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International audience; BACKGROUND: Clinical outcomes and socioeconomic consequences after a stroke may differ between regions. METHODS: One cohort was established prospectively in Kunming (China) to compare with a cohort of 156 stroke patients included in Limoges (France). During 1 year, patients hospitalized within 48 hours for a first-ever hemispheric stroke were included. Demographic data and neurocardiovascular risk factors were registered. Hemiplegia was evaluated. Functional outcome was assessed using the Barthel Index (BI) after 3 months. RESULTS: One hundred and eighteen patients were included in Kunming. Patients of Kunming were younger (61.4 ± 13.4 vs 72.3 ± 14.6 years in Limoges, P70 years (HR=6.29, 95% CI [2.36, 16.59]). Despite a better baseline BI for patients of Kunming (50.0 ± 34.9 vs 37.4 ± 34.2, P=0.0031), after adjustment for confusing, patients in Limoges had a 2.11 OR 95% CI [1.03, 4.31]) to reach a BI>80 at 3 months. CONCLUSIONS: Functional recovery for patients of Kunming was not as good as expected. The socioeconomic consequences of stroke in Kunming are significant as they involved younger subjects who were still in work.

International audience; Human alveolar echinococcosis is a parasitic zoonosis with intermediate (rodents and small lagomorphs) and final (carnivores) hosts. The latter can transmit the parasite to humans, by their feces, which are contaminated by the oncospheres of Echinococcus multilocularis, the larvae of which develop in the liver like a slow cancer. Political, socioeconomic, and ecological factors can affect the intermediate and final hosts and thus influence the long-term emergence and stability of endemic areas. The past 20 years have been marked by: Epidemiologic changes: discovery of an endemic area in China, the largest in the world; extension of the European endemic range to the east and north; extension of the French endemic range to the west and south; and the settlement of contaminated foxes in urban centers, which will modify the populations at risk over time. Progress in diagnosis: initial use of liver ultrasound to screen for asymptomatic disease; value of magnetic resonance imaging to confirm diagnosis and assess extension of disease before beginning treatment; mastery of immunological and genetic diagnosis; and the introduction of positron emission tomography combined with computed tomography to assess the functional activity of the lesions and monitor treatment. Consensus has defined the main directions of a multidisciplinary treatment approach: radical liver resection when possible; avoidance of palliative surgical procedures; use of interventional radiology or endoscopy to treat biliary and vascular complications, whenever possible; consideration of liver transplantation only when all other treatment possibilities have been exhausted; and treatment of all patients, without exception, by albendazole for at least two years after radical surgery and long term (at least several years) in other cases. In France, survival and quality of life have improved very substantially, due to earlier diagnosis, clinical classification of cases, and rigorous follow-up as part of the FrancEchino network. Better understanding of the immunological and immunogenetic mechanisms that underlie the course of disease may open up the possibility of immunomodulation that could replace or round out the current treatments. These are far from satisfactory, in view of the constraints of prolonged, most often life-long treatment by benzimidazoles and their side effects.

International audience; Eosinophilic meningitis is an uncommon clinical entity, which is mostly caused by Angiostrongylus cantonensis, a nematode which parasitizes rat's lungs. Humans represent a dead-end in the parasite's lifecycle and become infected by ingesting snails, slugs or transport hosts. Due to uncontrolled proliferation and circulation of snails and rats, human angiostrongyliasis has emerged in new foci in continental China. The treatment, which relies upon a combination of albendazole and corticosteroids, is still a matter of debate. In order to assess the epidemiological features of two outbreaks which occurred in Kunming, capital of the Yunnan province, 2003 and 2005, along with the clinical and treatment issues, a retro-prospective study was carried out among thirty-four clinical cases of eosinophilic meningitis. Furthermore, a parasitological survey was carried out on randomized samples of snails sold in the markets of the city On admission, all cases were found to have acute headaches and an eosinophilic pleocytosis rate > 5% in the cerebro spinal fluid (CSF). All patients reported the consumption of raw snails Pomacea canaliculata, 14 days on average before the onset of headaches (range 1-30 days). Hyperesthesia due to radiculitis was observed in 68% of the cases and the meningitis syndrome was present in 41%. The average value of blood eosinophil count in CSF and in peripheral blood was 38% and 900/ml, respectively. Two treatment schedules were used (without randomization): one with progressive doses over 4 weeks; the other with immediate high doses for 10 days with 3 sessions separated by 14-day intervals. The results were compared by the Kaplan Meier log rank test. All the cases had a favorable evolution. The analysis suggested better effectiveness and tolerance of the albendazole - dexamethasone combination used at the highest dosage, namely 20mglkg daily and 10mg daily respectively. Eosinophilic meningitis appeared to be recently emerging or re-emerging in Kunming. Deep-rooted culinary habits of eating raw food, and large amount of snails sold on local markets (about one ton per day) provide ideal conditions for the outbreak, or occurrence of this disease. According to the resdjlts of this study Chinese local authorities should be urged to improve information to the population about the risks of eating raw snails, in order to strengthen the control of both rat and snail populations and reinforce the supervision of local food markets.