A powder X-ray diffractometer, D2 Phaser with Lynxeye (Bruker, Germany) was used to assess the crystallinity of prednisolone in the drug loaded tablets. Samples were scanned from 2Theta = 5° to 50° using a scan type coupled with a two theta/theta scintillation counter over 30 min. A Mettler Toledo DSC823e DSC (Mettler, Switzerland) was utilized to perform thermal analysis. http://www.selleckchem.com/products/gsk1120212-jtp-74057.html Samples of approximately 5 mg were accurately weighed and placed in a 40 μL standard aluminium pan DSC analysis. Analysis was carried on under a nitrogen

environment (50 mL/min). In order to exclude the effect of humidity, samples were heated to 100 °C for 5 min then cooled to −20 °C at a rate of 10 °C/min. This was followed by a heat scan from −20 °C to 300 °C at a rate of 10 °C/min. All measurements were carried out in triplicates. A flow-through

cell (Sotax, Switzerland) dissolution apparatus with an open loop system was utilized to assess drug release pattern from the 3D printed tablets. The dissolution apparatus was connected to piston pumps and a fraction collector (Sotax, Switzerland). Cells of 12 mm diameter containing Olaparib 5 mm glass beads were utilized during the study. Filtration was conducted using 25 mm glass microfiber filter discs (FG/B) (Whatman, US) which were placed above the cells. The prednisolone loaded tablets were analysed using dissolution media of a pH 1.2 (HCl 0.1 M) for 2 h followed by phosphate buffer (pH 6.8) for additional 22 h at 37 ± 0.5 °C. The flow rate was 8 ml/min and samples were collected to Sotax fraction collector at time intervals 0, 0.5, 1, 1.5, 2, 2.5, 3, 3.5, 4, 6, 8, 10, 12, 15, 18, 21 and 24 h. Samples were further filtered through 0.22 μm Millex-GP syringe filter (Merck Millipore, USA) and analysed by HPLC (section 2.5). Three tablets of each strength were assessed. Ellipse shaped tablets were printed using an FDM 3D printer loaded with original PVA (drug free) filament. When a series of PVA tablet with increasing dimensions were printed, a high level of correlation was identified between the theoretical volume of the

tablet science design and the mass of the printed tablets (R2 = 0.9996). This indicated the ability of FDM 3D printing method to achieve a sufficient control of the mass of the printed tablets. Such ability is a key advantage for developing a mini-manufacturing unit that can tailor tablet mass by manipulating the volume of the design through an input on software. In order to investigate the ability of the printed tablet to contain a given dose of API and control its release, a model drug needed to be incorporated into PVA filament before loading it in the nozzle of the 3D printer. Prednisolone was chosen as a model drug due to its high thermal stability and neutral nature. A simple loading process based on incubation in methanolic solution was developed. The yielded prednisolone loaded filament showed a drug loading of approximately 1.9% w/w.

However, the splinting regimen did not have a therapeutic effect on active wrist extension, flexion, radial, and ulnar deviation, self-rated performance

of the wrist, or satisfaction with that performance. Following baseline measurements, participants were randomised to experimental (dynamic splint) or control groups using the principles of concealed random allocation. For this purpose, a computerised blocked randomisation sequence Selleck CX5461 was generated prior to the commencement of the trial by an independent offsite person. Participants’ allocations were placed in opaque sealed and sequentially numbered envelopes that were held off-site. A participant was considered to have entered the trial once his/her envelope was opened. Both the control and the experimental groups received usual care, consisting of general advice and a home exercise program, which was monitored but not supervised. The advice and exercises were standardised and provided by a therapist blinded to the allocation. For example, both control and treatment groups received a program consisting Obeticholic Acid of the same type of exercises which participants were instructed to perform at least three times throughout the day. Participants were shown the exercises and given a copy in written format. These exercises were directed at increasing

active and passive wrist flexion, wrist extension, radial deviation, ulnar deviation, forearm pronation, and supination. They were also aimed at increasing wrist and grip strength. Verbal advice was given about how quickly participants could expect pain to resolve, and their strength and function to return. The participants were also advised to use the hand of the affected wrist as much as possible in day-to-day activities. In addition to the advice and exercises, participants in the experimental group received a dynamic splint (see Figure 1). The splint was custom-made from thermoplastic material and incorporated an axis about the flexion-extension plane of the wrist. The fingers

and thumb were unrestricted. A constant low-load stretch was applied in the direction of wrist extension via an Fossariinae elastic band, with the stretch set as high as tolerated by each participant. This stretch was adjusted once every two weeks to maintain the wrist at maximal tolerated extension. Participants were instructed to wear the splint for as long as possible during the day, aiming for at least six hours a day of cumulative splint wear. They were encouraged to actively flex their wrist against the splint intermittently, and were advised to continue activities of daily living whilst wearing the splint wherever possible. Both control and experimental participants were asked to record in diaries how often they performed their exercises.

A red color with sodium amalgam and HCl acid. The flavone glycoside RS-2 was found to be soluble in water, ethanol and acetone and crystallized from methanol. RS-2 analyzed for molecular formula C29H34O13, m.p. 285–286° and M+ 590 (CIMS). The wavelengths of maximum absorption as observed with various shift reagents were at; λmax (MeOH) 270, 347 nm, λmax (NaOMe) 287, 395 nm, λmax (AlCl3) 278, 389, 405 nm, λmax (AlCl3 + HCl) 277, 389, 405 nm, and λmax (NaOMe) 272, 348 nm as depicted in Graph 2. The characteristic band observed in the IR spectrum of RS-2

and the structural assignments made with the help of available literature1, 2, 3 and 4 are described below: 3396.3 cm−1 (Hydrogen bonding intermolecular stretching), 2864.5 cm−1 (CH3 stretching of CH3), 1637.9 cm−1 (α,β-unsaturated C O), 1461.5 cm−1 (Aromatic ring system), 1219.0 cm−1 (C–O–C– stretching selleckchem vibration), and 771 cm−1 (C–H out of plane bending) as portrayed in Graph 1. Significant band at Vmax (KBr) 3396.3 cm−1 as mentioned in Graph 1 in the IR spectrum of the glycoside (RS-2) indicated the presence of hydroxyl group(s) in it. The glycoside (RS-2) was acetylated with Ac2O/Pyridine to give an acetylated product having molecular formula, C41H46O19, m.p. 204–205° and M+ 842 (CIMS). The estimation of percentage of the

acetyl group (31.04%) in the acetylated derivative was given by Weisenberger method5 SP600125 supplier as described by Belcher and Godbert6 which showed that there were six acetylable hydroxyl groups in the glycoside (RS-2). The appearance of band in IR spectrum of the acetyl derivative at Vmax (KBr) 1725.4 cm−1 with disappearance of band at Vmax (KBr) 3396.3 cm−1 confirmed that the acetylation of all the hydroxyl groups present

in the glycoside RS-2 was complete. 7 and 8 The IR absorption spectrum of the flavone glycoside (RS-2) displayed important band at Vmax (KBr) 2925.9 cm−1 indicating the presence of methoxyl group(s) in it. The methoxyl group estimation (16.05%) was done by Zeisel’s method 9 which confirmed the presence of three methoxyl groups in RS-2. The 1H NMR spectrum old of the flavonoidal glycoside (RS-2) showed three singlets at δ 4.0, δ 3.97 and δ 3.80 as depicted in Graph 3 each of these integrating for three protons, thereby suggesting the presence of three methoxyl groups in RS-2. Characteristic band at Vmax (KBr) 1461.5 cm−1 in the IR spectrum of glycoside RS-2 showed the presence of C C ring stretching. The structure of the glycoside (RS-2) was elucidated by its acid hydrolysis and identifying the components of hydrolyzate and the aglycone respectively. The glycoside (RS-2) on its acid hydrolysis with 7% alcoholic H2SO4 yielded an aglycone RS-2(A) as a solid residue and sugar moiety(ies) in the filtrate. They were separated by filtration and studied separately. The aglycone RS-2(A) was found to be homogenous on TLC examination (EtOAc–MeOH–H2O, 3:2:1). It crystallized from MeOH.

1, 91.3%) who received PRV exhibited an anti-rotavirus IgA seroresponse (≥3-fold rise from baseline (pD1 to PD3), with a PD3 GMT of 31.3 units/mL. By contrast only 20.0% of placebo recipients (95% CI: 10.0, 33.7%) developed a seroresponse and the PD3 GMT was 3.2 units/mL. SNA response to the human RV serotypes (G1, G2, G3, G4, and P1A [8]) contained in PRV were also measured, as summarized in Table 2. The seroresponses were relatively poor, ranging from 7.0% (for G2) to 33.3% (G4). GMTs were also modest. The SNA

seroresponses detected among the placebo was 0.0% for all serotypes, except P1A [8] (4.0%). Table 3 summarizes the number of person-years of observation by age group, cases of severe RVGE and the incidence density through the first year of life and during the second year of life, according to the ITT and PP analyses. Through the first year of life, there were only 55 RVGE cases detected. Of these 55 RVGE cases, 9 RVGE selleck chemicals cases (3 severe, 6 non-severe) Afatinib occurred prior to 2 weeks after the dose of vaccine; therefore, only 46 RVGE cases (8 severe, 38 non-severe) were part of the PP efficacy analyses. In total, 11 RVGE cases were classified as severe, 4 among PRV vaccinees and 7 among controls, yielding an ITT vaccine efficacy of 42.9% (95% CI: −125.7, 87.7). As 3 RVGE of the cases in the control group

occurred prior to 2 weeks after the third dose of vaccine, the per-protocol efficacy was 1.0% (95% CI: −431.7, 81.6) through the first year of life. Through the first year of life, the efficacy of PRV against RVGE of any severity in the PP population was 9.3% (22 in the PRV group, 24 in the placebo group; 95% CI: −68.9, 51.5). During the second year of follow-up (Table 3), after the surveillance system was modified to adapt those to local customs and heath care seeking practices, there were 96 cases of severe RVGE detected, including 43 among PRV recipients and 53 among placebo subjects; the point estimate of the PP vaccine efficacy was 19.2% (95% CI, −23.1,47.3%) during the second year of follow-up.

The efficacy of PRV against RVGE of any severity on the PP population during the second year of life was also 19.2% (129 cases in the PRV group, 158 cases in the placebo group; 95% CI: −2.7, 36.4). A total of 370 RV isolates from cases of gastroenteritis in vaccinees and controls were submitted to PCR to determine the RV G and P genotypes. Of these, 353 RV isolates (95.4%) contained a G or P type present in PRV. G1 viruses were the most commonly circulating during the course of the study (61%) with a predominance of G1P [8] strains (54.3%) and G1P [6] strains (6.2%). G2 viruses were next most common (27%) with varying P-types—notably G2P [6] (22.2%) and G2P [4] (4.3%) strains. G8 and G9 strains were seen in small numbers (4.6% and 2.4% respectively).

The study hospital is a 2500 bed tertiary care hospital in southern India with approximately 400 paediatric admissions each month including about 40 cases presenting with diarrhoea requiring hospitalization for rehydration. The study design for the IRSN has been described previously [4]. Briefly, all children under 5 years of age presenting to the hospital with acute gastroenteritis and requiring hospitalization for rehydration for at least 6 h were enrolled in the study after written consent Histone Methyltransferase inhibitor was obtained from the parent or guardian. Standardized protocols were followed

for the enrolment and diagnostic evaluation of children in this study. One stool sample was collected within 24–48 h of hospitalization. Demographic data and clinical

information on duration and frequency of diarrhoea and vomiting, degree of fever and dehydration were recorded on a standard case report form for all children at admission by a study clinician. Additional clinical data on extraintestinal manifestations and outcomes were recorded where available, by review of the inpatient chart selleck post-discharge. The study was approved by the Institutional Review Board of CMC, Vellore. The severity of diarrhoea was assessed for all children using the 20-point Vesikari scoring system based on the duration and peak frequency of diarrhoea and vomiting, degree of fever, severity of dehydration and treatment provided [5] using data collected at admission. The level of dehydration was assessed using the Integrated Management of Neonatal and Childhood Illnesses (IMNCI) criteria (Table 1). An episode was considered mild for scores 0–5, moderate for 6–10 and severe for score ≥11. The data were collected for Vesikari scoring throughout the IRSN surveillance, but additional information on duration of fever, dehydration, presence and duration of seizures were collected for assessment of severity using the 24-point Clark scoring scale [6] on all children

for the last 9 months. Axillary or oral temperature measurements were used instead of rectal temperatures. According to Clark’s scoring key, a episode was considered mild for a score of 0–8, moderate to severe for scores 9–16 and severe for scores 17–24 [9]. (Table 1) A 10% faecal suspension was screened for rotavirus using a commercial enzyme immunoassay MTMR9 (EIA) for detection of VP6 antigen (Rota IDEIA, Dako Ltd, Ely, United Kingdom) according to the manufacturer’s instructions. Viral RNA was extracted from 30% EIA positive faecal suspensions using Trizol reagent (Invitrogen, Paisley, United Kingdom). Complementary DNA (cDNA) was generated by reverse transcription using 400 U of Moloney murine leukemia virus reverse transcriptase (M-MLV) reverse transcriptase (Invitrogen, Paisley, United Kingdom) in the presence of random primers (hexamers; Pd(N)6, Pharmacia Biotech, Little Chalfont, United Kingdom).

“
“Aeromonas species are mesophilic, motile microorganism present in aquatic and environmental habitats. It’s wide distribution

depends on the seasonal changes, pollution level 3-Methyladenine supplier in water. It is a Gram negative, short rod shaped, oxidase and catalase positive, facultative anaerobes and non spore forming. Antibiotics are organic molecules of microbes, at low concentration, they are poisonous for the growth of other microbes. In general, it acts against bacteria by attacking the peptidoglycan cell wall. This study was designed towards the search of antimicrobial compound from Aeromonas species isolated from river soil sample collected at Mohanur, Namakkal District and its antimicrobial potency against bacteria isolated from meat samples. Wet soil samples collected in  sterile bags were transported immediately to the laboratory for analysis. One selleck products gram of sample suspended in 9 ml

of sterile distilled water was shaken well to homogenize the suspension. One millilitre of the supernatant was diluted serially in tenfold 10−1–10−6. 0.1 ml aliquot at 10−6 were dispensed in starch ampicillin agar1 for 24 h at 30 °C and observed for golden yellow colour colonies. Standard biochemical tests were done and final confirmation by 16S rDNA sequencing. One gram of meat sample collected from local market was smashed in 2 ml phosphate buffered saline with mortar and pestle, 0.1 ml was streaked directly on chromogenic,2 mannitol salt,3Salmonella–Shigella agar 4 plates prepared by adopting standard procedures was incubated at 37 °C for 24 h and pigmentation was observed. The identified isolates were subjected to slime production on congo red plate as well for beta lactamase on Muller–Hinton agar. 3 Optimization was carried

out by maintaining the pH at 8. Peptone in the nutrient broth was replaced with different carbon sources such as sucrose, starch, glucose, fructose and maltose. Similarly, beef extract with nitrogen sources like ammonium chloride, ammonium nitrate, ammonium sulphate, potassium nitrate and sodium nitrate were added at a final concentration of 1% (w/v) by keeping the remaining same. The best carbon, nitrogen sources. over Antimicrobial substance and Aeromonas selected in the optimization process was used for the bacteriocin like or antimicrobial substance production, partial purification by treating with solid ammonium sulphate at 40% saturation. The contents were mixed for 2 h at 4 °C, centrifuged at 10,000 rpm for 20 min. The pellet obtained was dissolved in 500 μl phosphate buffered saline and 50 μl of this was used for SDS PAGE, 5 antimicrobial activity against identified meat bacterial isolates by agar well diffusion method.

This conclusion rests partly on four assumptions: 1) ‘a delayed analgesic response does not seem plausible’; 2) ‘the included trials investigated similar treatment and dosing protocols’; 3) ‘results varied from exceptionally

effective to slightly harmful’; and 4) ‘conflicting results are difficult to explain’. First, the conflicting results in LLLT were explained recently in our neck pain review with 16 LLLT trials included (Chow et al 2009), where we found significant short-term pain relief at 19.4 mm (95% CI 9.7 to 29.2). In the current review, LEE011 two studies with 830 nm wavelengths used an extremely high dose of 54 Joules (Dundar et al 2007) and a very low dose of 0.9 Joules (Thorsen et al 1992), respectively. In our review, we found that an optimal dose was 5.9 Joules per point for this wavelength. The World Association for Laser Therapy (WALT) developed evidence-based guidelines with wavelength-specific doses and treatment protocols in 2005 (www.walt.nu/dosage-recommendations.html).

The WALT recommendation is to use a minimum 4 Joules at each of a minimum of four points in the cervical spine with 830 nm wavelength. The reviewers build the case that a pattern of delayed response did not appear consistently within trials measuring at different time-points. This statement is contradicted by the results in trials measuring buy Protease Inhibitor Library at several time-points. One trial found no significant effect after 2 weeks of daily LLLT, but a significant delayed analgesic response at 14 weeks follow-up (Altan et al 2003). Another included trial reported a delayed analgesic response with a mean reduction in pain intensity of 10 mm over placebo (Gur et al 2004) from the end of LLLT until the one week follow-up. The last study with medium-term follow-up reported pain intensity to be as low as 9.46 mm (+/– 13.17) after LLLT, thus leaving no possibility to investigate possible delayed analgesic responses to LLLT (Ceccherelli et al 1989). Evidence of delayed analgesic responses

after intensive Cell press regimens of LLLT has been reported for other diagnoses, too (Vasseljen et al 1992, Bjordal, 2007). For these reasons, the inclusion of a crossover trial (Thorsen et al 1992) in meta-analyses is not valid. The crossover trial was also interpreted as ‘slightly harmful’, although the original trial report dismissed this as an artefact caused by baseline imbalance after an exploratory statistical analysis. Balancing benefit and harm is always an important issue when drugs are concerned. We believe that the authors fail to address this issue properly when concluding that a combination drug (orphenadrine/paracetamol) is effective in the short-term. The actual drug branded as ‘Norgesic’ was only investigated in a single Norwegian trial lasting one week with no follow-up.

The composition of this adjuvant mimics bacterial DNA and so acts to stimulate the immune system through the TLR9 pathway [20], [21], [22] and [23]. The CpG ODN, is being used in at least one registered FDA monitored clinical trial, but has not yet been approved by the FDA for use in conjunction with a specific vaccine [21]. We found that the presence

of CpG inside the spheres had a significant positive effect on the immune response (Fig. 2a, P = 0.0002). In addition, although previously published findings [24] and [25] showed increased CTL responses when MPLA was placed in the microsphere, we observed strong CTL responses only when MPLA was included in the carrier solution to rehydrate the microspheres for injection ( Fig. 2b, P = 0.0002). We believe MPLA in the carrier solution acts to stimulate the tissue macrophages in the area where transformation to dendritic cells takes place, GS-7340 in vitro after which phagocytosis and antigen presentation occur. We found that presence of epitope inside the sphere was also critical. In particular, free epitope, even when combined with CpG and MPLA but without the presence of spheres produced essentially no immune response compared to the formulation using the PLGA loaded microspheres for the OVA ( Fig. 2c, P = 0.0015) and for the

VSV epitope ( Fig. 2d, P = 0.0002). We evaluated the dose response to inoculation with 11 μM microspheres loaded with 1%, 10% and 100% of maximum epitope for the OVA and VSV epitopes. The OVA epitope DNA Damage inhibitor dose response showed a plateau beginning at the lowest level with no statistically significant difference between the 1% and 100% loaded levels ( Fig. 3a, P = 0.25), whereas the VSV epitope showed a statistically significant increase in immune response with increasing loaded concentration at the loading levels tested ( Fig. 3b, P < 0.0001). Also, the difference in immune responses to OVA and VSV both at 1% loading were not statistically significant (P = 0.45), whereas

the difference in responses to OVA and VSV both at 100% were statistically significant (P = 0.0013). We next evaluated the immune response exhibited from two epitopes delivered simultaneously by putting the two epitopes in the same microsphere, with a concentration of OVA and VSV both else at 1% of maximum concentration. We used these concentrations because, as just mentioned, they produced immune responses of similar strength with single-epitope loadings. We administered these spheres in a total amount equal to the amount used previously, with CpG in the spheres and MPLA in the carrier solution. The immune response to OVA in the presence of VSV was not significantly different from the response to OVA in the sphere by itself ( Fig. 4a, P = 0.15), whereas the immune response to VSV in the presence of OVA was slightly greater than the response to VSV in the sphere by itself ( Fig. 4b, P = 0.045).

, 1984). This sort of process ALK inhibition might increase the odds of the organism detecting any change in circumstances. Perhaps if there has been a history that adverse events

are controllable, it is reasonable in a new situation for the organism to continue attempts at active coping for a longer period of time than had the control experiences not occurred previously. The neural mechanisms proposed here would lead to this scenario. If, as argued here, the mPFC can exert inhibitory control over limbic and brainstem stress-responsive structures, and if there is plasticity in this circuitry initiated by control, then a number of clinical implications can be drawn. Strengthening of these pathways would lead to reduced passivity/withdrawal and the emotions that drive these behaviors, and weakening these pathways would have the opposite effect. If part of resistance/resilience is the maintenance of active coping in the face of adverse circumstances, then teaching individuals that they can influence what happens to them, how they feel, and how others see them, might alter how they respond to future adverse events in the direction of resistance/resilience. The writing of this paper was supported by MH050479. Numerous students and colleagues contributed enormously to the work reviewed. Special

thanks go to J. Amat, S. Bland, M. Baratta, J. Christianson, A. Der-Avakian, R. Drugan, R. selleck kinase inhibitor Grahn, J. Hammack, R. Jackson, K. Kubala, S. Maswood, T. Minor, K. Short, P. Sparks, L. Watkins, M. Will, and W. Woodmansee. “
“The stress response is characterized by a synchronized set of endocrine, immunological, autonomic, behavioral and cognitive responses to perceived threats that is necessary for survival and has been

conserved throughout evolution. The prevalence of stressors in the dynamic environment of an animal, make it essential to have mechanisms that limit activity of stress response systems and promote rapid recovery to pre-stress levels. For example, activation of the hypothalamic-pituitary-adrenal (HPA) axis by stress is under tight feedback regulation that serves to restrain Linifanib (ABT-869) and terminate the response (Dallman et al., 1972). Dysfunctions in this feedback as a result of repeated or chronic stress or even a single severe stress are thought to underlie the link between stress and many neuropsychiatric diseases, including depression, post-traumatic stress disorder (PTSD), substance abuse and Alzheimer’s disease, as well as medical conditions including obesity, cardiovascular disease, inflammatory disorders and irritable bowel syndrome (Chrousos, 2000a, Chrousos and Gold, 1992, de Kloet et al., 2005, Goeders, 2003, McEwen, 1998, Larauche et al., 2012, Chrousos, 2000b and McEwen and Stellar, 1993).

En conclusion, le dépistage du cancer du sein est plus utile que dommageable, mais le bénéfice n’est pas énorme et ce n’est pas une folie que de le refuser. Il a été proposé aux femmes qui ont beaucoup surestimé le bénéfice par méconnaissance du risque : une réduction de 20 ou 30 % n’aura pas un effet considérable si le risque est faible. Par ailleurs, les inconvénients, en particulier le surdiagnostic, ont été complètement occultés. Une femme qui refuse le dépistage du cancer du sein est beaucoup moins déraisonnable qu’une Selleck MK 1775 femme qui continue à fumer car le tabac tue

un consommateur régulier sur deux. l’auteur déclare ne pas avoir de conflits d’intérêts en relation avec cet article. “
“La sclérose latérale amyotrophique (SLA) est une pathologie neurodégénérative liée à l’atteinte des neurones moteurs centraux (cortex cérébral) et périphériques (corne antérieure

ALK signaling pathway de la moelle épinière et noyaux moteurs du bulbe). Sur le plan clinique, l’évolution est progressive, marquée par des paralysies extensives conduisant au décès, le plus fréquemment par insuffisance respiratoire. La médiane de survie des patients est environ de 20 mois depuis la date de diagnostic. Il s’agit de la plus fréquente des maladies du motoneurone dont l’incidence est relativement homogène à la surface du globe (2/100 000 personnes-années [PA]), exception faite des agrégats décrits sur l’Île de Guam, la Péninsule Kii et la Nouvelle-Guinée occidentale. Afin de promouvoir l’étude de l’incidence de la maladie, des registres de population ont été progressivement constitués en Europe (Italie, République d’Irlande, Écosse, Angleterre, France) et aux États-Unis. Le caractère

invariablement et rapidement fatal de la maladie a conduit à l’utilisation de son taux de mortalité pour estimer son incidence. Cette approche a été rendue possible par la disponibilité, dans la plupart des pays, d’une organisation de recueil des certificats de décès de la population – la SLA disposant d’un code spécifique permettant son identification parmi les statistiques nationales. L’incidence de la SLA apparaît relativement stable dans les populations caucasiennes d’Europe et d’Amérique du Nord où elle est comprise entre 1,5 et 2,5/100 000 personnes-années to [1] and [2]. Les registres de population basés sur l’identification des cas par de multiples sources ont par ailleurs largement contribué à l’amélioration de la description du profil épidémiologique de la maladie [3]. Les études épidémiologiques réalisées en dehors de ces zones font habituellement état d’une incidence inférieure. Outre de possibles différences de susceptibilité liées aux origines ethniques, ou de possibles différences d’exposition aux facteurs exogènes, les méthodes épidémiologiques employées pourraient expliquer ces résultats [4].