The appearance of the thymus and the integrated evolution of adaptive immune and neuroendocrine systems

in Acta Clinica Belgica (2012), 67

The immune system may be considered as a sensory organ able to respond to different kinds of danger signals that are not detected by nervous cells. The immune response is not autonomous but also regulated ... [more ▼]

The immune system may be considered as a sensory organ able to respond to different kinds of danger signals that are not detected by nervous cells. The immune response is not autonomous but also regulated by central and peripheral nervous system, as well as by neuropeptides, vitamin D and neuroendocrine axes such as the corticotrope, somatotrope, thyrotrope and gonadotrope axes. During evolution, the thymus emerged concomitantly with recombinase-dependent adaptive immunity as an ‘immune brain’ or a ‘master class’ highly specialized in the orchestration of central immunological self-tolerance. This was an absolute requirement for survival of species because of the high risk of autotoxicity inherent to the stochastic generation of extreme diversity characterizing this novel adaptive type of immune defenses against non-self. The thymus now appears to be an obligatory intersection for the integrated evolution of the major systems of cell-to-cell signaling, the nervous, endocrine and immune systems. The presentation of many self-peptides by thymic major histocompatibility complex (MHC) proteins is controlled by the autoimmune regulator (AIRE) gene/protein and is responsible for the clonal deletion of self-reactive T cells. In the same time, by still unexplained mechanisms, MHC presentation of the same self-peptides in the thymus promotes the generation of self-specific FOXP3+ CD4+CD25+ natural regulatory T cells (nTreg) that are able to inhibit in periphery self-reactive CD4+ and CD8+ T cells having escaped the thymus censorship. Moreover, a thymus dysfunction is more and more established as the primary event driving the development of organ-specific autoimmunity, which is the tribute paid, mainly by mankind, for the preservation of self against non-self. Our novel knowledge about thymus physiology and physiopathology already serves as the basis for the development of various innovative and efficient immunomodulating strategies in pharmacology. [less ▲]

Clostridium perfringens hip arthritis in a haemodialysis patient.

in Acta Clinica Belgica (2012), 67(1), 49-50

Haemodialysis patients have acquired immunity disturbances, co-morbidities and a vascular access, factors predisposing them to infection and bacteraemia. Clostridium perfringens is an anaerobic bacterium ... [more ▼]

Haemodialysis patients have acquired immunity disturbances, co-morbidities and a vascular access, factors predisposing them to infection and bacteraemia. Clostridium perfringens is an anaerobic bacterium potentially causing severe infections, including rarely septic arthritis. We report the first case of Clostridium perfringens septic arthritis in a haemodialysis patient and suggest a haematogenous spread. After rapid joint lavage combined with appropriate anti-microbial therapy, the patient recovered. [less ▲]

Metformin and lactic acidosis.

in Acta Clinica Belgica (2011), 66(5), 329-31

PEGASE, an integrated river/basin model dedicated to surface water quality assessment: application to cocaine

in Acta Clinica Belgica (2010), 65(Supplement 1), 42-48

The Aquapôle of the University of Liège has been involved in environmental modeling for more than 20 years. Among other, its current R&D unit focuses on the compartment of surface water, and – for ... [more ▼]

The Aquapôle of the University of Liège has been involved in environmental modeling for more than 20 years. Among other, its current R&D unit focuses on the compartment of surface water, and – for modeling processes – is specialized on the water quality. One of its environmental models, called Pegase (Planification Et Gestion de l’ASsainissement des Eaux), French acronym for “Planning and management of water purification” is devoted to the modeling of the environmental state of surface water, at different scales from small watersheds (10 km²) and basins up to entire transnational Districts (more than 100.000 km²). The software is used operationally by several administrations (Agencies and Ministries) mainly through Europe (France and Benelux, Germany ...), and several calculations have also been performed at international District levels for international commissions (Scheldt, Meuse, Moselle ...) Recently, the Pegase model has been adapted to describe the cocaine’s behavior (using a stable metabolite of the cocaine in the environment: the benzoylecgonine) in waste water, waste water treatment plants (WWTP) and surface water. The cocaine is newly described in the model as an additional micropollutant (Pegase already treats numerous heavy metals), thanks to the implementation of new state variable equations and their specific parameterizations. At a first stage, only the urban sources (releases associated to the consumption by inhabitants) were considered as the industrial releases and the soil loads are assumed to be negligible. Simulations of benzoylecgonine have been done in the Walloon and Flemish regions, where many measurements from the COWAT project were available. These first results are showing a good agreement between calculated and measured values. This ability of the model to simulate the fate of the cocaine derivatives in surface waters should be continued and extended to other metabolites. [less ▲]

Determinants of blood pressure control in hypertensive patients seen in third referral centers

in Acta Clinica Belgica (2010, January 02), 65(1), 68

This work was designed to look for the main characteristics of hypertensive patients seen in Academic Centers from Belgium, with special emphasis on factors influencing blood pressure (BP) control.

PTH reference target for the follow-up of hemodialyzed patients and new KDIGO guidelines: the end of a nightmare?

in Acta Clinica Belgica (2010)

Urinary NGAL: Use of absolute value or ratio to creatinine?

in Acta Clinica Belgica (2010), 65-3

Introduction: Neutrophil gelatinase-associated lipocalin (NGAL) has emerged as a promising marker for the detection of acute kidney injury. This marker has been proposed for urinary measurement. However ... [more ▼]

Introduction: Neutrophil gelatinase-associated lipocalin (NGAL) has emerged as a promising marker for the detection of acute kidney injury. This marker has been proposed for urinary measurement. However, in the literature, authors indistinctly use "absolute" value or NGAL to creatinine ratio. Up to now, there are no strong arguments favouring for one. This question is of importance as this marker is sensed to be used only on urine random samples. To find an answer to this very practical matter, one approach could be to compare biological CV(intra-individual variation) of the "absolute" and ratio results. [less ▲]

Management of severe preeclampsia

in Acta Clinica Belgica (2010), 65(3), 163-169

Features of severe preeclampsia include severe proteinuric hypertension and symptoms of central nervous system dysfunction, hepatocellular injury, thrombocytopenia, oliguria, pulmonary oedema ... [more ▼]

Features of severe preeclampsia include severe proteinuric hypertension and symptoms of central nervous system dysfunction, hepatocellular injury, thrombocytopenia, oliguria, pulmonary oedema, cerebrovascular accident and severe intrauterine growth restriction. Women with severe preeclampsia must be hospitalized to confirm the diagnosis, to assess the severity of the disease, to monitor the progression of the disease and to try to stabilize the disease. Severe preeclampsia may be managed expectantly, in selected cases. The objective of expectant management in these patients is to improve neonatal outcome. Expectant management is based on antihypertensive treatment and prevention of end organ dysfunction. Antihypertensive treatment improves maternal outcome but has the potential to be deleterious for the foetus. Plasma volume expansion has been suggested for severe preeclampsia but trials failed to show any benefit. Magnesium sulfate is the anticonvulsivant of choice to treat or prevent eclampsia when indicated. Antenatal corticosteroids are recommended in severely preeclamptic women with 26-34 weeks gestation. Timing of delivery is based upon gestational age, severity of preeclampsia, maternal and foetal risks. [less ▲]

Validated quantitative simultaneous determination of cocaine opiates and amphetamines in serum by U-HPLC coupled to tandem mass spectrometry

in Acta Clinica Belgica (2010), 65(Supplement 1),

Dosage des opiacés, cocaïne et amphéramines dans le sérum par UPLC/MSMS

in Acta Clinica Belgica (2010), 65(1), 75-84