Intérêt d’outils digitaux dans le maintien d’un parcours de soins obésité dans le contexte épidémique Covid-19. Retour de l’expérimentation article 51 Espace Médical Nutrition et Obésité

L’épidémie de Covid-19, au-delà de mettre en évidence l’obésité comme facteur pronostique important, modifie grandement la prise en charge de cette maladie chronique. L’expérimentation article 51 Espace médical nutrition et obésité (EMNO) a dû intégrer des outils numériques pour maintenir les parcours de soins. Cette démarche a également été enrichie par l’apport d’un outil d’éducation thérapeutique digital. L’ensemble du processus de prise en charge a ainsi été réalisé malgré la situation, avec un retour très positif des patients inclus dans l’expérimentation. En contexte épidémique, le maintien des parcours de soins d’une maladie chronique comme l’obésité peut ainsi être assuré avec l’apport du numérique tout en dépassant le simple cadre de la téléconsultation et du suivi en y associant une approche pédagogique digitale.

Serotonergic paraneurones in the female mouse urethral epithelium and their potential role in peripheral sensory information processing

AIM

The mechanisms underlying detection and transmission of sensory signals arising from visceral organs, such as the urethra, are poorly understood. Recently, specialized ACh-expressing cells embedded in the urethral epithelium have been proposed as chemosensory sentinels for detection of bacterial infection. Here, we examined the morphology and potential role in sensory signalling of a different class of specialized cells that express serotonin (5-HT), termed paraneurones.

METHODS

Urethrae, dorsal root ganglia neurones and spinal cords were isolated from adult female mice and used for immunohistochemistry and calcium imaging. Visceromotor reflexes (VMRs) were recorded in vivo.

RESULTS

We identified two morphologically distinct groups of 5-HT+ cells with distinct regional locations: bipolar-like cells predominant in the mid-urethra and multipolar-like cells predominant in the proximal and distal urethra. Sensory nerve fibres positive for calcitonin gene-related peptide, substance P, and TRPV1 were found in close proximity to 5-HT+ paraneurones. In vitro 5-HT (1 μm) stimulation of urethral primary afferent neurones, mimicking 5-HT release from paraneurones, elicited changes in the intracellular calcium concentration ([Ca2+ ]i ) mediated by 5-HT2 and 5-HT3 receptors. Approximately 50% of 5-HT responding cells also responded to capsaicin with changes in the [Ca2+ ]i . In vivo intra-urethral 5-HT application increased VMRs induced by urethral distention and activated pERK in lumbosacral spinal cord neurones.

CONCLUSION

These morphological and functional findings provide insights into a putative paraneurone-neural network within the urethra that utilizes 5-HT signalling, presumably from paraneurones, to modulate primary sensory pathways carrying nociceptive and non-nociceptive (mechano-sensitive) information to the central nervous system.

A novel interferometric method for the study of the viscoelastic properties of ultra-thin polymer films determined from nanobubble inflation

Glass formation and glassy behavior remain as the important areas of investigation in soft matter physics with many aspects which are still not completely understood, especially at the nanometer size-scale. In the present work, we show an extension of the "nanobubble inflation" method developed by O'Connell and McKenna [Rev. Sci. Instrum. 78, 013901 (2007)] which uses an interferometric method to measure the topography of a large array of 5 μm sized nanometer thick films subjected to constant inflation pressures during which the bubbles grow or creep with time. The interferometric method offers the possibility of making measurements on multiple bubbles at once as well as having the advantage over the AFM methods of O'Connell and McKenna of being a true non-contact method. Here we demonstrate the method using ultra-thin films of both poly(vinyl acetate) (PVAc) and polystyrene (PS) and discuss the capabilities of the method relative to the AFM method, its advantages and disadvantages. Furthermore we show that the results from experiments on PVAc are consistent with the prior work on PVAc, while high stress results with PS show signs of a new non-linear response regime that may be related to the plasticity of the ultra-thin film.

Neuroimaging evidence of brain abnormalities in mastocytosis

Mastocytosis is a rare disease in which chronic symptoms are related to mast cell accumulation and activation. Patients can display depression-anxiety-like symptoms and cognitive impairment. The pathophysiology of these symptoms may be associated with tissular mast cell infiltration, mast cell mediator release or both. The objective of this study is to perform morphological or functional brain analyses in mastocytosis to identify brain changes associated with this mast cell disorder. We performed a prospective and monocentric comparative study to evaluate the link between subjective psycho-cognitive complaints, psychiatric evaluation and objective medical data using magnetic resonance imaging with morphological and perfusion sequences (arterial spin-labeled perfusion) in 39 patients with mastocytosis compared with 33 healthy controls. In the test cohort of 39 mastocytosis patients with psycho-cognitive complaints, we found that 49% of them had morphological brain abnormalities, mainly abnormal punctuated white matter abnormalities (WMA). WMA were equally frequent in cutaneous mastocytosis patients and indolent forms of systemic mastocytosis patients (42% and 41% of patients with WMA, respectively). Patients with WMA showed increased perfusion in the putamen compared with patients without WMA and with healthy controls. Putamen perfusion was also negatively correlated with depression subscores. This study demonstrates, for we believe the first time, a high prevalence of morphological and functional abnormalities in the brains of mastocytosis patients with neuropsychiatric complaints. Further studies are required to determine the mechanism underpinning this association and to ascertain its specificity.

A new tribological experimental setup to study confined and sheared monolayers

We have developed an original experimental setup, coupling tribology, and velocimetry experiments together with a direct visualization of the contact. The significant interest of the setup is to measure simultaneously the apparent friction coefficient and the velocity of confined layers down to molecular scale. The major challenge of this experimental coupling is to catch information on a nanometer-thick sheared zone confined between a rigid spherical indenter of millimetric radius sliding on a flat surface at constant speed. In order to demonstrate the accuracy of this setup to investigate nanometer-scale sliding layers, we studied a model lipid monolayer deposited on glass slides. It shows that our experimental setup will, therefore, help to highlight the hydrodynamic of such sheared confined layers in lubrication, biolubrication, or friction on solid polymer.

Pigmented skin patches without scleroderma as a predominant clinical symptom revealing systemic sclerosis

Skin induration remains the major clinical symptom of systemic sclerosis (SSc), an autoimmune disease with potentially life-threatening visceral involvement. However, skin induration can be absent in some patients, making the diagnosis difficult to confirm and leading to delay in management. Skin pigmentation abnormalities have been reported in patients with SSc, and can be important to recognize for diagnosis. We report two patients who developed hyperpigmented skin patches without any sign of scleroderma, as a major clinical skin symptom of incipient SSc.

Circulating CXCR5+CD4+helper T cells in systemic lupus erythematosus patients share phenotypic properties with germinal center follicular helper T cells and promote antibody production

OBJECTIVE

Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by the production of autoantibodies. Recently, a specific highly activated T helper cell subset, follicular helper T (Tfh) cell, has emerged as a key immunoregulator of germinal center (GC) formation and high-affinity antibody production. To identify the pathophysiological role of Tfh cells in SLE patients, we compared the phenotypic and functional properties of circulating Tfh-like cells in lupus patients to GC-Tfh cells, and correlated the percentage of Tfh-like cells with autoantibody production and SLE disease activity.

METHODS

Peripheral blood was collected from 29 lupus patients and 25 healthy controls. Tonsils were obtained surgically from non-SLE controls and used as a source of GC-Tfh cells. Tfh cells were defined by their signature surface markers (CXCR5, ICOS, CD57, PD-1 and BTLA) via flow cytometry. IL-21 expression levels from Tfh cells were measured by real-time PCR and intracellular staining. The function of Tfh cells was carried out by co-culture of Tfh cells and autologous B cells in vitro. IgG in the culture supernatant was detected by ELISA.

RESULTS

The frequency of circulating Tfh-like cells was significantly increased in SLE patients compared to healthy controls (p < 0.05). The Tfh-like cells not only display similar phenotypes and signature cytokines with GC-Tfh cells, but also are capable of driving B cells to differentiate into IgG-secreting plasma cells in vitro. In addition, the frequency of Tfh-like cells correlated positively with the percentage of circulating plasmablasts, levels of serum anti-dsDNA antibodies and ANA.

CONCLUSION

The accumulated circulating Tfh-like cells in lupus patients share phenotypic and functional properties with GC-Tfh cells. Tfh-like cells may serve as perpetuators in the pathogenesis of SLE by enhancing the self-reactive B cell clones to further differentiate into auto antibody-producing plasmablasts, and ultimately cause autoimmunity.

Analysis of local properties during a scratch test on a polymeric surface using molecular dynamics simulations

This work demonstrates a possible route to connect a particle (chain) based understanding with continuum mechanical questions about contact mechanics. The bond orientation, chain conformation and stress field of a polymer film were analyzed during scratch tests (tangential contact) using a molecular dynamics (MD) simulation approach. Scratch tests with a conical tip at constant scratching velocity were simulated on linear amorphous polymer surfaces at various temperatures and roughnesses of the tip and for various interactions between the tip and the particles of the polymer chains. The second Legendre polynomial (computed for small domains around the tip) gave the bond orientation inside the polymer film during sliding of the tip. The gyration tensor (layer-resolved in the direction of the polymer film thickness) provided information about the conformation of the polymer chains. These results allowed us to argue in favor of Briscoe's hypothesis (thin film sheared vs. "bulk" compressive behavior) concerning the friction properties of the polymer surfaces. Finally, the first stress measurements of the virial stress tensor (in sub-boxes placed in the MD cell) revealed a complex combination between compressive hydrostatic pressure and shear stress, which may be interpreted as a complex sheared domain at the interface.

Nerve growth factor content is increased in the rectal mucosa of children with diarrhea-predominant irritable bowel syndrome

BACKGROUND

The enteric nervous system is a complex network that includes, in the digestive mucosa, neuronal bodies and fibers interacting with the immune system and mucosal mast cells (MC). These interactions involve the secretion of messengers, such as the neurotrophin nerve growth factor (NGF), which influence colonic motility and sensitivity, both affected in irritable bowel syndrome (IBS). This study was designed to test the hypothesis that, in children with IBS, colonic mucosal innervation, NGF content, and MC infiltration are altered. We aimed to measure MC infiltration, number of neuronal bodies, distance from MC to nerve fibers, inflammation, and NGF content in rectal mucosa of pediatric patients with IBS as compared with controls.

METHODS

Rectal biopsies from children (median age: 14 years) with diarrhea-predominant IBS (n = 11) and controls (n = 14) were studied. MC and neuronal mucosal structures were identified by tryptase, CD117 and PGP9.5 immunoreactivity. Inflammatory cells (neutrophils, eosinophils, and lymphocytes) were counted. NGF was quantified in situ by ELISA.

KEY RESULTS

No mucosal inflammation was detected in IBS. MC infiltration and number of neuronal bodies were not significantly different between IBS and controls. The distance between MC and nerve fibers was not different in IBS compared with controls (5.2 ± 0.3 vs 5.0 ± 0.3 μm). Number of MC in close proximity to nerve fibers (<5 μm) was not different in the two groups. However, in IBS, NGF content was higher than controls (0.93 ± 0.3 vs 0.62 ± 0.3 pg mg(-1) protein, P < 0.05) and significantly correlated with MC number.

CONCLUSIONS & INFERENCES

Regardless of inflammation, NGF content is increased in rectal mucosa of diarrhea-predominant IBS children.

Targeting the multidrug ABCG2 transporter with flavonoidic inhibitors: in vitro optimization and in vivo validation

This review describes the breast cancer resistance protein ABCG2 through its structure, functional roles and involvement in cell multidrug resistance, especially in cancer cells resistance to chemotherapeutics. The different types of known inhibitors are described, some being non-selective, since they also bind to other targets, and others being quite specific such as flavonoids. The different classes of active flavonoids and other polyphenols are described, some as plant natural compounds, but most of them being prepared and derivatized through medicinal chemistry. Quantitative structure-activity relationships of the ability of flavones, chalcones, xanthones, acridones and various benzopyrane/benzofurane derivatives to inhibit ABCG2-mediated drug efflux have led to pharmacophores and molecular models allowing to optimize the available hit compounds and to design new-generation lead compounds. Interestingly, inhibitory flavonoids are quite specific for ABCG2 versus ABCB1 and ABCC1, and appear either non-competitive or partially competitive towards mitoxantrone efflux. Most compounds do not inhibit ATPase activity, and are assumed not to be transported themselves by the transporter. Some acridones, firstly optimized in vitro as potent inhibitors, are indeed efficient in vivo, against human xenografts in SCID mice, more efficiently than gefitinib taken as a control. Future developments should open the way to more efficient/targeted modulators including (i) the potential interest of bimodulation by combining two different inhibitors, (ii) computer-assisted ligand-based drug design for getting more potent and more specific inhibitors, (iii) structure-based drug design from ABCG2 molecular models allowing in silico screening and docking of new inhibitors.

[In a medical setting, why and how can the doctor identify the patient as a victim of abuse]

People who were victims of childhood abuse (sexual, emotional or physical), later on will develop psychosomatic illnesses and psychological problems. These health problems, sad consequences of past abuse, will bring them to consult a physician at one point or another. But, because these patients often do not talk about the ancient trauma, the physician is unaware of this past abuse and only treats the illness' symptoms. Abused people will also develop behavioral problems which put them repeatedly back into the position of victim, without realizing why. If this dysfunctional behavior is not identified as the result of trauma, these multi-abused patients will go from bad to worse, repeating in an endless cycle their role as victim. If the physician is able to identify this typical replay of victimization, the patient can be helped to become aware of and to avoid compulsive self-abusive behaviors which are discussed in the following article.

Electron tomography combining ESEM and STEM: a new 3D imaging technique

This paper presents the development and the application of a new electron tomography technique based on STEM (Scanning Transmission Electron Microscopy) configuration in ESEM (Environmental Scanning Electron Microscopy). This combination provides a new approach for the characterization of the 3D structure of materials, as it optimizes a compromise between the resolution level of a few tens of nm and the large tomogram size due to the high thickness of transparency. The method is well adapted for non-conductive samples, and exhibits good contrast even for materials with low atomic number. The paper describes the development of a dedicated stage for this new tomography technique. Taking advantage of the size of the ESEM chamber, the range of tilt angles is not limited by the space around the sample. The performance of this device is illustrated through the three-dimensional characterization of samples issued from materials science and chosen to illustrate the results in resolution, contrast and thickness.

Effect of reactive oxygen and carbonyl species on crucial cellular antioxidant enzymes

Numerous reactive oxygen species (ROS) and reactive carbonyl species (RCS) issuing from lipid and sugar oxidation are known to damage a large number of proteins leading to enzyme inhibition and alteration of cellular functions. Whereas studies in literature only focus on the reactivity of one or two of these compounds, we aimed at comparing in the same conditions of incubations (4 and 24h at 37°C) the effects of both various RCS (4-hydroxynonenal, 4-hydroxyhexenal, acrolein, methylglyoxal, glyoxal, malondialdehyde) and ROS (H₂O₂, AAPH) on the activity of key enzymes involved in cellular oxidative stress: superoxide dismutase (Cu,Zn-SOD), glutathione peroxidase (GPx), glutathione S-transferase (GST) and glucose-6-phosphate dehydrogenase (G6PDH). This was realized both in vitro on purified proteins and MIAPaCa-2 cells. Incubation of these enzymes with RCS resulted in a significant time- and concentration-dependent inhibition for both pure enzymes and in cell lysates. Among all RCS and ROS, hydroxynonenal (HNE) was observed as the most toxic for all studied enzymes except for SOD and is followed by hydrogen peroxide. At 100μM, HNE resulted in a 50% reduction of GPx, 56% of GST, 65% of G6PDH, and only 10% of Cu,Zn-SOD. Meanwhile it seems that concentrations used in our study are closer to biological conditions for ROS than for RCS. H₂O₂ and AAPH-induced peroxyl radicals may be probably more toxic towards the studied enzymes in vivo.

[Sexual abuse: a cause for psychosomatic illnesses]

A human being is a psychosomatic entity, an inseparable mind/body unit. Psychosomatic illness is caused by a break of this vulnerable internal equilibrium from important emotional perturbations provoked by experiences of abuse. Patients rarely consult their physician for abuse they suffered, and they often keep it a lifetime secret. Moreover, since there is a latency period between the abuse and the emergence of physical symptoms, neither the physician nor the patient realize how past abuse and present symptoms are related. Symptomatic treatment cannot treat the root pathologies and thus, psychosomatic illnesses most commonly become chronic.

Serotonin signaling is altered in irritable bowel syndrome with diarrhea but not in functional dyspepsia in pediatric age patients

BACKGROUND & AIMS

In adults, irritable bowel syndrome (IBS) and functional dyspepsia (FD) are chronic conditions that often start during childhood. We investigated mucosal serotonin (5-HT) signaling in children with the idea that data from subjects with a shorter history may improve our understanding of underlying pathophysiological mechanisms.

METHODS

Ninety-eight children undergoing gastroscopy or colonoscopy were studied prospectively. Biopsy specimens were evaluated for inflammation, enterochromaffin cell numbers, 5-HT content, and messenger RNA (mRNA) levels for the synthetic enzyme, tryptophan hydroxylase 1, and the serotonin transporter (SERT) were assessed by quantitative real-time reverse-transcription polymerase chain reaction.

RESULTS

Data from 12 children with IBS and 17 with FD were compared with age-matched controls (12 with rectal biopsies and 12 with gastric biopsies) and with subjects with organic disorders. In patients with FD, a small number of immune cells were observed in the gastric mucosa in half of the patients, but no abnormalities with respect to the 5-HT pathway were identified. In patients with IBS, no differences were detected between patients and controls regarding intraepithelial lymphocytes and CD3+ cells in the lamina propria although all patients showed at least a slight inflammatory infiltrate. In the IBS samples, higher 5-HT content (P < .01) and lower SERT mRNA (P < .05) were detected as compared with controls. Severe inflammation in the colonic mucosa had a high impact on 5-HT signaling with a significant decrease in enterochromaffin cells (P < .01) and 5-HT content (P < .01) and a high SERT mRNA expression (P < .01).

CONCLUSIONS

These results confirm the role of 5-HT signaling in IBS in children and argue against such a role in FD.

[Nebivolol: the first vasodilatory beta-blocker with a beta3-adrenergic agonist activity]

Several studies suggest that the beta(3)-adrenergic stimulation could be a new therapeutic target for the treatment of cardiovascular diseases. The vascular effects induced by beta(3)-adrenergic stimulation are able to decrease the left ventricular strain allowing to reduce after-load. In addition, the increased coronary blood flow due to vasorelaxation increases the myocardial oxygene delivery. The hypothesis about the beneficial role of beta(3)-adrenoceptors is supported by recent data about a beta-blocker of third generation, nebivolol, currently used in the treatment of heart failure and hypertension. The present review presents the beta(3)-adrenoceptors characteristics as well as its involvement in the cardiovascular effects of nebivolol.

Experimental and theoretical analysis of a dynamic JKR contact

Analysis of the adhesive contact between solids makes use of contact mechanics, surface physics, and fracture mechanics. The elastic adhesive contacts have been intensively studied, and now, interest still remains about how the viscoelasticity of the solids may be taken into account for the calculation of the work of adhesion, the major difficulty being to separate the surface and bulk energy dissipations. This paper describes a new and original experimental device for "dynamic JKR" tests, which allows us to study dynamic adhesive contacts under a cyclic normal load. PDMS contacts on PDMS were studied at different frequencies and temperatures, and it was possible using the JKR model to determine the hysteretic value of the work of adhesion. The results obtained follow the same evolution as the loss factor of the material.