Self-perceived attention difficulties are associated with sensory hypersensitivity in migraine.

BACKGROUND: Attention is the process which enables to preferentially select salient or relevant stimuli and to attenuate the response to irrelevant incoming stimuli. Migraine is characterized by both attentional alterations and an abnormal sensory processing to external stimulations. The aim of the study was to investigate potential interactions between self-perceived attentional difficulties and sensory hypersensitivity in migraine patients. METHODS: Forty-six episodic migraineurs without aura and 46 healthy controls filled out questionnaires on self-perceived attention difficulties and self-reported sensitivity to visual, auditory and olfactory stimulations. RESULTS: Compared to controls, migraineurs reported significantly higher levels of attention difficulty and sensory sensitivity. Sensory hypersensitivity correlated significantly with self-perceived attentional difficulties in migraineurs (P=0.002), but not with migraine disability or levels of anxiety or depression. Ictal and interictal sensory sensitivities were significantly correlated in migraineurs within visual (P<0.001), auditory (P<0.001) and olfactory (P=0.001) modalities. CONCLUSION: This study shows for the first time an association between self-reported attentional difficulties and multimodal sensory hypersensitivity. Studies combining behavioral and physiological measures of sensory processing and attention processes are necessary to further understand the peculiar vulnerability of migraineurs to sensory stimuli.

Epibulbar osseous choristoma: a clinicopathological case series and review of the literature.

BACKGROUND: Choristomas are benign, congenital tumours composed of normal tissue in an abnormal location. Osseous choristomas represent the rarest form of epibulbar choristomas, with now 65 cases reported in the literature. We did a retrospective clinicopathological study of all patients with epibulbar osseous choristoma observed at our institution since 1982 and updated the last review of the literature. HISTORY AND SIGNS: Three Caucasian male patients, aged between 3 months and 11 years, were identified. All osseous choristomas were located under the superotemporal bulbar conjunctiva of the right eye. THERAPY AND OUTCOME: All lesions were managed with surgical excision. Histopathology revealed the presence of lamellar bone in all cases, one of which was associated with a dermolipoma. CONCLUSIONS: We report a small rare case series of 3 epibulbar osseous choristomas and did a review of the literature. In one patient, the osteoma was associated with a dermolipoma, corresponding to the fourth reported complex choristoma of this type, in an otherwise normal eye, in the literature.

Scleritis after proton therapy in uveal melanoma.

BACKGROUND: Sclera is a very radioresistant tissue and scleritis after proton therapy has not been described so far. HISTORY AND SIGNS: Four female patients, aged between 31 and 74 years, were treated with proton therapy for uveal melanoma (height range: 2.2 - 3.5 mm), located in the macula, the superior equator and 2 in the ciliary body. All patients had a history of a previous or active inflammatory disease and developed scleritis after radiotherapy. THERAPY AND OUTCOME: Two patients had infectious scleritis and were treated with adequate antibiotic therapy. After systemic corticotherapy, 3 patients recovered completely; the remaining patient was managed with additional immunosuppressive treatment as well as a conjunctival and scleral graft, but has not become pain free yet. CONCLUSION: Scleritis is a possible complication after proton therapy, probably on an ischemic basis, where there is a predisposing factor such as inflammatory systemic disease.

V kappa gene family in (Glu60 Ala30 Tyr10)n (GAT)-specific antibodies that express CGAT (or pGAT) public idiotypic specificities. Protein and mRNA sequencing of eight monoclonal V kappa chains.

A large proportion of (Glu60 Ala30 Tyr10)n (GAT)-specific antibodies expresses public idiotypic specificities, termed CGAT (or pGAT), that require the presence of both the heavy and the light chains in order to be expressed. We report in this paper the complete sequence of eight V kappa regions pertaining to eight anti-GAT monoclonal antibodies derived from three strains of mice: BALB/c, DBA/2, and C57BL/6. The methodology used a combination of NH2-terminal amino acid and mRNA nucleotide sequencing. All eight sequences analyzed, although highly homologous and all pertaining to the same V kappa 1 subgroup, allowed definition of three germline genes that are likely to be present in all three strains of mice and also in NZB. It seems likely, however, that any given strain may not necessarily use all three genes for making anti-GAT antibodies. The search for structural correlates of idiotypes could not be framed in a simple picture, but our data suggest that similar idiotopes may result from different interacting primary structures, leading to structural homologies that should be visualized at three-dimensional level.

Is implant placement performed at the same surgical time as orbital exenteration a viable procedure?

PURPOSE: To assess the efficacy and safety of bone-anchored dental implant placement at the same time as orbital exenteration compared with delayed implant placement. MATERIALS AND METHODS: A retrospective comparative study was conducted in a single tertiary care center between December 2003 and December 2017. Patients who underwent bone-anchored implant placement at the same time as orbital exenteration were included (group 1) and compared with patients who underwent delayed implant placement (group 2). The main outcome was the 1-year success rate of implant osseointegration. The secondary outcomes were the 5-year success rate of osseointegration, postoperative complications, and time between orbital exenteration and prosthesis placement. RESULTS: Ten and 11 patients (21 and 22 implants) with a mean follow-up of 50.2 and 48.5 months were included in groups 1 and 2, respectively. Patients in group 1 were significantly older (69.7 vs 61.2 years, P = .026). No significant differences were found between both groups regarding tumor type and location, prior treatments, smoking status, and postoperative radiation beam radiotherapy. The 1- and 5-year success rates of osseointegration were 95.5% and 93.3% in group 1, and 100% and 100% in group 2, respectively (P = .488 and P = .450 between both groups). One implant did not osseointegrate in group 1 due to osteitis. Ethmoidal fistula was the most common postoperative complication found in both groups (P = .670). The mean time between orbital exenteration and episthesis placement was 8 (3 to 14) vs 11 (3 to 15) months in groups 1 and 2, respectively (P = .467). CONCLUSION: Placing implants at the same time as orbital exenteration is a viable procedure. It reduces surgical morbidity and allows placement of implants in a nonirradiated area.

Orbital exenteration and conjunctival melanoma: a 14-year study at the Jules Gonin Eye Hospital.

PURPOSE: To report our 14-year experience with orbital exenteration and assess risk factors for poor prognosis by focusing on conjunctival melanoma. PATIENTS AND METHOD: A retrospective study was conducted in our tertiary care centre (Jules Gonin Eye Hospital, Lausanne, Switzerland) between 2003 and 2017. Inclusion criteria were patients aged ≥18 years with a follow-up >12 months, without metastatic spread at the time of surgery. Data recorded were age, gender, tumour histology, surgical technique, postoperative complications, surgical margin status, local recurrence, postoperative radiation beam therapy and metastatic status. RESULTS: Twenty-five patients with a mean age of 63.2 years (38-92) were included. Conjunctival melanoma was the most frequently identified tumour (n = 14, 56%) followed by conjunctival squamous cell carcinoma (n = 4, 16%), sebaceous carcinoma (n = 3, 12%), choroidal melanoma (n = 2, 8%) and basal cell carcinoma (n = 2, 8%). Eighteen tumours (72%) originated from the conjunctival tissue. Clear surgical margins were achieved in 21 (84%) patients. Fourteen (56%) patients experienced distant metastases and died from metastatic spread after a mean follow-up of 52.3 months (6-120). The 1-, 3- and 5-year overall survival (OS) was 96%, 72% and 60%, respectively. In the univariate analysis, positive surgical margins, local recurrence and metachronous metastases were associated with a decreased OS (p = 0.002, p = 0.005 and p = 0.007, respectively). In the multivariate analysis, positive surgical margins and metachronous metastases were also associated with a decreased OS (p = 0.02 and p = 0.042, respectively). Conjunctival melanoma was not associated with a poorer prognosis (p = 0.280). CONCLUSION: Free surgical margins are needed to increase OS. To achieve clearer surgical margins, neoadjuvant targeted therapies/immunotherapies may be considered.

The temporal relationship between speech auditory brainstem responses and the acoustic pattern of the phoneme /ba/ in normal-hearing adults.

OBJECTIVE: To investigate the temporal relationship between speech auditory brainstem responses and acoustic pattern of the phoneme /ba/. METHODS: Speech elicited auditory brainstem responses (Speech ABR) to /ba/ were recorded in 23 normal-hearing subjects. Effect of stimulus intensity was assessed on Speech ABR components latencies in 11 subjects. The effect of different transducers on electromagnetic leakage was also measured. RESULTS: Speech ABR showed a reproducible onset response (OR) 6ms after stimulus onset. The frequency following response (FFR) waveform mimicked the 500Hz low pass filtered temporal waveform of phoneme /ba/ with a latency shift of 14.6ms. In addition, the OR and FFR latencies decreased with increasing stimulus intensity, with a greater rate for FFR (-1.4ms/10dB) than for OR (-0.6ms/10dB). CONCLUSIONS: A close relationship was found between the pattern of the acoustic stimulus and the FFR temporal structure. Furthermore, differences in latency behaviour suggest different generation mechanisms for FFR and OR. SIGNIFICANCE: The results provided further insight into the temporal encoding of basic speech stimulus at the brainstem level in humans.

[Medical ethics and cultures of the world]. / Ethique médicale et cultures du monde.

We celebrate the anniversary of the Société de Pathologie exotique, founded in 1908. Is the term exotic still appropriate to single out a kind of pathology, in the era of Globalization? And what is the meaning of labeling different sets of ethical values, some of which can be said exotic, with the legitimate purpose of acknowledging, on an equal footing, the irreducible differences among cultures? Further research often reveals behind the so-called pluralism of values the socio-economic inequalities, which explain disparities. "Exotic" indicates a crying need for more in-depth analysis of medical practices in all countries, including Western ones, and an alternating close and remote look at all of them, in order to display "a rainbow of values on an ethical horizon".

Ghrelin control of GH secretion and feeding behaviour: the role of the GHS-R1a receptor studied in vivo and in vitro using novel non-peptide ligands.

Energy homeostasis is controlled by a complex regulatory system of molecules that affect food intake and that are critical for maintaining a stable body weight during life. Ghrelin is a peptide of 28 amino acid synthesized predominantly by the stomach and the gut, which activate the type 1a growth hormone (GH) secretagogue receptor (GHS-R1a), a G-protein coupled receptor. The acylated form of ghrelin potently stimulates GH secretion both in vitro and in vivo in several animal species, including humans. Beside the endocrine effect, ghrelin shows also extraendocrine activities, including stimulation of feeding behaviour. Several classes of small synthetic peptide and non-peptide ligands of the GHS-R1a have been described and are able to release GH and stimulate food intake. However, in time, it appeared that the stimulating effects on GH secretion could be divorced from those on food intake, suggesting that more than a single receptor might be involved. Several experimental data have even questioned the physiological role of ghrelin in the control of GH secretion and energy metabolism. By using novel agonists, partial agonists, and antagonists for the GHS-R1a receptor, we have studied whether the stimulation of this receptor could account for the purported physiological role of ghrelin. Our results demonstrate that the ability to bind in vitro the GHS-R1a is not predictive of the in vivo biological activity of the compounds and that the endocrine and extraendocrine effects could be mediated also by receptors different from the GHS-R1a.

[Clinical, radiological, pathological features, treatment and follow-up of periocular and/or orbital amyloidosis: Report of 6 cases and literature review]. / Caractéristiques cliniques, radiologiques, anatomopathologiques, thérapeutiques et évolutives de l'amylose périoculaire et/ou intraorbitaire : à propos de 6 cas et revue de la littérature.

PURPOSE: To assess demographic, clinical, radiological, pathological features, treatment and follow-up of periocular or/and orbital amyloidosis. PATIENTS AND METHODS: We conducted an observational retrospective monocentric study from January 2004 to April 2017 in patients diagnosed with histologically proven periocular or/and orbital amyloidosis. RESULTS: Six patients were included (2 females, 4 males). Mean age was 76.8 years (range 66-88 years). Mean time between first ophthalmological symptoms and diagnosis was 27 months (range 11-36 months). The main symptoms were subconjunctival infiltration (6 patients; 100%), periocular pain or discomfort (4 patients; 66.6%) and subconjunctival hemorrhage (1 patient; 16.6%). Clinical findings included ptosis (4 patients; 66.6%), keratitis (3 patients; 50%) leading to corneal perforation in one patient, and proptosis (3 patients; 50%). One-half of the patients showed bilateral involvement. AL amyloidosis was identified on immunohistochemistry in 5 patients (83.3%). One case of B cell marginal zone orbital lymphoma was diagnosed. Systemic work-up was negative for all patients. Treatment consisted of simple monitoring (1 patient; 16.6%), surgical debulking (3 patients; 50%), ptosis surgery (1 patient; 16.6%), eyelid or eyelash malposition surgery (2 patients; 33.3%) and orbital radiation beam therapy (2 patients; 33.3%). Mean follow-up was 14.6 months (range 6-36 months), and no progression nor recurrence were noted. CONCLUSION: Periocular or/and orbital amyloidosis is rarely encountered. Diagnosis is based on pathological examination, and immunohistochemistry analysis should always be performed to guide systemic work-up. Orbital lymphoma and multiple myeloma should be ruled out if AL amyloidosis is diagnosed. Progression is slow, and surgery is the mainstay of treatment in symptomatic patients. Long-term multidisciplinary follow-up is advocated.

A brief history of vaccines and vaccination.

Human vaccinology, with its primary focus on the individual, seems far removed from veterinary medicine, with its concern for the health of the herd. Yet several episodes in the past (smallpox, fowl cholera, anthrax, swine erysipelas, rabies, tuberculosis, etc.) serve to illustrate the proximity between research on veterinary and human vaccines. In some cases the human vaccine was developed first, while in other cases it was the animal vaccine. The history of vaccinology clearly demonstrates the importance of these 'two medicines' working together. Foot and mouth disease (FMD) vaccines were among the first vaccines to be developed, beginning at the end of the 19th Century. Thanks to the discoveries of several researchers, including European researchers such as Vallée (French), Waldmann (German), Frenkel (Dutch) and Capstick (British), FMD vaccines began to be produced on an industrial scale from 1950 onwards, making possible vaccination of millions of animals in Europe and beyond. Vaccination strategies against FMD have always been dependent on the properties of the vaccines being used. At the beginning of the 21st Century FMD vaccines are designed in such a way that serological tests can differentiate infected from vaccinated animals, which has affected OIE regulations on international trade in animals and animal products. The history of vaccination against rinderpest, bovine contagious pleuropneumonia, and Marek's disease will also be dealt with.

[How can social sciences contribute to vaccination in the tropics?]. / Programmes de vaccination en milieu tropical l'apport d'une réflexion en sciences sociales.

In the past, governments were eager to propagate vaccines along generally adopted authoritarian methods. Yet, a retrospective inquiry detects uneven acceptance of vaccines, for reasons which point to differences in cultures and political contexts and involve also the efficacy and reliability of vaccines. After the Alma Ata conference in 1978, vaccines in the Tropics have become part of the core package of primary health care. In the context of political unrest and defiance toward the dominant powers (as illustrated in many countries, from Philippines to Nigeria), it remains more crucial than ever to pay due attention to the needs and demands of the population and listen to the way they wish to receive preventive and curative care. The importance of communicating on science in the making and respecting the individual's bodily integrity and intellectual autonomy is paramount in the Tropics.

[French specificities in the history of vaccination. The end of an exception?]. / Les particularités françaises de l'histoire de la vaccination. La fin d'une exception?

Five years after the National Health minister launched the vaccination program against hepatitis B in 1994, French public health experts are not satisfied by the coverage rate among young people. Is this stagnation related to the controversial way the program was initially managed and to the debate that has raged on the link between the vaccine and multiple sclerosis? Is the popular reaction of distrust specific to the vaccine or does it reveal a growing concern towards the whole vaccinal enterprise? More generally, is it the end of the almost unconditional French acceptance of vaccines? A historical retrospective on the history of vaccination in the country of Louis Pasteur.

[Back to the Future. Vaccine trials against Ebola in the history of resistance to immunization]. / « Back to the Future ¼. Les essais vaccinaux contre Ebola, au regard de l'histoire des résistances à l'immunisation.

Vaccine trials against Ebola virus have been conceived and organized, in August 2014, after the epidemic started in three countries of West Africa. If the preparedness had been missing, the planners tried to anticipate the resistance to vaccination, in Guinea, Sierra Leone and Liberia. This article offers a retrospective view on the resistances to vaccination throughout its history, from smallpox inoculation to anti-polio vaccine. Resistances have been linked to the political contexts and the rejection of an oppressive power, either local or foreign, as well as mistakes and scientific uncertainties. The analysis of the historical factors of resistance leads to reverse the question: what convinces people to accept a vaccine trial, despite the obscurities of the immunization processes inside the body? The article hypothesizes that Guineans and West Africans face a dilemma similar to their counterparts in the past, whether or not to rally to an experimental immunization, the results of which are still pending. They may appropriate the Western beliefs about the efficacy of vaccines to their own ways of circumventing misfortune. Further field studies will be required to assess the role of the vaccinal trials and the response to the epidemic in the "convalescence" of these societies, being aware that the trials will not allow a complete assessment of the vaccines, because of the end of the epidemic.