Favoriser l'autonomie du patient face aux données additionnelles en médecine génomique

Depuis ces dernières années, nous assistons à une révolution technologique en génétique moléculaire avec l’avènement du séquençage de nouvelle génération (NGS). Lors des consultations médicales de génétique à l’hôpital, le patient est confronté à la question difficile de la recherche et de la divulgation des données dites additionnelles, qui ne sont pas en lien avec sa pathologie, la donnée primaire. Il peut s’agir de données incidentes (la découverte est fortuite) ou de données secondaires, c’est-à-dire des données recherchées activement dans une liste de gènes définie. Comment s’assurer de l’autonomie suffisante des patients face à cette question? Quel est le rôle de l’équipe soignante? Peut-on harmoniser les pratiques relativement à ces données? Nous proposons une stratégie de l’échelle variable appliquée à la génétique qui consiste à adapter le degré d’autonomie exigé en fonction de l’impact médical et du niveau de fiabilité des données génétiques transmises au patient. Nous apportons également des éléments pour favoriser l’autonomie du patient. Il nous paraît nécessaire de dissocier distinctement la donnée primaire des données additionnelles, de développer les moyens visant à délivrer une information adéquate au patient et enfin d’accompagner le patient dans sa démarche par un soutien psychologique et de respecter un délai de réflexion. De manière ultime, il appartient à l’équipe médicale d’évaluer au cas par cas du bienfondé de la recherche de ces données et de leur révélation au patient.

Prevention of post-concussion-like symptoms in patients presenting at the emergency room, early single eye movement desensitization, and reprocessing intervention versus usual care: study protocol for a two-center randomized controlled trial

Background

Recent data suggest that 10–20% of injury patients will suffer for several months after the event from diverse symptoms, generally referred to as post-concussion-like symptoms (PCLS), which will lead to a decline in quality of life. A preliminary randomized control trial suggested that this condition may be induced by the stress experienced during the event or emergency room (ER) stay and can be prevented in up to 75% of patients with a single, early, short eye movement desensitization and reprocessing (EMDR) psychotherapeutic session delivered in the ER.

The protocol of the SOFTER 3 study was designed to compare the impact on 3-month PCLS of early EMDR intervention and usual care in patients presenting at the ER. Secondary outcomes included 3-month post-traumatic stress disorder, 12-month PCLS, self-reported stress at the ER, self-assessed recovery expectation at discharge and 3 months, and self-reported chronic pain at discharge and 3 months.

Methods

This is a two-group, open-label, multicenter, comparative, randomized controlled trial with 3- and 12-month phone follow-up for reports of persisting symptoms (PCLS and post-traumatic stress disorder). Those eligible for inclusion were adults (≥18 years old) presenting at the ER departments of the University Hospital of Bordeaux and University Hospital of Lyon, assessed as being at high risk of PCLS using a three-item scoring rule. The intervention groups were a (1) EMDR Recent Traumatic Episode Protocol intervention performed by a trained psychologist during ER stay or (2) usual care. The number of patients to be enrolled in each group was 223 to evidence a 15% decrease in PCLS prevalence in the EMDR group.

Discussion

In 2012, the year of the last national survey in France, 10.6 million people attended the ER, some of whom did so several times since 18 million visits were recorded in the same year. The SOFTER 3 study therefore addresses a major public health challenge.

Trial registration

Clinical Trials. NCT03400813. Registered 17 January 2018 – retrospectively registered.

Electronic supplementary material

The online version of this article (10.1186/s13063-018-2902-2) contains supplementary material, which is available to authorized users.

A French translation and validation of the Durand Adaptive Psychopathic Traits Questionnaire: An investigation with community samples from France and Canada

This study presents a French translation and validation of the Durand Adaptive Psychopathic Traits Questionnaire (DAPTQ; Durand, 2017), an instrument for assessing adaptive traits known to correlate with the psychopathic personality. The first sample, which included individuals from France and Canada (N = 135, 52% in France, Mage = 26.98, SD = 9.24), completed the DAPTQ in French, alongside measures of empathy, positive and negative affects, satisfaction with life, and self-esteem. The second sample included bilingual (French and English) individuals from France and Canada (N = 141, 52% in France, Mage = 29.73, SD = 9.09) who completed both versions of the DAPTQ (French and English), alongside measurements of perceived stress, trait anxiety, and creativity. The results support the DAPTQ-French version good internal consistency (α = .89/.87), convergent validity, and concurrent validity. Correlation between the DAPTQ total and subscales across versions (French-English) showed strong associations (r = .84 to .96). These findings support the cross-cultural equivalence of the DAPTQ and its effectiveness as a valid assessment method of adaptive traits in the field of psychopathy.

The interplay of gender, parental behaviors, and child maltreatment in relation to psychopathic traits

Many studies have reported an effect of childhood maltreatment and parenting behavior with the future development of psychopathic traits. However, there is a limited amount of research on parenting behavior and adult psychopathic traits as possible identifiers of childhood maltreatment. The aim of this study is three-fold (1) identify specific parenting behaviors and adult psychopathic traits that predict forms of childhood maltreatment, (2) explore gender differences, and (3) expand on other studies on psychopathy by focusing on a representative sample of the community. There are significant associations between recalled childhood maltreatment and parenting behavior, and psychopathic traits. Parental rejection was the most recurrent predictor of childhood maltreatment with a significant positive relation to almost all its forms. Paternal overprotection was positively associated with sexual abuse, while the opposite was true for maternal overprotection. Psychopathic traits displayed in adulthood were also strong indicators of childhood maltreatment; females with high levels of boldness were more likely to have experienced sexual abuse in childhood, and those high in disinhibition were more likely to have experienced physical neglect and sexual abuse. While males were generally higher in terms of psychopathic traits, females reported more childhood abuse and negative parental behaviors. These findings provide support for using parenting behavior and psychopathic traits as markers of childhood maltreatment.

Incremental Validity of the Durand Adaptive Psychopathic Traits Questionnaire Above Self-Report Psychopathy Measures in Community Samples

Although highly debated, the notion of the existence of an adaptive side to psychopathy is supported by some researchers. Currently, 2 instruments assessing psychopathic traits include an adaptive component, which might not cover the full spectrum of adaptive psychopathic traits. The Durand Adaptive Psychopathic Traits Questionnaire (DAPTQ; Durand, 2017 ) is a 41-item self-reported instrument assessing adaptive traits known to correlate with the psychopathic personality. In this study, I investigated in 2 samples (N = 263 and N = 262) the incremental validity of the DAPTQ over the Psychopathic Personality Inventory-Short Form (PPI-SF) and the Triarchic Psychopathy Measure (TriPM) using multiple criterion measures. Results showed that the DAPTQ significantly increased the predictive validity over the PPI-SF on 5 factors of the HEXACO. Additionally, the DAPTQ provided incremental validity over both the PPI-SF and the TriPM on measures of communication adaptability, perceived stress, and trait anxiety. Overall, these results support the validity of the DAPTQ in community samples. Directions for future studies to further validate the DAPTQ are discussed.

Neuraxial analgesia is not associated with an increased risk of post-partum relapses in MS

Background:

Obstetrical analgesia remains a matter of controversy because of the fear of neurotoxicity of local anesthetics on demyelinated fibers or their potential relationship with subsequent relapses.

Objective:

To assess the impact of neuraxial analgesia on the risk of relapse during the first 3 months post-partum, with a focus on women who experienced relapses during pregnancy.

Methods:

We analyzed data of women followed-up prospectively during their pregnancies and at least 3 months post-partum, collected in the Pregnancy in Multiple Sclerosis (PRIMS) and Prevention of Post-Partum Relapses with Progestin and Estradiol in Multiple Sclerosis (POPARTMUS) studies between 1992–1995 and 2005–2012, respectively. The association of neuraxial analgesia with the occurrence of a post-partum relapse was estimated by logistic regression analysis.

Results:

A total of 389 women were included, 215 from PRIMS and 174 from POPARTMUS. In total, 156 women (40%) had neuraxial analgesia. Overall, 24% experienced a relapse during pregnancy and 25% in the 3 months post-partum. Women with a pregnancy relapse were more likely to have a post-partum relapse (odds ratio (OR) = 1.83, p = 0.02), independently of the use of neuraxial analgesia. There was no association between neuraxial analgesia and post-partum relapse (OR = 1.08, p = 0.78).

Conclusion:

Neuraxial analgesia was not associated with an increased risk of post-partum relapses, whatever multiple sclerosis (MS) activity during pregnancy.

Influence of allelic variations in relation to norepinephrine and mineralocorticoid receptors on psychopathic traits: a pilot study

Background

Past findings support a relationship between abnormalities in the amygdala and the presence of psychopathic traits. Among other genes and biomarkers relevant to the amygdala, norepinephrine and mineralocorticoid receptors might both play a role in psychopathy due to their association with traits peripheral to psychopathy. The purpose is to examine if allelic variations in single nucleotide polymorphisms related to norepinephrine and mineralocorticoid receptors play a role in the display of psychopathic traits and executive functions.

Methods

Fifty-seven healthy participants from the community provided a saliva sample for SNP sampling of rs5522 and rs5569. Participants then completed the Psychopathic Personality Inventory–Short Form (PPI-SF) and the Tower of Hanoi.

Results

Allelic variations of both rs5522 and rs5569 were significant when compared to PPI-SF total score and the fearless dominance component of the PPI-SF. A significant result was also obtained between rs5522 and the number of moves needed to complete the 5-disk Tower of Hanoi.

Conclusion

This pilot study offers preliminary results regarding the effect of allelic variations in SNPs related to norepinephrine and mineralocorticoid receptors on the presence of psychopathic traits. Suggestions are provided to enhance the reliability and validity of a larger-scale study.

G protein-dependent signaling triggers a β-arrestin-scaffolded p70S6K/ rpS6 module that controls 5'TOP mRNA translation

Many interaction partners of β-arrestins intervene in the control of mRNA translation. However, how β-arrestins regulate this cellular process has been poorly explored. In this study, we show that β-arrestins constitutively assemble a p70S6K/ribosomal protein S6 (rpS6) complex in HEK293 cells and in primary Sertoli cells of the testis. We demonstrate that this interaction is direct, and experimentally validate the interaction interface between β-arrestin 1 and p70S6K predicted by our docking algorithm. Like most GPCRs, the biological function of follicle-stimulating hormone receptor (FSHR) is transduced by G proteins and β-arrestins. Upon follicle-stimulating hormone (FSH) stimulation, activation of G protein-dependent signaling enhances p70S6K activity within the β-arrestin/p70S6K/rpS6 preassembled complex, which is not recruited to the FSHR. In agreement, FSH-induced rpS6 phosphorylation within the β-arrestin scaffold was decreased in cells depleted of Gα_s. Integration of the cooperative action of β-arrestin and G proteins led to the translation of 5' oligopyrimidine track mRNA with high efficacy within minutes of FSH input. Hence, this work highlights new relationships between G proteins and β-arrestins when acting cooperatively on a common signaling pathway, contrasting with their previously shown parallel action on the ERK MAP kinase pathway. In addition, this study provides insights into how GPCR can exert trophic effects in the cell.-Tréfier, A., Musnier, A., Landomiel, F., Bourquard, T., Boulo, T., Ayoub, M. A., León, K., Bruneau, G., Chevalier, M., Durand, G., Blache, M.-C., Inoue, A., Fontaine, J., Gauthier, C., Tesseraud, S., Reiter, E., Poupon, A., Crépieux, P. G protein-dependent signaling triggers a β-arrestin-scaffolded p70S6K/ rpS6 module that controls 5'TOP mRNA translation.

Aptamers in Bordeaux 2017: An exceptional "millésime"

About 150 participants attended the symposium organised at the Palais de la Bourse in Bordeaux, France on September 22-23, 2017. Thirty speakers from all over the world delivered lectures covering selection processes, aptamer chemistry and innovative applications of these powerful tools that display major advantages over antibodies. Beyond the remarkable science presented, lively discussion and fruitful exchange between participants made this meeting a great success. A series of lectures were focused on synthetic biology (riboswitches, new synthetic base pairs, mutated polymerases). Innovative selection procedures including functional screening of oligonucleotide pools were described. Examples of aptasensors for the detection of pathogens were reported. The potential of aptamers for the diagnostic and the treatment of diseases was also presented. Brief summaries of the lectures presented during the symposium are given in this report. The third edition of this symposium will take place in Boulder, Colorado in Summer 2018 (information available at http://www.aptamers-in-bordeaux.com/).

The Durand Adaptive Psychopathic Traits Questionnaire: Development and Validation

Although the term psychopathy is embedded with negativity, evidence points to the existence of another form of psychopathy, which involves adaptive traits such as stress and anxiety immunity, remarkable social skills, noteworthy leadership ability, and an absence of fear. The newly developed Durand Adaptive Psychopathic Traits Questionnaire (DAPTQ) aims to assess adaptive traits known to correlate with the psychopathic personality. Validation of the questionnaire among 765 individuals from the community gave support to a 9-factor solution: Leadership, Logical Thinking, Composure, Creativity, Fearlessness, Money Smart, Focus, Extroversion, and Management. The DAPTQ and its 9 subscales demonstrated good internal consistency reliability in a community sample (.68-.88). Convergent validity and divergent validity were supported by administering the DAPTQ alongside established measures of the psychopathic personality. Overall, these findings support the potential of the DAPTQ as an instrument for measuring psychopathy-associated adaptive traits. Limitations of this study and potential directions for future research are also discussed. Further studies are needed to validate the DAPTQ and its subscales against a wider range of personality traits and behaviors.

Fournierella massiliensis gen. nov., sp. nov., a new human-associated member of the family Ruminococcaceae

An anaerobic bacterium, strain AT2T, was isolated from the fresh stool sample of a healthy French man using the culturomics approach. The 16S rRNA gene sequence analysis showed that strain AT2T had 95.2 % nucleotide sequence similarity with Gemmiger formicilisATCC 27749T, the phylogenetically closest species with standing in nomenclature. Cells are Gram-stain-negative, catalase- and oxidase-negative, obligately anaerobic, non-motile, non-spore-forming, rod-shaped, and the bacilli were mesothermophilic. The major fatty acids were C16 : 0 (43.8 %) and C18 : 1n9 (20 %). The DNA G+C content of the strain based on its genome sequence was 56.8 mol%. Based on the phenotypic, biochemical and phylogenetic analysis, we propose the creation of the genus Fournierella gen. nov., which contains strain AT2T (=CSUR P2014T=DSM 100451T) as the type strain of the type species Fournierella massiliensis gen. nov., sp. nov.

Emergence of Clostridium difficile tcdC variant 078 in Marseille, France

The purpose of this investigation was to evaluate the epidemiology of hypervirulent Clostridium difficile ribotypes from January 2013 to February 2017 in the Marseille area of southern France. By using the Xpert Clostridium difficile Epi polymerase chain reaction (PCR) assay and sequencing the tcdC gene, we characterised C. difficile isolates from symptomatic patients diagnosed with C. difficile infection (CDI) in Marseille university hospitals. We first tested retrospectively 278 C. difficile samples isolated from January 2013 to December 2014 and observed a high prevalence of isolates with tcdC mutations and deletions previously described in both hypervirulent ribotypes RT027 and RT078 (16.4% and 10.7%, respectively). We highlighted the co-circulation of these two hypervirulent C. difficile tcdC variants (tV) with distinct epidemiological characteristics. While an RT027 outbreak occurred mainly as healthcare-associated infection in the elderly, CDI caused by tV078 occurred mainly in a younger population as community-associated infection. From January 2016, a systematic survey of these two hypervirulent C. difficile ribotypes revealed the emergence of CDI caused by tV078, currently being more prevalent than RT027 in the Marseille area. The present study is the first report of the emergence of CDI caused by tV078 in southern France. We showed the simultaneous circulation and sequential spread of hypervirulent ribotypes, such as RT027 and tV078. This emphasises the need for an efficient surveillance system for CDI with ribotyping and an optimised management of CDI caused by hypervirulent strains.

A colorimetric nanosensor based on a selective target-responsive aptamer kissing complex

Herein, we report a novel approach for the design of a colorimetric aptasensor based on functionalized gold nanoparticle probes. This approach relies on the conjugation of nanoparticles by two functional DNA and RNA hairpins that engage specific kissing (loop-loop) interactions in response to the addition of a small analyte ligand, leading to particle aggregation and then red-to-purple colour change of the colloidal solution.

Single-molecule observations of RNA-RNA kissing interactions in a DNA nanostructure

RNA molecules uniquely form a complex through specific hairpin loops, called a kissing complex. The kissing complex is widely investigated and used for the construction of RNA nanostructures. Molecular switches have also been created by combining a kissing loop and a ligand-binding aptamer to control the interactions of RNA molecules. In this study, we incorporated two kinds of RNA molecules into a DNA origami structure and used atomic force microscopy to observe their ligand-responsive interactions at the single-molecule level. We used a designed RNA aptamer called GTPswitch, which has a guanosine triphosphate (GTP) responsive domain and can bind to the target RNA hairpin named Aptakiss in the presence of GTP. We observed shape changes of the DNA/RNA strands in the DNA origami, which are induced by the GTPswitch, into two different shapes in the absence and presence of GTP, respectively. We also found that the switching function in the nanospace could be improved by using a cover strand over the kissing loop of the GTPswitch or by deleting one base from this kissing loop. These newly designed ligand-responsive aptamers can be used for the controlled assembly of the various DNA and RNA nanostructures.

Culture of previously uncultured members of the human gut microbiota by culturomics

Metagenomics revolutionized the understanding of the relations among the human microbiome, health and diseases, but generated a countless number of sequences that have not been assigned to a known microorganism¹. The pure culture of prokaryotes, neglected in recent decades, remains essential to elucidating the role of these organisms². We recently introduced microbial culturomics, a culturing approach that uses multiple culture conditions and matrix-assisted laser desorption/ionization-time of flight and 16S rRNA for identification². Here, we have selected the best culture conditions to increase the number of studied samples and have applied new protocols (fresh-sample inoculation; detection of microcolonies and specific cultures of Proteobacteria and microaerophilic and halophilic prokaryotes) to address the weaknesses of the previous studies^3-5. We identified 1,057 prokaryotic species, thereby adding 531 species to the human gut repertoire: 146 bacteria known in humans but not in the gut, 187 bacteria and 1 archaea not previously isolated in humans, and 197 potentially new species. Genome sequencing was performed on the new species. By comparing the results of the metagenomic and culturomic analyses, we show that the use of culturomics allows the culture of organisms corresponding to sequences previously not assigned. Altogether, culturomics doubles the number of species isolated at least once from the human gut.

[What is patient autonomy?]

What does patient autonomy mean? If an autonomous choice is defined as an objective and rational choice, is the doctor's prescription not always the best route? Our contemporary democracies are marked by moral and religious pluralism which obliges society to respect a multiplicity of choices of existence. Three levels are important in terms of autonomy: a range of intellectual capacities, freedom with regard to constraints (external and internal), the capacity to be in control of one's existence.

"Intestinimonas massiliensis" sp. nov, a new bacterium isolated from human gut

Here we report the main features of the proposed new bacterial species “Intestinimonas massiliensis” sp. nov. The type strain GD2^T (CSUR = P1930) was isolated from the gut microbiota of a healthy patient using a culturomics approach combined with taxonogenomics.

Normal postoperative appearances of lung cancer

The major lung resections are the pneumonectomies and lobectomies. The sublobar resections are segmentectomies and wedge resections. These are performed either through open surgery through a thoracotomy or by video-assisted mini-invasive surgery for lobectomies and sublobar resections. Understanding the procedures involved allows the normal postoperative appearances to be interpreted and these normal anatomical changes to be distinguished from potential postoperative complications. Surgery results in a more or less extensive physiological adaptation of the chest cavity depending on the lung volume, which has been resected. This adaptation evolves during the initial months postoperatively. Chest radiography and computed tomography can show narrowing of the intercostal spaces, a rise of the diaphragm and shift of the mediastinum on the side concerned following major resections.