induced sodium retention was higher after 1-month placebo treatment (72 +/- 78 vs 48 +/- 67 mumol/min), whereas this retention was significantly reduced by lisinopril (13 +/- 27 vs 69 +/- 60 mumol/min).

Nature and role of sexual pheromones emitted by males ofAcrolepiopsis assectella (LEP.).

Seven compounds that do not exist in the extracts from legs of males have been isolated in the hair-pencil extracts of maleAcrolepiopsis assectella. By combining techniques of GC-MS and GC-FT-IR, six of these compounds have been identified. They are sixn-alkanes: hexadecane (C16), heptadecane (C17), octadecane (C18), nonadecane (C19), eicosane (C20), and heneicosane (C21). Twelven-alkanes of the homologous series, from the C14-C25 compounds were presented to virgin females, mated females, and males. At the end of the scotophase, four of then-alkanes (C16, C17, C19, C21) present in the hair-pencil extract induced the virgin females to adopt the acceptance posture after having induced the virgin females to remain stationary. The two othern-alkanes (C18 and C20) present in the extract have less effect on the females similar to then-alkanes not present in the males. The blends tested do not seem to indicate any synergy between the most active compounds. The threen-alkanes with an odd number of carbons and the C16 compound would thus be the principle components of the male pheromone ofA. assectella. As well as their role of female aphrodisiac, they tend to make males and fertilized females flee.

Effects of lisinopril and hydrochlorothiazide on platelet function and blood rheology in essential hypertension: a randomly allocated double-blind study.

AIM: To compare the effects of an angiotensin converting enzyme (ACE) inhibitor and a thiazide diuretic on platelet function and haemorrheological variables, since these factors may contribute to the atherosclerotic and thrombotic complications associated with hypertension. METHODS: Following a 2-week placebo period, 80 male and female patients with mild to moderate hypertension, aged 50 +/- 10 (mean +/- SD) years, were randomly allocated in a double-blind study to 4 weeks of treatment with the ACE inhibitor lisinopril at 20 mg once a day or the diuretic hydrochlorothiazide at 25 mg once a day. Venous blood was sampled before and at the end of the 4-week treatment period to assess platelet function and haemorrheological variables. RESULTS: Both treatments lowered systolic and diastolic blood pressure equally and had no significant effect on platelet counts and platelet aggregation in response to ADP and to arachidonic acid. Haematocrit plasma viscosity and blood filterability were not altered by either drug. Hydrochlorothiazide tended to increase and lisinopril tended to decrease whole blood viscosity at all shear rates but these changes did not reach statistical significance. Lisinopril increased the erythrocyte aggregation time (from 1.98 +/- 0.50 to 2.08 +/- 0.52 s) and decreased the disaggregation shear rate (from 159 +/- 46 to 153 +/- 40 s-1) and the disaggregation shear stress (from 705 +/- 257 to 659 +/- 204 mPa). Hydrochlorothiazide induced the opposite effects (2.00 +/- 0.47 to 1.92 +/- 0.39 s, 181 +/- 531 to 196 +/- 82 s-1 and 813 +/- 268 to 868 +/- 392 mPa, respectively) with a statistically significant (P < 0.05) intergroup difference. CONCLUSIONS: These findings suggest that chronic treatment with the ACE inhibitor lisinopril, but not the diuretic hydrochlorothiazide, may produce favourable effects on blood rheology, but the clinical relevance requires further investigation.

Use of monitoring software to improve the measurement of carotid wall thickness by B-mode imaging.

METHODOLOGY: High-resolution B-mode imaging is a reliable, easily performed and non-invasive means of studying atherosclerosis in superficial blood vessels. Recently it has been used for in vivo studies on the thickness of the common carotid artery wall. It is very sensitive, although the results of practical investigations are highly dependent on both the operator and the direction and angle of ultrasound beams directed towards the vessel. PROTOCOL: We have assessed inter- and intra-observer reproducibility of the measurement of common carotid artery wall thickness in 13 subjects, using two procedures. The first was a standard echographical investigation. In the second procedure, the principal parameters recorded from the first investigation were used to reposition the beam with the same incident angle. RESULTS: Intra-observer variability (correlation coefficient, r = 0.61 for procedure 1 and r = 0.77 for procedure 2) and inter-observer variation (r = 0.58 for procedure 1 and r = 0.71 for procedure 2) were reduced when the second investigation was assisted by reproducibility software. CONCLUSIONS: The proposed method is a reliable and reproducible way of assessing combined intimal and medial wall thickness in the common carotid artery. It may be possible to improve reproducibility using specific software to aid the operator. Since the intimal and medial thickness of the common carotid artery appears to be a sensitive marker of vascular risk, the proposed standardized method of measuring these parameter may allow early detection and assessment of changes.