Interstitial lung disease due to domestic moulds

Identifying the role of fungi present in the domestic environment in the development of interstitial pneumonia can be a difficult clinical problem. We report a case of interstitial lung disease case occurring in a 53-year-old patient. He presented with profound hypoxemia (PaO(2) 54mmHg). Chest CT showed diffuse ground glass opacities. Initial blood tests for allergy and autoimmune disease were negative. Faced with a worsening of his clinical status after returning home he was hospitalized several times. At fibreoptic bronchoscopy, multiple white deposits were observed. Bronchoalveolar lavage with differential cell count was performed, revealing a 23% lymphocytosis. Serology for specific household molds showed moderate reaction to various molds found in homes, especially Stachybotrys?chartarum. Pulmonary function tests revealed a moderate restrictive pattern with impaired diffusion of carbon monoxide and a bronchiolocentric interstitial pneumonia was found at lung biopsy. After a permanent move to a new residence, clinical parameters, radiological, biological and functional normalized. The final diagnosis was interstitial lung disease related to mycotoxins of S.?Chartarum. The diagnosis of hypersensitivity pneumonitis to domestic mold or interstitial lung disease secondary to mycotoxins should be considered in patients presenting with interstitial pneumonia and requires specific investigations to ensure that an environmental cause with an allergic or toxic role is not missed.     

Medium-throughput computer aided micro-island method to assay embryonic dopaminergic neuron cultures in vitro

In Parkinson's disease (PD) midbrain dopaminergic (DA) neurons degenerate and die, causing loss of motor function. Currently no therapies exist to ameliorate neurodegeneration or to restore DA neurons, although neurotrophic factors (NTFs) are promising leads. Prior in vivo studies the NTFs are routinely assessed in vitro by quantifying the survival of DA neurons from embryonic rodent midbrain cultures. Current in vitro methods are limited in terms of assay reliability, arduous workflow, low throughput, low statistical power and may obscure detection of molecules with minor yet critically important therapeutic effects. We have developed a medium-throughput, micro-island culture method. It permits analysis of 10-12 data points from a single embryo - several fold more than any previously published method - and enables comparisons of DA neurons from a single gene knockout (KO) embryo. It is computer-aided, improves statistical power and decreases the number of animals and workload per experiment. This method enhances testing capabilities of NTFs and other factors, and enables small scale screening of chemical drug libraries. We have validated the method by confirming the known effects of glial cell line-derived neurotrophic factor (GDNF) and neurturin (NRTN), and demonstrated additive effects via simultaneous addition of GDNF and heparin binding growth associated molecule (HB-GAM). We also show for the first time that DA neurons isolated from GDNF receptor RET-deficient mice are still GDNF responsive, suggesting the presence of an alternative non-RET receptor for GDNF in the DA system. Finally, the method can be adapted for analyses of other low abundance neuronal systems.     

The comparison of the process of five different vitrification devices

Over the last decade, several methods have been designed to improve the survival rate of vitrificated embryos. Although some teams have succeeded, the main remaining drawback of these methods is that they do not provide a leak proof environment for cryopreserved biological samples. To respond to that demand in respect with the European reglementation, the Cryo Bio System company (CBS) designed the HSV High Security Vitrification Kit (HSV). This system is composed of three distinct parts, a High Security thermal-autogenic sealed clear straw, a capillary with its extremity in form of a gutter, and an introducer that can be mounted on the manipulation rod before introduction into the straw. In this study, we confirmed that the CBS vitrification kit is a suitable method for vitrification in association with a small amount of cryoprotector enriched viscous media such as 25 microM Ficool 400, 750 mM Sucrose, 1% Bovine albumin, 20% Dimethyl Sulfoxide and 20% Ethylene glycol in a Phosphate buffered saline solution. We also evaluated the speed of the temperature decrease during vitrification in comparison with four other commercially available non-aseptic methods and showed the protective role of the CBS system during transfer. These physical data have now been confirmed biologically by P. Vanderzwalmen who obtained easily reproductible good results with human embryo using our method. Today, the HSV represents the unique aseptic alternative device (EC and FDA approved) for embryos, oocytes, and biological samples vitrification.     

Analysis and treatment of a patient with bilateral pthiriasis palpebrarum

OBSERVATION: a 41-year-old man presented to the ophthalmologic emergency department with ocular burns. The examination showed many parasites at several stages of the parasitic cycle. The parasitologic analysis found many Pthirus pubis in the eyelids. The dermatological consultation determined that other locations were affected and sought other sexually transmitted diseases and also detected other exposed patients. The detailed clinical examination determined the type of ectoparasite concerned and noted the various phases of its parasitic cycle. The differential diagnosis with Pthirus capitatis can be difficult and its treatment is different. Precise knowledge of the various ectoparasites provided the diagnosis. Screening for sexually transmitted diseases and investigations of the subjects' contacts were essential. CONCLUSION: the diagnosis of pthiriasis is easy at an advanced stage; however, it could be more difficult at earlier stages. Its treatment is not often familiar to the ophthalmologist. Eradicating pthiriasis without investigating other sexually transmitted infections as well as the subjects' contacts could have more serious consequences on public health.     

Medical demography and intergenerational inequalities in general practitioners' earnings

This article examines the link between restrictions on the number of physicians and general practitioners' (GPs) earnings. Using a representative panel of 6016 French self-employed GPs over the years 1983-2004, we estimate an earnings function to identify experience, time and cohort effects. The estimated gap in earnings between 'good' and 'bad' cohorts can be as large as 25%. GPs who began their practices during the eighties have the lowest permanent earnings: they belong to the large cohorts of the baby-boom and face the consequences of an unlimited number of places in medical schools. Conversely, the decrease in the number of places in medical schools led to an increase in permanent earnings of GPs who began their practices in the mid-nineties. A stochastic dominance analysis shows that unobserved heterogeneity does not compensate for average differences in earnings between cohorts. These findings suggest that the first years of practice are decisive for a GP. If competition between physicians is too intense at the beginning of their careers, they will suffer from permanently lower earnings. To conclude, our results show that the policies aimed at reducing the number of medical students succeeded in buoying up physicians' permanent earnings.     

Sun exposure rapidly reduces plasmacytoid dendritic cells and inflammatory dermal dendritic cells in psoriatic skin

Background Interferon (IFN)‐α‐producing plasmacytoid dendritic cells (pDCs), inflammatory CD11c+CD1c? myeloid dendritic cells (mDCs) and macrophages have been found to contribute to the pathogenesis of psoriasis. Heliotherapy is a well‐established treatment modality of this disease, although the details of how the effects are mediated are unknown. Objectives To test the hypothesis that exposure to natural sun affects pathogenic DC subsets in lesional skin. Methods Skin biopsies were obtained from lesional and nonlesional skin in 10 patients with moderate to severe psoriasis subjected to controlled sun exposure on Gran Canaria. Biopsies were obtained at baseline, day 2 and day 16 and examined by immunohistochemistry. Results  Sixteen days of heliotherapy had excellent clinical effect on patients with psoriasis, with significant reductions in Psoriasis Area and Severity Index (PASI) scores. In lesional skin pDC numbers and expression of MxA, a surrogate marker for IFN‐α, were rapidly reduced. Inflammatory CD11c+CD1c? mDCs were significantly reduced whereas resident dermal CD11c+CD1c+ mDCs were unaffected. Expression levels of the maturation marker DC‐LAMP (CD208) on mDCs were significantly reduced after sun exposure, as were the numbers of lesional dermal macrophages. A decrease of dermal DC subsets and macrophages was already observed after 1 day of sun exposure. An additional finding was that DC‐SIGN (CD209) is primarily expressed on CD163+ macrophages and not DCs. Conclusions The clinical improvement in psoriasis following sun exposure is associated with rapid changes in dermal DC populations and macrophages in lesional skin, preceding the clinical effect. These findings support the concept that these DC subsets are involved in the pathogenesis of psoriasis and suggest that sun‐induced clinical benefit may partly be explained by its effect on dermal DCs.