Multisystem Langerhans' cell histiocytosis (Hand-Schüller-Christian disease) in an adult: a case report and review of the literature.

Langerhans' cell histiocytosis (LCH) is a rare and enigmatic clonal disorder that affects mainly children. It is characterized by single or multiple granulomatous mass lesions composed of cells with the Langerhans' cell phenotype. Clinical presentation and behavior are heterogeneous and can range from a solitary lytic bone lesion (i.e., eosinophilic granuloma) with a favorable course to a fatal disseminated leukaemia-like form, with a wide spectrum of intermediate clinical presentations between these two extremes. Although LCH typically involves the bone, lesions can be found in almost all organs. We are reporting the case of a multisystem LCH in a 47-year-old patient who presented with a panhypopituitarism and diabetes insipidus, and who, 5 years later, developed mandibular, mastoid and femoral lesions. The final diagnosis of LCH was made on mandibular biopsy.

The use of telomerase activity for the detection of prostatic cancer cells after prostatic massage.

PURPOSE: Prostate cancer is the most commonly diagnosed cancer in the United States. The diagnosis or followup of prostate cancer in men older than 50 years is based on digital rectal examination, measurement of the free-to-total prostatic specific antigen ratio and transrectal ultrasound assisted needle biopsy of the prostate. We developed and evaluated a noninvasive method for diagnosing prostate cancer based on the measurement of telomerase activity after prostatic massage in fresh voided urine or after urethral washing. MATERIALS AND METHODS: We obtained 36 specimens of cells after prostatic massage in the fresh voided urine of 16 patients who subsequently underwent radical prostatectomy and after urethral washing in 20 who underwent prostate needle biopsies. Ethylenediaminetetraacetic acid was immediately added to the collected urine or washing to a final concentration of 20 mM. After protein extraction by CHAPS buffer each specimen was tested for telomerase activity in a 2-step modified telomeric repeat amplification protocol assay. The 2 prostate cancer cell lines PC-3 and LNCaP with high telomerase activity were used as a positive control. RESULTS: Telomerase activity was detected in 14 of 24 samples with known prostate cancer (sensitivity 58%). In contrast, no telomerase activity was found in the 12 cases without histological evidence of prostate tumor (specificity 100%). Eight of 9 poorly differentiated cancers expressed telomerase activity (89%), while only 6 of 15 well and moderately differentiated cancers showed telomerase activity (40%). CONCLUSIONS: Our data illustrate that telomerase activity may be detected in voided urine or washing after prostatic massage in patients with prostate cancer. Sensitivity was higher for poorly differentiated tumors. This approach is not currently available for detecting prostate cancer in clinical practice. However, these results are promising and further studies are ongoing.

Prognostic value of sentinel node biopsy in 327 prospective melanoma patients from a single institution

Résumé Etude de la valeur pronostique de la biopsie du ganglion sentinelle dans une étude prospective monocentrique de 327 patients atteints de mélanome malin But II s'agit de confirmer la validité de la biopsie du ganglion sentinelle, d'en définir la morbidité, d'investiguer les facteurs prédictifs pour le statut du ganglion sentinelle ainsi que de déterminer les facteurs pronostiques pour la survie sans récidive et la survie spécifique liée à la maladie. Matériel et méthode D'octobre 1997 à décembre 2004, 327 patients consécutifs présentant un mélanome cutané primaire des membres, du tronc et de la tête, sans adénopathie clinique ni métastase à distance ont été inclus. La biopsie du ganglion sentinelle a été réalisée selon la triple technique (lymphoscintigraphie, colorant bleu vital et sonde de détection gamma). Les paramètres et la survie ont été évalués par différentes analyses de régression logistique multiple selon Cox et la survie évaluée selon Kaplan Meier. Résultats Vingt-trois pour cent des patients présentaient au moins un ganglion sentinelle métastatique, ce qui était associé de façon significative à l'épaisseur selon Breslow (p<0.001). Le taux de succès de la biopsie du ganglion sentinelle était de 99.1% et sa morbidité de 7.6%. Avec une durée médiane de suivi de 33 mois, la survie sans récidive à 5 ans était de 43% pour les patients avec un ganglion sentinelle positif et de 83.5% pour ceux avec un ganglion sentinelle négatif. La survie spécifique liée à la maladie à 5 ans était de 49% pour les patients avec un ganglion sentinelle positif et de 87.4% pour ceux avec un ganglion sentinelle négatif. Le taux de faux négatif de la biopsie du ganglion sentinelle était de 8.6%. L'analyse multivariée a démontré que la survie sans récidive était significativement péjorée par :l'épaisseur selon Breslow (RR=5.6, p<0.001), un ganglion sentinelle positif (RR=5.0, p<0.001), et le sexe masculin (RR=2.9, p=0.001). La survie spécifique liée à la maladie était significativement diminuée par : un ganglion sentinelle métastatique (RR=8.4, p<O.OOI), le sexe masculin (RR=6.1, p<0.001), l'épaisseur selon Breslow (RR=3.2, p=0.013), et la présence d'une ulcération (RR=2.6, p=0.015). Conclusion La biopsie du ganglion sentinelle est une procédure fiable avec une haute sensibilité (91.4%) et une faible morbidité (7.6%). L'épaisseur selon Breslow était le seul facteur prédictif significatif pour le statut du ganglion sentinelle. La survie sans récidive était péjorée selon un ordre décroissant par :l'épaisseur selon Breslow, un ganglion sentinelle métastatique, et le sexe masculin. De façon similaire la survie spécifique liée à la maladie était péjorée par : un ganglion sentinelle métastatique, le sexe masculin, l'épaisseur selon Breslow, et une ulcération. Ces données renforcent le statut du ganglion sentinelle en tant que puissant moyen pour évaluer le stade tumoral ainsi que le pronostic.

Le pergélisol dans les terrains sédimentaires à forte déclivité: distribution, régime thermique et instabilités

Résumé: Dans le contexte d'un climat de plus en plus chaud, la localisation du pergélisol dans les terrains sédimentaires à forte déclivité et l'évaluation des mouvements de terrain qui y ont cours s'avèrent primordiales. S'insérant dans cette problématique, ce travail de thèse s'articule autour de deux axes de recherche différents. D'un point de vue statique, cette recherche propose une étude de la distribution et des caractéristiques du pergélisol dans les éboulis de la zone périglaciaire alpine. D'un point de vue dynamique, une analyse de l'influence des caractéristiques du pergélisol (teneur en glace, température du pergélisol, etc.) et des variations des températures de l'air et du sol sur les vitesses de fluage des corps sédimentaires gelés est effectuée. Afin de répondre à ce double objectif, l'approche "terrain" a été privilégiée. Pour déterminer la répartition et les caractéristiques du pergélisol, les méthodes traditionnelles de prospection du pergélisol ont été utilisées, à savoir la mesure de la température du sol à la base du manteau neigeux (BTS), la mesure de la température du sol en continu ainsi que la méthode géoélectrique. Les mouvements de terrain ont pour leur part été mesurés à l'aide d'un GPS différentiel. L'étude de la distribution du pergélisol a été effectuée dans une quinzaine d'éboulis situés dans les régions du Mont Gelé (Verbier-Nendaz) et d'Arolla principalement. Dans la plupart des cas, un pergélisol a pu être mis en évidence dans la partie inférieure des accumulations sédimentaires, alors que la partie médiane des éboulis n'est, le plus souvent, pas gelée. Si cette absence de pergélisol se prolonge parfois dans les portions sommitales des pentes, les mesures réalisées montrent que dans d'autres cas des sédiments gelés y sont à nouveau présents. Les résistivités électriques mesurées dans les portions gelées des éboulis étudiés sont dans la plupart des cas nettement inférieures à celles mesurées sur les glaciers rocheux. Des études préalables ont montré que des circulations d'air internes sont responsables de l'anomalie thermique négative et, lorsqu'il existe, du pergélisol que l'on trouve dans la partie inférieure d'éboulis situés plus de 1000 m plus bas que la limite inférieure régionale du pergélisol discontinu. L'étude de quatre sites de basse altitude (1400-1900 m), et notamment l'équipement du site de Dreveneuse (Préalpes Valaisannes) avec deux forages, des capteurs de température de surface et un anémomètre a permis de vérifier et de préciser le mécanisme de ventilation actif au sein des éboulis froids de basse altitude. Ce mécanisme fonctionne de la manière suivante: en hiver, l'air contenu dans l'éboulis, plus chaud et plus léger que l'air extérieur, monte à l'intérieur de l'accumulation sédimentaire et est expulsé dans ses parties sommitales. Cet effet de cheminée provoque une aspiration d'air froid à l'intérieur de la partie inférieure de l'éboulis, causant ainsi un sur-refroidissement marqué du terrain. En été, le mécanisme s'inverse, l'éboulis étant plus froid que l'air environnant. De l'air froid est alors expulsé au bas de la pente. Une ventilation ascendante hivernale a pu être mise en évidence dans certains des éboulis de haute altitude étudiés. Elle est probablement en grande partie responsable de la configuration particulière des zones gelées observées. Même si l'existence d'un effet de cheminée n'a pu être démontrée dans tous les cas, du fait notamment de la glace interstitielle qui entrave le cheminement de l'air, des indices laissant présager son possible fonctionnement existent dans la quasi totalité des éboulis étudiés. L'absence de pergélisol à des altitudes qui lui sont favorables pourrait en tous les cas s'expliquer par un réchauffement du terrain lié à des expulsions d'air relativement chaud. L'étude des mouvements de terrain a été effectuée sur une dizaine de sites, principalement sur des glaciers rocheux, mais également sur une moraine de poussée et - II - Résumé ? abstract quelques éboulis. Plusieurs glaciers rocheux présentent des formes de déstabilisation récente (niches d'arrachement, blocs basculés, apparition de la matrice fine à la surface, etc.), ce qui témoigne d'une récente accélération des vitesses de déplacement. Ce phénomène, qui semble général à l'échelle alpine, est probablement à mettre sur le compte du réchauffement du pergélisol depuis une vingtaine d'années. Les vitesses mesurées sur ces formations sont souvent plus élevées que les valeurs habituellement proposées dans la littérature. On note par ailleurs une forte variabilité inter-annuelle des vitesses, qui semblent dépendre de la variation de la température moyenne annuelle de surface. Abstract: In the context of a warmer climate, the localisation of permafrost in steep sedimentary terrain and the measurement of terrain movements that occur in these areas is of great importance. With respect to these problems, this PhD thesis follows two different research axes. From a static point of view, the research presents a study of the permafrost distribution and characteristics in the talus slopes of the alpine periglacial belt. From a dynamic point of view, an analysis of the influence of the permafrost characteristics (ice content, permafrost temperature, etc.) and air and soil temperature variations on the creep velocities of frozen sedimentary bodies is carried out. In order to attain this double objective, the "field" approach was favoured. To determine the distribution and the characteristics of permafrost, the traditional methods of permafrost prospecting were used, i.e. ground surface temperature measurements at the base of the snow cover (BTS), year-round ground temperature measurements and DC-resistivity prospecting. The terrain movements were measured using a differential GPS. The permafrost distribution study was carried out on 15 talus slopes located mainly in the Mont Gelé (Verbier-Nendaz) and Arolla areas (Swiss Alps). In most cases, permafrost was found in the lower part of the talus slope, whereas the medium part was free of ice. In some cases, the upper part of the talus is also free of permafrost, whereas in other cases permafrost is present. Electrical resistivities measured in the frozen parts of the studied talus are in most cases clearly lower than those measured on rock glaciers. Former studies have shown that internal air circulation is responsible for the negative thermal anomaly and, when it exists, the permafrost present in the lower part of talus slopes located more than 1000 m below the regional lower limit of discontinuous permafrost. The study of four low-altitude talus slopes (1400-1900 m), and notably the equipment of Dreveneuse field site (Valais Prealps) with two boreholes, surface temperature sensors and an anemometer permitted to verify and to detail the ventilation mechanism active in low altitude talus slopes. This mechanism works in the following way: in winter, the air contained in the block accumulation is warmer and lighter than the surrounding air and therefore moves upward in the talus and is expelled in its upper part. This chimney effect induces an aspiration of cold air in the interior of the lower part of talus, that causes a strong overcooling of the ground. In summer, the mechanism is reversed because the talus slope is colder than the surrounding air. Cold air is then expelled in the lower part of the slope. Evidence of ascending ventilation in wintertime could also be found in some of the studied high-altitude talus slopes. It is probably mainly responsible for the particular configuration of the observed frozen areas. Even if the existence of a chimney effect could not be demonstrated in all cases, notably because of interstitial ice that obstructs Résumé ? abstract - III - the air circulation, indices of its presence exist in nearly all the studied talus. The absence of permafrost at altitudes favourable to its presence could be explained, for example, by the terrain warming caused by expulsion of relatively warm air. Terrain movements were measured at about ten sites, mainly on rock glaciers, but also on a push moraine and some talus slopes. Field observations reveal that many rock glaciers display recent destabilization features (landslide scars, tilted blocks, presence of fine grained sediments at the surface, etc.) that indicate a probable recent acceleration of the creep velocities. This phenomenon, which seems to be widespread at the alpine scale, is probably linked to the permafrost warming during the last decades. The measured velocities are often higher than values usually proposed in the literature. In addition, strong inter-annual variations of the velocities were observed, which seems to depend on the mean annual ground temperature variations.

Localization and fine structure of a vaccinia virus gene encoding an envelope antigen.

The major antigen on the envelope of extracellular vaccinia virus particles is a polypeptide with an apparent molecular weight of 37,000 (p37K; G. Hiller and K. Weber, J. Virol. 55:651-659, 1985). The gene encoding p37K was mapped in the vaccinia virus genome by hybrid selection of RNA followed by in vitro translation. p37K was then identified among the in vitro translation products by immunoprecipitation with a monoclonal antibody. The gene is located close to the right-hand end of the HindIII F fragment. The corresponding region of the DNA was sequenced, and an open reading frame encoding a polypeptide of 41,748 daltons was observed. The 5' end of the mRNA, as defined by nuclease S1 analysis, maps within only a few nucleotides of the translation initiation codon. Examination of the DNA sequence around the putative initiation site of transcription revealed a characteristic sequence, TAAATG, which includes the ATG translation initiation codon and which is conserved in all but one late gene so far analyzed. It is therefore likely that this sequence is an important regulatory signal for late gene expression in vaccinia virus.

Tree cover at fine and coarse spatial grains interacts with shade tolerance to shape plant species distributions across the Alps

The role of competition for light among plants has long been recognized at local scales, but its potential importance for plant species' distribution at larger spatial scales has largely been ignored. Tree cover acts as a modulator of local abiotic conditions, notably by reducing light availability below the canopy and thus the performance of species that are not adapted to low-light conditions. However, this local effect may propagate to coarser spatial grains. Using 6,935 vegetation plots located across the European Alps, we fit Generalized Linear Models (GLM) for the distribution of 960 herbs and shrubs species to assess the effect of tree cover at both plot and landscape grain sizes (~ 10-m and 1-km, respectively). We ran four models with different combinations of variables (climate, soil and tree cover) for each species at both spatial grains. We used partial regressions to evaluate the independent effects of plot- and landscape-scale tree cover on plant communities. Finally, the effects on species' elevational range limits were assessed by simulating a removal experiment comparing the species' distribution under high and low tree cover. Accounting for tree cover improved model performance, with shade-tolerant species increasing their probability of presence at high tree cover whereas shade-intolerant species showed the opposite pattern. The tree cover effect occurred consistently at both plot and landscape spatial grains, albeit strongest at the former. Importantly, tree cover at the two grain sizes had partially independent effects on plot-scale plant communities, suggesting that the effects may be transmitted to coarser grains through meta-community dynamics. At high tree cover, shade-intolerant species exhibited elevational range contractions, especially at their upper limit, whereas shade-tolerant species showed elevational range expansions at both limits. Our findings suggest that the range shifts for herb and shrub species may be modulated by tree cover dynamics.

From bird to sparrow: Learning-induced modulations in fine-grained semantic discrimination.

Recognition of environmental sounds is believed to proceed through discrimination steps from broad to more narrow categories. Very little is known about the neural processes that underlie fine-grained discrimination within narrow categories or about their plasticity in relation to newly acquired expertise. We investigated how the cortical representation of birdsongs is modulated by brief training to recognize individual species. During a 60-minute session, participants learned to recognize a set of birdsongs; they improved significantly their performance for trained (T) but not control species (C), which were counterbalanced across participants. Auditory evoked potentials (AEPs) were recorded during pre- and post-training sessions. Pre vs. post changes in AEPs were significantly different between T and C i) at 206-232ms post stimulus onset within a cluster on the anterior part of the left superior temporal gyrus; ii) at 246-291ms in the left middle frontal gyrus; and iii) 512-545ms in the left middle temporal gyrus as well as bilaterally in the cingulate cortex. All effects were driven by weaker activity for T than C species. Thus, expertise in discriminating T species modulated early stages of semantic processing, during and immediately after the time window that sustains the discrimination between human vs. animal vocalizations. Moreover, the training-induced plasticity is reflected by the sharpening of a left lateralized semantic network, including the anterior part of the temporal convexity and the frontal cortex. Training to identify birdsongs influenced, however, also the processing of C species, but at a much later stage. Correct discrimination of untrained sounds seems to require an additional step which results from lower-level features analysis such as apperception. We therefore suggest that the access to objects within an auditory semantic category is different and depends on subject's level of expertise. More specifically, correct intra-categorical auditory discrimination for untrained items follows the temporal hierarchy and transpires in a late stage of semantic processing. On the other hand, correct categorization of individually trained stimuli occurs earlier, during a period contemporaneous with human vs. animal vocalization discrimination, and involves a parallel semantic pathway requiring expertise.

The use of beta-blockers is associated with the occurrence of acute kidney injury in severe alcoholic hepatitis.

BACKGROUND & AIMS: The beneficial effect of nonselective beta-blockers (NSBB) has recently been questioned in patients with end-stage cirrhosis. We analysed the impact of NSBB on outcomes in severe alcoholic hepatitis (AH). METHODS: This study was based on a prospective database of patients with severe, biopsy-proven AH. Patients admitted from July, 2006 to July, 2014 were retrospectively studied. Patients were divided into two groups (with and without NSBB) and assessed for the occurrence of Acute Kidney Injury (AKI) and transplant-free mortality during a 168-day follow-up period. RESULTS: One hundred thirty-nine patients were included, the mean Maddrey score was 71 ± 34 and 86 patients (61.9%) developed AKI. Forty-eight patients (34.5%) received NSBB. The overall 168-day transplant-free mortality was 50.5% (95%CI, 41.3-60.0%). The overall 168-day cumulative incidence of AKI was 61.9% (95%CI, 53.2-69.4%). When compared, patients with NSBB had a lower heart rate (65 ± 13 vs 92 ± 12, P < 0.0001) and a lower mean arterial pressure (MAP, 78 ± 3 vs 87 ± 5, P < 0.0001). Patients with NSBB had comparable MELD scores, Maddrey scores, and medical histories. The 168-day transplant-free mortality was 56.8% (95%CI, 41.3-69.7%) in patients with NSBB and 46.7% (95%CI, 35.0-57.6%) without NSBB (P = 0.25). The 168-day cumulative incidence of AKI was 89.6% (95%CI, 74.9-95.9%) with NSBB compared to 50.4% (95%CI: 39.0-60.7) for no NSBB (P = 0.0001). The independent factors predicting AKI were a higher MELD score and the presence of NSBB. CONCLUSIONS: The use of NSBB in patients with severe AH is independently associated with a higher cumulative incidence of AKI.

Endoscopic epiglottopexy using Lichtenberger's needle carrier to avoid breakdown of repair.

Severe type III laryngomalacia LM is represented by a retroflexed epiglottis that touches the posterior pharyngeal wall and obstructs the laryngeal inlet. Endoscopic epiglottopexy is advised in such cases wherein pexy sutures are passed between the epiglottis and base of tongue. Using conventional needle carriers, it is difficult to pass such sutures that go deep enough into the tongue base. Such a pexy is prone to a break down. We describe a novel technique of placing these glossoepiglottic sutures using the Lichtenberger's needle carrier. We used this technique in three patients with excellent results and report no complications. We propose to use this technique in cases of epiglottic prolapse seen in severe LM and certain hypotonic conditions.

MRI/TRUS fusion software-based targeted biopsy: the new standard of care?

The advent of multiparametric MRI has made it possible to change the way in which prostate biopsy is done, allowing to direct biopsies to suspicious lesions rather than randomly. The subject of this review relates to a computer-assisted strategy, the MRI/US fusion software-based targeted biopsy, and to its performance compared to the other sampling methods. Different devices with different methods to register MR images to live TRUS are currently in use to allow software-based targeted biopsy. Main clinical indications of MRI/US fusion software-based targeted biopsy are re-biopsy in men with persistent suspicious of prostate cancer after first negative standard biopsy and the follow-up of patients under active surveillance. Some studies have compared MRI/US fusion software-based targeted versus standard biopsy. In men at risk with MRI-suspicious lesion, targeted biopsy consistently detects more men with clinically significant disease as compared to standard biopsy; some studies have also shown decreased detection of insignificant disease. Only two studies directly compared MRI/US fusion software-based targeted biopsy with MRI/US fusion visual targeted biopsy, and the diagnostic ability seems to be in favor of the software approach. To date, no study comparing software-based targeted biopsy against in-bore MRI biopsy is available. The new software-based targeted approach seems to have the characteristics to be added in the standard pathway for achieving accurate risk stratification. Once reproducibility and cost-effectiveness will be verified, the actual issue will be to determine whether MRI/TRUS fusion software-based targeted biopsy represents anadd-on test or a replacement to standard TRUS biopsy.

Divergence with gene flow and fine-scale phylogeographical structure in the wedge-billed woodcreeper, Glyphorynchus spirurus, a Neotropical rainforest bird.

Determining the relative roles of vicariance and selection in restricting gene flow between populations is of central importance to the evolutionary process of population divergence and speciation. Here we use molecular and morphological data to contrast the effect of isolation (by mountains and geographical distance) with that of ecological factors (altitudinal gradients) in promoting differentiation in the wedge-billed woodcreeper, Glyphorynchus spirurus, a tropical forest bird, in Ecuador. Tarsus length and beak size increased relative to body size with altitude on both sides of the Andes, and were correlated with the amount of moss on tree trunks, suggesting the role of selection in driving adaptive divergence. In contrast, molecular data revealed a considerable degree of admixture along these altitudinal gradients, suggesting that adaptive divergence in morphological traits has occurred in the presence of gene flow. As suggested by mitochondrial DNA sequence data, the Andes act as a barrier to gene flow between ancient subspecific lineages. Genome-wide amplified fragment length polymorphism markers reflected more recent patterns of gene flow and revealed fine-scale patterns of population differentiation that were not detectable with mitochondrial DNA, including the differentiation of isolated coastal populations west of the Andes. Our results support the predominant role of geographical isolation in driving genetic differentiation in G. spirurus, yet suggest the role of selection in driving parallel morphological divergence along ecological gradients.

Accuracy of cognitive MRI-targeted biopsy in hitting prostate cancer-positive regions of interest.

PURPOSE: Prostate cancer (PCa) diagnosis relies on clinical suspicion leading to systematic transrectal ultrasound-guided biopsy (TRUSGB). Multiparametric magnetic resonance imaging (mpMRI) allows for targeted biopsy of suspicious areas of the prostate instead of random 12-core biopsy. This method has been shown to be more accurate in detecting significant PCa. However, the precise spatial accuracy of cognitive targeting is unknown. METHODS: Consecutive patients undergoing mpMRI-targeted TRUSGB with cognitive registration (MRTB-COG) followed by robot-assisted radical prostatectomy were included in the present analysis. The regions of interest (ROIs) involved by the index lesion reported on mpMRI were subsequently targeted by two experienced urologists using the cognitive approach. The 27 ROIs were used as spatial reference. Mapping on radical prostatectomy specimen was used as reference to determine true-positive mpMRI findings. Per core correlation analysis was performed. RESULTS: Forty patients were included. Overall, 40 index lesions involving 137 ROIs (mean ROIs per index lesion 3.43) were identified on MRI. After correlating these findings with final pathology, 117 ROIs (85 %) were considered as true-positive lesions. A total of 102 biopsy cores directed toward such true-positive ROIs were available for final analysis. Cognitive targeted biopsy hit the target in 82 % of the cases (84/102). The only identified risk factor for missing the target was an anterior situated ROI (p = 0.01). CONCLUSION: In experienced hands, cognitive MRTB-COG allows for an accuracy of 82 % in hitting the correct target, given that it is a true-positive lesion. Anterior tumors are less likely to be successfully targeted.