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Introduction: Primary spontaneous pneumothorax (PSP) is the presence of air in the pleural space, occurring in the absence of trauma and known lung disease. Standardized expert guidelines on PSP are needed due to the variety of diagnostic methods, therapeutic strategies and medical and surgical disciplines involved in its management.Methods: Literature review, analysis of literature according to the GRADE (Grading of Recommendation Assessment, Development and Evaluation) methodology; proposals for guidelines rated by experts, patients, and organizers to reach a consensus. Only expert opinions with strong agreement were selected.Results: A large PSP is defined as presence of a visible rim along the entire axillary line between the lung margin and the chest wall and ≥2 cm at the hilum level on frontal chest x-ray. The therapeutic strategy depends on the clinical presentation: emergency needle aspiration for tension PSP; in the absence of signs of severity: conservative management (small PSP), needle aspiration or chest tube drainage (large PSP). Outpatient treatment is possible if a dedicated outpatient care system is previously organized. Indications, surgical procedures and perioperative analgesia are detailed. Associated measures, including smoking cessation, are described.Conclusion: These guidelines are a step towards PSP treatment and follow-up strategy optimization in France.

International audience; Matrix metalloproteinases (MMPs) are a group of proteases known to regulate the turnover of extracellular matrix and thus are suggested to be important in the process of several diseases associated with tissue remodeling. Furthermore, the concept that modulation of airway remodeling including excessive proteolysis damage of the tissue, may be of interest as a basis for future treatment. Degradation of extracellular matrix is currently associated with structural and recruited cell activation and release of inflammatory mediators and MMPs. Indeed, a marked increase in their expression is observed associated with a variety of inflammatory diseases, including respiratory pathologies. In these conditions, we have to consider MMPs as therapeutic targets which can be inhibited by non-selective and/or selective inhibitors as anti-inflammatory compounds. The present review aims to discuss the potential interest of the inhibition of MMP in inflammatory diseases with a focus on respiratory diseases.

Tauopathy comprises hyperphosphorylation of the microtubule-associated protein tau, causing intracellular aggregation and accumulation as neurofibrillary tangles and neuropil treads. Some primary tauopathies are linked to mutations in theMAPTgene coding for protein tau, but most are sporadic with unknown causes. Also, in Alzheimer's disease, the most frequent secondary tauopathy, neither the cause nor the pathological mechanisms and repercussions are understood. Transgenic mice expressing mutant Tau-P301L suffer cognitive and motor defects and die prematurely from unknown causes. Here,in situelectrophysiology in symptomatic Tau-P301L mice (7–8 months of age) revealed reduced postinspiratory discharges of laryngeal motor outputs that control laryngeal constrictor muscles. Under high chemical drive (hypercapnia), postinspiratory discharge was nearly abolished, whereas laryngeal inspiratory discharge was increased disproportionally. The latter may suggest a shift of postinspiratory laryngeal constrictor activity into inspiration.In vivodouble-chamber plethysmography of Tau-P301L mice showed significantly reduced respiratory airflow but significantly increased chest movements during baseline breathing, but particularly in hypercapnia, confirming a significant increase in inspiratory resistive load. Histological analysis demonstrated hyperphosphorylated tau in brainstem nuclei, directly or indirectly involved in upper airway motor control (i.e., the Kölliker–Fuse, periaqueductal gray, and intermediate reticular nuclei). In contrast, young Tau-P301L mice did not show breathing disorders or brainstem tauopathy. Consequently, in aging Tau-P301L mice, progressive upper airway dysfunction is linked to progressive tauopathy in identified neural circuits. Because patients with tauopathy suffer from upper airway dysfunction, the Tau-P301L mice can serve as an experimental model to study disease-specific synaptic dysfunction in well defined functional neural circuits.

International audience; Regular physical activity is recognized as an effective health promotion measure. Among various activities, swimming is preferred by a large portion of the population. Although swimming is generally beneficial to a person's overall health, recent data suggest that it may also sometimes have detrimental effects on the respiratory system. Chemicals resulting from the interaction between chlorine and organic matter may be irritating to the respiratory tract and induce upper and lower respiratory symptoms, particularly in children, lifeguards and high-level swimmers. The prevalence of atopy, rhinitis, asthma and airway hyper-responsiveness is increased in elite swimmers compared with the general population. This may be related to the airway epithelial damage and increased nasal and lung permeability caused by the exposure to chlorine subproducts in indoor swimming pools, in association with airway inflammatory and remodelling processes. Currently, the recommended management of swimmers' respiratory disorders is similar to that of the general population, apart from the specific rules for the use of medications in elite athletes. Further studies are needed to better understand the mechanisms related to the development or worsening of respiratory disorders in recreational or competitive swimmers, to determine how we can optimize treatment and possibly help prevent the development of asthma.

International audience; Serotonin (5-HT) is a neuromodulator-transmitter influencing global brain function. Past and present findings illustrate a prominent role for 5-HT in the modulation of ponto-medullary autonomic circuits. 5-HT is also involved in the control of neurotrophic processes during pre- and postnatal development of neural circuits. The functional implications of 5-HT are particularly illustrated in the alterations to the serotonergic system, as seen in a wide range of neurological disorders. This article reviews the role of 5-HT in the development and control of respiratory networks in the ponto-medullary brainstem. The review further examines the role of 5-HT in breathing disorders occurring at different stages of life, in particular, the neonatal neurodevelopmental diseases such as Rett, sudden infant death and Prader-Willi syndromes, adult diseases such as sleep apnoea and mental illness linked to neurodegeneration.

According to a 2000 estimate based on workforce data and the CAREX (Carcinogen Exposure) database 1 there were 386,000 deaths worldwide due to non-cancer respiratory diseases (asthma: 38,000; chronic obstructive pulmonary disease (COPD): 318,000; pneumoconioses: 30,000) and nearly 6.6 million disability-adjusted life years (DALYs) (asthma: 1,621,000; COPD: 3,733,000; pneumoconioses: 1,288,000) attributable to occupational exposure to airborne particulates. The same figures for Europe were 52,700 deaths (asthma: 6,200; COPD: 39,300; pneumoconioses: 7,200) and 868,000 DALYs (asthma: 139,000; COPD: 468,000; pneumoconioses: 261,000). Respiratory diseases rank as the third most prevalent occupational disease category (after ergonomic and stress-related diseases) according to a survey of occupational diseases in the European Union (EU). The prevalence of respiratory diseases was 296 per 100,000 population, with the highest proportion found in the mining industry. This amounts to almost 600,000 persons in the former 15 member states. Many of these diseases, though induced while working, are chronic, thus explaining the highest prevalence among older workers (0.5% aged 55–64 yrs). Traditional high-risk occupations, such as mining, farming, manufacturing and service work ( e.g. hairdressers), are among the professions with a high prevalence of occupational lung diseases. However, high rates of occupational lung disease are also seen in newer professions, such as public administration, education 2 and occupational cleaning; the latter could be a reflection of problems related to new cleaning procedures, as found by the European Community Respiratory Health Survey (ECRHS) 3, or to problems with indoor air in public spaces. The pneumoconioses induced by exposure to mineral and other dusts at high concentrations were the dominating occupational lung diseases in the early industrialisation era. Their prevalence has been decreasing during the past decades. At the same time the obstructive lung diseases have gained increased importance, first because these diseases are widespread in the population, hence even small occupational contributions …

International audience; Climate change will affect individuals with pre-existing respiratory disease, but the extent of the effect remains unclear. The present position statement was developed on behalf of the European Respiratory Society in order to identify areas of concern arising from climate change for individuals with respiratory disease, healthcare workers in the respiratory sector and policy makers. The statement was developed following a 2-day workshop held in Leuven (Belgium) in March 2008. Key areas of concern for the respiratory community arising from climate change are discussed and recommendations made to address gaps in knowledge. The most important recommendation was the development of more accurate predictive models for predicting the impact of climate change on respiratory health. Respiratory healthcare workers also have an advocatory role in persuading governments and the European Union to maintain awareness and appropriate actions with respect to climate change, and these areas are also discussed in the position statement.

International audience; Prader-Willi Syndrome (PWS) is a complex neurogenetic disease with various symptoms, including breathing deficits and possible alteration of serotonin (5HT) metabolism. As PWS results from the absence of paternal expression of several imprinted genes among which NECDIN (Ndn), we examined whether Ndn deficiency in mice induced breathing and 5HT deficits. In vivo, Ndn-deficient mice (Ndn-/-) had irregular breathing, severe apneas and blunted respiratory response to hypoxia. In vitro, medullary preparations from Ndn-/- neonates produced a respiratory-like rhythm that was highly irregular, frequently interrupted and abnormally regulated by central hypoxia. In wild type (wt) and Ndn-/- neonates, immunohistofluorescence and biochemistry revealed that medullary 5HT neurons expressed Ndn in wt and that the medulla contained abnormally high levels of 5HT in Ndn-/-. Thus, our preliminary results fully confirm a primary role of Ndn in PWS, revealing that Ndn-deficiency in mice induces respiratory and 5HT alterations reminiscent of PWS.

Several pathologies, such as central hypoventilation syndrome, central sleep apnea and cases of sudden infant death syndrome, involve defects in central breathing control. On a cellular and molecular level these disorders remain poorly defined and mechanistically not understood. A complex network of distinct brainstem neurons coordinates respiratory rhythm generation and modulation, which traditionally has been mapped by anatomical, physiological and pharmacological techniques. Recently, targeted gene inactivation of several transcription factors in mice was found to affect the development of specific groups of brainstem neurons and result in distinct respiratory phenotypes. These mutants promise a higher precision in the analysis of central breathing control and new diagnostic perspectives for respiratory syndromes, as indicated by the recent discovery of corresponding mutations in humans.

International audience; The purpose of this study was twofold-(1) investigate the role of subjective social status as a predictor of ill-health, with a further exploration of the extent to which this relationship could be accounted for by conventional measures of socioeconomic position; (2) examine the determinants of a relatively new measure of subjective social status used in this study. A 10 rung self-anchoring scale was used to measure subjective social status in the Whitehall II study, a prospective cohort study of London-based civil service employees. Results indicate that subjective status is a strong predictor of ill-health, and that education, occupation and income do not explain this relationship fully for all the health measures examined. The results provide further support for the multidimensional nature of both social inequality and health. Multiple regression shows subjective status to be determined by occupational position, education, household income, satisfaction with standard of living, and feeling of financial security regarding the future. The results suggest that subjective social status reflects the cognitive averaging of standard markers of socioeconomic situation and is free of psychological biases.

We would like to alert the medical community to pos-sible respiratory side effects of vagal nerve stimulation(VNS) during the treatment of nonsurgical refractorypartial epilepsy. We observed hypopneic–polypneic epi-sodes during sleep in a 9-year-old girl with epilepsy withcontinuous spike–waves during slow sleep (CSWSS)syndrome. These events were time-locked to each periodof VNS stimulation and occurred without any modifica-tion of cardiac frequency. VNS may elicit a reduction of25–50% in seizure frequency in both adults and childrenwith intractable epilepsy (1). Adverse side effects andcomplications of VNS were few and mostly transient andwere reported in adult patients only. They includehoarseness, neck pain, hypersalivation, cough, and short-ness of breath (“air-missing”) sensations during physicalexercise. These sensations might be related to the in-crease in end-expiratory volume observed in some pa-tients receiving stimulation at high intensity. In contrastto the common observation that VNS modifies the respi-ratory pattern in animals, only one study has reportedalterations in the respiratory pattern in humans (2).In the present case, the mother’s pregnancy wasmarked by fetal death of a twin sister at 24 weeks ofpostconceptional age. Birth was uneventful at 36 weeksof gestational age. Systematic transfontanellar ultrasoundanalysis revealed bilateral diffuse periventricular leuko-malacia. At age 2 years, she had right tonic partial sei-zures with loss of contact, and magnetic resonanceimaging (MRI) evidenced a left parietal extended isch-emic lesion.At age 5 years, her seizures changed and increased infrequency: during daytime, they were characterized byabsence seizures associated with mild and inconstant ato-nia (up to one seizure every 2–3 min). Sleep EEGshowed CSWSS. Over the course of the following year,she was treated unsuccessfully with seven different an-tiepileptic drugs (AEDs). A ketogenic diet also was in-effective. She was considered an ineligible candidate forsurgery because of the extent of the left sylvian ischemiclesion.At age 6 years, a neurocybernetic prosthesis (Cyberon-ics, Houston, Texas U.S.A.) was implanted. The stimu-lation allowed a drug-free period of 2 months, duringwhich there was an initial seizure-free period of 6 weeks.Then absences reappeared but were less numerous thanbefore implantation. Subsequently she was given la-motrigine (LTG) with VNS. Despite the use of variousAED combinations and changes in stimulation param-eters over the next year, the absences persisted.At age 6

The abnormal metabolism of serotonin during the perinatal period alters respiratory network maturation at birth as revealed by comparing the monoamine oxidase A-deficient transgenic (Tg8) with the control (C3H) mice (Bou-Flores et al., 2000). To know whether these alterations occur only transiently or induce persistent respiratory dysfunction during adulthood, we studied the respiratory activity and regulations in adult C3H and Tg8 mice. First, plethysmographic and pneumotachographic analyses of breathing patterns revealed weaker tidal volumes and shorter inspiratory durations in Tg8 than in C3H mice. Second, electrophysiological studies showed that the firing activity of inspiratory medullary neurons and phrenic motoneurons is higher in Tg8 mice and that of the intercostal motoneurons in C3H mice. Third, histological studies indicated abnormally large cell bodies of Tg8 intercostal but not phrenic motoneurons. Finally, respiratory responses to hypoxia and lung inflation are weaker in Tg8 than in C3H mice.dl-p-chlorophenyl-alanine treatments applied to Tg8 mice depress the high serotonin level present during adulthood; the treated mice recover normal respiratory responses to both hypoxia and lung inflation, but their breathing parameters are not significantly affected. Therefore in Tg8 mice the high serotonin level occurring during the perinatal period alters respiratory network maturation and produces a permanent respiratory dysfunction, whereas the high serotonin level present in adults alters the respiratory regulatory processes. In conclusion, the metabolism of serotonin plays a crucial role in the maturation of the respiratory network and in both the respiratory activity and the respiratory regulations.

International audience; The recognition of high level clinical scenes is fundamental in patient monitoring. In this paper, we propose a technique for recognizing a session, i.e. the clinical process evolution, by comparison against a predetermined set of scenarios, i.e. the possible behaviors for this process. We use temporal constraint networks to represent both scenario and session. Specific operations on networks are then applied to perform the recognition task. An index of temporal proximity is introduced to quantify the degree of matching between two temporal networks in order to select the best scenario fitting a session. We explore the application of our technique, implemented in the Déjà Vu system, to the recognition of typical medical scenarios with both precise and imprecise temporal information.

International audience