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Background Cardiac arrest is the third cause of death in Europe. It is a medical emergency characterized by high mortality and morbidity. Myocardial infarction is the leading cause of cardiac arrest. Data collection through national and international registries is essential to advance knowledge and improve diagnostic and therapeutic practices. Purpose: we assess the epidemiological impact of OHCA within a territory of approximately 300.000 inhabitants and follow patients’ intrahospital clinical pathway with the aim to identify possible predictors of survival and neurological outcome. Methods an electronic database is used to collect and share data across the Emergency Medical Services (EMS) and reference Cardiologists. Respectively, the EMS collects out–of–hospital patient data, whereas Cardiologists collect all information about intrahospital progress. Results during an observation period of two years, 100 patients with OHCA were enrolled. The majority were male and the average age was 65 years old. The first rhythm identified was shockable in 41% of the cases. Witnesses performed cardiopulmonary resuscitation and used automatic external defibrillator respectively in 57% and 10% of the cases. Only 34% of the victims obtained ROSC and were admitted into the cardiac intensive care unit and half of them died before discharge. Within this group, cardiac arrest was caused by myocardial infarction in 46% of the cases. Of these, culprit lesion was located in the left anterior descending artery in 46,2 % of the cases. It appears that a blood pH value below 7,04 – measured at the arrival in Emergency Department – is a poor prognostic predictor of ROSC, with a 79% sensitivity and 86% specificity (AUC 0,81, 95% CI 0,644 – 0,977). On the other hand, a plasma level of lactic acid expresses multiorgan damage secondary to cardiac arrest and therefore represents a predictor of survival and neurological outcomes, but not ROSC. Conclusion during the two years of observation, the incidence of OHCA turned out to be slightly lower compared to the data available in the literature. Mortality remains extremely high: only 12% of the population survives, of which 16% with poor neurological outcome. Blood gas analysis, if correctly interpreted, could be an optimal tool to target therapeutic choices for cardiac arrest victims. Further studies with a higher sample size will be needed to validate this data.

In recent years, the term “drucebo effect” (drug + nocebo) has been coined to mean the nocebo effect attributable more to the patient's expectations, the doctor's preferences and the interference of the mass media rather than the actual pharmacological effect [1,2]. We evaluated this effect over the last 10 years in 9,605 outpatients treated with statins, in primary (27%) and secondary (73%) prevention. Statin intolerance was reported in 1,729 patients (18%) with discontinuation of therapy for 5 days to 4 weeks. The table shows the causes of the presumed intolerance. In patients with muscular symptoms we calculated the related SMIS (Statin Myalgia Index Score) [3]. Patients with myalgia with or without CPK elevation and probable or possible SMIS were advised to halve the statin dose and reassess after 2–4 weeks. With persisting symptoms, the statin was changed. If symptoms persisted also with the second statin, the patient was advised to take the drug every other day. In case of unlikely SMIS, the decision to resume statin therapy was shared with the patients, with an accurate counseling, informing them of the important benefits of statins regarding mortality and morbidity. Probable true statin intolerance was found in 576 patients (6% of the overall statin therapy population: 332 with myalgia with or without CPK elevation and SMIS probable, 152 with myalgia and CPK elevation with SMIS possible, 46 with asymptomatic elevation of CPK, 15 transaminases increase, 21 with general malaise, 10 with severe depression). In 12% of patients, on the other hand, the interruption is attributable to a nocebo effect due both to the patient and both to the treating physician or other specialist, inclined to attribute the unwanted symptoms more to the drug than to other factors or to consider it non-modifiable by changing statin or doses. The Influence of the mass media is significant, too, and it is difficult to distinguish a greater responsibility of one or the other. Conclusions in patients treated with statins a drucebo effect is attributable in part to the patient, in part to the doctor and to the mass media, which tend to attribute the symptoms (especially of muscle origin) to the treatment and to interrupt the therapy without take into account the clear benefits regarding reduction of mortality and morbidity [4]. In our study, a probable true intolerance to statins is found in about one third of patients who report symptoms of a presumed intolerance. Funding Acknowledgement Type of funding sources: None.

In recent years, the term “drucebo effect” (drug + nocebo) has been coined to mean the nocebo effect attributable more to the patient‘s expectations, the doctor‘s preferences and the interference of the mass media rather than the actual pharmacological effect . We evaluated this effect in 9,605 patients treated with statins, in primary (27%) and secondary (73%) prevention. Presumed statin intolerance was reported in 1,729 patients (18%) with discontinuation of therapy for 5 days to 4 weeks. Table 1 shows the causes of the presumed intolerance and the related SMIS (Statin Myalgia Index Score). Patients with myalgia with or without CPK elevation and probable or possible SMIS were advised to halve the dose, with reassessment after 2–4 weeks. With persisting symptoms, the statin was changed. If symptoms were also present with the second statin, the patient was advised to take the drug every other day. In patients with unlikely SMIS, the decision to resume therapy was shared with the patient, informing him of the benefits of statins on mortality and morbidity. Probable true intolerance was found in 576 patients (6% of the overall population on statin therapy: 332 with myalgia with or without CPK elevation and SMIS probable, 152 with myalgia and CPK elevation with SMIS possible, 46 with asymptomatic CPK elevation, 15 transaminase increased, 21 with general malaise, 10 with severe depression). In 12% of patients, on the other hand, the interruption is attributable to a nocebo effect due to both the patient and the treating physician or other specialist, who are inclined to attribute the unwanted symptoms more to the drug than to other factors or to consider it non–modifiable by modifying the drug or the doses. Interference from the mass media is common, and it is difficult to distinguish a greater responsibility of one or the other.In patients treated with statins, a drucebo effect is frequently found, which is partly attributable to the patient, partly to the doctor and the mass media, who tend to attribute muscle symptoms to the treatment with statins and to interrupt therapy without taking into account the benefits regarding the reduction of mortality and morbidity found in numerous studies with indisputable evidence of efficacy and safety. In our study, a probable true intolerance to statins is found in about one third of patients who report symptoms.

Introduction Elderly patient hospitalized due to acute heart failure often have a concomitant acute lung disease (acute bronchitis, pneumonia, chronic obstructive pulmonary disease-COPD- exacerbation). Establishing the role of each disease in a clinical picture of acute cardiopulmonary syndrome can be challenging. Procalcitonin has been used as a guide to antibiotic therapy with contrasting results. A common thread of these diseases is inflammation; a hyperinflammatory response determines more serious symptoms and a worse prognosis. Purpose We evaluated the effectiveness of a treatment with dexamethasone in patients with acute cardiopulmonary syndrome and a strong inflammatory response. Materials and methods We evaluated 157 consecutive HFPEF (heart failure with preserved ejection fraction) patients ≥80 years of age, with concomitant symptoms attributable to acute bronchitis, pneumonia, or COPD exacerbation, hospitalized due to worsening dyspnoea, with an NT-proBNP ≥3,000 pg/ml, and a finding X-ray of lung congestion with or without a consolidation. Reactive C Protein was measured. Patients with SARS-CoV-2, indication to corticosteroids use for other clinical conditions or need for mechanical ventilation were excluded. The 96 patients with values>20 mg/dl were randomized into 2 groups: 48 patients were treated open-label with dexamethasone at a dose of 8 mg iv/day for a maximun of ten days, in addition to the usual therapies for acute heart failure and lung disease, while the same number of patients were treated with the usual therapy. In both groups the antibiotic was administered only if the procalcitonin was≥0.25 μg/L. Clinical recovery time, length of hospitalization, in-hospital mortality, the need for a new hospitalization and mortality at one month were evaluated. Results The mean age of the patients was 88±4 years in the dexamethasone group and 87±5 in the usual therapy group. The results are shown in Table 1. Patients treated with dexamethasone experienced a faster clinical recovery and a shorter length of hospitalization. No significant differences were found regarding either in-hospital mortality or need for rehospitalization and mortality at 30 days. Conclusions Very elderly patients with acute cardiopulmonary syndrome and hyperinflammatory state associated with an excessive increase in Reactive Protein C have a favorable response to dexamethasone therapy in addition to the usual therapy in terms of clinical improvement and length of hospitalization. Our case history is small to evaluate a possible improvement in mortality. These findings need to be consolidated from double-blind randomized controlled trials Funding Acknowledgement Type of funding sources: None. Table 1

Pathogenic Variants (PV) in major cancer predisposition genes are only identified in approximately 10% of patients with Hereditary Breast and Ovarian Cancer (HBOC) syndrome. Next Generation Sequencing (NGS) leads to the characterization of incidental variants in genes other than those known to be associated with HBOC syndrome. The aim of this study was to determine if such incidental PV were specific to a phenotype. The detection rates of HBOC-associated and incidental PV in 1812 patients who underwent genetic testing were compared with rates in control groups FLOSSIES and ExAC. The rates of incidental PV in the PALB2, ATM and CHEK2 genes were significantly increased in the HBOC group compared to controls with, respective odds ratios of 15.2 (95% CI = 5.6-47.6), 9.6 (95% CI = 4.8-19.6) and 2.7 (95% CI = 1.3-5.5). Unsupervised Hierarchical Clustering on Principle Components characterized 3 clusters: by HBOC (P = 0.01); by ExAC and FLOSSIES (P = 0.01 and 0.02 respectively); and by HBOC, ExAC and FLOSSIES (P = 0.01, 0.04 and 0.04 respectively). Interestingly, PALB2 and ATM were grouped in the same statistical cluster defined by the HBOC group, whereas CHEK2 was in a different cluster. We identified co-occurrences of PV in ATM and BRCA genes and confirmed the Manchester Scoring System as a reliable PV predictor tool for BRCA genes but not for ATM or PALB2. This study demonstrates that ATM PV, and to a lesser extent CHEK2 PV, are associated with HBOC syndrome. The co-occurrence of ATM PV with BRCA PV suggests that such ATM variants are not sufficient alone to induce cancer, supporting a multigenism hypothesis.

Introduction Sur la base d’observations issues de cohortes cliniques, M.J. Maurer a propose d’utiliser la survie sans evenement (rechute, remise en traitement, deces) a 24 mois (EFS-24) comme indicateur pronostique precoce des patients atteints de Lymphome dffus a grandes cellules B (LDGCB) traites par immuno-chimiotherapie. Cependant, la methode de validation de l’indicateur fait debat, et n’a jamais ete utilisee sur des cohortes de patients non selectionnees c’est-a-dire issues de la population generale. Nous proposons dans cette etude de : – Tester et valider l’EFS-24 en population generale a partir des donnees des registres de cancers ; – Valider l’indicateur en utilisant les dernieres methodes d’estimation de la survie nette. Methodes La population d’etude est constituee de 1312 cas de lymphome diffus a grandes cellules B diagnostiques sur la periode 2002-2008 par trois registres de cancers francais specialises sur les hemopathies malignes (Basse-Normandie, Cote d’Or et Gironde). Nous proposons de valider l’EFS-24 a partir d’un modele du taux de mortalite en exces. Les analyses sont realisees avec le package R mexhaz. Resultats Sur 615 patients ayant recu une premiere ligne de traitement par R-CHOP, 65 % d’entre eux ont atteint l’EFS-24. Le suivi median des patients de la cohorte est de 10 ans. Le modele final retenu comprend les variables suivantes : AGE (> 70 ans ou non), EFS-24 (Atteinte ou non), IPI (0-2 versus 3-5) et ACE27 (pas ou peu versus moderees a severes). L’âge et l’EFS-24 sont modelises avec des effets non proportionnels au cours du temps. La Fig. 1 (A) montre que les patients sans evenement a 24 mois et ayant des caracteristiques defavorables (ACE27 2-3, IPI 3-5, âge > 70 ans) ont une mortalite en exces plus elevee que celle estimee pour les patients ayant connu un evenement dans les 24 mois apres le diagnostic ayant des caracteristiques plutot favorables (ACE27 0-1, IPI 0-2, âge ≤ 70 ans), des 30 mois apres le diagnostic. Cela se traduit par une survie nette des deux groupes des patients comparable 10 ans apres le diagnostic ( Fig. 1 (B)). Conclusion Notre etude en population generale montre que l’utilisation de l’indicateur precoce de survie sans evenement a 24 mois est un indicateur pronostique precoce valide uniquement chez un sous-groupe favorable des patients traites par R-CHOP et atteints de LDGCB (jeunes, sans comorbidite avec un index pronostique favorable).

Eser, Sultan (Balikesir Author), Background In 2015, the second cycle of the CONCORD programme established global surveillance of cancer survival as a metric of the effectiveness of health systems and to inform global policy on cancer control. CONCORD-3 updates the worldwide surveillance of cancer survival to 2014. Methods CONCORD-3 includes individual records for 37.5 million patients diagnosed with cancer during the 15-year period 2000-14. Data were provided by 322 population-based cancer registries in 71 countries and territories, 47 of which provided data with 100% population coverage. The study includes 18 cancers or groups of cancers: oesophagus, stomach, colon, rectum, liver, pancreas, lung, breast (women), cervix, ovary, prostate, and melanoma of the skin in adults, and brain tumours, leukaemias, and lymphomas in both adults and children. Standardised quality control procedures were applied; errors were rectified by the registry concerned. We estimated 5-year net survival. Estimates were age-standardised with the International Cancer Survival Standard weights.Findings For most cancers, 5-year net survival remains among the highest in the world in the USA and Canada, in Australia and New Zealand, and in Finland, Iceland, Norway, and Sweden. For many cancers, Denmark is closing the survival gap with the other Nordic countries. Survival trends are generally increasing, even for some of the more lethal cancers: in some countries, survival has increased by up to 5% for cancers of the liver, pancreas, and lung. For women diagnosed during 2010-14, 5-year survival for breast cancer is now 89.5% in Australia and 90.2% in the USA, but international differences remain very wide, with levels as low as 66.1% in India. For gastrointestinal cancers, the highest levels of 5-year survival are seen in southeast Asia: in South Korea for cancers of the stomach (68.9%), colon (71.8%), and rectum (71.1%); in Japan for oesophageal cancer (36.0%); and in Taiwan for liver cancer (27.9%). By contrast, in the same world region, survival is generally lower than elsewhere for melanoma of the skin (59.9% in South Korea, 52.1% in Taiwan, and 49.6% in China), and for both lymphoid malignancies (52.5%, 50.5%, and 38.3%) and myeloid malignancies (45.9%, 33.4%, and 24.8%). For children diagnosed during 2010-14, 5-year survival for acute lymphoblastic leukaemia ranged from 49.8% in Ecuador to 95.2% in Finland. 5-year survival from brain tumours in children is higher than for adults but the global range is very wide (from 28.9% in Brazil to nearly 80% in Sweden and Denmark). Interpretation The CONCORD programme enables timely comparisons of the overall effectiveness of health systems in providing care for 18 cancers that collectively represent 75% of all cancers diagnosed worldwide every year. It contributes to the evidence base for global policy on cancer control. Since 2017, the Organisation for Economic Co-operation and Development has used findings from the CONCORD programme as the official benchmark of cancer survival, among their indicators of the quality of health care in 48 countries worldwide. Governments must recognise population-based cancer registries as key policy tools that can be used to evaluate both the impact of cancer prevention strategies and the effectiveness of health systems for all patients diagnosed with cancer., American Cancer Society Centers for Disease Control and Prevention Swiss Re Swiss Cancer Research foundation Swiss Cancer League Institut National du Cancer La Ligue Contre le Cancer Rossy Family Foundation US National Cancer Institute Susan G Komen Foundation

Objectif Avant un essai randomise controle sur l’emploi d’un collier cervical souple dans l’apnee obstructive du sommeil (AOS), nous avons evalue dans une etude pilote : – la tolerance du collier chez des patients avec AOS ; – l’impact de ce support sur la permeabilite pharyngee dans l’AOS ; – le nombre d’inclusions necessaires a l’essai envisage pour des resultats solides. Methodes Vingt patients avec une AOS severe selon une 1re polygraphie ont ete randomises vers une 2e polygraphie soit sans intervention (groupe controle, n = 10) soit avec port du collier (groupe intervention, n = 10). Les resultats des polygraphies ont ete compares et la tolerance du collier a ete evaluee par un questionnaire. Resultats Quatorze hommes et six femmes, 53,3 ± 2,7 ans, 34,0 ± 0,3 kg/m2, ont ete etudies. En majorite, la tolerance du collier a ete bonne. Il n’y a pas eu de difference significative entre les resultats des 1re et 2e polygraphies dans chacun des deux groupes, e.g., l’index d’apnee-hypopnee etait de 57,8 ± 5,5 vs. 52,4 ± 7,2 (p = 0,4) dans le groupe controle et 56,6 ± 8,1 vs. 52,0 ± 8,4 (p = 0,39) dans le groupe intervention. L’evolution des resultats entre les deux polygraphies etaient semblables entre les deux groupes. Le nombre d’inclusions necessaires a l’essai envisage a ete calcule a 246 selon la methode du d de Cohen. Conclusion Cette etude pilote chez des patients avec AOS severe montre un collier cervical souple bien tolere et sans effet sur la permeabilite pharyngee. Un essai randomise controle plus large pour des resultats solides apparait realisable.

Introduction Le myelome multiple (MM) et le plasmocytome (P) sont des hemopathies lymphoides a cellules B matures diagnostiquees chez des patients plutot âges (mediane d’âge au diagnostic de 75 ans chez les femmes et 72 ans chez les hommes) dont le pronostic reste severe malgre les progres recents de leur prise en charge. La complexite croissante de l’arsenal therapeutique rend necessaire l’utilisation de modeles de risque les plus precis pour definir des groupes pronostiques homogenes et proposer ainsi des plans de traitement ajustes au pronostic. Or, les deux scores pronostiques en usage dans les cas de MM/P (ISS et Durie-Salmon) n’integrent pas d’information sur les comorbidites alors que la relation entre une comorbidite severe et un pronostic defavorable est pourtant etablie. Cette etude a donc pour objectif principal de determiner l’impact des comorbidites sur la survie « nette » a cinq ans des patients Girondins diagnostiques entre 2002–2013 avec un MM/P en utilisant une methode de modelisation statistique adequate aux etudes en population : un modele flexible du taux de mortalite en exces. Methodes La population d’etude est constituee par tous les cas de MM/P diagnostiques chez des patients residant en Gironde entre le 01/01/2002 et le 31/12/2013. Les variables recueillies sont le sexe, la date de diagnostic, le code morphologique, le statut vital, l’ACE-27 (Index de comorbidite) et le stade de Durie-Salmon. Les patients ont ete suivis jusqu’au 01/01/2016. Les estimations ponctuelles de survie « nette » sont calculees avec la methode de pohar-perme. Le modele flexible utilise est celui decrit par L. Remontet et al. Nous utilisons la strategie de modelisation des effets complexes proposee par W. Wynant et M. Abrahamowicz. Resultats Au total, 1176 patients sont inclus dans l’etude avec moins de 2,5 % de perdus de vue a la date de point. La mediane d’âge des patients est 73 ans. Les patients sans comorbidite ou avec une comorbidite peu severe representent 68 % des cas. Le modele final retient un effet non-proportionnel et non lineaire de l’âge, un effet proportionnel de l’ACE-27. Il n’y pas d’interaction entre l’âge et l’ACE-27. Le risque de mortalite en exces estime est respectivement de 1,5 [1,2 ; 1,9] et 1,8 [1,4 ; 2,3] pour les comorbidites moderees et severes en prenant comme reference les patients sans comorbidite ou avec une comorbidite legere au diagnostic. Conclusion Les comorbidites ont un impact defavorable sur la survie nette a cinq ans des patients atteints d’un MM/P suivant un gradient qui augmente avec leur severite. Bien que l’incidence des MM/P augmente avec l’âge, les comorbidites impactent la survie nette de facon identique que ce soit chez les plus jeunes ou les plus âges. Cependant des investigations complementaires sont necessaires afin d’ajuster les modeles sur la toxicite des traitements dispenses (facteur de confusion potentiel).

Introduction En restituant l’impact propre de la maladie sur la mortalite du collectif de patients etudies, la survie nette est devenue une methode d’analyse incontournable en epidemiologie des cancers, surtout lorsque l’on souhaite realiser des comparaisons de survie dans l’espace ou le temps. Son estimation parametrique repose sur la modelisation du taux de mortalite en exces. Malgre un controle serre de la qualite des donnees, la quantite de donnees manquantes peut atteindre parfois une proportion non negligeable dans les etudes retrospective en population generale. Ne pas prendre en compte le manque de completude des informations peut conduire a une inference erronee ou a des estimations biaisees. Nous proposons ici d’illustrer l’utilisation de differentes methodologies de gestion des DM et d’evaluer l’influence de ce choix sur l’ajustement de modeles du taux de mortalite en exces. Methode Nous comparons trois methodes de gestion des DM (complete case analysis [CCA], missing data indicator [MDI] et multivariate imputation by chained equations [MICE]) sur l’analyse multivariee du taux de mortalite en exces (modele d’Esteve). Pour chacune des trois methodes de gestion des DM nous appliquons la meme strategie de modelisation : – selection des covariables associees en univarie aux taux de mortalite en exces (p – strategie de modelisation pas a pas descendante ; – verification de l’adequation des modeles (ponts Brownians). Concernant l’algorithme MICE son utilisation necessite de verifier au prealable que les donnees soient manquantes au hasard conditionnellement au statut vital (decedes/censures). Nous appliquons egalement les lois de Rubin afin de synthetiser les estimations obtenues par MICE. Les modeles obtenus selon les differentes methodes de gestion des DM sont compares en fonction : des covariables selectionnees, la difference absolue moyenne entre les parametres, la variance des estimateurs, l’adequation des modeles. Nous appliquons cette methodologie sur les donnees de l’etude IsoLymph, une etude de cohorte retrospective exhaustive d’environ 2000 patients francais atteints d’un lymphome folliculaire ou diffus a grandes cellules B (entre 2002–2008). Elle cherche a identifier les determinants associes a la survie de ces patients et en particulier l’impact des inegalites sociales. Resultats L’analyse a porte sur les 1102 cas de lymphome diffus B. Sur la quinzaine de variables etudiees cinq possedent des DM (etat general, comorbidite, stade au diagnostic, EDI, solitude). La gestion des DM par MDI et MICE a permis de travailler sur l’ensemble des cas, contrairement au CCA qui supprime de l’analyse 221 patients (20 %), ce qui se traduit par une augmentation de la variance des estimateurs. Les estimations des parametres du modele final different aussi selon les methodes utilisees avec une difference absolue moyenne de 8 % entre MICE versus CCA et de 2 % entre MICE versus MDI. Enfin, l’utilisation du MDI a rendu le modele non proportionnel au cours du temps sur la modalite missing de la variable solitude. Conclusion Des etudes par simulations Monte Carlo, ont montre que dans le cas d’une typologie de DM de type missing at random et dans un contexte de modelisation parametrique du taux de mortalite en exces, le MICE fourni les parametres les moins biaises et les plus precis, ceci est le cas dans notre etude. Cette technique nous permet egalement d’obtenir un modele plus adequat que le MDI.

To better define the merits of the bileaflet and tilting-disc valves, we prospectively randomized 102 patients (mean age, 57 years; range, 11 to 85 years) to receive either the St. Jude (n = 55) or the Medtronic-Hall (n = 47) mitral valve prosthesis between September 1986 and May 1991. The two groups were not different with respect to preoperative New York Heart Association class, incidence of mitral stenosis and insufficiency, angina score, extent of coronary artery disease, ventricular function, completeness of revascularization, or cross-clamp or bypass time. The hospital mortality (14.5% versus 10.6%, St. Jude versus Medtronic-Hall) and late mortality (7.3% versus 2.1%) were not significantly different. Follow-up was complete in 84 of 89 hospital survivors (94%) with a mean of 26 months (range, 1 to 60 months). The linearized rates of valve-related events and the 3-year actuarial survival demonstrated no significant differences between both cohorts. Comparison of the clinical outcome and echocardiographic parameters obtained at the time of follow-up demonstrated no significant differences between the two prostheses. These data indicate that the Medtronic-Hall and St. Jude mitral prostheses are similar with respect to their rates of valve-related complications and hemodynamic profiles. This study suggests that there is no difference between the St. Jude and Medtronic-Hall prostheses with regard to early clinical performance or hemodynamic results and therefore does not support the preferential selection of either prosthesis.

We consider here the application of trivial LP-based rounding heuristics to the capacitated lot-sizing problem (CLSP). The motivation behind the use of LP-based heuristics is that their extension to cope with complicating features (to be expected, for example, when dealing with a master production scheduling problem within a MRP system) is generally easier than with alternative approaches such as lagrangian relaxation. It is well known that strong model formulations, like the Plant Location Formulation (PLF) or the Shortest Path Formulation (SPF), are needed to obtain good results when working on a CLSP. Still, from a practical point of view, a few questions deserve investigation. First, the relative performance of PLF and SPF should be assessed. Second, given the increased size of the more complicated formulations, the possible benefits of using interior point methods must be considered. Third, the sensitivity of the computation times with respect to the characteristics of problem instances should be eva...

Introduction Nous proposons d’estimer le risque de survenue d’un second cancer apres un diagnostic de Lymphome de Hodgkin (LH). Methodes La population d’etude correspond a tous les cas incidents de LH enregistres par 10 registres de cancer francais entre 1989 et 2004. Les patients ont ete suivis jusqu’au 31/12/2007. Les indicateurs utilises comportaient le rapport d’incidence standardise (RIS) et l’exces de risque absolu (ERA) de second cancer. L’analyse des facteurs associes aux RIS et ERA a ete realisee a l’aide de regressions de Poisson. Resultats Le RIS diminuait en fonction de la periode du diagnostic (RIS = 1,9 [1,4 ; 2,5] pour 1989–1994 et 1,4 [0,9 ; 2,1] pour 2000–2004). A l’inverse, celui-ci augmentait en fonction de la duree du suivi (RIS = 1,4 [1,0 ; 1,9] pour un suivi de 2 mois a 5 ans et 2,2 [1,6 ; 3,1] pour un suivi de plus de 9 ans). Les analyses multivariees ont confirme ces tendances sans toutefois atteindre la significativite statistique. Discussion Nous avons observe un risque eleve de second cancer apres un premier LH. Ce risque etait plus eleve pour les patients ayant un suivi superieur a neuf ans ce qui pourrait s’expliquer par les effets secondaires a long terme des traitements du premier cancer. La diminution du risque observee pour la periode la plus recente apres 2000 est contemporaine d’une modification des standards de traitement mais ces resultats doivent etre confirmes par un suivi a plus long terme.

0.3 mg/day betamethyldigoxin was given per os in three daily administrations to 8 healthy subjects, and 8 compensated and 8 decompensated heart patients. Prior to the treatment, and 6 hr after the last administration, blood digoxin values were determined radio-immunologically, together with cardiac output, systolic stroke volume, cardiac index (dilution of indocyanine green), and systolic time intervals, by simultaneous recording of the ECG, carotid pulse, and the phonocardiogram. No significant change in output, stroke volume and cardiac index was noted in the healthy subjects, whereas these parameters were distinctly improved in the decompensated patients. Changes in the systolic intervals after treatment were significant in all cases though there was no significant correlation with the blood digoxin levels reached. In particular, the healthy and compensated subjects displayed a reduction in the corrected electromechanical systole (delta Q-S2), the corrected pre-ejection period (delta PEP), the corrected left ventricular ejection time (delta LVET), and their ratio (PEP/LVET), whereas in the decompensated patients the picture differed to the extent that the LVET increased owing to an augment-systolic stroke volume, the other parameters being reduced. In the healthy subjects, the polygraphic data were normal prior to the treatment, while in the compensated patients delta PEP and the PEP/LVET ratio were enhanced, and the delta LVET was less than in the normal subjects. It is felt that recording of the systolic intervals may be regarded as a sound method, owing to its simplicity and its ability to demonstrate latent cardiac failure before haemodynamic changes appear. Simultaneous determination of serum digoxin and the polygraphic data, therefore, opens the way to the commencement of appropriate, safe and timely management of as yet non-decompensated heart patients.

The following parameters were determined in 20 diabetics with chronic obliterating arteriopathy of the lower extremities: C-HDL, apo-A1, apo-B, triglyceridaemia, the glycaemic profile and HbA1c oscillometry, photoplethysmogram and claudication distance on a treadmill. Examination of the results obtained did not show any variation in the lipoproteic picture and only an improvement, in some subjects, in claudication distance. It is therefore hypothesised that in diabetic C-HDL and apo-A1 are not predictive of atherosclerotic risk although it cannot be excluded that changes in such constants may represent a synergetic factor in determining arteriosclerosis.

Proceedings of the ICA 2019 and EAA Euroregio : 23rd International Congress on Acoustics, integrating 4th EAA Euroregio 2019 : 9-13 September 2019, Aachen, Germany / proceedings editor: Martin Ochmann, Michael Vorländer, Janina Fels 23rd International Congress on Acoustics, integrating 4th EAA Euroregio 2019, ICA 2019, Aachen, Germany, 9 Sep 2019 - 13 Sep 2019; Aachen (2019)., Published by Aachen