La vitamine D : effets « classiques », « non classiques » et évaluation du statut du patient

Knowledge about vitamin D has greatly improved during the last few years. Vitamin D cannot any more be considered as exclusively necessary to prevent ricket/osteomalacia. Its role in the prevention of some osteoporotic fractures in the elderly (in association with calcium nutrition) is now well-demonstrated and many epidemiologic and laboratory data argue for a role in the prevention of several diseases or anomalies (cancer, auto-immune diseases, cardiovascular events, sarcopenia…). A few intervention studies confirming some of these effects also exist. Vitamin D status can easily be assessed by measuring serum 25-OH vitamin D level. However, many experts have claimed that the population-based reference values for 25OHD are too low and that the cut-off value below which vitamin D insufficiency can be present is somewhere between 20 and 40 ng/mL with a clear tendency to target values above 30 ng/mL (75 nmol/L). The main consequences are that vitamin D insufficiency is highly frequent whereas the currently recommended supplementation doses are not sufficient.     

Une radiothérapie interne contre l’infection au VIH, la dernière pièce du puzzle ?

Although highly active antiretroviral therapy (HAART) has succeeded in many cases in suppressing ongoing viral replication, the HIV-infected cells are not eradicated by this therapy. In this article, the author proposes a new treatment protocol based on administration of radiophosphorus 32 (³²P) with HAART combination. The proposed new protocol consists of the following steps: HAART keeps viral replication below the level of detection. Then, ³²P is administered for the removal of the “residual disease”. By its beta emission, incorporated ³²P to viral RNA or proviral DNA may kill free virions and productively infected cells, reactivates latently infected cells and makes them vulnerable to immune competent cells and antiretroviral therapy. This new combination may exhibit synergistic interactions between virostatic effects of antiretroviral molecules and radiobiological effect of internal radiotherapy and provide a new tool to purge the viral reservoirs.     

Associations de kystes de dinoflagellés des séries du Jurassique supérieur (Oxfordien–Tithonien) du Rif externe (Prérif interne et Mésorif,Maroc) et comparaisons régionales

A biostratigraphic study of dinoflagellate cysts of the Upper Jurassic series from the eastern External Rif Chain, has been achieved for the first time on four outcrop sections : the DM section (Douar Marticha), the TB section (the Tarhchenna “Sof”), the KSD section (the Kef Mallou “Sof”) and the Y section (Douar Lamriene) among which three sections (TB, KSD and Y) are well-dated by ammonites and calpionellids fauna. The DM and TB sections are complementary in terms of stratigraphy and correspond respectively to the upper part of the “Ferrysch” Formation, a thick shaly–silty and sandy sequence assigned to the Callovian-Oxfordian stages and to the El Gouzat limestones Formation (Kimmeridgian - Lower Tithonian age) and to the Tarhchenna marly limestones Formation (Upper Tithonian age) from the EL Gouzat area (Mesorif). The KSD and Y sections are also complementary and correspond to the Kimmeridgian-Lower Tithonian Msila limestones Formation and to the overlying marly limestones Massif Formation of Upper Tithonian age, outcropping in the Msila region (Internal Prerif). These four sections have shown many dinocysts rich levels, which had allowed characterizing the Middle? and Upper Oxfordian substages in the DM section. In the other sections, the dinoflagellate cyst assemblages are nearly similar to those of the Kimmeridgian–Tithonian of many sections from the Boreal, Sub-boreal and North tethyan realms, particularily from England, Russia and South-East France basin. The results of the present work confirm once again, the important value of dinoflagellate cysts, for age dating of ammonites-lacking Mesozoic sedimentary sequences and for biostratigraphic correlations.     

Fibroblast growth factor 23–Klotho : un nouvel axe de régulation du bilan du phosphate

The kidney is a key player of phosphate balance, it determines serum phosphate levels by coupling phosphate reabsorption in the renal proximal tubule, calcitriol synthesis and consequently intestinal phosphate absorption. The identification of fibroblast growth factor 23 (FGF23) as a hormone regulating phosphate and calcitriol metabolism has unveiled the mechanisms that coordinate these renal proximal tubule functions. A bone–kidney axis has emerged that controls bone mineralization. Animal model studies have improved our understanding of phosphate homeostasis and revealed the role of the protein Klotho, which is mandatory to FGF23 action. In this review we detail FGF23 and Klotho implications in physiology and in genetic or acquired disorders. Phosphate ion is involved in vascular and soft tissue calcification and is important for cell proliferation. Disorders of FGF23–Klotho axis alter life-span and the survival in some cancers.     

Tumeurs du grêle et du côlon : importance de l’anatomie en coupes

The aim of this article is to describe the anatomic specificities of each different digestive tumors in CT imaging and to show the interest of contrast-enhanced CT and bowel opacification. Some specific points about lymph nodes of the abdomen and peritoneum anatomy will be discussed.     

Apport du TDM en imagerie multimodalité : le point de vue du physicien médical

The recent introduction of hybrid systems SPECT/CT and PET/CT in nuclear medicine, greatly improved the diagnostic accuracy for particular clinical indications, due to the possible attenuation correction of functional images and the availability of helpful anatomic information. The introduction of CT in the nuclear diagnostic process results in a significant increase of the patient dose. This increase should be justified and optimized considering both the clinical question and the CT settings available on these systems. The choice of CT settings directly affects the effective dose. It varies basically as the square of the tube voltage, linearly with the length of the scan and the product of the current by the rotation time of the tube. It is also inversely proportional to the pitch. For attenuation correction, the literature shows that it is possible to use a low CT tube current without significant effect on tumor FDG uptake or lesion size. Conversely low CT voltage must be used with caution, depending on the algorithm implemented in the CT hybrid device to transform CT Hounsfield units to the attenuation map at the appropriate energy. The radiation dose for anatomic correlation can be substantially lower than for diagnostic-quality CT. It is possible to reduce the patient's radiation dose by a factor of 2 or 3 by acquiring a low-dose PET/CT scan for anatomic correlation of adequate image quality if compared with diagnostic ¹⁸FDG PET/CT. Using specific CT settings, the effective dose can range 7.3–11.3 mSv depending on the patient weight and age.     

« Sens et essence du monde et du moi onirique » dans <Emphasis Type="Italic">Rêve et Existence</Emphasis> de Ludwig Binswanger

This paper reflects on one of Ludwig Binswanger’s best-known essays, in an effort to clarify the mode of existence of the person within the oneiric world and, therefore, the manifestation mode of that world itself. The author argues that what matters most in the expression of that world is not that it consists of images, but that it is devoid of syntax. This makes it both global and perfective and explains why nothing in it is actually determined by the ego of the dreamer. Its space has no horizon, no perspective and no vantage point, and its temporality is in gestation (chronogenetics), with no concept of the separation of present, past and future. It is characterised by process and lacking in structure. In addition, it is strangely familiar, because it echoes the past in a way that indicates inevitable fate. While the dreaming ego is well folded into that world, its mode of existence remains impersonal; it doesn’t decide for itself, and it doesn’t confront what is coming. The strangeness encountered is not that of the Other, but that of the stranger the ego perceives within itself. Dreaming, therefore, offers the opportunity for human beings to experience existence when it is still undecided — Freud called it the id and Schelling Gemüt — in a place where the ego has not yet become a person. It is only in the waking world that people can integrate their still inchoative egos and give them a destination.     

Les aptamères : du concept à l’outil

Aptamers are oligonucleotides, generally DNA or RNA but occasionnally chemically modified nucleic acids, which are identified within randomly synthesized libraries containing up to 10¹⁵ different candidates. They are obtained following a process of in vitro selection termed systematic evolution of ligands by exponantial enrichment (SELEX) that makes use of iterative steps of selection and amplification. Aptamers were successfully raised against a wide range of targets: amino acids, antibiotics, dyes, peptides, proteins, nucleic acids, intact viruses or live cells. They generally display high affinity (Kd in the nanomolar range or lower are frequent for proteins) and high specificity. They are easily obtained by chemical synthesis and can be converted in tools of interest for diagnostic purposes, by conjugation to various pendant groups. They rival antibodies and can be used in vivo in human beings.     

Les faunes d'ammonites du Carixien inférieur et moyen du gisement des Cottards (Cher)

The study of the traditional Cottard layer forthe first time allows the exact succession of lower and middle Carixian ammonites to be established.The most striking fact is the evolution of the Tropidoceras-Acanthopleuroceras lineage, a regular modification of the ribbing density and L¹ structure, an iterative variation of section and tuberculization.Precisions are given on Polymorphites and Beaniceras and three new species are described: Polymorphites evolutus, Beaniceras cottardiense, Acanthopleuroceras alisiense.     

Impact du délai diagnostique sur la survie du cancer du testicule

Objectives

Testicular cancer is the leading cancer of young adults and its incidence is increasing in almost all industrialized countries. The survival rate after testicular cancer is 95%, all stages combined, but a group of patients with poor prognosis still fails to respond to treatment. The time to diagnosis is defined as the time in months between perception of the first symptoms of testicular cancer by the patient and the diagnosis of the disease by the doctor. The objective of this study is to determine whether the time to diagnosis has a prognostic value, particularly whether it is correlated with the stage of the disease and survival.

Material and Methods

The time to diagnosis was studied in 542 patients with a diagnosis of testicular cancer between 1983 and 2002 in the Midi-Pyrenées region. Information concerning the disease and treatments contained in medical files was collected on a summary document. The time to diagnosis was correlated with prognostic parameters, including stage and survival.

Results

The mean time to diagnosis was 3.7±5.1 months and was longer for seminomas (4.9±6.1 months) than for non-seminomatous germ cell tumours (NSGCT) (2.8 ±4.0 months). The time to diagnosis was correlated with the stage of the disease and the 5-year survival on the overall population and in the NSGCT group, but not in the seminoma group.

Conclusions

Early diagnosis has a prognostic value (correlation with stage of the disease and 5-year survival rate). Testicular cancer information campaigns should therefore be envisaged.     

Détermination par TEP-TDM au 18FDG du statut ganglionnaire dans les cancers du col utérin – intérêt de la mesure du SUV de la tumeur primitive

Purpose. – To evaluate the value of ¹⁸F-fluoro-2-désoxyglucose (FDG) PET-CT and maximal standardized uptake value (SUV_max) of the primary tumor for lymph node staging in cervical cancer.Materials and methods. – This retrospective study involved a series of 18 consecutive patients who had benefited from PET-CT and MRI at initial staging for a stage IB or higher cervical carcinoma. The SUV_max of each primary tumor was measured retrospectively. All patients had been previously treated by radiochemotherapy. Lymph node status was obtained in 12 of 18 cases.Results. – The sensitivity and specificity for determining lymph node status was 80 and 86%, respectively, for PET-CT, and 80 and 71% for MRI. In 16.6% of cases, PET-CT revealed unknown sus-diaphragmatic lesions. SUV_max of the primary tumor was significantly higher in the N+ than in the N− group (15.6 ± 1.6 vs 8.5 ± 3.9, p < 0.01). The optimal threshold was determined to be 10.8 from ROC analysis.Conclusion. – When staging with FDG PET-CT, SUV_max of a primary cervical cancer seems to be a good predictor of lymph node status. This could lead to an intensification of treatment for patients whose SUV_max is higher than 10.8. A prospective study would allow to assess a potential benefit of treatment intensification for patients with SUV_max higher than 10.8.     

Sélaciens nouveaux du London Clay de l'Essex (Yprésien du bassin de Londres)

The Ypresian locality of Burnham-on-Crouch(Essex) has yielded numerous Selachian species, some of which are new: Hexanchus agassizi sp. nov., Scyliorhinus burnhamensis sp. nov., S. casieri sp. nov., S. pattersoni sp. nov., S. woodwardi sp. nov., Pararhincodon ypresiensis sp. nov., Triakis wardi sp. nov., Mustelus whitei sp. nov. The Hexanchid teeth classicaly refered to Notidanus serratissimusAg. include in fact two separate species belonging to different genera: Notorhynchus serratissimus (Ag.) and Hexanchus agassizi sp. nov. Lamna affinis (Casier) is arranged in the genus Isurolamna nov. in consideration of his dental peculiarities. The genus Burnhamia nov. is created for Rhinoptera daviesiWoodward that can be regarded as a Mobulid. Oxyrhina sheppeyensisCasier must be classified in the genus Anomotodon. The genus Triakis, Mustelus, Anomotodon and Pararhincodon are pointed out for the first time in the Ypresian.     

Évaluation de la réponse au traitement du lymphome avec la TEP F-FDG : existe-t-il un consensus dans l’évaluation de la réponse ?

The concept of risk-adapted therapy in lymphoma is increasingly accepted as a way to achieve higher cure rates with a lower or equal risk of treatment-related morbidity and mortality. Tailoring and individualizing therapy according to the need of the patient is a therapeutic option which could maybe soon become the standard of care. However, it is still not proven that modifying therapy based on interim-PET can improve patient outcomes. Therefore, this issue must be analyzed in appropriately designed clinical trials. ¹⁸F-FDG PET enables evaluation of the early metabolic changes rather than the morphologic changes which occur later during therapy. In lymphoma these early metabolic changes are highly predictive of the final treatment response. PET performed after a few courses of standard chemotherapy is a reliable prognostic tool to identify poor responders to therapy. Interim-PET is a powerful prognostic tool when compared to other well-established clinical parameters in lymphoma. However, the major drawback in the literature appeared to be related to the lack of uniform and reliable criteria for interim-PET scan interpretation. Therefore, in April 2009 an international meeting took place in Deauville (France), where uniform criteria were established for interim-PET scan interpretation. On the other hand, when PET is used to assess treatment response after completion of therapy, the criteria established in the International Harmonization Project in 2007 must be applied. These recommendations were designed to standardize the interpretation of interim PET and PET at the conclusion of therapy of patients with lymphoma both in clinical practice and clinical trials.     

Limites de la scintigraphie osseuse dans le suivi des métastases osseuses du carcinome mammaire : étude du centre tunisien

Bone metastases, a relatively frequent complication of breast carcinoma, are more and more associated with better survival. This in part through a specific detection and monitoring. In Sousse (Tunisia), bone scan is the exam most frequently performed for monitoring bone metastases, which is also the only functional exam available until December 2011. We studied the place of bone scan in the monitoring of these bone metastases. We followed 115 patients between 2000 and 2004 with a follow-up of 7 to 11 years. We used Measurable Criteria Disease response of Anderson (MDA) scintigraphic criteria. Complete remission was rare. Partial remission rate decreased gradually over time. Partial remission rate was 22.6% at the first evaluation and became equal to 10% at the fourth assessment. Stability is a false reassuring category since among the 27 cases judged to be stable after the first evaluation, only nine continued to be stable at the fourth evaluation and one at the sixth. In conclusion, bone scan is reliable only in cases of complete or partial remission. For other stages bone scintigraphy had many limitations since this examination informs about the osteoblastic reaction around metastases and not the tumour itself. ¹⁸F-FDG-PET/CT (¹⁸Fluoro-deoxy-glucose) indeed shows the metastasis metabolism itself, so is better positioned to evaluate the therapeutic response.     

Systématique du groupe « Palaeochelys sensu lato – Mauremys » (Chelonii,Testudinoidea) du Tertiaire d’Europe occidentale : principaux résultats

Among fossil chelonians from the Tertiary of Western Europe, freshwater Testudinoidea (sensu Hirayama, 1985, Gaffney et Meylan, 1988) are abundant, and more particularly the “Palaeochelys sensu lato—Mauremys” group. This group has never been studied as a whole. Taxa of this group were before referred to extinct genera such as Ocadia, Clemmys, Emys or to the fossil genera Palaeochelys, Borkenia and Palaeoemys. These taxa are redefined, new taxa are described and a hypothesis of phylogenetic relationships is given.     

Contexte géographique et géologique du site de Kocabaş, Bassin de Denizli,Anatolie, Turquie

The site of Kocaba? is located in the Denizli Basin, in western Anatolia, 400 km southwest of Ankara, 360 km south of Istanbul, 200 km east-southeast of Izmir and 150 km northwest of Antalya. The Denizli Basin depression, at the junction of the Buyuk Menderes and Gediz grabens, which began to form at the beginning of the Miocene, was filled in around the edges, along fault lines, by significant travertine formations, some of which are still active today. The age of the Kocaba? travertines, which yielded the Kocaba? Homo erectus skullcap, was evaluated by thermoluminescence at 828,000 years, by electron spin resonance (ESR) at 1,110,000 years and by the ²⁶Al/¹⁰Be cosmogenic nuclide method to more than 1.22 Ma and less than 1.5 Ma, a date which has been confirmed by magnetostratigraphy and biochronology.     

Les occupations humaines du Nord du Maroc,du Paléolithique Moyen et du Paléolithique Supérieur. Nouvelles données sur la base des recherches archéologiques des projets de 2005 à 2020

In this work, we present a synthetic panorama of the human occupations of northern Morocco, with an emphasis on the association of anthropological with cultural records, within the framework of the Middle Palaeolithic (MSA) and the Upper Palaeolithic. We also present the projects developed over the past 15 years and the most interesting results we have obtained. And we conclude bay providing some reflections on the cultural and historical evaluation of the archaeological records from the Tetouan region in the Middle and the Upper Palaeolithic phases.