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Resume Introduction La drepanocytose est la premiere maladie genetique en Ile-de-France. L’accident vasculaire cerebral est l’une des complications la plus severe de cette maladie. Chez l’enfant drepanocytaire SS, le Doppler transcrânien (DTC) est, par le biais de l’etude des vitesses moyennes des arteres de la base du crâne, le « gold standard » pour le depistage et le diagnostic de vasculopathie. A notre connaissance, chez l’adulte drepanocytaire, aucune norme concernant les vitesses des arteres de la base du crâne, n’a ete etablie. Il nous est donc apparu utile d’etablir une approche des vitesses cerebrales enregistrees chez les adultes drepanocytaires SS sans complication neurovasculaire. Materiel et methodes Il s’agit d’une etude observationnelle, prospective, monocentrique realisee entre fevrier 2017 et juin 2017. L’objectif principal de l’etude etant de determiner la moyenne et l’ecart-type des vitesses systoliques maximales (VSM) et les moyennes des vitesses maximales pour l’ensemble des arteres enregistrees lors de l’echo Doppler transcrânien. Les objectifs secondaires etant, d’une part, de comparer les moyennes des vitesses systoliques maximales chez l’adulte drepanocytaire a celles de l’adulte sain, ainsi qu'a celles des enfants drepanocytaires, , d’autre part, de determiner si des parametres pouvaient influencer sur les vitesses enregistrees au DTC. Resultats Quarante patients ont ete inclus entre le 1er fevrier 2017 et le 30 juin 2017, avec un âge moyen de 39,3 ans. La moyenne des vitesses maximales au niveau des arteres est de : 78 cm/s pour les arteres cerebrales moyennes ; 59,6 cm/s pour les arteres carotides internes ; 61 cm/s pour les arteres cerebrales anterieures ; 44 cm/s pour les arteres cerebrales posterieures et de 55 cm/s pour le tronc basilaire. Discussion Les vitesses circulatoires les plus elevees sont retrouvees au niveau des arteres cerebrales moyennes. Les vitesses retrouvees au niveau des arteres carotides internes et des arteres cerebrales anterieures sont superieures aux vitesses du systeme vertebrobasilaire. Les vitesses chez l’adulte drepanocytaire sont plus basses que celles decrites chez l’enfant drepanocytaire SS, mais sont significativement plus elevees par rapport aux vitesses retrouvees chez l’adulte sain. Conclusion Cette etude est a notre connaissance la premiere evaluant les vitesses circulatoires au Doppler transcrânien chez l’adulte drepanocytaire. Ce travail presente des limites du fait de son faible echantillon, cependant, elle constitue une base pour les etudes ulterieures concernant le Doppler transcrânien chez l’adulte drepanocytaire.

Locked coil strands can be used in all types of rope supported bridges where long-term corrosion protection is a primary requirement. This paper reports advances of corrosion protection of locked coil strands with galvanically protective coatings and high density polyethylene (HDPE) sheathing.

Resume L’insomnie ne peut pas etre consideree uniquement comme un trouble du sommeil car elle entraine des consequences diurnes parfois tres importantes. Ces consequences touchent differents domaines : vie sociale, loisirs, activite professionnelle. Depuis quelques annees, ces repercussions diurnes font partie integrante de la definition de l’insomnie et servent meme parfois a en quantifier la severite. L’un des objectifs de l’etude suivante a ete de mieux connaitre le point de vue des medecins generalists en ce qui concerne les consequences de l’insomnie et notamment leurs repercussions socioprofessionnelles.

The rates of pregnant women with functional symptoms of venous insufficiency who accepted or refused to wear therapeutic compression stockings were evaluated and compared in relation to their clinical evolution and their compliance levels.The observational study was conducted in pregnant women between 4 and 28 weeks of amenorrhea presenting a CEAP C0S to C3S venous disease. Therapeutic compression stockings (BSN medical, UltraSheer Maternity stockings, 15-20 mmHg) were offered to pregnant women satisfying the inclusion criteria during routine check visits, and both groups of patients (those who accepted as well as those who refused) were followed up until the end of the pregnancy. The clinical profiles of both groups and the evolution of the venous insufficiency were monitored and compared. The women were requested to indicate pain and further quality of life parameter by means of a specific questionnaire (CIVIQ).Ninety-eight women were included in the study and followed up; 30.6% (N.=30) of the women refused to wear compression stockings (Wr), 69.4% accepted 10.6% were not compliant to a daily wear (Wanc) and 58.8% wore them every day (Wac). Leg pain was more prominent in case of the Wac group (49.5 ± 21.3) than in case of the Wanc (42.1 ± 20.4) and Wr groups (36.6 ± 18). Their global quality also decreased (48.8 ± 15.7 vs. 43.6 ± 16.1 and 36.6 ± 15.6). Regular use of compression stockings led to decrease of pain (Wac -17 ± 10.1 vs. Wanc -10.3 ± 10.5 vs. Wr -4.2 ± 9.8 [P0.0001]) and enhanced total quality of life (Wac 13.5 ± 9.6 vs. Wanc 10.7 ± 11.3 vs. Wr -3.3 ± 9.4 [P0.0001). Similar results were observed on the CIVIQ subscale (pain, psychological, social, physical impact of legs' pain on women quality of life).In daily practice, more than two third of the pregnant women accepted to wear compression stockings. The use of compression stockings reduced the legs pain and increased the quality of life of pregnant women.

We investigate the dust energy balance for the edge-on galaxy IC 2531, one of the seven galaxies in the HEROES sample. We perform a state-of-the-art radiative transfer modelling based, for the first time, on a set of optical and near-infrared galaxy images. We show that taking into account near-infrared imaging in the modelling significantly improves the constraints on the retrieved parameters of the dust content. We confirm the result from previous studies that including a young stellar population in the modelling is important for explaining the observed stellar energy distribution. However, the discrepancy between the observed and modelled thermal emission at far-infrared wavelengths, the so-called dust energy balance problem, is still present: the model underestimates the observed fluxes by a factor of about two. We compare two different dust models, and find that dust parameters and thus the spectral energy distribution in the infrared domain are sensitive to the adopted dust model. In general, the THEMIS model reproduces the observed emission in the infrared wavelength domain better than the popular Zubko et al. BARE-GR-S model. Our study of IC 2531 is a pilot case for detailed and uniform radiative transfer modelling of the entire HEROES sample, which will shed more light on the strength and origins of the dust energy balance problem., Comment: 15 pages, 8 figures, Accepted for publication in Astronomy & Astrophysics

The largest-to-date randomized trial (Women's Health Initiative) comparing the effects of hormone replacement therapy (HRT) and a placebo concluded that the continuous use of an oral combination of conjugated equine estrogens (CEE) and medroxy-progesterone acetate (MPA) increases the risk of breast cancer. This conclusion may not apply to women taking other estrogen and progestin formulations, as suggested by discrepancies in the findings of in vitro studies, epidemiological surveys and, mostly, in vivo studies of human breast epithelial cell proliferation showing opposite effects of HRT combining CEE plus MPA or estradiol plus progesterone. To evaluate the risk of breast cancer associated with the use of the latter combination, commonly prescribed in France, a cohort including 3175 postmenopausal women was followed for a mean of 8.9 years (28 367 woman-years). In total, 1739 (55%) of these women were users of one type of estrogen replacement with systemic effect during at least 12 months, any time after the menopause, and were classified as HRT users. Among them, 83% were receiving exclusively or mostly a combination of a transdermal estradiol gel and a progestin other than MPA. Some 105 cases of breast cancer occurred during the follow-up period, corresponding to a mean of 37 new cases per 10 000 women/year. Using multivariate analysis adjusted for the calendar period of treatment, date of birth and age at menopause, we were unable to detect an increase in the relative risk (RR) of breast cancer (RR 0.98, 95% confidence interval (CI): 0.65-1.5) in the HRT users. The RR of breast cancer per year of use of HRT was 1.005 (95% CI 0.97-1.05). These results do not justify early interruption of such a type of HRT, which is beneficial for quality of life, prevention of bone loss and cardiovascular risk profile, without the activation of coagulation and inflammatory protein synthesis measured in users of oral estrogens.

Low back pain (LBP)-related disability involves patients with chronic outcome.To identify the factors predictive of chronic evolution of acute LBP and to develop a predictive clinical index.Prospective investigation of 2487 employed patients referred for their first consultation with acute LBP (less than eight days). Chronic evolution defined by persistence of symptoms, unchanged or worse, at seven weeks. A predictive index was developed according to a logistic regression model.One hundred fifty-five patients (6.2%) were considered to have unchanged or worsened LBP at the time of final evaluation, which was carried out on average 42 +/- 15 days after the initial visit, and were thus regarded as having a chronic outcome. When comparing patients with chronic outcome and the others, there were 25 elementary characteristics for which the degree of significance of the bilateral test was less than 0.01. They were introduced into a logistic regression model. Five parameters appeared to be related to chronic outcome: characteristics of current episode (isolated acute low back pain, acute exacerbation of chronic low back pain, sciatica), two daily living activity items, duration of certificate to remain off work and taking part in a sport. They were used to develop an easily applied index providing identification, as of the initial consultation, of the risk of chronic evolution.The early recognition of patients with LBP with high risk of chronic outcome can be achieved with an easily applied clinical index.

The prevalence of pressure ulcers in hospitals in France is given, and the anatomical location of these ulcers is explored. The importance of establishing accurate stages for these wounds is also emphasized. Four methods of cost-effectiveness analysis are proposed and described: analysis of one case; analysis of one ward; analysis of care time; and analysis of one tetraplegic young man.

Introduction et but de l’etude La population âgee denutrie est exposee a un grand risque de morbidite et de mortalite. Le but de cette etude etait de decrire l’evolution du profil clinique des sujets âges denutris, apres un suivi d’un an, en fonction des modalites de prise en charge de la denutrition. Materiel et methodes Etude observationnelle prospective d’une cohorte de sujets âges denutris (MNA au depistage Resultats 806 sujets âges de 85,4± 6 ans ont ete inclus dans cette cohorte. Majoritairement des femmes (73,3 %), 78,3 % etaient atteints d’une affection de longue duree. A l’inclusion, l’etat nutritionnel etait decrit par : le poids moyen de 54 ± 10,9 kg, l’IMC a 23 chez 8,7 %, une denutrition (MNA Seuls 29,2 % des patients recevaient un traitement anterieur de la denutrition, et 10,4 % ne recevaient aucune prise en charge nutritionnelle apres la visite d’inclusion. 72,7 % des patients ont recu un traitement adjuvant pendant le suivi : 32 % pendant 1 a 3 mois, 23,1 % pendant 3 a 6 mois et 17,8 % pendant 6 mois et plus. Une prise de poids a ete constatee chez 45,3 % d’entre eux, significative chez les moins de 85 ans (OR = 1,94 ; IC95 % = 1,34-2,8, p Conclusions L’effet de la prise en charge de la denutrition des personnes âgees et de sa duree ont ete evalues dans cette etude : l’etat nutritionnel et cognitif se sont ameliores chez les personnes de moins de 85 ans et traitees pendant au moins 6 mois.