Basal Ti level in the human placenta and meconium and evidence of a materno-foetal transfer of food-grade TiO2 nanoparticles in an ex vivo placental perfusion model.

BACKGROUND: Titanium dioxide (TiO2) is broadly used in common consumer goods, including as a food additive (E171 in Europe) for colouring and opacifying properties. The E171 additive contains TiO2 nanoparticles (NPs), part of them being absorbed in the intestine and accumulated in several systemic organs. Exposure to TiO2-NPs in rodents during pregnancy resulted in alteration of placental functions and a materno-foetal transfer of NPs, both with toxic effects on the foetus. However, no human data are available for pregnant women exposed to food-grade TiO2-NPs and their potential transfer to the foetus. In this study, human placentae collected at term from normal pregnancies and meconium (the first stool of newborns) from unpaired mothers/children were analysed using inductively coupled plasma mass spectrometry (ICP-MS) and scanning transmission electron microscopy (STEM) coupled to energy-dispersive X-ray (EDX) spectroscopy for their titanium (Ti) contents and for analysis of TiO2 particle deposition, respectively. Using an ex vivo placenta perfusion model, we also assessed the transplacental passage of food-grade TiO2 particles. RESULTS: By ICP-MS analysis, we evidenced the presence of Ti in all placentae (basal level ranging from 0.01 to 0.48 mg/kg of tissue) and in 50% of the meconium samples (0.02-1.50 mg/kg), suggesting a materno-foetal passage of Ti. STEM-EDX observation of the placental tissues confirmed the presence of TiO2-NPs in addition to iron (Fe), tin (Sn), aluminium (Al) and silicon (Si) as mixed or isolated particle deposits. TiO2 particles, as well as Si, Al, Fe and zinc (Zn) particles were also recovered in the meconium. In placenta perfusion experiments, confocal imaging and SEM-EDX analysis of foetal exudate confirmed a low transfer of food-grade TiO2 particles to the foetal side, which was barely quantifiable by ICP-MS. Diameter measurements showed that 70 to 100% of the TiO2 particles recovered in the foetal exudate were nanosized. CONCLUSIONS: Altogether, these results show a materno-foetal transfer of TiO2 particles during pregnancy, with food-grade TiO2 as a potential source for foetal exposure to NPs. These data emphasize the need for risk assessment of chronic exposure to TiO2-NPs during pregnancy.

[Mental health care in French correctional facilities during the Covid-19 pandemic]. / Prisons confinées : quelles conséquences pour les soins psychiatriques et la santé mentale des personnes détenues en France ?

OBJECTIVE: The impact of the Covid-19 pandemic on the 11 million people currently incarcerated worldwide is the subject of many concerns. Prisons and jails are filled with people suffering from many preexisting medical conditions increasing the risk of complications. Detainees' access to medical services is already limited and overcrowding poses a threat of massive contagion. Beyond the health impact of the crisis, the tightening of prison conditions worries. On March 16, 2020, in France, the lockdown measures have been accompanied by specific provisions for prisons: all facilities have suspended visitations, group activities and external interventions. Over 10,000 prisoners have been released to reduce the prison population and the risk of virus propagation. These adjustments had major consequences on the healthcare system in French prisons. The objectives of this article are to describe the reorganization of the three levels of psychiatric care for inmates in France in the context of Covid-19 pandemic and to have a look at the impact of lockdown measures and early releases on mental health of prisoners. METHODS: This work is based on a survey conducted in April 2020 in France among psychiatric healthcare providers working in 42 ambulatory units for inmates and in the 9 full-time inpatient psychiatric wards exclusively for inmates called "UHSAs" (which stands for "unités hospitalières spécialement aménagées", and can be translated as "specially equipped hospital units"). A review of the international literature on mental healthcare system for inmates during the Covid-19 epidemic has also been performed. RESULTS: The Covid-19 epidemic has been rather contained during the period of confinement in French prisons but the impact of confinement measures on the prison population is significant. The three levels of psychiatric care for inmates have implemented specific measures to ensure continuity of care, to support detainees during Coronavirus lockdown and to prevent an infection's spread. Among the most important are: limitation of medical consultations to serious and urgent cases, creation of "Covid units", cancellation of voluntary psychiatric hospitalizations, reinforcement of preventive hygiene measures and reshuffling of medical staff. Prolonged confinement has consequences on mental health of detainees. Currently, mental health workers are facing multiple clinical situations such as forced drug and substance withdrawal (linked to difficulties in supplying psychoactive substances), symptoms of anxiety (due to concerns for their own and their relatives' well-being) and decompensation among patients with severe psychiatric conditions. Early releases from prison may also raise some issues. People recently released from prison are identified as at high risk of death by suicide and drug overdose. The lack of time to provide the necessary link between health services within prisons and health structures outside could have serious consequences, emphasizing the well-known "revolving prison doors" effect. DISCUSSION: The current lockdown measures applied in French jails and prisons point out the disparities between psychiatric care for inmates and psychiatric care for general population. Giving the high vulnerability of prison population, public health authorities should pay more attention to health care in prisons.

Ischaemic myelopathy secondary to disseminated intravascular coagulation in AIDS.

A 39-year-old patient with AIDS presented with a rapidly progressive myelopathy with a partial Brown-Séquard syndrome. He died, 9 weeks after onset of the first neurological signs, from diffuse encephalopathy. Neuropathological examination revealed multiple, usually small, frequently haemorrhagic, infarcts or various ages and numerous fibrin thrombi in medium and small penetrating vessels and capillaries of the brain and spinal cord, characteristic of disseminated intravascular coagulation. There were no inflammatory changes. Immunohistochemical studies for human immunodeficiency virus, cytomegalovirus, varicella zoster virus, herpes simplex virus type 1 and type 2 were negative. Ischaemic spinal cord lesions due to disseminated intravascular coagulation may represent an unusual cause of focal, non-inflammatory, non-tumoral, myelopathic syndrome in AIDS.

Fatal systemic carnitine deficiency with lipid storage in skeletal muscle, heart, liver and kidney.

A fatal case of systemic carnitine deficiency is reported. The patient suffered from slowly progressive muscle weakness since early childhood. After the age of 17 years her weakness progressed more rapidly until her death at the age of 20. A pregnancy during the last year of the patient's life was followed by rapid deterioration in her condition. An episode of renal insufficiency occurred at the age of 17 years and hepatomegaly, increased BSP dye retention and intermittent ketoacidosis were present during the last month of her life. Biopsy and autopsy specimens of muscle showed a lipid storage myopathy. Type 1 fibers were selectively severely affected, and many Type 1 fibers were atrophic. Abundant large mitochondria, some also containing abnormal inclusions, were also present in the muscle fibers. At autopsy there was marked accumulation of sudanophilic lipid deposits in all hepatocytes, in the renal tubular epithelial cells, and a patchy increase of lipid material was found in the myocardial fibers. There was marked carnitine deficiency in the patient's liver as well as muscel, while the carnitine palmityltransferase activities in these tissues were abnormally high. The basic metabolic abnormality is assumed to be a defect in carnitine biosynthesis.

Mini-Mental Parkinson: first validation study of a new bedside test constructed for Parkinson's disease.

We have developed a brief screening test aimed at identifying cognitive disorders in Parkinson's disease. The Mini-Mental Parkinson derives from the Mini-Mental State Examination of Folstein. It includes seven ordered subsections, with a total score of 32. A pilot study was conducted in 50 community-dwelling parkinsonian patients, in order to establish its metrological qualities. Comparisons were made with a neuropsychological battery including several tests widely used in the assessment of specific cognitive disorders in Parkinson's disease. The correlations between the Mini-Mental Parkinson and each component of this battery were substantial, especially for the performance subtests of the WAIS-R (r = 0.62 to 0.72), the Stroop test (r = 0.65) the 15-objects test (r = 0.64), the word fluency (r = 0.63) and the Odd Man Out test (r = 0.61). The validity of each subtest of the Mini-Mental Parkinson was adequate except for one, based on a word choice, which requires a modification in French before definitive use. The test-retest reliability was high (r = 0.84). There was a significant difference in the mean scores in cases with confusional event (22.4), even without current signs of dementia, compared with patients with no such history (27.2). In conclusion, this brief test is suitable for assessment of parkinsonian patients.

Determination of fatty acid composition of pork fat by Fourier transform infrared spectroscopy.

The fatty acid composition of pork fat determines its processing quality. FTIR spectroscopic methods were evaluated on pork back and breast fat, directly on fat slices and on the fat extracts. Near infrared transmission and middle infrared using an ATR method were developed to determine the fatty acid content in the fat extracts. The results obtained with 80 back and 80 breast samples showed the validity of infrared spectroscopy to estimate SFA (saturated fatty acids), MUFA (monounsaturated fatty acids), PUFA (polyunsaturated fatty acids), C16:0, C18:0, C18:1 and C18:2 contents in fat extracts. Correlation coefficients (R(2)) were around 0.91 and 0.98 for MIR (ATR) and around 0.85 and 0.96 for NIR (transmission). Direct measurements on fat slices by NIR predicted SFA, PUFA, C18:1 and C18:2, although the coefficient correlations were less good; 0.69-0.79. This method though, is easier and faster than other techniques and is accurate enough to discriminate fat samples separated by standard visual and texture classification. Measurements could be made in 1 min.

[Microcirculatory changes following psychoaffective shocks]. / Modifications microcirculatoires sous l'effet de chocs psycho-affectifs.

The basis for the study conducted was a clinical observation: the fairly stereotyped microcirculatory disorders occurring during "affective" neuroses. Examinations were performed initially with the capillaroscope alone and then this was combined with plethysmography and Doppler tests in the hands and the fingers (9.2 MHz sound). Fifty-two patients were examined (30 by capillaroscopy alone and 22 with associated plethysmography and Doppler to the hands). A more psychiatrically orientated consultation with 51 of these patients indicated that an affective shock had preceded the onset of the acrosyndrome in 27 cases. The syndromes provoked may be severe and may lead to pseudo-necrotic lesions. High doses of vascular tonics are necessary, the condition being made worse by the tricyclic antidepressants.

[Polyradiculoneuritis in a developmental flare-up of Behçet's disease]. / Polyradiculonévrite au cours d'une poussée évolutive de maladie de Behçet.

A patient with Behçet's disease developed a polyradiculitis that was mainly motor. It was associated with an acute episode of mucocutaneous, articular and inflammatory symptoms and the neurological disorders regressed in a few months. A possible cause effect relationship is considered. Peripheral nerve lesions are rare in Behçet's disease. Only a few cases of polyneuritis radiculitis and mononeuritis multiplex have been reported.

[Long-term prognostic factors in Parkinson's disease (author's transl)]. / Maladie de Parkinson. Les facteurs de pronostic à long terme.

Acturial methods are used to study the correlation between the initial condition and early therapeutic results, and the present condition of 164 parkinsonian patients treated with L. dopa for 4 to 8 years. There is an ineluctable deterioration in motility. There is a lower risk in patients who are autonomous and only slightly akinetic at the beginning of treatment. Intellectual deterioration is seen in some patients only. The risk factors are: males, the clinical forms of Parkinson's disease in which tremor is not predominant, onset of the disease before 60 years of age, and depression and transitory psychotic disorders during the first year of treatment. This deterioration appears 3 to 5 years after starting dopatherapy, which could be the cause. Life expectancy is still reduced by the disease at the present time. It is longer in patients in whom the disease started with isolated tremors, absence of Babinski's sign, and no loss of autonomy, and those in whom a good initial therapeutic result was obtained.

[Cognitive deficits in Parkinson's disease]. / Les altérations cognitives au cours de la maladie de Parkinson.

No clear general view has emerged from the many recent studies devoted to cognitive disorders in Parkinson's disease. Disparity of the populations and methods, as well as interference from motor disorders and possible psychiatric disorders account for the variability of epidemiological data. Subtle cognitive disorders can be found in most patients at the very beginning of the disease. Recent memory is disturbed in free recall tests, but recognition capacities are preserved. Individualization of visuospatial disorders is discussed. Alteration of conceptual capacities is the predominant disorder. Clinically obvious cognitive disorders appear only in some patients after several years of neurological disease. Some risk factors are agreed upon. The bradyphrenia concept is debated, and the term dementia is not accepted by all authors. The major cognitive alterations in Parkinson's disease differ from those observed in Alzheimer dementia, but the latter is more frequent in parkinsonian patients than in the general population. Patients with Parkinson's disease are also exposed to the risk of transient psychotic episodes. Where parkinsonian cognitive pathology is concerned, modern imaging methods are of no help to clinicians. The anatomical and biochemical changes observed in these patients are reviewed, and their responsibility in the genesis of cognitive disorders is discussed: lesions of brainstem nuclei and alterations in their cortical projections on one side, Alzheimer type dementia lesions and Lewys' bodies on the other side. The diverse and inconstant cognitive disorders of patients with Parkinson's disease cannot be explained by lesions of one single structure; they probably result from variable combinations of multiple known or unknown neuronal and biochemical changes.

[Long-term study of 416 cases of Parkinson disease. Prognostic factors and therapeutic implications]. / Etude à long terme de 416 cas de maladie de Parkinson. Facteurs de pronostic et implications thérapeutiques.

As L-Dopa was marketed in France in 1971 for treatment of Parkinson's disease we used 1971 to divide a sample of patients into 2 groups. Group 1 (152 patients) includes patients with diagnosis made before 1971 and group 2 (264 patients) with diagnosis after 1971. The prognostic factors were motor deterioration, intellectual deterioration and death. The prognostic variables include the neuro-psychological status at the onset of the disease and at the beginning of L-Dopa treatment. The statistical analysis is based on Kaplan-Meier estimate, Log-rank test and Cox's model. In group 2, 10 years after the beginning treatment of L-Dopa, motor deterioration affected 60 p. 100 of the patients. The poor variables were akineto-hypertonic type, severe akinesia, poor clinical result after one year. Intellectual deterioration was frequent: 30 p. 100 at 10 years. The poor variables were age over 60, depression or psychotic episodes occurring during the first year. The 10 years-survival rate was 64 p. 100 and was not different from that recorded in a French population of same age and sex distribution. The poor variables were severe akinesia, presence of a Babinski sign, poor therapeutic result after one year, occurrence of psychotic episodes during the first year. The interval between the onset of the disease and the beginning of L-Dopa did not have any prognostic value, whatever the response criterion. In group 1, the same prognostic factors were pointed out. Survival and intellectual deterioration were not different in the 2 groups, but in group 1, motor deterioration appeared earlier.(ABSTRACT TRUNCATED AT 250 WORDS)

[Multiple and recurrent paralysis of cranial nerves: primary Gougerot-Sjögren syndrome]. / Paralysies multiples et récidivantes des nerfs crâniens. Syndrome de Goujerot-Sjögren primitif.

Over a period of 10 years, a 49-year-old man had 3 episodes of recurrent cranial nerve palsy regressing within a few weeks. Each episode was accompanied with acute inaugural headache and diplopia and once with sensory impairment of the trigeminal nerf and once with tinnitus. The diagnosis of Goujerot-Sjögren's syndrome was retained after demonstration of hypergammaglobulinaemia, a positive Rose Bengale test and histological examination of biopsy specimens from the accessory salivary glands which revealed advanced typical lesions. Clinically, impaired secretion was not obvious.

[Striato-nigral degeneration. Apropos of a clinical, therapeutic, and anatomic study of 2 cases]. / Dégénérescence striato-nigrique. A propos de l'étude clinique, thérapeutique et anatomique de 2 cas

The authors report two anatomo-clinical cases of striato-nigral degeneration with trial of L-Dopa; one of them included an olivoponto-cerebellar degeneration. The features of this degeneration are compared with the literature and related to heredo-degenerative diseases of the nervous system.

[Parkinsonian features of Steele-Richardson-Olszewski syndrome]. / Les signes parkinsoniens du syndrome de Steele-Richardson-Olszewski.

A study of parkinsonian signs was conducted in 29 patients fulfilling Lees' criteria for progressive supranuclear palsy, or Steele-Richardson-Olszewski syndrome, and 2 patients with incomplete ophthalmoplegia but 4 other cardinal features. The patients comprised 17 men and 14 women and their ages at onset ranged from 52 to 77 yrs (mean, 65.1). Parkinsonian features: akinesia, rigidity or resting tremor were present in 29 cases and appeared a mean 0.5 yrs (range 0-3) after onset. In 9 cases (29 p. 100), the parkinsonian features were similar to those of Parkinson's disease, including a resting tremor in 6 cases. The parkinsonian syndrome was initially the sole manifestation in 7 patients, who were diagnosed as having Parkinson's disease. Levodopa was effective in 6 cases, for more than a year in 3. In the other 20 cases (64 p. 100) parkinsonian signs were atypical, usually with a predominantly axial distribution. Levodopa or dopamine agonists showed transient efficacy in 6 cases. In most patients, the treatment with levodopa (n = 27) or bromocriptine (n = 15) was well tolerated. Only two disclosed akinetic fluctuations. The other main clinical features included postural instability with falls (n = 30; mean time after onset 1.8 yrs, range 0-7 yrs); characteristic ophthalmoplegia (n = 29; mean interval 4.4., range 0-18 yrs); intellectual decline and/or frontal signs (n = 22; mean interval 2.4, range 0-8 yrs); axial rigidity (n = 18; mean interval 4.2, range 1-11 yrs); pseudo-bulbar palsy (n = 18; mean interval 3, range 0-8 yrs). An upper limb dystonia was present in an autopsy-proven case.(ABSTRACT TRUNCATED AT 250 WORDS)

[Musical hallucinations: 7 cases]. / Hallucinose musicale: 7 cas.

Musical hallucinations (MH) occurred in 7 patients (5 women and 2 men, age 58-90 yrs) with mild to severe unilateral or bilateral deafness. The hallucinations usually consisted of musical memories (childhood songs, past "hits"). They started abruptly and were identified, sometimes after a period of doubt, as hallucinations. They became "louder" in the silence and, when iterative, could be distressing. By concentrating, 3 patients could change the ongoing tune for another. Elementary (1 case) or verbal (3 cases) auditory hallucinations could be associated and, in one case, vivid visual hallucinations occurred which were not criticized. One patient suffered depression and the MH faded after antidepressive treatment. In the other cases, no psychiatric disorder was identified. Neurological examination, EEGs and brain MRI (in 5 cases) were normal in all but one case, in which MH followed seizures secondary to a left parietal metastasis. Such MH may be termed hallucinosis according to Ey's description. They share some characteristics with other hallucinatory phenomena associated with sensory deprivation, such as the Charles Bonnet syndrome and "pain memories" in phantom limbs. However, the role of deafness, the underlying central mechanisms and psychological factors are poorly understood.

[Paralysis of the posterior branch of the radial nerve caused by a lipoma]. / Paralysie de la branche postérieure du nerf radial due à un lipome.

A case of compression of the posterior branch of the radial nerve by a lipoma is reported. This case is unusual because of the large size of the tumor (13 cm x 6 cm) and the interest of CT to exclude a liposarcoma. The risk of liposarcoma is greater with large size tumors. Reported 27 cases have been analyzed. The posterior branch of the radical nerve is particularly vulnerable because of the anatomic relationships. Thus benign extraneural sof-tissue tumors of the extremities may be responsible of nerves compressions.

[Contribution of position emission tomography in a case of Marchiafava Bignami disease: Morel's laminar sclerosis?]. / Apport de la tomographie par émission de positons dans un cas de maladie de Marchiafava Bignami: sclérose laminaire de Morel?

We report the case of a 26-year old alcoholic woman who abruptly presented with confusion associated with a major hypertonia. She evolved into a chronically vegetative state. Magnetic resonance imaging (MRI) was consistent with the diagnosis of Marchiafava Bignami disease. The corpus callosum first presented an oedematous aspect, then a central atrophy with an axial band. The clinical presentation and the functional imaging strongly suggest an association between the Marchiafava Bignami disease and diffuse cortical lesions, such as the laminar sclerosis of Morel.

[Lobar holoprosencephaly associated with heterotopic gray matter. A case disclosed in adulthood by epilepsy]. / Holoprosencéphalie lobaire associée à des hétérotopies de substance grise. Un cas révélé à l'âge adulte par une épilepsie.

A case of lobar holoprosencephaly associated with heterotopias of the grey matter is reported. The patient was a young woman whose cerebral malformation was revealed by epileptic seizures at the age of 22. There was no intellectual deficit. Computerized tomography and, chiefly, magnetic resonance imaging, enabled the study of the malformation.

[Münchhausen syndrome. A study of 8 cases of neurologic manifestations]. / Le syndrome de Münchhausen. Etude de 8 cas à expression neurologique.

Eight cases of Münchhausen syndrome were registered within two years in two hospital neurological departments. Summaries of their clinical history were obtained following an enquiry in 58 hospitals of Paris and suburbs. All patients met Asher's description for the emergency presentation, the truculence-evasiveness manner, the luxuriance of tales, the eclecticism of the alleged symptoms, the vehement request of dangerous or painful procedures and the apparent senselessness. The paucity of scars and modesty of peregrinations recorded are discussed, as well as the lack of self-inflicted injury. Ethical implications and traps set by these tricky patients against consistent medical strategies are developed.

[Cerebral venous thrombosis in Behçet's disease (author's transl)]. / Thromboses veineuses cérébrales au cours de la maladie de Behçet.

Two patients with Behcet's disease and angiographically demonstrated cerebral venous thrombosis are described. Dural sinuses were involved in one patient and an internal cerebral vein in the other. Cerebral venous thrombosis was the first manifestation of the disease and occurred in the absence of other signs of "Neuro-Behçet". The outcome was favorable. The unusualness of such localisations, their unknown mechanism, and difficulties in their diagnostic and treatment are emphasized.