Cancer du sein: inhibiteurs de l'aromatase en situation adjuvante, un peu, beaucoup ou pas du tout [Aromatase inhibitors in the adjuvant treatment of postmenopausal patients with early breast cancer: a little, a lot or no way?]

Several large randomized trials showed that tamoxifen alone is no more the standard adjuvant hormonal therapy for menopausal patients. Aromatase inhibitors, given upfront or sequentially after tamoxifen, confirmed their efficacy by improving disease free survival, risk of distant metastasis and overall survival in some situations or subgroups of patients. These drugs are usually well tolerated, but they clearly increase bone mineral density loss as well as the risk of fractures and their long term safety on the cardio-vascular system needs to be followed. Thus, even if the role of the aromatase inhibitors is now evident in the adjuvant therapy of postmenopausal women the benefice/risk ratio should be carefully evaluated for each patient.

Abaisser la pression arterielle: urgent ou pas urgent? [How urgent is it to decrease high blood pressure?]

Severe hypertension represents a frequent problem for the general practitioner. One has to decide if the blood pressure needs to be decreased immediately (hypertensive emergency), or if the blood pressure maybe progressively decreased in a few hours and normalized in a few days (hypertensive crisis). Thus it is crucial to identify on the basis of the clinical history and a careful physical examination, the patients for whom the arterial blood pressure elevation represents an acute danger for organ damage or a vital threat in the absence of immediate blood pressure control. In the case of hypertensive crisis, oral medication is usually sufficient (slow release or GITS nifedipine, nitroglycerin, labetalol, captopril). The hypertensive emergency sometimes requires an oral medication before the admission to the emergency room, then followed by intravenous drug administration (sodium nitroprussiate, nitroglycerin, labetalol).

Patient with syncope and LQTS carrying a mutation in the PAS domain of the hERG1 channel.

We report the case of a woman with syncope and persistently prolonged QTc interval. Screening of congenital long QT syndrome (LQTS) genes revealed that she was a heterozygous carrier of a novel KCNH2 mutation, c.G238C. Electrophysiological and biochemical characterizations unveiled the pathogenicity of this new mutation, displaying a 2-fold reduction in protein expression and current density due to a maturation/trafficking-deficient mechanism. The patient's phenotype can be fully explained by this observation. This study illustrates the importance of performing genetic analyses and mutation characterization when there is a suspicion of congenital LQTS. Identifying mutations in the PAS domain or other domains of the hERG1 channel and understanding their effect may provide more focused and mutation-specific risk assessment in this population.

Geographic variation in the frequency of isolation and fluconazole and voriconazole susceptibilities of Candida glabrata: an assessment from the ARTEMIS DISK Global Antifungal Surveillance Program.

Geographic differences in frequency and azole resistance among Candida glabrata may impact empiric antifungal therapy choice. We examined geographic variation in isolation and azole susceptibility of C. glabrata. We examined 23 305 clinical isolates of C. glabrata during ARTEMIS DISK global surveillance. Susceptibility testing to fluconazole and voriconazole was assessed by disk diffusion, and the results were grouped by geographic location: North America (NA) (2470 isolates), Latin America (LA) (2039), Europe (EU) (12 439), Africa and the Middle East (AME) (728), and Asia-Pacific (AP) (5629). Overall, C. glabrata accounted for 11.6% of 201 653 isolates of Candida and varied as a proportion of all Candida isolated from 7.4% in LA to 21.1% in NA. Decreased susceptibility (S) to fluconazole was observed in all geographic regions and ranged from 62.8% in AME to 76.7% in LA. Variation in fluconazole susceptibility was observed within each region: AP (range, 50-100% S), AME (48-86.9%), EU (44.8-88%), LA (43-92%), and NA (74.5-91.6%). Voriconazole was more active than fluconazole (range, 82.3-84.2% S) with similar regional variation. Among 22 sentinel sites participating in ARTEMIS from 2001 through 2007 (84 140 total isolates, 8163 C. glabrata), the frequency of C. glabrata isolation increased in 14 sites and the frequency of fluconazole resistance (R) increased in 11 sites over the 7-year period of study. The sites with the highest cumulative rates of fluconazole R were in Poland (22% R), the Czech Republic (27% R), Venezuela (27% R), and Greece (33% R). C. glabrata was most often isolated from blood, normally sterile body fluids and urine. There is substantial geographic and institutional variation in both frequency of isolation and azole resistance among C. glabrata. Prompt species identification and fluconazole susceptibility testing are necessary to optimize therapy for invasive candidiasis.

DIAfit, un programme suisse pour promouvoir l'activité physique chez les patients avec diabète de type 2 [DIAfit, a Swiss program encouraging physical activity in patients with type 2 diabetes].

Physical activity has a beneficial effect on the cardiovascular risk and the well-being in patients with type 2 diabetes. Thereby, both aerobic physical activities and resistance activities are recommended. DIAfit is a programm for patients with type 2 diabetes that is being implemented in Switzerland. Its objective is to allow the initiation of a structured physical activity in the setting of a pluridisciplinary team to promote a healthy lifestyle.

The European dimension for the mouse genome mutagenesis program.

The European Mouse Mutagenesis Consortium is the European initiative contributing to the international effort on functional annotation of the mouse genome. Its objectives are to establish and integrate mutagenesis platforms, gene expression resources, phenotyping units, storage and distribution centers and bioinformatics resources. The combined efforts will accelerate our understanding of gene function and of human health and disease.

Intervention précoce en Guidance Interactive et modification de la réactivité neuroendocrinienne chez l'ancien grand prématuré âgé de 12 mois et sa mère

L'étude a pour objectif de mettre en évidence les effets d'une intervention précoce inspirée des thérapies en Guidance Interactive sur la qualité de l'attachement ainsi que sur la réactivité neuroendocrinienne de stress chez des grands prématurés âgés de 12 mois ainsi que chez leurs mères. La population étudiée comprend 48 grands prématurés (<33 semaines de gestation) et leurs mères. Un programme d'intervention précoce a été proposé aléatoirement à la moitié des dyades incluses dans l'étude. Des mesures de cortisol salivaire ont été effectuées à 12 mois lors d'un épisode de stress modéré (la Situation Étrange) tant chez la mère que chez l'enfant. Les mères ayant bénéficié de l'intervention précoce montrent des taux de cortisol plus élevés que celles n'ayant pas bénéficié de l'intervention. Les auteurs font l'hypothèse que ces mères ont pu développer leur sensibilité envers leur enfant et se montrent, par conséquent, plus concernées lors de l'épisode de stress modéré. The present project aims to assess the effects of an early intervention inspired from Interactive Guidance therapy, on later attachment quality and stress reactivity of prematurely born infants and their mothers. The studied population contends 48 preterm born infants (< 33 weeks og gestational age). Half of the dyads receive an intervention program aiming at promoting the parents' responsivity-sensitivity to infant's cues. Infant's and mother's stress reactivity (salivary cortisol) to mild stressors (Strange Situation) will be assessed at 12 months. Mothers with intervention program show higher cortisol levels than the others. The authors postulate that these mothers enhance their caregiving quality and, subsequently, are more prone to be sensitive to infant's cues and to be concerned during the mild stress episode.