Les théories de l’économie animale et l’émergence de la psychiatrie de l’Encyclopédie à l’aliénisme

The author analysesEncyclopédie’s articles devoted to nervous and mental functioning and disorders, showing that a new approach to lunacy as a mental illness, which is defined in some articles as a “general trouble of the animal economy”, progressively emerged. The term,animal economy, unified physical and moral aspects of the study of man. It was elaborated by XVIIIth century physiologists and was widely accepted by French physicians. This idea is based on the vitalistic thought of the Montpellier school, which equated life with sensibility, and on English medical conceptions of a nervous-centred organism. Later on Philippe Pinel’s work displayed the legacy of these conceptions. On one hand, the comprehensive view of physical and moral dimensions in theanimal economy neutralized the question of an organic or psychogenetic origin of madness. This enabled him to consider it as a determinate field of sensibility interactions and as a medical matter, and to legitimize the group of therapeutic practices that he namedtraitement moral. On the other hand, Pinel departed from the classical conception ofanimal economy by developing his concept of aprinciple of mania, which underlies the manifold symptoms and forms of madness, and which are only perceptible to a trained specialist (aliéniste). The historical development analysed in this article show how alienists were enabled to claim both the wholly medical nature of insanity as disease, and their specific competence as apart from the other medical disciplines. To this extent, Esquirol achieved Pinel’s scientific work.     

Application de la technique de PCR en temps réel à l’étude de l’ADN ancien

Real-time Polymerase Chain Reaction (PCR) for the study of ancient DNA. The properties of ancient DNA (aDNA) make difficult the retrieval of DNA sequence. The advantage of Real-Time PCR was exploited, for the first time, in the study of aDNA. We determined the optimal condition to amplify, in one round of PCR, aDNA, which should be directly sequenced. Beside the verification of aDNA authenticity, we compared two cleaning bone methods: scalpel and ethanol. The ethanol specimens showed the best DNA yield. The aDNA was extracted and amplified (mitochondrial hypervariable region I) from five skeletons exhumed from the archaeological site of Notre-Dame-du-Bourg (France), dated from 3rd to 17th century. To cite this article: R. Kefi et al., C. R. Palevol 2 (2003) 125–132.     

Cytochrome P450 et activation génétique — de la pharmacologie à l’élimination du cholestérol et à la régression de l’athérosclérose

Background

Lipoproteins are closely associated with the atherosclerotic vascular process. Elevated levels of highdensity lipoprotein cholesterol (HDL-C) and apolipoprotein AI (apo AI) in plasma indicate a low probability of coronary heart disease (CHD) together with enhanced longevity, and elevated levels of low-density lipoproteincholesterol (LDL-C) and apo B indicate an increased risk of CHD and death. Studies linking gene activation and the induction of cytochrome P450 with elevated plasma levels of apo AI and HDL-C and lowered plasma levels of LDL-C presented a new potential approach to prevent and treat atherosclerotic disease.

Objective and methods

This is a review aimed at clarifying the effects of P450-enzymes and gene activation on cholesterol homeostasis, the atherosclerotic vascular process, prevention and regression of atherosclerosis and the manifestation of atherosclerotic disease, particularly CHD, the leading cause of death in the world.

Results

P450-enzymes maintain cellular cholesterol homeostasis. They respond to cholesterol accumulation by enhancing the generation of hydroxycholesterols (oxysterols) and activating cholesterol-eliminating mechanisms. The CYP7A1, CYP27A1, CYP46A1 and CYP3A4 enzymes generate major oxysterols that enter the circulation. The oxysterols activate — via nuclear receptors — ATP-binding cassette (ABC) A1 and other genes, leading to the elimination of excess cholesterol and protecting arteries from atherosclerosis. Several drugs and nonpharmacologic compounds are ligands for the liver X receptor, pregnane X receptor and other receptors, activate P450 and other genes involved in cholesterol elimination, prevent or regress atherosclerosis and reduce cardiovascular events.

Conclusions

P450-enzymes are essential in the physiological maintenance of cholesterol balance. They activate mechanisms which eliminate excess cholesterol and counteract the atherosclerotic process. Several drugs and nonpharmacologic compounds induce P450 and other genes, prevent or regress atherosclerosis and reduce the occurrence of non-fatal and fatal CHD and other atherosclerotic diseases.     

Stratégies biologiques à l’heure de l’Assistance Médicale à la Procréation chez le blessé médullaire

Most men with spinal cord injury (SCI) men have fertility problems caused by anejaculation and decreased fertility of the ejaculate. There are two main causes for the impaired reproductive potential in SCI men: ejaculatory dysfunction and poor quality semen. However, current treatment techniques allow a large number of SCI males to achieve ejaculation (rectal electro-stimulation, penile vibrator stimulation). Firstly, masturbation and/or penile vibrator are used at home allowing the couple to perform insemination themselves. The semen of men with spinal cord injuries has commonly been characterised by small volume, abnormal count (low or high), decreased sperm mobility, increased formation of reactive oxygen species, sperm autoimmunity, necrospermia. This impairment is thought to be due to insufficient drainage, genitourinary infections and raised scrotal temperature. Testicular biopsy reveals varying degrees of tubule degeneration and decreased spermatogenetic activity. Semen could be used for various assisted reproductive technologies such as intrauterine insemination,in vitro fertilisation (IVF) and microinsemination (ICSI). The literature reports pregnancy rates by intrauterine insemination of about 15 to 20% per couple. Clinical pregnancy rates after IVF and ICSI techniques are 30% per cycle and these results are comparable to the clinical pregnancy rates when these techniques are performed for female infertility. However, semen must be frozen as soon as possible after the injury and the patient must be informed about the various available assisted reproductive technologies.     

Le principe de l’anonymat du donneur de gamètes à l’épreuve de son contexte. Analyse des conceptions juridiques de l’identité

This study clarifies the lively debate surrounding the anonymity of gamete donors. This principle, which has not been challenged since 1994, is currently criticized by a number of people, who were conceived through medically assisted procreation technologies with donor and who now have reached adulthood. Their testimony has a very significant impact on French public opinion. Several official reports have already suggested that the anonymity of gamete donors may well be removed under certain circumstances. To understand why public opinion has evolved so dramatically, we must revisit the legal position of gamete donors in the specific context of less visible changes in the law. Indeed, the legal concepts of parenthood and identity have been reshuffled over time, and such changes have deeply affected the legal issues relating to the anonymity of gamete donors. Formerly, the law governing the identification of individuals was shaped by political and social objectives. Now it is more concerned with the sense of identity and personal fulfilment of people. This change, based on modern western notions of egalitarianism and individuality, has dramatically affected the outcome of parenthood trials. Moreover, biological tests have made the truth available like never before. The possibility of finding out the truth has shocked the practice of many areas of family law and has created a new set of challenges, especially when the secrecy of the genetic parents has been legally established. In France, women have traditionally been able to deliver their children anonymously. A deadlock has resulted, which may now be overcome by introducing a new concept of personal origins. Now the law is evolving to permit the children to demand their biological mothers’ identity under certain circumstances, but without affecting anyone’s rights. The concept of personal origins has been quite successful on the European scene and has also charged the debate. It is now recognized under French and European laws that individuals must have privileged access to their personal origins. Can the principle of anonymity of gamete donors remain immune from such a (r)evolution ?     

Hommage à rené delépine à l'occasion de son départ à la retraite

A tribute to René Delépine on the occasion of his retirement. The career of René Delépine is reviewed on the occasion of his retirement. When he was a student, a meeting with Jean Feldmann led to a lifelong inclination towards phycology. Eventually appointed to the position of assistant professor at the University of Paris-VI (University Pierre-et-Marie-Curie), René Delépine worked and published primarily on the taxonomy of antarctic and subantarctic marine algae but he was also interested in seaweed aquaculture and utilizations. After organizing the national colloque ValVA (Valorisation des végétaux aquatiques), he became increasingly involved in the commercial application of seaweeds. His main activity, however, remained university teaching for which he was always enthusiastic, especially for teaching in the field and on the subject of the utilizations of algae. A list of his publications is given at the end of this article.     

Données descriptives de l’activité d’Assistance médicale à la procréation avec don de spermatozoïdes au sein des CECOS de 1973 à 2006 en France

Introduction

The first CECOS (Centre for study and conservation of human eggs and sperm) was created in 1973 by Georges David and till today, most of the activity of sperm donation in France is managed by the CECOS. This work presents a detailed report of the activity of sperm donation between 1973 and 2006 in this French CECOS network.

Material and methods

Annual activity reports have been compiled by the French CECOS network since 1973. We have collected and analysed these annual reports in order to establish a general estimation of the activity of sperm donation in France during the period of more than 30 years.

Results

Sixty-nine thousand nine hundred forty-five couples asked for assisted reproductive techniques with sperm donation (mainly artificial insemination) to conceive their first child. About 20% of these couples tried to conceive a second or third child. A total of 44,045 children were thus conceived with the effective contribution of 10,347 donors of spermatozoa (out of 16,971 donors who came in the centres for a donation). This report of activity is the largest ever published.     

Rôle de la TEP FDG dans l’évaluation de l’extension locorégionale et à distance du mélanome

FDG PET/CT is a relevant examination for patients with high-risk melanoma. For early stages with thickness ≥ 1 mm, lymph node ultrasound, and when negative, lymphoscintigraphy for determination of sentinel lymph node, remain necessary. For more advanced stages, FDG PET can map the lesions and guide the therapeutic strategy, either with surgical management, or systemic therapy (or sometimes both). In patients with high-risk melanoma, it allows to detect relapses early, including in asymptomatic patients, with a potential impact on therapeutic decisions. Beside the detection of classical secondary localizations, FDG PET has the advantage of allowing whole-body imaging, the identification of soft tissue lesions, frequent in melanomas, as well as rarer sites of involvement, such as those of the gastro-intestinal tract. For the assessment of cerebral and leptomeningeal involvement, MRI remains mandatory. Evolutions in the therapeutic management of advanced melanomas, and the search for biomarkers to guide the therapeutic strategy, ask for more refined analyses of PET, with metabolic tumour volume analysis and radiomics. The combination of metabolic imaging data with biological and molecular data, and the development of new PET tracers may improve the assessment of prognosis and the prediction of response to therapies, in order to tailor the therapeutic strategy to each patient. Further studies are needed to consolidate the role of PET/CT in this disease for which numerous therapeutic innovations are emerging.     

Application de l’imagerie moléculaire par fluorescence à la clinique

Fluorescence probes and imaging methods have been extensively developed in microscopy to visualize biological pathways, cell trafficking and intracellular interactions, which are the main targets of molecular imaging. The translation of these methods from microscopy to preclinical and clinical applications requires to image through large thickness of live biological tissues, and to ensure the non-toxicity of the probes. We hereafter list the main issues that must be addressed to translate fluorescence techniques to clinic, and we present the main envisioned solutions. As first realistic clinical application, we present work in progress on intraoperative fluorescence guided surgery.     

Intérêt de l’introduction à la nomenclature du test de détection des HPV

Le cancer du col de l’utérus reste un problème de santé publique puisque 900 000 nouveaux cas sont diagnostiqués chaque année de par le monde [Luthra] et il est responsable en France de plus de 1600 décès par an. Pourtant, depuis plus de 40 ans, le dépistage de masse des précurseurs du cancer invasif est tout à fait réalisable et le traitement des anomalies cervicales pré-invasives amène généralement à la guérison.     

Évaluation de la faisabilité de la tomoscintigraphie myocardique précoce au sestamibi synchronisée à l’électrocardiogramme

BackgroundOur aim was to assess the feasibility of early acquisition (10 min) gated single photon emission computed tomography (SPECT) by comparison to conventional imaging at one hour.Methods and resultsOne hundred and four patients referred for exercise test and SPECT were included. Sequential imaging was started 10 min (SPECT 10) and 60 min (SPECT 60) after injection of the radiotracer (Tc-99m sestamibi). Stress myocardial perfusion was visually analyzed from 10 to 60 min stress by two experienced nuclear-cardiologists. Six patients were further excluded, because of high digestive accumulation: one patient at 10 min, three at 10 and 60 min, two at rest. The participants were classified as follows: group G1 (normal SPECT 10 and 60, n = 53), group G2 (abnormal SPECT 10 and/or SPECT 60, n = 45). The left ventricle ejection fraction (EF) and volumes (end-systolic and end-diastolic volumes, ESV, EDV) were calculated with the Cedars-Sinai program.ResultsQuality imaging was the same at SPECT 10 min and SPECT 60 min. Perfusion scores: G1 10 min = 0,4 versus G1 60 min = 0,4 (p = NS); G2 10 min = 10,2 versus G2 60 min = 10,1 (p = NS); EFG1 10 min = 71 ± 11% versus EFG1 60 min = 68 ± 10% (p = 4E-04); EFG2 10 min = 56 ± 15% versus EFG2 60 min = 53 ± 15% (p = 0,002); EDV G1 10 min = 72 ± 20 ml versus EDV G1 60 min = 76 ± 19 (p = 0,002); EDV G2 10 min = 98 ± 46 ml versus EDV G2 60 min = 105 ± 38 (p = 0,08); ESVG1 10 min = 22 ± 12 m versus ESV G1 60 min = 25 ± 12 (p = 9E-04); ESVG2 10 min = 47 ± 35 ml versus ESV G2 60 min = 53 ± 36 (p = 3E-04).ConclusionsThis study suggests that early gated Sestamibi SPECT after stress provides same perfusion analysis than classical late imaging.     

Intérêt de la tomoscintigraphie cardiaque à la 123I-mIBG couplée à la perfusion myocardique dans le diagnostic de l’atrophie multisystématisée

ObjectiveThe aim of this prospective study is to assess the pertinence of using ¹²³I-mIBG myocardial tomoscintigraphy coupled with perfusion scintigraphy as a diagnostic tool, to discriminate between multiple system atrophy (MSA) and idiopathic Parkinson's disease (PD) at first guided by clinical data and L-DOPA tests.Material and methodsForty patients, aged from 43 to 78 years (median 62 years) with Parkinson's syndrome were studied. Nineteen had a diagnosis of PD (criteria of brain bank) and 21 AMS (Gibbs criteria). All were given test to acute L-DOPA. Chest-centered planar imaging (128 × 128 matrix, 5 minutes of duration) is performed at 1 hour and 4 hours after injection of 220 MBq of ¹²³I-mIBG, in addition a non-synchronised tomoscintigraphy (64 × 64 matrix, 32 images of 50 seconds , zoom 1.45) was performed after the 4th hour and 15 minutes after injection of 200 to 400 MBq of ^99mTc-tetrofosmin. Besides neurological data, the parameters retained for comparison purposes with ¹²³I-mIBG cardiac tomoscintigraphy were patients’ age, duration of disease and L-DOPA test results. Two regions of interest (ROI) identical in size and in shape are used for ¹²³I-mIBG uptake quantifications (H/M and washout [Wo]). The first one was placed in projection of mediastinum (M) and the other one in projection of heart (H).ResultsWe found an overall decreased uptake of the myocardial ¹²³I-mIBG without perfusion abnormality in 15 of 19 patients with PD and 11 among them were L-DOPA sensitive (L-DOPA test greater than 30%). Normal tracer uptake with ¹²³I-mIBG associated with an almost quite normal perfusion was seen in 15 of 21 patients with MSA and they were little or not L-DOPA sensitive (L-DOPA test less than 30%). Therefore, 10 discordant cases (25%) between cardiac scintigraphy and clinical evolution of disease with also discordant L-DOPA tests were observed. In the PD group, quantification of data enhanced the diagnostic decision with low heart to mediastinum ratio (H/M) (1.32 ± 0.15 at the early stage and 1.25 ± 0.13 at the later stage). In the MSA group, the uptake of ¹²³I-mIBG (1.66 ± 0.43 at the early stage and 1.72 ± 0.42 at the later stage) was comparable to literature data, however, with significant inter-individual variations. The association of data of scintigraphy with L-DOPA test allows to improve sensitivity in 84% and specificity in 90.5%.ConclusionOur prospective study of 40 cases shows the relevance of cardiac sympathetic postganglionic imaging with ¹²³I-mIBG coupled with myocardial perfusion scintigraphy to discriminate between MSA and PD with a higher sensitivity (71.4%) compared to the test with L-DOPA but a lower specificity (78.9%) than the L-DOPA. The difficulty of diagnosis is firstly linked to damage occurring to both the pre- and postganglionic sympathetic systems in patients with MSA and secondly to the integrity of the sympathetic nerve endings in patients with PD. However, the association of data of scintigraphy with L-DOPA test show a significant improvement of sensibility (84%).     

La contribution de la pensée d’Alfred Kraus à l’étude phénoménologique des troubles bipolaires

German psychiatry is one of the areas where we see the development of an unconventional psychiatry, characterized by its reference to philosophical traditions that are remote from the natural sciences, and by its emphasis on the overall nature of the mentally ill person. This approach first emerged during the period of comprehensive psychiatry promoted by Karl Jaspers and Kurt Schneider. This particular form of psychopathology focuses its attention on the inner experience of the ill person and attempts to understand it, in particular through empathy. This approach was soon reinforced by a philosophical method founded by Husserl and further developed by Heidegger: phenomenology. Firstly, this consists of a way of approaching and examining the discrete elements of consciousness, leading to the notion of intentionality (Brentano, Husserl). The central place of consciousness in this approach leads to the questioning of existence and of the person supporting this consciousness: this philosophy thus leads to existentialism (Jaspers, Sartre) and Heidegger’s concept of Dasein (the existential analytic, Dasein’s ontology). Phenomenological psychiatry is thus a clinical science characterized by its approach and its reference to what might overall be described as comprehensive anthropology. There are numerous authors who affiliate themselves with this phenomenological psychology. Our article is devoted to Alfred Kraus’s approach. We will first of all address the notions of comprehensive psychiatry and phenomenology. After introducing Alfred Kraus and the specific philosophical and clinical foundations of his work, we will examine the Krausian theory of identity based on Mead and Sartre, which establishes a distinction between ego-subject (a free element that produces ego achievements) and ego-object (identifications, in particular with social roles in the case of depressives). The ego-subject is the transcendent element (Sartre), which constantly exceeds what I am (ego-object) and there is thus an internal negativity. We will then address the clinical concept of manic-depressive illness. The identity structure of the depressive is characterized by hyper-identification. The notion of psychotic breakdown will then be covered, where it appears that melancholia is not an affective disorder, a mood disorder, but a case of depersonalisation. The personality disorder which precedes melancholia results from a threat that weighs on this fragile identity propped up against its identifications, which is expressed in hypernomic behaviour: this being a reinterpretation of the notions of a specifically depressive temperament, constitution, premorbid personality or typus melancholicus. Hypernomic behaviour is characterized by the scrupulous observance of role expectations and an extreme respect for laws and norms which is expressed as a form of hyperadaptation. Finally, the last part is devoted to the intolerance of ambiguity, which can be cognitive or emotional (the inability to experience negative feelings).     

Influence de la congélation sur le taux de fragmentation de l’ADN des spermes normaux à sévèrement altérés

Ejaculated sperm cryopreservation can be proposed in the course of anART procedure, particularly in the case of severe oligozoospermia likely to deteriorate. The aim of this study was to evaluate the influence of the freezing-thawing process on sperm DNA fragmentation (analysed by the TUNEL technique). The first step of this work consisted of adapting the TUNEL technique to perform this analysis on very poor quality sperm. A study was then performed on 72 patients divided into 4 groups according to their spermatic characteristics: group 1 [n=20] (“normal” parameters according to WHO), group 2 [n=24] (normal sperm count associated with asthenospermia and/or teratospermia), group 3 [n=16] (total sperm count between 5 and 20 M) and group 4 [n=12] (total sperm count below 5 M). Spermatic parameters and DNA fragmentation (performed by TUNEL in situ technique, 400 spermatozoa read per slide) were evaluated on raw semen - for all patients -, raw migrated sperm - for patients of group 1 and 2 -, migrated frozen-thawed sperm - for all patients-. A TUNEL technique adapted to oligospermic samples was developed, manipulating spermatozoa directly on the slide rather than in suspension, to limit spermatic sample loss. After the whole migration-freezing-thawing process, the mean DNA fragmentation rate decreased for patients in group 1 (2.9 vs 5.1%, p<0.0001) whereas this rate increased for patients in groups 2 (10.5 vs 6.8%, p<0.0001), 3 (10.7 vs 7.6%, p<0.05) and 4 (15.2 vs 8.7%, p<0.005). DNA fragmentation rates from thawed samples were also correlated with initial spermatic parameters. At the intermediary step, migration decreased DNA fragmentation rate in comparison with raw semen rate in both groups (1.9 vs 4.7% [p<0.05] in group 1; 2.5 vs 5.4% [p<0.05] in group 2). DNA fragmentation rate decreases after migration and then increases after freezing-thawing so that this rate is lower than the raw semen rate for “normal“ sperms and higher than the raw semen rate for altered sperms. Nevertheless, this DNA damage induced by cryopreservation on altered sperms remains moderate. Sperm “resistance” to cryopreservation also appears to depend on spermatic parameters. Cryopreservation may positively select spermatozoa, accelerating elimination of senescent spermatozoa by necrosis, so that early apoptotic spermatozoa from fresh ejaculate are not found in thawed samples. These results, that need to be completed by a study on a larger sample of oligospermic patients, encourage us to continue cryopreserving severely altered sperms.     

Les symptômes de premier rang de la schizophrénie: de la clinique à l’approche expérimentale

Theoretical models about action monitoring and action attribution developed over the last ten years have given a new framework in the understanding of first-rank symptoms of schizophrenia, as described by Kurt Schneider. Impaired action attribution has been demonstrated in patients with first-rank symptoms. Moreover, positron emission tomography studies have revealed that the cortical network involved in action attribution processes in normal subjects is not correctly activated in patients with first-rank symptoms. These results demonstrate that these symptoms are related to cognitive and cerebral correlates and they shed new light on the understanding of psychotic symptoms.     

Caractérisation des peuplements de macroinvertébrés benthiques à l’aide de la carte auto-organisatrice (SOM)

Macrobenthic organisms are much used nowadays as bio-indicators for their ability to reflect different disturbances of aquatic ecosystems. However, they have never been used to assess the ecological status of the lagoons of Benin. The current study aims at revealing the ecological state of the lagoon of Porto-Novo through the study of changes in the settlement of benthic organisms collected in this lagoon. The sampling was carried out from July 2007 to June 2009 on a frequency of four seasons of collection per year. The self-organizing map (SOM) of Kohonen has been used for various patterns of distribution of collected organisms. A discriminant analysis (AFD) has allowed the identification of the parameters that govern the patterns observed in this environment. Four groups of macrobenthic communities emerged that were well predicted (75%). The distribution of benthic macro invertebrates of this lagoon is therefore zonal, seasonal and discriminated by variables of mineralization and sediment grain size. The difference in taxonomic richness corresponds to environmental conditions of stations appearing more or less stable and highlighting a gradient of the stress on organisms. Places with unstable conditions are affected by human activities due to their proximity to homes that are enriched in organic matter. These places are full of polluted-tolerant species such as the Gastropods Potamididae, Cirratulidae Polychaetes, Diptera Chironomidae and Oligochaeta. The macrobenthic fauna, which is well differentiated in the groups, is then subjected to human disturbance.