Admissions of patients with alcohol intoxication in the Emergency Department: a growing phenomenon.

QUESTION UNDER STUDY: To investigate the change over time in the number of ED admissions with positive blood alcohol concentration (BAC) and to evaluate predictors of BAC level. METHODS: We conducted a single site retrospective study at the ED of a tertiary referral hospital (western part of Switzerland) and obtained all the BAC performed from 2002 to 2011. We determined the proportion of ED admissions with positive BAC (number of positive BAC/number of admissions). Regression models assessed trends in the proportion of admissions with positive BAC and the predictors of BAC level among patients with positive BAC. RESULTS: A total of 319,489 admissions were recorded and 20,021 BAC tests were performed, of which 14,359 were positive, divided 34.5% female and 65.5% male. The mean (SD) age was 41.7(16.8), and the mean BAC was 2.12(1.04) permille (g of ethanol/liter of blood). An increase in the number of positive BAC was observed, from 756 in 2002 to 1,819 in 2011. The total number of admissions also increased but less: 1.2 versus 2.4 times more admissions with positive BAC. Being male was independently associated with a higher (+0.19 permille) BAC, as was each passing year (+0.03). A significant quadratic association with age indicated a maximum BAC at age 53. CONCLUSION: We observed an increase in the percentage of admissions with positive BAC that was not limited to younger individuals. Given the potential consequences of alcohol intoxication, and the large burden imposed on ED teams, communities should be encouraged to take measures aimed at reducing alcohol intoxication.

Self-reported alcohol consumption and its association with adherence and outcome of antiretroviral therapy in the Swiss HIV Cohort Study.

BACKGROUND: Alcohol consumption leading to morbidity and mortality affects HIV-infected individuals. Here, we aimed to study self-reported alcohol consumption and to determine its association with adherence to antiretroviral therapy (ART) and HIV surrogate markers. METHODS: Cross-sectional data on daily alcohol consumption from August 2005 to August 2007 were analysed and categorized according to the World Health Organization definition (light, moderate or severe health risk). Multivariate logistic regression models and Pearson's chi(2) statistics were used to test the influence of alcohol use on endpoints. RESULTS: Of 6,323 individuals, 52.3% consumed alcohol less than once a week in the past 6 months. Alcohol intake was deemed light in 39.9%, moderate in 5.0% and severe in 2.8%. Higher alcohol consumption was significantly associated with older age, less education, injection drug use, being in a drug maintenance programme, psychiatric treatment, hepatitis C virus coinfection and with a longer time since diagnosis of HIV. Lower alcohol consumption was found in males, non-Caucasians, individuals currently on ART and those with more ART experience. In patients on ART (n=4,519), missed doses and alcohol consumption were positively correlated (P<0.001). Severe alcohol consumers, who were pretreated with ART, were more often off treatment despite having CD4+ T-cell count <200 cells/microl; however, severe alcohol consumption per se did not delay starting ART. In treated individuals, alcohol consumption was not associated with worse HIV surrogate markers. CONCLUSIONS: Higher alcohol consumption in HIV-infected individuals was associated with several psychosocial and demographic factors, non-adherence to ART and, in pretreated individuals, being off treatment despite low CD4+ T-cell counts.

Study of drug tolerance mechanisms and of the calcineurin pathway in the opportunistic pathogen "Candida albicans"

ABSTRACT :Azole antifungal drugs possess fungistatic activity in Candida albicans making this human pathogen tolerant to these agents. The conversion of azoles into fungicidal agents is of interest since their fungistatic properties increase the ability of C. albicans to develop drug resistance. In C. albicans, the phosphatase calcineurin (calcineurin) is essential for antifungal drug tolerance. Up to now, the only known target of calcineurin is Crzl, which is a transcription factor (TF) involved in responses to ionic stress. Thus, most of the components of the calcineurin signaling remain to be identified in C. albicans.In this work, the calcineurin pathway was investigated in order to i) characterize the role of calcineurin in the biology of C. albicans, ii) identify putative targets of calcineurin and iii) characterize the phenomenon of tolerance to antifungal drugs. Towards these aims, four different approaches were used.First, using C. albicans microarrays, an attempt was made to identify a set of calcineurindependent genes (CDGs). Since CDGs were highly dependent upon the external stimulus used to activate calcineurin (Ca2+ or terbinafine), this stimulus bias was bypassed by the construction of strains expressing a truncated autoactive form of calcineurin (Cmp1tr) in a doxycyclinedependent manner. The characterization of Cmpltr was undertaken and results showed that it mimicked awild-type activated calcineurin for all tested phenotypes (i.e. Cnbl-dependence, inhibition by FK506, phosphatase 2B activity, ability to dephosphorylate Crzl and to regulate Crz1-and calcineurin-dependent genes, role in antifungal drug tolerance and susceptibility, role in colony formation on Spider agar). Cmp1tr was therefore considered as a valid tool to study the calcineurin signaling pathway. In silico analysis of CDGs allowed the identification of i) a significant overlap between CDGs and genes regulated by the Cyrl signalíng pathway, ii) putative interactions between calcineurin activation and cell wall reorganization and phospholipid transport, iii) a putative interactión between calcineurin and the regulation of translation and iv) a putative relation between calcineurin and proteasome regulation. Further in silico analyses of the promoters of Crz1-independent CDGs were performed to identify TFs (other than Crz1) that were likely to regulate CDGs and therefore to be a direct target of calcineurin. The analyses revealed that Rpn4 and Mnl1 were TFs likely to be regulated by calcineurin.Second, in order to better characterize azole tolerance, an attempt was made to i) confirm the role of Hsp90 in fluconazole tolerance with a doxycycline-dependent Hsp90 expression system and ii) assess its calcineurin-dependence. Hsp90 was found to be significantly involved in fluconazole tolerance. However, results were not in agreement with the hypothesis that Hsp90 mediates fluconazole tolerance by the only downstream effector calcineurin. Rather Hsp90 is interacting with numerous components for fluconazole tolerance.Third, a collection of C. albicans TFs mutants were screened for loss of tolerance to terbinafine and fluconazole in order to identify TFs involved in antifungal drug tolerance. Out of the 265 TFs mutants screened, only the upc2Δ/Δ mutant showed a loss of fluconazole and terbinafine tolerance. Interestingly, no relation between Upc2 and calcineurin activity was found. These results suggested that the tolerance to antifungal drugs must not be only considered as a calcineurin-dependent phenomenon in C. albicans.Fourth, using FRCS analyses, an attempt was made to identify putative signs of programmed cell death (PCD) in calcineurin mutant cells upon loss of tolerance to terbinafine. A high proportion of cells died from both RO5-dependent (which is a sign of PCD) and ROS-independent (which is a sign of loss of homeostasis) processes in the calcineurin mutant. While these results suggest that calcineurin represses both loss of homeostasis and PCD, the role of calcineurin in PCD is still an open question.In conclusion, this work allowed i) the identification of several putative calcineurin targets, ii) the discovery of several links between calcineurin and signaling pathways and important biological processes and iii) the identification of novel components of calcineurin-independent mechanisms that participate in tolerance to antifungal drugs in C. albicans.RÉSUME :Les azoles sont des antifongiques qui présentent une activité fongistatique contre Candida albicans et rendent cette levure tolérante à ces agents. La conversion des azoles en agents fongicides est d'intérêts car leurs propriétés fongistatiques favorisent le développement de résistance aux drogues chez C. albicans. La calcineurine (calcineurin) est une phosphatase essentielle pour la tolérance aux antifongiques chez C. albicans. La seule cible connue de la calcineurin est Crz1, un facteur de transcription (FT) impliqué dans la réponse aux stress ionique. Ainsi, la plupart des constituants de la voie de signalisation de la calcineurin restent encore à être identifiés chez C. albicans.Dans ce travail de thèse, la voie de signalisation de la calcineurin a été étudiée de sorte à i) caractériser le rôle de la calcineurin dans la biologie de C. albicans, ii) identifier de nouvelles cibles de la calcineurin et iii) caractériser le phénomène de tolérance aux antifongiques. A ce propos, quatre approches ont été entreprises.Premièrement, des puces à ADN de C. albicans ont été utilisées afin d'identifier les gènes dépendants de la calcineurin (GDCs). Les GDCs étant étroitement dépendants du stimulus utilisé pour activer la calcineurin, le biais «stimulus» a été évité via la construction d'une souche exprimant une forme tronquée et autoactive de la calcineurin (Cmp1tr), en présence de doxycycline. La caractérisation de Cmp1tr a été entreprise et les résultats ont montré qu'elle mimait une calcineurin sauvage et activée pour la plupart des phénotypes testés (i.e. dépendance à Cnb1, inhibition par le FK506, activité phosphatase 2B, déphosphorylation de Crz1 et régulation de gènes dépendant de la calcineurin, rôle dans la tolérance et la susceptibilité aux antifongiques, rôle dans la formation des colonies sur milieu Spider). Cmp1tr a donc été considéré comme un outil pertinent pour l'étude de la voie de signalisation de la calcineurin. Les analyses in silico des GDCs ont permis l'identification i) d'un chevauchement entre les GDCs èt les gènes régulés par la voie de signalisation de Cyrl, ii) d'une interaction entre la calcineurin et la réorganisation de la paroi cellulaire ainsi que le transport des phospholipides, iii) d'une interaction entre calcineurin et la régulation de la traduction et iv) une relation entre la calcineurin et la régulation du protéasome. De plus, une analyse in silico des promoteurs des GDCs avec une régulation indépendante de Crz1 a permis d'identifier deux FTs qui pourraient être des cibles directes de la calcineurin, Rpn4 et Mnll.Deuxièmement, afin de caractériser la tolérance aux azoles, il a été entrepris i) de confirmer le rôle de Hsp90 dans la tolérance au fluconazole en utilisant un système d'expression dépendant de la doxycycline et ii) de caractériser sa dépendance à la calcineurin. Hsp90 a été montré impliqué dans la tolérance aux azoles. Cependant, les résultats n'ont pas corroboré une hypothèse expliquant le rôle d'Hsp90 dans la tolérance aux antifongiques par son unique. interaction avec la calcineurin. Il a été proposé que le rôle d'Hsp90 dans la tolérance aux antifongiques soit dû à ces multiples interactions avec le protéome de C. albicans plutôt que par son interaction avec un partenaire unique.Troisièmement, une collection de mutant pour des FTs de C. albicans a été criblée pour une perte de tolérance au fluconazole ou à la terbinafine, de sorte à identifier les FTs impliqués dans la tolérance aux antifongiques. Sur les 265 FTs passés au crible, seul le mutant upc2Δ/Δ a montré une perte de tolérance au fluconazole et à la terbinafine. Aucune relation n'a été trouvée entre la calcineurin et l'activité d'Upc2. Ces résultats suggèrent que la perte de tolérance aux antifongiques ne doit pas être considérée comme un phénomène exclusivement lié à la voie de signalisation de la calcineurin.Quatrièmement, en utilisant la cytométrie de flux, la présence de signes de mort cellulaire programmée (MCP) a été recherchée lors de la perte de tolérance du mutant calcineurin incubé avec de la terbinafine. Une grande proportion de cellules mortes incluant ou non une production de ROS (un signe de MCP) a été détectée dans le mutant calcineurin. Ces résultats préliminaires suggèrent que la calcineurin réprime autant la perte d'homéostasie qu'elle régule l'entrée en MCP. Cependant d'autres analyses sont nécessaires pour démontrer clairement le rôle de la calcineurin dans la régulation de la MCP.En conclusion, ce travail de thèse a permis i) l'identification de plusieurs cibles possibles de la calcineurine, ii) la découverte de plusieurs interactions entre la calcineurine et d'autres voies de signalisation et processus biologiques importants et iii) de démontrer la présence de voies indépendantes de la calcineurine impliquées dans la tolérance aux antifongiques chez C. albicans.

Alcohol consumption and social inequality at the individual and country levels--results from an international study.

BACKGROUND: International comparisons of social inequalities in alcohol use have not been extensively investigated. The purpose of this study was to examine the relationship of country-level characteristics and individual socio-economic status (SES) on individual alcohol consumption in 33 countries. METHODS: Data on 101,525 men and women collected by cross-sectional surveys in 33 countries of the GENACIS study were used. Individual SES was measured by highest attained educational level. Alcohol use measures included drinking status and monthly risky single occasion drinking (RSOD). The relationship between individuals' education and drinking indicators was examined by meta-analysis. In a second step the individual level data and country data were combined and tested in multilevel models. As country level indicators we used the Purchasing Power Parity of the gross national income, the Gini coefficient and the Gender Gap Index. RESULTS: For both genders and all countries higher individual SES was positively associated with drinking status. Also higher country level SES was associated with higher proportions of drinkers. Lower SES was associated with RSOD among men. Women of higher SES in low income countries were more often RSO drinkers than women of lower SES. The opposite was true in higher income countries. CONCLUSION: For the most part, findings regarding SES and drinking in higher income countries were as expected. However, women of higher SES in low and middle income countries appear at higher risk of engaging in RSOD. This finding should be kept in mind when developing new policy and prevention initiatives.

The role of nonhematopoietic MHC class II expression in immune responses and tolerance

Si les rôles fonctionnels de diverses cellules immunitaires infiltrant des tissus enflammés sont assez bien compris, par contre, étonnamment, on connaît bien moins la capacité des cellules non hématopoïétiques résidant dans des tissus, à moduler l'activité biologique des cellules immunitaires immigrantes, et donc le résultat de la réponse immunitaire. La présentation des antigènes, dans le contexte des molécules du CMH de classe II (CMHII) à la surface des cellules présentatrices d'antigènes (CPA) professionnelles à une sous- population de lymphocytes T, est cruciale pour le développement des réponses immunitaires protectives spécifiques de l'antigène. En général, l'expression de CMHII est réservée aux CPAs. Toutefois, au cours des pathologies inflammatoires spécifiques d'organe, telles que l'auto-immunité ou la maladie inflammatoire de l'intestin, l'expression de CMHII est également induite par la cytokine interféron (IFN)-y sur des cellules non hématopoïétiques qui résident dans des tissus enflammés. Les conséquences de ce phénomène sont encore peu comprises. Dans cette étude, nous avons utilisé une souche de souris génétiquement modifiées, qui n'a pas la capacité d'induire l'expression de CMHII sur les cellules non hématopoïétiques, mais a maintenu la régulation normale d'expression de CMHII sur les cellules hématopoïétiques. Nous avons appliqué ces souris à différents modèles d'inflammation intestinale et à un modèle de maladie qui imite la maladie auto-immune de l'inflammation du muscle cardiaque (myocardite) chez l'homme. Nous avons pu montrer que, au cours de l'inflammation intestinale, l'expression du CMHII nonhématopoïétique, ou encore l'expression du CMHII par les cellules épithéliales de l'intestin, confère une protection contre la maladie, en réduisant les cellules immunitaires inflammatoires et en augmentant les cellules Τ régulatrices anti-inflammatoires. Ces résultats pourraient expliquer l'échec des traitements d'anti-IFN-γ dans les maladies intestinales inflammatoires chez l'homme. En revanche, dans la myocardite auto-immune, nos résultats indiquent que la présentation d'antigènes par les cellules non hématopoïétiques du coeur est nécessaire pour l'apparition de la pathologie cardiaque, comme nos souris sont résistantes à la maladie. Toutefois, cela n'est pas dû à un défaut d'activation des lymphocytes T, car les lymphocytes Τ des souris mutantes sont parfaitement capables de promouvoir la maladie après le transfert adoptif dans des animaux de type naturel. Nos résultats suggèrent que, durant les maladies inflammatoires spécifiques d'organe, la présentation d'antigène par des cellules non hématopoïétiques module et contribue au résultat de la réponse immunitaire d'une manière opposée, conférant soit la protection contre la maladie ou sa promotion. Nos résultats pourraient ouvrir la voie à des thérapies qui prennent en compte la contribution de la présentation d'antigènes par les cellules non hématopoïétiques, au cours des maladies inflammatoires spécifiques d'organe. - Les molécules du CMH de classe II (CMHII) sont fondamentales pour la présentation des antigènes aux lymphocytes Τ CD4+, car elles permettent le développement des réponses immunitaires spécifiques de l'antigène. Il est largement admis que l'expression de CMHII est réservée aux cellules présentatrices d'antigènes (CPA). Cependant, dans des conditions inflammatoires, l'expression de CMHII est en principe également induite par l'interféron (IFN)-y sur les cellules non hématopoïétiques, telles que les cellules épithéliales et les cardiomyocytes. Une controverse existe jusqu'à présent au sujet de la fonction de cette présentation d'antigènes non professionnelle, pour savoir si elle favorise la tolérance ou l'immunité dépendante des lymphocytes Τ in vivo. Pour répondre à cette question, nous avons testé des souris qui ne sont pas capables d'induire l'expression du CMHII sur les cellules non hématopoïétiques (souris PIV-/- K14 CIITA Tg) parmi différents modèles murins de pathologies inflammatoires, à savoir les modèles de vaccination pour induire des réponses spécifiques d'antigènes des lymphocytes B, plusieurs modèles de colite et un modèle de myocardite auto-immune expérimental (EAM). Pour cela, nous avons administré à ces souris un modèle de colite atténuée, induite par une infection chronique à Helicobacter hepaticus et par l'administration d'anticorps monoclonaux bloquant le récepteur de l'interleukine (IL)-10 (anti-IL-10R). Dans ce système, nous avons pu observer que l'expression abrogée de CMHII a aggravé la colite bactérienne, soit par les cellules non hématopoïétiques, soit exclusivement par les cellules épithéliales intestinales (CEI) dans un autre modèle murin (souris plV_fl/fl vil-Cre Tg). Ce phénotype du côlon a été associé à une augmentation des fréquences de cellules immunitaires innées, de lymphocytes Th1 CD4+, et d'expression des cytokines et de chimiokines pro-inflammatoires, y compris l'IFN-γ. Notamment, l'expression défectueuse de CMHII non hématopoïétique a également réduit les cellules Τ régulatrices (Treg) Forkhead box P3 (FoxP3)+, sans influencer les fréquences des cellules innées lymphoïdes et des cellules Th17. Ces résultats suggèrent un rôle tolérogène de CEIs CMHII+ qui contribue à l'homéostasie immunitaire intestinale. En revanche, dans le modèle d'EAM, les souris ayant subi une ablation de CMHII non hématopoïétique étaient résistantes à l'induction de la maladie, alors que la progression de la pathologie cardiaque, dans les souris de type naturel ou hétérozygotes, a été accompagnée par une régulation positive de l'expression de CMHII du myocarde. Cependant, l'inflammation cardiaque pourrait être transférée de manière adoptive depuis des souris amorcées PIV-/- K14 CIITA Tg vers des souris de type naturel, indiquant l'absence de défaut intrinsèque d'amorçage des cellules T CD4+ dans notre modèle de souris. Ces observations impliquent un rôle à jouer pour des cellules CMHII+ non hématopoïétiques résidentes du coeur, dans la promotion active de ΙΈΑΜ. En conclusion, nos résultats, provenant de diverses pathologies inflammatoires spécifiques d'organes, suggèrent un rôle complexe et divergent, soit tolérogène, soit immunogène/ pathologique, pour l'expression de CMHII non hématopoïétique au cours des pathologies inflammatoires. L'expression non professionnelle de CMHII semble influencer le résultat des réponses immunitaires en fonction de différents facteurs, tels que le tissu cible, le(s) type(s) de cellule(s) non hématopoïétique(s) participante(s) et l'origine de l'inflammation. Nos résultats pourraient potentiellement ouvrir la voie à des applications thérapeutiques, qui tiennent compte de la contribution de la présentation d'antigènes par des CPAs non professionnelles, au cours de l'inflammation spécifique d'organe. - MHC class II (MHCII) molecules are fundamental for the presentation of antigens to CD4+ Τ cells, allowing the development of antigen-specific immune responses. It is widely accepted that MHCII expression is restricted to antigen-presenting cells (APC). However, under inflammatory conditions, MHCII expression is typically also induced by interferon (IFN)-y on nonhematopoietic cells such as epithelial cells and cardiomyocytes. So far, it remains controversial whether this nonprofessional antigen-presentation function promotes CD4+ Τ cell-dependent tolerance or immunity in vivo. To address this issue, we utilised mice which lack inducible MHCII expression on nonhematopoietic cells (pIV-/- K14 CIITA Tg mice) in different mouse models of inflammatory pathologies, namely immunisation models to induce antigen-specific Β cell responses, various colitis models and a model of experimental autoimmune myocarditis (EAM). In an attenuated model of colitis induced by chronic Helicobacter hepaticus infection and treatment with anti-interleukin (IL)-10 receptor (anti-IL-10R) monoclonal blocking antibody, we observed that abrogated MHCII expression by nonhematopoietic cells or, in an alternative tamoxifen-inducible mouse model (plV_fl/fl vil-Cre Tg mice), exclusively by intestinal epithelial cells (IEC), exacerbated bacterial-driven colitis, which was associated with increased colonic frequencies of innate immune cells, CD4+ Th1 cells and expression of proinflammatory cytokines and chemokines, including IFN-γ. Notably, defective nonhematopoietic MHCII expression also resulted in reduced Forkhead box P3 (FoxP3)+ regulatory Τ (Treg) cells without influencing innate lymphoid cell (ILC) and Th17 cell frequencies. These findings suggest a tolerogenic role of MHClT lECs to contribute to intestinal immune homeostasis. In contrast, in the EAM model, mice ablated of nonhematopoietic MHCII were resistant to disease induction, whereas progression of cardiac pathology in WT and heterozygous control mice was accompanied by upregulation of myocardial MHCII expression. However, cardiac inflammation could be adoptively transferred from primed pIV-/- K14 CIITA Tg mice into WT mice, indicating no intrinsic defect of CD4+ Τ activation in our mouse model. These observations imply a role for MHCIT heart-resident nonhematopoietic cells in actively promoting EAM. In conclusion, our findings from different organ-specific inflammatory pathologies suggest a complex and diverging role - either tolerogenic or immunogenic/ pathologic - for nonhematopoietic MHCII expression during inflammatory pathologies: Nonprofessional MHCII expression appears to influence the outcome of immune responses depending on 7 factors such as the target tissue, participating non hematopoietic cell type(s) and the origin of inflammation. Our findings may potentially open the way to therapeutic applications taking into account the contribution of antigen presentation by nonprofessional, tissue-resident APCs during organ-specific inflammation.

The association between alcohol screening scores and health status in male veterans.

OBJECTIVES: Alcohol use is associated with self-reported health status. However, little is known about the concurrent association between alcohol screening scores and patient perception of health. We evaluated this association in a sample of primarily older male veterans.METHODS: This secondary, cross-sectional analysis included male general medicine outpatients from 7 VA medical centers who returned mailed questionnaires. Screening scores from the Alcohol Use Disorders Identification Test Consumption (AUDIT-C) questionnaire were divided into 6 categories (0, 1­3, 4­5, 6­7, 8­9, and 10­12). Outcomes included scores on the 8 subscales and 2 component scores of the 36-item Short Form Health Survey (SF-36). Unadjusted and adjusted linear regression models were fit to characterize the association between AUDIT-C categories and SF-36 scores. Models were adjusted for demographic characteristics, smoking, and site?both alone and in combination with 14 self-reported comorbid conditions.RESULTS: Male respondents (n = 24,531; mean age = 63.6 years) represented 69% of those surveyed with the SF-36. After adjustment, a quadratic (inverted U-shaped) relationship was demonstrated between AUDIT-C categories and all SF-36 scores such that patients with AUDIT-C scores 4­5 or 6­7 reported the highest health status, and patients with AUDIT-C scores 0, 8­9, and =10 reported the lowest health status.CONCLUSIONS: Across all measures of health status, patients with the most severe alcohol misuse had significantly poorer health status than those who screened positive for alcohol misuse at mild or moderate levels of severity. The relatively good health status reported by patients with mild-moderate alcohol misuse might interfere with clinicians' acceptance and adoption of guidelines recommending that they counsel these patients about their drinking.

The alcohol purchase task in young men from the general population.

BACKGROUND: The alcohol purchase task (APT), which presents a scenario and asks participants how many drinks they would purchase and consume at different prices, has been used among students and small clinical samples to obtain measures of alcohol demand but not in large, general population samples. METHODS: We administered the APT to a large sample of young men from the general population (Cohort Study on Substance Use Risk Factors). Participants who reported drinking in the past year (n=4790), reported on past 12 months alcohol use, on DSM-5 alcohol use disorder (AUD) criteria and on alcohol related consequences were included. RESULTS: Among the APT's demand parameters, intensity was 8.7 (SD=6.5) indicating that, when drinks are free, participants report a planned consumption of almost 9 drinks. The maximum alcohol expenditure (Omax) was over 35CHF (1CHF=1.1USD) and the demand became elastic (Pmax) at 8.4CHF (SD=5.6). The mean price at which the consumption was suppressed was 15.6CHF (SD=5.4). Exponential equation provided a satisfactory fit to individual responses (mean R(2): 0.8, median: 0.8). Demand intensity was correlated with alcohol use, number of AUD criteria and number of consequences (all r≥0.3, p<0.0001). Omax was correlated with alcohol use (p<0.0001). The elasticity parameter was weakly correlated with alcohol use in the expected direction. CONCLUSION: The APT measures are useful in characterizing demand for alcohol in young men in the general population. Demand may provide a clinically useful index of strength of motivation for alcohol use in general population samples.

Acute Effects of Cannabis Smoking on Skills Related to Driving : an fMRI Study

Introduction : Driving is a complex everyday task requiring mechanisms of perception, attention, learning, memory, decision making and action control, thus indicating that involves numerous and varied brain networks. If many data have been accumulated over time about the effects of alcohol consumption on driving capability, much less is known about the role of other psychoactive substances, such as cannabis (Chang et al.2007, Ramaekers et al, 2006). Indeed, the solicited brain areas during safe driving which could be affected by cannabis exposure have not yet been clearly identified. Our aim is to study these brain regions during a tracking task related to driving skills and to evaluate the modulation due to the tolerance of cannabis effects. Methods : Eight non-smoker control subjects participated to an fMRI experiment based on a visuo-motor tracking task, alternating active tracking blocks with passive tracking viewing and rest condition. Half of the active tracking conditions included randomly presented traffic lights as distractors. Subjects were asked to track with a joystick with their right hand and to press a button with their left index at each appearance of a distractor. Four smoking subjects participated to the same fMRI sessions once before and once after smoking cannabis and a placebo in two independent cross-over experiments. We quantified the performance of the subjects by measuring the precision of the behavioural responses (i.e. percentage of time of correct tracking and reaction times to distractors). Functional MRI data were acquired using on a 3.0T Siemens Trio system equipped with a 32-channel head coil. BOLD signals will be obtained with a gradient-echo EPI sequence (TR=2s, TE=30ms, FoV=216mm, FA=90°, matrix size 72×72, 32 slices, thickness 3mm). Preprocessing, single subject analysis and group statistics were conducted on SPM8b. Results were thresholded at p<0.05 (FWE corrected) and at k>30 for spatial extent. Results : Behavioural results showed a significant impairment in task and cognitive test performance of the subjects after cannabis inhalation when comparing their tracking accuracy either to the controls subjects or to their performances before the inhalation or after the placebo inhalation (p<0.001 corrected). In controls, fMRI BOLD analysis of the active tracking condition compared to the passive one revealed networks of polymodal areas in superior frontal and parietal cortex dealing with attention and visuo-spatial coordination. In accordance to what is known of the visual and sensory motor networks we found activations in V4, frontal eye-field, right middle frontal gyrus, intra-parietal sulcus, temporo-parietal junction, premotor and sensory-motor cortex. The presence of distractors added a significant activation in the precuneus. Preliminary results on cannabis smokers in the acute phase, compared either to themselves before the cannabis inhalation or to control subjects, showed a decreased activation in large portions of the frontal and parietal attention network during the simple tracking task, but greater involvement of precuneus, of the superior part of intraparietal sulcus and middle frontal gyrus bilaterally when distractors were present in the task. Conclusions : Our preliminary results suggest that acute cannabis smoking alters performances and brain activity during active tracking tasks, partly reorganizing the recruitment of brain areas of the attention network.

Association of alcohol consumption and HIV surrogate markers in participants of the swiss HIV cohort study.

BACKGROUND: Alcohol consumption may affect the course of HIV infection and/or antiretroviral therapy (ART). The authors investigated the association between self-reported alcohol consumption and HIV surrogate markers in both treated and untreated individuals. DESIGN: Prospective cohort study. METHODS: Over a 7-year period, the authors analyzed 2 groups of individuals in the Swiss HIV Cohort Study: (1) ART-naïve individuals remaining off ART and (2) individuals initiating first ART. For individuals initiating first ART, time-dependent Cox proportional hazards models were used to assess the association between alcohol consumption, virological failure, and ART interruption. For both groups, trajectories of log-transformed CD4 cell counts were analyzed using linear mixed models with repeated measures. RESULTS: The authors included 2982 individuals initiating first ART and 2085 ART naives. In individuals initiating first ART, 241 (8%) experienced virological failure. Alcohol consumption was not associated with virological failure. ART interruption was noted in 449 (15%) individuals and was more prevalent in severe compared with none/light health risk drinkers [hazard ratio: 2.24, 95% confidence interval: 1.42 to 3.52]. The association remained significant even after adjusting for nonadherence. The authors did not find an association between alcohol consumption and change in CD4 cell count over time in either group. CONCLUSIONS: No effect of alcohol consumption on either virological failure or CD4 cell count in both groups of ART-initiating and ART-naive individuals was found. However, severe drinkers were more likely to interrupt ART. Efforts on ART continuation should be especially implemented in individuals reporting high alcohol consumption.

AtABCG29 is a monolignol transporter involved in lignin biosynthesis.

Lignin is the defining constituent of wood and the second most abundant natural polymer on earth. Lignin is produced by the oxidative coupling of three monolignols: p-coumaryl alcohol, coniferyl alcohol, and sinapyl alcohol. Monolignols are synthesized via the phenylpropanoid pathway and eventually polymerized in the cell wall by peroxidases and laccases. However, the mechanism whereby monolignols are transported from the cytosol to the cell wall has remained elusive. Here we report the discovery that AtABCG29, an ATP-binding cassette transporter, acts as a p-coumaryl alcohol transporter. Expression of AtABCG29 promoter-driven reporter genes and a Citrine-AtABCG29 fusion construct revealed that AtABCG29 is targeted to the plasma membrane of the root endodermis and vascular tissue. Moreover, yeasts expressing AtABCG29 exhibited an increased tolerance to p-coumaryl alcohol by excreting this monolignol. Vesicles isolated from yeasts expressing AtABCG29 exhibited a p-coumaryl alcohol transport activity. Loss-of-function Arabidopsis mutants contained less lignin subunits and were more sensitive to p-coumaryl alcohol. Changes in secondary metabolite profiles in abcg29 underline the importance of regulating p-coumaryl alcohol levels in the cytosol. This is the first identification of a monolignol transporter, closing a crucial gap in our understanding of lignin biosynthesis, which could open new directions for lignin engineering.