Ossification du ligament commun cervical postérieur : coexistence de spondylarthrite et d'une hyperostose idiopathique diffuse du squelette

Introduction: L'ossification du ligament commun vertébral postérieur (LCVP) est une hyperostose prédominant au rachis cervical, associée à différentes pathologies constructrices comme l'arthrose, la maladie de Forestier (ou DISH : Diffuse Idiopathic Squeletal Hyperostosis) ou les spondylarthrites (1). Nous rapportons le cas d'une patiente avec ossification cervicale du LCVP, avec coexistence de DISH et de spondylarthrite.Observation: Patiente de 55 ans, d'origine Irakienne, qui présente depuis l'âge de 40 ans des lombalgies et des talalgies attribuées initialement à un métier physique. En 2008, apparait une cervicobrachialgie C6 gauche. L'IRM cervicale retrouve plusieurs hernies discales (C5-C6 et C6-C7 gauches) avec un canal cervical étroit constitutionnel et une ossification du LCVP cervical. Cette ossification est attribuée à un DISH (Figure1). L'échec du traitement conservateur de la névralgie et la menace neurologique de l'ossification du LCVP conduisent en 2010 à une laminectomie C3-C6 avec fixation postérieure (figure 2). En 2011, la patiente consulte en raison de la persistance de cette névralgie, ainsi que pour des lombalgies inflammatoires. La coexistence de ces symptômes inflammatoires et de l'ossification du LCVP nous incite à réaliser une IRM des sacroiliaques qui retrouve une sacroiliite bilatérale (figure 3). Le diagnostic de spondylarthrite HLA B27 négative est retenu devant l'association des signes cliniques et radiologiques. L'étiologie précise quant à l'origine de l'ossification du LCVP reste incertaine, néanmoins un traitement spécifique de la spondylarthopathie est proposé.Discussion: L'ossification du ligament vertébral commun postérieur est une hyperostose dont les principales causes sont le DISH et les spondylarthrites. On retrouve une ossification du ligament commun vertébral, qu'il soit lombaire, cervical ou dorsal, dans 10 à 50 % des DISH, et 3.5 à 30% des spondylarthrites. 4 types d'ossification du LCVP sont décrites : continue, segmentaire, mixte ou circonscrite. Selon Resnick, le DISH se différencie de la spondylarthrite par la présence d'ossifications antérolatérales d'au moins 4 vertèbres contigües sans érosion des sacroiliaques. Cependant on retrouve dans la littérature quelques cas décrivant la coexistence des 2 pathologies. Récemment, Kim et al. Ont rapporté un cas similaire à notre patiente, avec ossification du LCVP cervical et coexistence de DISH et de spondylarthrite (2).Conclusion: Devant la présence d'une ossification du ligament vertébral commun postérieur cervical, il convient de rechercher des signes de DISH et de spondylarthrite, car leur coexistence est possible. La prévalence exacte de cette association reste encore à déterminer.

Granular layer in the periplasmic space of gram-positive bacteria and fine structures of Enterococcus gallinarum and Streptococcus gordonii septa revealed by cryo-electron microscopy of vitreous sections.

High-resolution structural information on optimally preserved bacterial cells can be obtained with cryo-electron microscopy of vitreous sections. With the help of this technique, the existence of a periplasmic space between the plasma membrane and the thick peptidoglycan layer of the gram-positive bacteria Bacillus subtilis and Staphylococcus aureus was recently shown. This raises questions about the mode of polymerization of peptidoglycan. In the present study, we report the structure of the cell envelope of three gram-positive bacteria (B. subtilis, Streptococcus gordonii, and Enterococcus gallinarum). In the three cases, a previously undescribed granular layer adjacent to the plasma membrane is found in the periplasmic space. In order to better understand how nascent peptidoglycan is incorporated into the mature peptidoglycan, we investigated cellular regions known to represent the sites of cell wall production. Each of these sites possesses a specific structure. We propose a hypothetic model of peptidoglycan polymerization that accommodates these differences: peptidoglycan precursors could be exported from the cytoplasm to the periplasmic space, where they could diffuse until they would interact with the interface between the granular layer and the thick peptidoglycan layer. They could then polymerize with mature peptidoglycan. We report cytoplasmic structures at the E. gallinarum septum that could be interpreted as cytoskeletal elements driving cell division (FtsZ ring). Although immunoelectron microscopy and fluorescence microscopy studies have demonstrated the septal and cytoplasmic localization of FtsZ, direct visualization of in situ FtsZ filaments has not been obtained in any electron microscopy study of fixed and dehydrated bacteria.

A New Method for ECG Tracking of Persistent Atrial Fibrillation Termination during Stepwise Ablation

Stepwise radiofrequency catheter ablation (step-CA) has become the treatment of choice for the restoration of sinus rhythm (SR) in patients with long-standing persistent atrial fibrillation (pers-AF). Its success rate appears limited as the amount of ablation to achieve long term SR is unknown. Multiple organization indexes (OIs) have been previously developed to track the organization of AF during step-CA, however, with limited success. We report an adaptive method for tracking AF termination (AF-term) based on OIs characterizing the relationship between harmonic components of atrial activity from the surface ECG of AF activity. By computing their relative evolution during the last two steps preceding AF-term, we found that the performance of our OIs was superior to classical indices to track the efficiency of step-CA "en route" to AF-term. Our preliminary results suggest that the gradual synchronization between the fundamental and its first harmonic of AF activity appears as a promising parameter for predicting AF-term during step-CA.

Use of accuracy profile for the validation of a gas chromatography-negative chemical ionization tandem mass spectrometry method: quantification of ethyl glucuronide in hair

Introduction: Ethylglucuronide (EtG) is a direct and specific metabolite of ethanol. Its determination in hair is of increasing interest for detecting and monitoring alcohol abuse. The quantification of EtG in hair requires analytical methods showing highest sensitivity and specificity. We present a fully validated method based on gas chromatography-negative chemical ionization tandem mass spectrometry (GC-NCI-MS/MS). The method was validated using French Society of Pharmaceutical Sciences and Techniques (SFSTP) guidelines which are based on the determination of the total measurement error and accuracy profiles. Methods: Washed and powdered hair is extracted in water using an ultrasonic incubation. After purification by Oasis MAX solid phase extraction, the derivatized EtG is detected and quantified by GC-NCI-MS/MS method in the selected reaction monitoring mode. The transitions m/z 347 / 163 and m/z 347 / 119 were used for the quantification and identification of EtG. Four quality controls (QC) prepared with hair samples taken post mortem from 2 subjects with a known history of alcoholism were used. A proficiency test with 7 participating laboratories was first run to validate the EtG concentration of each QC sample. Considering the results of this test, these samples were then used as internal controls for validation of the method. Results: The mean EtG concentrations measured in the 4 QC were 259.4, 130.4, 40.8, and 8.4 pg/mg hair. Method validation has shown linearity between 8.4 and 259.4 pg/mg hair (r2 > 0.999). The lower limit of quantification was set up at 8.4 pg/mg. Repeatability and intermediate precision were found less than 13.2% for all concentrations tested. Conclusion: The method proved to be suitable for routine analysis of EtG in hair. GC-NCI-MS/MS method was then successfully applied to the analysis of EtG in hair samples collected from different alcohol consumers.