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Piche T.,Nice University Hospital Center
Neurogastroenterology and Motility | Year: 2014

In this issue of Neurogastroenterology and Motility, Dr Ewa Wilcz-Villega and colleagues report low expression of E-cadherin, a tight junction protein involved in the regulation of paracellular permeability, in the colonic mucosa of patients with the irritable bowel syndrome (IBS) with predominance of diarrhea (IBS-D) or alternating symptoms (IBS-A). These findings constitute an improvement in our knowledge of epithelial barrier disruption associated with IBS. There is mounting evidence to indicate that a compromised epithelial barrier is associated with low-grade immune activation and intestinal dysfunction in at least a proportion of IBS patients. During the last 10 years of research, much interest has focused on the increase in the number of different types of immune cells in the gut mucosa of IBS patients including: mast cells, T lymphocytes, and other local cells such as enteroendocrine cells. The inflammatory mediators released by these cells or other luminal factors could be at the origin of altered epithelial barrier functions and enteric nervous system signaling, which lead to gut hypersensitivity. A current conceptual framework states that clinical symptoms of IBS could be associated with structural and functional abnormalities of the mucosal barrier, highlighting the crucial importance of elucidating the contributory role of epithelial barrier defects in the pathogenesis of IBS. More importantly, disruption of the epithelial barrier could also participate in the generation of persistent abdominal pain and discomfort mimicking IBS in patients with inflammatory bowel diseases considered in remission. This mini review gives a brief summary of clinical and experimental evidence concerning the mechanisms underlying epithelial barrier defects in IBS. © 2014 John Wiley & Sons Ltd.

To evaluate the evidence for quality of life (QoL) impairment, disability, healthcare resource use and economic burden associated with chronic daily headache (CDH), focusing on chronic migraine (CM) with or without medication overuse. A systematic review and qualitative synthesis of studies of patients/subjects with CDH that included CM, occurring on at least 15 days per month. Thirty-four studies were included for review (25 studies of patients and nine of subjects from the general population). CDH and CDH with medication overuse headache (MOH) were consistently associated with a lower QoL compared to control or episodic headache (EH) and CDH without MOH. CDH was consistently associated with greater disability and productivity loss, more consultations, more or longer hospitalizations and higher direct costs than EH. Data were not amenable to statistical pooling. The findings of this review underline the detriment to QoL and the disabling nature of CDH, and in particular CM and CDH with MOH, and negative impact on workplace productivity compared to other types of headache.

Passeron T.,Nice University Hospital Center | Ortonne J.-P.,French Institute of Health and Medical Research
Journal of Investigative Dermatology | Year: 2012

Vitiligo is characterized by a substantial loss of functional melanocytes in the epidermis and sometimes in hair follicles. Genetic and pathophysiological studies have provided strong evidence that vitiligo is a polygenetic, multifactorial disorder. The key roles of oxidative stress within melanocytes and anti-melanocyte immune responses have been addressed in many studies, but the relationship between these mechanisms remains unclear. In this issue, Toosi et al. report the upregulation of IL-6 and IL-8 after the activation of the unfolded protein response (UPR) following exposure of melanocytes to phenols. Their results shed light on the missing link between oxidative stress and immune responses in vitiligo. © 2012 The Society for Investigative Dermatology.

Kestemont P.,Nice University Hospital Center
Journal of drugs in dermatology : JDD | Year: 2012

Increasing volume is an important part of facial rejuvenation since volume loss is common and typically age-related. HA E Volume is a moderately firm gel designed to be injected into the subcutaneous tissue for volume enhancement. To assess the efficacy, patient satisfaction, and safety fo HA E Volume in patients with bilateral volume loss of the cheeks. This was a multi-center, six-month, open-label study. Subjects received HA E in the cheeks at baseline, and a touch-up injection was optional three weeks later. Global aesthetic improvement, cheek thickness (caliper measurements),changes in volume using three-dimensional (3-D) photo analysis, adverse events and injection site reactions were evaluated at each visit. Optimal correction was defined as results obtained three weeks after last injection. A subject satisfaction questionnaire was performed three weeks after the last injection. Investigators evaluated the great majority of subjects as much or very much improved in terms of aesthetic improvement of their cheeks at week 3 and at mounts 3 and 6 (89.3%, 90.9%, and 76.4%, respectively). After six months, 65.8 percent of the correction achieved at week 3 (optimal correction) was maintained in terms of cheek thickness (caliper assessments), confirmed by 67.7 percent of the volume maintained based on 3-D volume analyses. The majority of subjects (92.1%) were satisfied or very satisfied with their aesthetic outcome. A good tolerability profile was observed. Treatment with HA E Volume in cheeks led to good aesthetic improvement, sustained results confirmed by caliper and 3-D volume assessments, and high subject satisfaction.

Lanteri-Minet M.,Nice University Hospital Center
Headache | Year: 2014

Background Hypnic headache (HH) is a rare primary headache characterized by strictly sleep-related headache attacks. Methods This paper reviews the pertinent literature on HH. Results Disease information is mainly based on case reports and small case series (around 250 cases) published since its first description in 1988 by Raskin. HH usually starts over the age of 50. Frequency of patients with HH among patients consulting tertiary headache care centers is estimated from 0.07% to 0.35%, but exact prevalence of HH is unknown. Diagnostic criteria were recently updated by the third edition of the International Classification of Headache Disorders beta version (ICHD-3). Recent data suggest a possible hypothalamic involvement. Conclusion Development of clinical research is needed to better understand the mechanisms of HH and to optimize treatment. Evidence for treatment data are missing, so treatment recommendations are based only on case reports or smaller open case series and reflect clinical experience. Caffeine can be used first line for acute treatment. Lithium and caffeine are possibly effective in prevention. © 2014 American Headache Society.

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