Predicting the evolution of clinical skin aging in a multi-ethnic population: Developing causal Bayesian networks using dermatological expertise

INTRODUCTION

Software to predict the impact of aging on physical appearance is increasingly popular. But it does not consider the complex interplay of factors that contribute to skin aging.

OBJECTIVES

To predict the +15-year progression of clinical signs of skin aging by developing Causal Bayesian Belief Networks (CBBNs) using expert knowledge from dermatologists.

MATERIAL AND METHODS

Structures and conditional probability distributions were elicited worldwide from dermatologists with experience of at least 15 years in aesthetics. CBBN models were built for all phototypes and for ages ranging from 18 to 65 years, focusing on wrinkles, pigmentary heterogeneity and facial ptosis. Models were also evaluated by a group of independent dermatologists ensuring the quality of prediction of the cumulative effects of extrinsic and intrinsic skin aging factors, especially the distribution of scores for clinical signs 15 years after the initial assessment.

RESULTS

For easiness, only models on African skins are presented in this paper. The forehead wrinkle evolution model has been detailed. Specific atlas and extrinsic factors of facial aging were used for this skin type. But the prediction method has been validated for all phototypes, and for all clinical signs of facial aging.

CONCLUSION

This method proposes a skin aging model that predicts the aging process for each clinical sign, considering endogenous and exogenous factors. It simulates aging curves according to lifestyle. It can be used as a preventive tool and could be coupled with a generative AI algorithm to visualize aging and, potentially, other skin conditions, using appropriate images.

Effect of methionine and trace minerals (zinc, copper and manganese) supplementation on growth performance of broilers subjected to Eimeria challenge

Coccidiosis is a major intestinal challenge that causes economic loss to the broiler industry. Two battery cage studies were conducted to evaluate the effect of trace minerals, source and dose of methionine on growth performance and gut health of broilers subjected to Eimeria challenge. Experiment #1 consisted of 9 treatments of 2 × 2 × 2 factorial design + 1 arrangement with main factors of methionine (Met) sources (DL-Met vs. 2-hydroxy-4-(methylthio)-butanoic acid (HMTBa)), total sulfur amino acid (TSAA) levels (high vs. low; ±5% of recommended level), and sources of trace minerals (TM) Zn:Cu:Mn in the form Inorganic trace minerals (ITM) in sulfates (80:20:100ppm) vs. mineral methionine hydroxy-analogue bis-chelate (MMHAC, 40:10:50ppm), each with 8 pens of 10 birds. Experiment #2 consisted of 2 treatments--ITM [ZnSO4:tribasic copper chloride (TBCC):MnSO4 110:125:120ppm] and MMHAC (Zn:Cu:Mn, 40:30:40ppm), each with 36 pens of 10 birds. All birds except for treatment 9 in experiment #1 were orally gavaged with 1x, 4x and 16x recommended dose of coccidiosis vaccine on d0, d7 and d14, respectively. Data were subjected to one-way and/or three-way ANOVA, and means were separated by Fisher's protected LSD test with significance at p ≤ 0.05. In experiment #1, factorial analysis revealed the main effects of TSAA level and TM, but not Met source. High TSAA level improved body weight and cumulative feed intake at 14, 20, and 27d. MMHAC improved body weight at 14, and 27d; feed intake at 14, 20, and 27d; and cumulative FCR at 27d vs. sulfates. One-way ANOVA analysis showed that birds fed MMHAC and high levels of TSAA regardless of Met source had similar body weight as unchallenged birds on d27. In experiment #2, MMHAC improved body weight and cumulative FCR, and reduced jejunal IL-17A gene expression on d28. In summary, in broilers subjected to Eimeria challenge, supplementation of the reduced levels of bis-chelated trace minerals MMHAC improved growth performance compared to high levels of ITM (sulfates or TBCC), which might partially result from better immune response, high levels of TSAA improved growth performance, Met source had no effect. Supplementation of both bis-chelated trace minerals MMHAC and high levels of TSAA could overcome the growth performance challenge issue due to coccidiosis.

Safety and immunogenicity of the epicutaneous reactivation of pertussis toxin immunity in healthy adults: a phase I, randomized, double-blind, placebo-controlled trial

OBJECTIVES

Protection induced by acellular vaccines can be short, requiring novel immunization strategies. Objectives of this study were to evaluate safety and capacity of a recombinant pertussis toxin (PTgen) -coated Viaskin® epicutaneous patch to recall memory responses in healthy adults.

METHODS

This double-blind, placebo-controlled randomized trial (Phase I) assessed the safety and immunogenicity of PTgen administered on days 0 and 14 to healthy adults using Viaskin® patches applied directly or after epidermal laser-based skin preparation. Patch administration was followed by Boostrix®dTpa on day 42. Antibodies were assessed at days 0, 14, 28, 42 and 70.

RESULTS

Among 102 volunteers enrolled, 80 received Viaskin-PT (Viaskin-PT 25 μg (n = 25), Viaskin-PT 50 μg (n = 25), laser + Viaskin-PT 25 μg (n = 5), laser + Viaskin-PT 50 μg (n = 25)), Viaskin-placebo (n = 10) or laser + Viaskin-placebo (n = 2). Incidence of adverse events was similar across groups (any local event: 21/25 (84.0%), 24/25 (96.0%), 4/5 (80.0%), 24/25 (96.0%), 8/10 (80.0%), 10/12 (83.0%), respectively). Direct application induced no detectable response. On day 42, PT-IgG geometric mean concentrations were significantly higher following laser + Viaskin-PT 25 μg and 50 μg (139.87 (95% CI 87.30-224.10) and 121.76 (95% CI 95.04-156.00), respectively), than laser + Viaskin-placebo (59.49, 95% CI 39.37-89.90). Seroresponse rates were higher following laser + Viaskin-PT 25 μg (4/5 (80.0%), 95% CI 28.4-99.5) and 50 μg (22/25 (88.0%), 95% CI 68.8-97.5) than laser + Viaskin-placebo (0/12 (0.0%), 95% CI 0.0-26.5).

CONCLUSIONS

Viaskin-PT applied after laser-based epidermal skin preparation showed encouraging safety and immunogenicity results: anti-PT booster responses were not inferior to those elicited by Boostrix®dTpa. This study is registered at ClinicalTrials.gov (NCT03035370) and was funded by DBV Technologies.

P5369Alpha-V integrin regulates the contribution of PW1+ cells to cardiac fibrosis

Background

Activated cardiac fibroblasts produce extracellular matrix proteins that accumulate during cardiac fibrosis. We have recently shown that PW1 is expressed in a subset of cardiac stromal cells and that cardiac PW1+ cells represent a cellular source of fibroblasts in the ischemic hearts.

Purpose

We aimed to further identify new cell surface markers expressed by cardiac PW1+ cells and to investigate their role in the fibrogenic behavior of these cells.

Methods and results

We first performed transcriptomic and proteomic profiling of FACS-isolated cardiac PW1+ from normal and ischemic hearts. RNA-sequencing output files were processed with bioinformatics algorithms to identify 378 specific cell-surface markers for cardiac PW1+ cells. By comparing these candidates with the proteomic profile, we then cross-identified 9 cell surface proteins primarily involved in cell motility, adhesion to the matrix, inflammatory response and response to wounding. One of these candidates (i.e., aV-integrin or CD51) was expressed in almost all cardiac PW1+ cells (93±1%), and was predominantly found in cells expressing PW1 in the myocardium. Cardiac PW1+ cells showed a predominant expression of aVβ1 complex which is known to mediate fibrosis through TGF-beta activation in a number of tissues. The transfer of isolated cardiac PW1+CD51+ cells into ischemic hearts was associated with fibrosis development. We further demonstrated that inhibition of aV-integrin in cardiac PW1+ cells reduces their profibrotic gene expression profile and their ability to differentiate into fibroblasts. Lastly, a pharmacological blockade of aV-integrin improved cardiac function and animal survival following myocardial infarction coupled with a reduced infarct size and fibrotic lesion.

Conclusions

These data identify a targetable pathway that regulates cardiac fibrosis in response to an ischemic injury and demonstrate that pharmacological inhibition of aV-integrin leads to reduced pathological outcomes following cardiac ischemia.

Acknowledgement/Funding

Fondation Leducq (grant 13CVD01, CardioStemNet project), Fédération Française de Cardiologie and Era-CVD (ANR-16-ECVD-0011-03, Clarify project)

Knowledge Representation and Utilisation in a Man-Machine Dialogue with a Medical Decision Aid System

This study presents the man-machine communication procedure, called MEDIUM, with the medical decision aid system SPHINX. The knowledge processed by this procedure is concerned with the entities of the medical discourse, that is the signs, the symptoms and the results of clinical and paraclinical examinations. At first level, the knowledge is constituted by the definitions of the entities and their specific properties. At a second level, the knowledge is constituted by logical formulas which translate the relations that link entities. Part of the coherence of the discourse is judged with regard to the definitions of the entities. The coherence is completely established by evaluating the truth values of the formulas according to the data already stored during the session. Parts of sessions with the procedure MEDIUM are presented and results are discussed.

SPHINX — A System for Computer-Aided Diagnosis

This paper presents a system for computer-aided diagnosis, the SPHINX system, based on methods of inference and pattern matching used in artificial intelligence and on various heuristic features: fuzzy heuristics in relation to the suggestion power of the signs and heuristics based on the costs of complementary investigations. The first application was made in the diagnosis of epigastric pain. Its results are presented and discussed.

A Model for Medical Knowledge Representation Application to the Analysis of Descriptive Pathology Reports

A new knowledge-representation system is presented, designed for medical knowledge-based applications and in particular for the analysis of descriptive medical reports. Knowledge is represented at two levels. A definitional level uses a concept-type hierarchy, a relation-type hierarchy, and a set of schematic graphs to define the concepts used and the relations between them, as well as different types of cardinality restrictions on these relations. A set of compositional hierarchies using the classic “has-part” relation as well as a new set-inclusion relation allows concept composition to be precisely defined. An assertional level allows the creation and manipulation of empirical data, in the form of graphs using the concepts, relations, and constraints defined at the definition level. The use of cardinality constraints in graph unification is considered in the context of descriptive medical discourse analysis.

Representation of Medical Concepts of the Thyroid Gland by Physicians in Anatomy and Pathology

An experimental study in cognitive psychology is described, concerning the categorization of medical concepts into specific classes, expressed by physicians specialized in anatomic pathology consultations of the thyroid gland. This study belongs to a medical computer science project, called ARISTOTLE, concerning Natural Language Processing of specialized medical reports in anatomic pathology of the thyroid gland. This research has been done for two reasons: first, to specify the characteristics of human expert categorization in an area of medical knowledge and, secondly, to validate the hierarchical organization of a prototype declarative knowledge base. In this experiment, physicians were asked to categorize 121 concepts into 10 proposed classes. These classes and concepts belong to expert knowledge represented in a conceptual graph that was constructed before the experiment. Results show variable semantic distances between concepts of a same class, and dynamic variations of these distances due to contextual representation.

A Simplified Model for Intravoxel Incoherent Motion Perfusion Imaging of the Brain

BACKGROUND AND PURPOSE

Despite a recent resurgence, intravoxel incoherent motion MRI faces practical challenges, including limited SNR and demanding acquisition and postprocessing requirements. A simplified approach using linear fitting of a subset of higher b-values has seen success in other organ systems. We sought to validate this method for evaluation of brain pathology by comparing perfusion measurements using simplified linear fitting to conventional biexponential fitting.

MATERIALS AND METHODS

Forty-nine patients with gliomas and 17 with acute strokes underwent 3T MRI, including DWI with 16 b-values (range, 0-900 s/mm²). Conventional intravoxel incoherent motion was performed using nonlinear fitting of the standard biexponential equation. Simplified intravoxel incoherent motion was performed using linear fitting of the log-normalized signal curves for subsets of b-values >200 s/mm². Comparisons between ROIs (tumors, strokes, contralateral brain) and between models (biexponential and simplified linear) were performed by using 2-way ANOVA. The root mean square error and coefficient of determination (R²) were computed for the simplified model, with biexponential fitting as the reference standard.

RESULTS

Perfusion maps using simplified linear fitting were qualitatively similar to conventional biexponential fitting. The perfusion fraction was elevated in high-grade (n = 33) compared to low-grade (n = 16) gliomas and was reduced in strokes compared to the contralateral brain (P < .001 for both main effects). Decreasing the number of b-values used for linear fitting resulted in reduced accuracy (higher root mean square error and lower R²) compared with full biexponential fitting.

CONCLUSIONS

Intravoxel incoherent motion perfusion imaging of common brain pathology can be performed by using simplified linear fitting, with preservation of clinically relevant perfusion information.

Varroa destructor changes its cuticular hydrocarbons to mimic new hosts

Varroa destructor (Vd) is a honeybee ectoparasite. Its original host is the Asian honeybee, Apis cerana, but it has also become a severe, global threat to the European honeybee, Apis mellifera. Previous studies have shown that Varroa can mimic a host's cuticular hydrocarbons (HC), enabling the parasite to escape the hygienic behaviour of the host honeybees. By transferring mites between the two honeybee species, we further demonstrate that Vd is able to mimic the cuticular HC of a novel host species when artificially transferred to this new host. Mites originally from A. cerana are more efficient than mites from A. mellifera in mimicking HC of both A. cerana and A. mellifera. This remarkable adaptability may explain their relatively recent host-shift from A. cerana to A. mellifera.

Innate immune system activation by viral RNA: How to predict it?

The immune system is able to identify foreign pathogens via different pathways. In the case of viral infection, recognition of the viral RNA is a crucial step, and many efforts have been made to understand which features of viral RNA are detected by the immune system. The biased viral RNA composition, measured as host-virus nucleotidic divergence, or CpG enrichment, has been proposed as salient signal. Peculiar structural features of these RNA could also be related to the immune system activation. Here, we gather multiple datasets and proceed to a meta-analysis to uncover the best predictors of immune system activation by viral RNA. "A" nucleotide content and Minimum Folding Energy are good predictors, and are more easily generalized than more complex indicators suggested previously. As RNA composition and structure are highly correlated, we suggest further experiments on synthetic sequences to identify the viral RNA sensing mechanisms by immune system receptors.

Update on pulmonary Pneumocystis jirovecii infection in non-HIV patients

Pneumocystis jirovecii is the only fungus of its kind to be pathogenic in humans. It is primarily responsible for pneumonia (PJP). The key to understanding immune defences has focused on T-cells, mainly because of the HIV infection epidemic. Patients presenting with PJP all have a CD4 count below 200/mm(3). The introduction of systematic primary prophylaxis and the use of new anti-retroviral drugs have significantly reduced the incidence of this disease in the HIV-infected population, mainly in developed countries. The increasingly frequent use of corticosteroids, chemotherapy, and other immunosuppressive drugs has led to an outbreak of PJP in patients not infected by HIV. These patients presenting with PJP have more rapid and severe symptoms, sometimes atypical, leading to delay the initiation of a specific anti-infective therapy, sometimes a cause of death. However, the contribution of new diagnostic tools and a better understanding of patients at risk should improve their survival.

[Ogilvie's syndrome after cesarean section: A case report]

Ogilvie's syndrome is a rare postsurgical complication. The high mortality rate (normally 15 to 31% and up to 45% after caecal perforation) explains the seriousness of this clinical situation. The early diagnosis is made by plain abdominal X-ray. Conservative treatment is usually effective and surgery should be reserved for complicated cases or refractory to conservative treatment. We report a case of Ogilvie's syndrome after cesarean section, which has been treated by conservative methods.

Facial palsy after inferior alveolar nerve block: case report and review of the literature

Bell's palsy is an idiopathic and acute, peripheral nerve palsy resulting in inability to control facial muscles on the affected side because of the involvement of the facial nerve. This study describes a case of Bell's palsy that developed after dental anaesthesia. A 34-year-old pregnant woman at 35 weeks of amenorrhea, with no history of systemic disease, was referred by her dentist for treatment of a mandibular left molar in pulpitis. An inferior alveolar nerve block was made prior to the access cavity preparation. 2h later, the patient felt the onset of a complete paralysis of the left-sided facial muscles. The medical history, the physical examination and the complementary exams led neurologists to the diagnosis of Bell's palsy. The treatment and results of the 1-year follow-up are presented and discussed. Bell's palsy is a rare complication of maxillofacial surgery or dental procedures, the mechanisms of which remain uncertain.

[Recurrent fever and skin eruption revealing chronic meningococcemia]

INTRODUCTION

Chronic meningococcemia is an unusual clinical presentation within the spectrum of infections due to Neisseria meningitidis.

CASE REPORT

We report a 32-year-old man who presented with a 15-day history of fever and maculopapular skin rash, in the absence of meningeal irritation or severe sepsis manifestation. Blood culture identified N. meningitidis. Clinical course was uneventful after antibiotic treatment was initiated.

CONCLUSION

Early diagnosis of chronic meningococcemia is crucial for optimal management of the patient and his/her contacts. Such a diagnosis should be suspected in the presence of the characteristic clinical triad (recurrent fever, skin rash and arthralgia), and this clinical presentation should be distinguished from systemic vasculitis as inadequate prescription of corticosteroids may be deleterious.

Links between specialization in the finishing of bulls, mixing, farmers' attitudes towards animals and the production of finishing bulls: a survey on French farms

In France, beef bulls are finished by breeder-finishers who produce calves and then fatten them, or by specialized finishers who fatten bulls that they buy. According to previous results on both dairy cows and pigs, breeding on the farm promotes positive attitudes of farmers towards animals, which can lead to improved animal health and growth. The mixing of bulls on their arrival at a specialized unit could stress them and thus impair health and growth. We hypothesized that breeder-finishers have more positive attitudes towards bulls and their work with bulls than specialized finishers, and that positive attitudes lead to better production, whereas mixing may be counterproductive. We observed 1038 bulls (67 groups) finished by breeder-finishers or specialized finishers in mixed and unmixed groups. Using a questionnaire, we assessed farmers' beliefs about the sensitivities of bulls, their attitude towards contacts with bulls, their beliefs about successful factors in finishing, and job satisfaction. We recorded the number of clinical signs and weight gain of the bulls. Specialized finishers tended to have more negative contacts with bulls than breeder-finishers (P=0·06). Poor health of bulls was associated with (i) a positive attitude towards gentle contacts with bulls (P<0·01), (ii) job satisfaction (P=0·01), and (iii) was negatively correlated to beliefs in bulls being difficult animals (P=0·09). Fast growth of bulls was associated with job satisfaction (P<0·01). Unmixed bulls grew faster than mixed bulls (P=0·05). We conclude that in finishing bulls, it is production results that have an impact on attitudes, rather than the opposite: the need for close contacts with bulls resulting from health problems engenders more positive attitudes of farmers towards their animals, and good production results increase job satisfaction. Variations in production results between breeder-finishers and specialized finishers seem to lie more in the fact that the latter always use animals mixed at the beginning of the finishing period - with mixing impairing growth - than in the attitudes of farmers towards animals and their work.

Lupus érythémateux systémique et/ou polychondrite atrophiante compliqué d’un syndrome catastrophique des antiphospholipides

INTRODUCTION

Antiphospholipid syndrome is frequently associated with auto-immune disorders.

EXEGESIS

We report the case of a 59-years-old woman with an antiphospholipid syndrome associated with systemic lupus erythematosus and/or relapsing polychondritis.

CONCLUSION

This fatal evolution as a consequence of a delayed management shows that fast and invasive steps are required for diagnosis and treatment of systemic diseases.