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Le Touquet – Paris-Plage, France

Auxemery Y.,Ecole du Val de Grace | Auxemery Y.,University Paris - Sud
Medical Hypotheses | Year: 2012

Post traumatic stress disorder (PTSD) is a complex and heterogeneous disorder, which specific symptoms are re-experiencing, increased arousal and avoidance of stimuli associated with the trauma. PTSD has much comorbidity like depression, substance abuse, somatic complaints, repeated dissociative phenomena and transitory or chronic psychotic reactions. PTSD can manifest itself in different clinical forms: some patients present higher symptoms in one domain as compared to another, probably because of abnormalities in different neurobiological systems. Hyposerotonergic and hypernoradrenergic PTSD endophenotypes have been previously identified and the purpose of this paper is to focus on the hypothesis of a hyperdopaminergic endophenotype. The current review discusses several entities: PTSD with psychotic features with or without depression, the comorbide use of psychoactive substances that increase psychotic symptoms and traumatic brain injuries as agents of psycho traumatic and psychotic features. For all of these nosographic entities, the dopaminergic neuromodulation may play a central role. The hypothesis of a hyperdopaminergic endophenotype of PTSD opens up new research and therapeutic perspectives. Although antipsychotics are frequently used for people with PTSD further studies are needed to develop a consensus on the guidelines for treating the psychotic forms of PTSD. © 2012 Elsevier Ltd.

Fiole D.,Institute Of Recherche Biomedicale Des Armees | Fiole D.,Joseph Fourier University | Fiole D.,University of California at Los Angeles | Deman P.,Institute Of Recherche Biomedicale Des Armees | And 9 more authors.
Infection and Immunity | Year: 2014

The dynamics of the lung immune system at the microscopic level are largely unknown because of inefficient methods of restraining chest motion during image acquisition. In this study, we developed an improved intravital method for two-photon lung imaging uniquely based on a posteriori parenchymal tissue motion correction. We took advantage of the alveolar collagen pattern given by the second harmonic generation signal as a reference for frame registration. We describe here for the first time a detailed dynamic account of two major lung immune cell populations, alveolar macrophages and CD11b-positive dendritic cells, during homeostasis and infection by spores of Bacillus anthracis, the agent of anthrax. We show that after alveolar macrophages capture spores, CD11b-positive dendritic cells come in prolonged contact with infected macrophages. Dendritic cells are known to carry spores to the draining lymph nodes and elicit the immune response in pulmonary anthrax. The intimate and long-lasting contacts between these two lines of defense may therefore coordinate immune responses in the lung through an immunological synapse-like process. © 2014, American Society for Microbiology.

Bargues L.,Ecole du Val de Grace | Fall M.M.,Service de reanimation chirurgicale brules
Annals of Burns and Fire Disasters | Year: 2015

Disaster situations involving mass burn casualties can occur at any time after a fire, a terrorist attack, an industrial explosion or a transport accident. The various burn societies in the world published recommendations on disaster burn-care planning. French burn society (Société Française d’Étude et de Traitement des Brûlures-SFETB) proposes triage of burned victims according to Total Burn Surface Area (TBSA), inhalation injury and associated traumatic injuries. This plan seeks to classify victims and to refer each burned patient to a bed suited to its needs (burn centre, surgical or medical ICU, Emergency room, surgical ward and triage). Emergency Medical Services play a pivotal role in this organisation: first care, advanced medical post, medical coordination, triage and transportation, additional equipment supply in proximal hospital. Burn disaster plan should be adapted to local medical resources. © 2015, Annals of Burns and Fire Disasters. All rights reserved.

Clinical procedure is not established according to fixed guidelines. The contribution of neuroscience, technical and social advances such as the modification of health care university curricula interact with our viewpoint on this clinical perspective. The example of the construction and the deconstruction of a post-traumatic stress disorder over time illustrates the obvious fact that we can study thanks to an anthropological perspective which, with the editions of the DSM and psychometric studies, bring into question the degree of scientism of clinical psychiatry. The concept of psychic trauma and psycho-traumatic syndrome is changing in society in the same way as during the evolution of a psycho-traumatized subject because a clinical entity questions the subjectivity of a subject in connection with the subjectivity of an era. If the traumatic repetition syndrome has always existed, its expression changes according to the social context and the psychic progression of the psycho-traumatized subject. In contrast, what appears unchanging at the clinical and psychotherapeutic level is the absence of a universal response to a psychic trauma. In this respect, the traumatic reaction becomes emancipated from the general paradigm of stress turning to the singular as a subjective implication. The unmasking of this subjectivity during psychotherapy will enable the traumatic consequences to be overcome by recovering the existence of a sense to the event. If the paradigm of stress was useful in establishing epidemiological studies in spite of being criticized, this theoretical orientation has overall failed to open up the way for treatment. However, as the clinical perspective is continually changing, recent neuro-imaging and neurogenetics research have once again shown the theoretical evolution according to apparently external determinants but which could also change the treatment of the psychotraumatized patient.

Mayet A.,Center Depidemiologie Et Of Sante Publique Des Armees | Mayet A.,The Innovation Group | Genicon C.,Ecole du Val de Grace | Duron S.,Center Depidemiologie Et Of Sante Publique Des Armees | And 8 more authors.
Journal of Infection | Year: 2013

Objective: Since the start of 2010 there has been a flare-up of measles in France, following on the resurgence observed in 2008. The aim of this study was to present results of the epidemiological surveillance of measles in the French armed forces in metropolitan France and to describe the outbreak that occurred in 2010 and 2011. Methods: Criteria for report were those used for French national compulsory notification. The data, concerning active military personnel, were derived from epidemiological surveillance from 1992 to 2011 for the incidence rates and from notification forms completed in 2010 and 2011 by the military practitioners for the description of characteristics of cases. Results: Between January 1992 and July 2010, 833 cases of measles were reported. Since 2002, the mean incidence rate had been 1 case p.100,000. A significant increase in incidence was observed in 2010 (10.1 p.100,000) and in 2011 (41.4 p.100,000). Clusters of cases accounted for 72.3% of cases. Rates were much higher among subjects under 30. Only 68.6% of cases had been previously vaccinated with at least one dose of MMR vaccine. The mean vaccine coverage among contacts of cases was approximated to 54.3%. Conclusions: The outbreak of measles observed in 2010 and 2011 in the French armed forces followed the same pattern as that observed nationally and at European level, and can be seen as the likely consequence of inadequate vaccination coverage. © 2012 The British Infection Association.

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