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Background Eosinophilic annular erythema (EAE) is a rare eosinophil-related skin disease which typically manifests with annular erythematous plaques and severe pruritus. Besides the diagnosis, the treatment of EAE is challenging since relevant published data are sparse. Methods The aim of this study was to assess the underlying diseases, treatments and outcomes of patients with EAE. To this end, we conducted a retrospective multicenter study and a systematic review of the MEDLINE database. Results We included 18 patients with EAE followed in 8 centers. The MEDLINE database search yielded 37 relevant publications reporting 55 cases of EAE with 106 treatment sequences. The most common and efficient treatments included topical or systemic corticosteroids, hydroxychloroquine and dapsone. In refractory patients, a combination of systemic corticosteroids with hydroxychloroquine was associated with 88% of complete clinical response. Discussion To improve the management of EAE patients, we discuss the following treatment strategy: in topical steroid-resistant patients, hydroxychloroquine can be given as first-line systemic treatment. Dapsone, hydroxychloroquine or systemic corticosteroids are second-line options to consider. Last, monoclonal antibodies or JAK inhibitors targeting type 2 inflammation could represent promising last-resort options in refractory patients.

Earth and water monitoring and observation systems provide open geo data to scientists and professionals supporting distributed knowledge of major hydromet dynamics and extremes. Mobile technologies, at the same time, are empowering citizens who are nowadays informed and involved in volunteering actions designed and implemented to make our communities more safe and sustainable. Citizen science, as a consequence, is gaining momentum empowering the general public, from the “pleasure of doing science” to complementing observations, increasing scientific literacy, and supporting collaborative behaviour to solve specific water-related challenges. This work illustrates a conceptual transdisciplinary assessment model that was designed with the goal of standardizing the use of citizen science for advancing hydrology. This work was promoted by the Citizens AND HYdrology (CANDHY) Working Group established by the International Association of Hydrological Sciences (IAHS), and that is composed by a diverse group of hydrological, computer and social science experts. A community paper (Nardi et al., in press) presented the conceptualization of this transdisciplinary framework by identifying the shared constituents, interfaces and interlinkages between hydrological sciences and other academic and non-academic disciplines. Particular emphasis was given to the integration of human sensing and behavioural mechanisms into citizen science programs addressing hydrological problems. The proposed CANDHY transdisciplinary framework is here further tested and applied to assess some selected citizen science programs to understand the knowledge gaps and opportunities arising from ongoing citizen science programs. This comparative assessment shows some interesting preliminary results demonstrating the capacity of the proposed framework in homogenizing and accumulating knowledge from the collaboration of diverse participatory programs addressing similar or complementary hydrological challenges. Nardi F. et al., in press. Citizens AND HYdrology (CANDHY): conceptualizing a transdisciplinary framework for citizen science addressing hydrological challenges. Hydrological Sciences Journal, https://doi.org/10.1080/02626667.2020.1849707

Background Tattooing is a widespread phenomenon, with an estimated prevalence of 10-30% in Western populations. For psoriasis patients, current recommendations are to avoid having a tattoo if the disease is active and they are receiving immunosuppressive treatments. Although scientific data supporting these recommendations are lacking, dermatologists are often reluctant to advocate tattooing in psoriasis patients. Objective We aimed to evaluate the frequency of tattoo complications in patients with psoriasis and determine whether the occurrence of complications was associated with psoriasis status and treatments received at the time of tattooing. Methods We performed a multicentre cross-sectional study. Adults with psoriasis were consecutively included and classified as tattooed or non-tattooed. Prevalence of complications associated with tattoos was then evaluated according to psoriasis onset and treatments. The study was divided into three parts, in which data were collected through a series of questionnaires filled in by the dermatologist. Complications included pruritus, oedema, allergic reaction/eczema, infection/superinfection, granuloma, lichenification, photosensitivity, Koebner phenomenon and psoriasis flare after tattooing. Diagnosis of complications was made retrospectively. Results We included 2053 psoriatic patients, 20.2% had 894 tattoos. Amongst non-tattooed patients, 15.4% had wished to be tattooed, with psoriasis being stated as a reason for not having a tattoo by 44.0% and 5.7% indicating that they planned to have a tattoo in the future. Local complications, such as oedema, pruritus, allergy and Koebner phenomenon, were reported in tattoos in 6.6%, most frequently in patients with psoriasis requiring treatment at the time of tattooing (P

Multi-Criteria Decision Analysis (MCDA) requires a critical step, namely to elicit individual preferences. On the basis of learning theories, we formalize preference construction as learning about facts and values, and as a process; we also conceptualize an online preference elicitation survey that offers learning loops to increase factual learning and support preference construction. Another originality is gamification. Game elements (a narrative and non-player characters as motivational affordance) keep respondents engaged in the demanding task of weight elicitation. Our tool enables broad public participation in MCDA, allowing reliable online preference elicitation. The survey concept was tested with 107 students and a control treatment. Quantitative and qualitative data indicate that the concept works. Participants’ factual knowledge increased. The survey helped students to learn about their own preferences concerning the importance of objectives. The practical implication is that weighting can be reliably elicited by online surveys. Participants reported a positive experience; further ways to improve it are thoroughly discussed.

Serious games, gamification, or game-based interventions are increasingly used as tools to aid participatory decision-making processes, but their evaluation is often not very rigorous. Therefore, it is still unclear whether game-based interventions are really beneficial. We focused on the following overarching question: how effective are game-based interventions specifically designed to support decision-making processes. We used an illustrative case to reflect on this question. Using a published framework proposing that design processes of game-based interventions and their evaluation are intertwined, we designed simultaneously (1) a game-based intervention, specifically a card game and a workshop structure in which this card game is to be used, and (2) its evaluation procedure, formulating evaluation questions and proposing measure instruments based on the literature. We pre-tested the evaluation procedure in a small pilot study with 10 students. We illustrate the use of the design framework for an intervention to generate objectives in a decision-making process about sustainable wastewater management. Through our illustrative case, we identify future research opportunities about designing game-based interventions and evaluating their effectiveness. We found that it is possible to address the dual challenge of game-based interventions for participatory decision-making processes: (1) designing an informative and engaging game-based intervention without telling participants what to think and (2) designing a tailored evaluation procedure. Designing the game-based intervention and its evaluation simultaneously is valuable, because both are strongly intertwined. However, conducting the evaluation is demanding and requires the collaborative efforts of scientists, including across disciplinary boundaries. For instance, the data collection effort could be distributed among different research groups to increase sample size. This would allow including control treatment(s) and covering the variation span of the confounding factors more broadly. All material is made openly available to foster collaborative future research.

Serious games and gamification are nowadays pervasive. They are used to communicate about science and sometimes to involve citizens in science (e.g. citizen science). Concurrently, environmental decision analysis is challenged by the high cognitive load of the decision-making process and the possible biases threatening the rationality assumptions. Difficult decision-making processes can result in incomplete preference construction, and are generally limited to few participants. We reviewed 43 serious games and gamified applications related to water. We covered the broad diversity of serious games, which could be explained by the still unsettled terminology in the research area of gamification and serious gaming. We discuss how existing games could benefit early steps of Multi-Criteria Decision Analysis (MCDA), including problem structuring, stakeholder analysis, defining objectives, and exploring alternatives. We argue that no existing game allows for preference elicitation; one of the most challenging steps of MCDA. We propose many research opportunities for behavioral operational research.

Resume L’evaluation de la severite du psoriasis est une problematique complexe qui doit evaluer plusieurs dimensions : la severite clinique et le retentissement de la maladie (qualite de vie). Le plus souvent cette evaluation est realisee dans les essais cliniques. Le score de severite le plus utilise est le score PASI (Psoriasis Area Severity Index). Les scores utilises dans les essais ne sont pas les plus faciles a utiliser en pratique clinique quotidienne. En effet, le score PASI par exemple n’est pas tres adapte pour l’evaluation de faibles surfaces cutanees. Cependant les scores ont egalement un interet en pratique clinique. Des scores plus adaptes a la pratique clinique quotidienne ont ete developpes, comme le score SPI (Simplified Psoriasis Index) qui evalue la severite clinique, le retentissement et l’histoire du psoriasis. Les auto-scores destines aux patients sont de plus en plus souvent realises car ils permettent une evaluation plus precise de l’evolution de la maladie lorsqu’ils sont bien correles aux scores objectifs. Les scores et les auto-scores peuvent nous aider a mieux evaluer la severite clinique au cours du temps et ses variations, ainsi que la severite ressentie, afin de prendre la bonne decision therapeutique. © 2021 Elsevier Masson SAS. Tous droits reserves.

Atopic dermatitis is a multifactorial disease due to a combination of genetic and environmental factors. The pathophysiological mechanisms involved in AD are multiple: innate functional abnormality in the skin barrier partly linked to mutations of the filaggrin, a major structural protein of the skin; and genes involved in innate and adaptive immunity; Finally, the model of the hygiene theory has been clarified in recent years: environmental factors alter the diversity of skin and digestive microbiomes, and this diversity seems to play a major role in the development of atopy.

Le present article est une synthese de doctorat, portant sur l'analyse de donnees issues du bassin versant agricole Kervidy-Naizin, appartenant a l'Observatoire de Recherche en Environnement (ORE) AgrHys. Des 2000, face aux enjeux de la qualite de l'eau et du changement climatique, le site a beneficie d'un suivi hydrologique et chimique particulierement fin. Les travaux presentes ci-apres sont la premiere exploration de l'ensemble des chroniques longues de 12 ans du site de Kervidy-Naizin. Ces chroniques remarquables ont permis de repondre aux questions suivantes : quels sont les processus hydrologiques qui controlent les exportations de solutes dans le bassin versant ? Comment la dynamique temporelle d'humectation du bassin influence ces processus dominants ?Quatre methodes originales d'analyse fonctionnelle du bassin versant ont permis de repondre, en etudiant les trois niveaux de variabilite temporelle : la crue, la saisonnalite et les variations interannuelles. Ainsi, un modele conceptuel d'exportation des solutes a quatre compartiments est propose pour expliquer la diversite des dynamiques d'exportation dans ce bassin. Ces resultats montrent une structuration temporelle du signal de qualite de l'eau. Le signal, marque pour certains solutes par l'activite agricole intensive, est domine par la saisonnalite et varie sensiblement selon les conditions hydrometeorologiques de l'annee, et notamment le changement d'etat d'humidite du bassin.

Introduction Les syndromes hypereosinophiliques (SHE) sont une entite rare, potentiellement grave, au cours de laquelle il existe peu d’options therapeutiques. Les traitements habituellement recommandes dans les formes non liees a la deletion FIP1L1/PDGFRA sont les corticoides et en cas d’echec l’interferon-alpha (IFN-α), l’hydroxyuree ou le mepolizumab (dans un cadre protocolaire). Les donnees de la litterature sous-tendant l’utilisation de l’IFN-α au cours des SHE sont limitees a de petites series avec un suivi a court terme. Patients et methodes Nous avons realise une etude multicentrique, retrospective, descriptive, visant a evaluer l’efficacite et la tolerance de l’IFN-α au cours des SHE non lies a FIP1L1/PDGFRA. Les reponses hematologiques complete (RHC : eosinophiles Resultats Vingt-neuf patients (dont 9 femmes) d’âge moyen au diagnostic 38 ± 13 ans ont ete inclus. Quinze patients (52 %) avaient un SHE idiopathique, 10 (34 %) un SHE lymphoide, et 4 (14 %) un SHE clonal. Les manifestations cliniques les plus frequentes etaient l’atteinte cutanee (69 %) et l’atteinte digestive (31 %). L’IFN-α etait utilise sous forme pegylee chez 16 patients a une dose moyenne de 113 ± 45 μg/semaine et sous forme non pegylee chez 13 patients a une dose moyenne de 12 ± 9 MUI/semaine. Un mois apres le debut de l’IFN-α, 24 patients (83 %) etaient repondeurs dont 16 en RHC. A 1 an, 16 patients etaient toujours sous IFN-α dont 9 etaient en RHC et 7 en RHP. Le traitement par IFN-a etait associe a une baisse notable de la dose journaliere moyenne de prednisone de 20 ± 16 mg/j avant traitement, a 11 ± 6 mg/j a 6 mois et a 9 ± 9 mg/j a 1 an. Apres une duree mediane de 15 mois (1 a 161 mois), 21 patients (72 %) ont interrompu l’IFN-α suite aux effets indesirables (27 %) ou a une perte d’efficacite (31 %). Au terme du recueil, 8 patients etaient encore sous IFN-α avec une duree mediane de traitement de 21,5 mois (3 a 161 mois) dont 6 en RHC et 2 en RHP. Chez 7 d’entre eux, l’IFN-α pegyle etait utilise a la dose d’entretien mediane de 50 μg/semaine avec maintien d’une epargne cortisonique (dose journaliere mediane de prednisone a 5,5 mg/j). Conclusion L’IFN-α apparait comme etant un traitement efficace des SHE corticoresistants ou corticodependants non lies a la deletion FIP1L1/PDGFRA. Son efficacite peut se maintenir au long cours et a faible dose chez pres d’un quart des patients avec une bonne tolerance. Neanmoins une perte d’efficacite ou des effets indesirables justifient l’arret de l’IFN-α dans la majorite des cas, rendant necessaire le developpement de therapeutiques alternatives ciblant specifiquement l’eosinophile.

Introduction La maladie du greffon contre l’hote (GVH) apres greffe hematopoietique apparait chez 35 a 50 % des patients. Nous rapportons ici le cas d’un garcon de 4 ans avec une reaction cutanee severe simulant une necrolyse epidermique toxique (NET) ( Fig. 1 ). Resultats Allogreffe pour une leucemie aigue lymphoblastique, il a en traitements preventifs : aciclovir, fluconazole et ciclosporine. Puis en aplasie febrile : il recoit tazocilline, vancomycine et cefazoline. A J12 de la greffe, il a une eruption maculeuse qui s’etend ensuite avec un signe de Nikolsky, une atteinte genitale, des ulcerations endobuccales sans cheilite ni conjonctivite. Les diagnostics evoques sont une NET, une dermatose a IgA lineaire a la vancomycine ou une GVH aigue cutanee. Les medicaments suspects sont arretes. La biopsie cutanee retrouve un decollement epidermique complet, des lesions lichenoides et des corps de necrose posant le diagnostic de GVH aigue bulleuse de grade IV. Celle-ci est traitee par une corticotherapie IV forte dose, de la ciclosporine puis du mycophenolate mofetil associe a un inhibiteur de Jak (ruxolitinib). A J37, le tableau se complete par une GVH digestive de grade IV confortant le diagnostic de GVH cutanee. Discussion La GVH aigue apparait dans les 100 premiers jours. Les signes cutanes sont polymorphes (de l’exantheme a la NET). La GVH mimant une NET est rare (2 %) et grave (50 % de mortalite). Dans la litterature, ces pathologies ont des similitudes histologiques (infiltration de CD8 + , necrose keratinocytaire, decollement epidermique). Pourtant des differences existent : dans la GVH, moins de spongiose et d’eosinophiles et cliniquement, des lesions muqueuses moins severes. Conclusion Ce cas illustre une GVH aigue grave dont l’aspect clinique doit etre connu et differencie d’une NET afin d’adapter rapidement le traitement.

Introduction Les phytodermatoses sont des entites connues pour lesquelles on ne retrouve pas toujours l’agent causal. Il s’agit d’une phytophotodermatose lorsque l’exposition solaire est indispensable au developpement des lesions cutanees. Nous rapportons 2 cas pediatriques de phytodermatose. Methodes Le premier cas est celui d’un nourrisson de 6 mois, presentant un erytheme peribuccal associe a des phlyctenes et des erosions post bulleuses. L’interrogatoire retrouvait l’ingestion d’une puree de panais cuit lors d’un pique-nique ensoleille 24 h auparavant. Le deuxieme cas est celui d’une enfant de 5 ans consultant pour une eruption diffuse erythemateuse et pustulobulleuse du visage. L’interrogatoire retrouvait l’application directement sur le visage d’eau de pluie stagnant sur les feuilles d’une euphorbe maritime, la veille. Dans les 2 cas, l’evolution etait favorable sous dermocorticoides et soins locaux ( Fig. 1 ). Discussion Nous rapportons un cas de phytophotodermatose au panais chez un enfant avec un type de contact remarquable : l’application du panais cuit sur la peau. Le panais contient de la furocoumarine, agent photosensibilisant qui, associe a une exposition solaire prolongee est a l’origine de lesions phototoxiques potentiellement severes. L’euphorbe, espece vivace de la famille des euphorbiaces, est ici toxique via l’eau stagnante appliquee directement sur la peau. Toute la plante renferme un latex blanc et caustique contenant une resine et des ester diterpeniques. Conclusion Une eruption erythemato bulleuse, localisee sur les zones photo-exposees chez l’enfant, doit faire rechercher un contact avec un agent photosensibilisant vegetal (celeris, citron, figue, panais) mais egalement avec certaines plantes possedant des proprietes irritantes, independamment de l’exposition solaire, comme les euphorbes.

To improve hydro-chemical modeling and forecasting, there is a need to better understand flood-induced variability in water chemistry and the processes controlling it in watersheds. In the literature, assumptions are often made, for instance, that stream chemistry reacts differently to rainfall events depending on the season; however, methods to verify such assumptions are not well developed. Often, few floods are studied at a time and chemicals are used as tracers. Grouping similar events from large multivariate datasets using principal component analysis and clustering methods helps to explain hydrological processes; however, these methods currently have some limits (definition of flood descriptors, linear assumption, for instance). Most clustering methods have been used in the context of regionalization, focusing more on mapping results than on understanding processes. In this study, we extracted flood patterns using the probabilistic Latent Dirichlet Allocation (LDA) model, its first use in hydrology, to our knowledge. The LDA method allows multivariate temporal datasets to be considered without having to define explanatory factors beforehand or select representative floods. We analyzed a multivariate dataset from a long-term observatory (Kervidy-Naizin, western France) containing data for four solutes monitored daily for 12 years: nitrate, chloride, dissolved organic carbon, and sulfate. The LDA method extracted four different patterns that were distributed by season. Each pattern can be explained by seasonal hydrological processes. Hydro-meteorological parameters help explain the processes leading to these patterns, which increases understanding of flood-induced variability in water quality. Thus, the LDA method appears useful for analyzing long-term datasets.

A promising alternative of multi-layered devices showing electrochromic properties results from the design of a self-supported semi-interpenetrating polymer network (semi-IPN) including an electronic conductive polymer (ECP). The formation of the ECP in the network has already been described by oxidative polymerization using iron trichloride as an oxidant and leading to conducting semi-IPN with mixed electronic and ionic conductivities as well as convenient mechanical properties. This work relates to the elaboration of such semi-IPN using a PEO/NBR (Nitrile Butadiene Rubber) IPN in which a linear poly (3, 4-ethylenedioxythiophene) (PEDOT) is formed symmetrically and selectively as thin layers on the two sides of the film matrix. PEO/NBR/PEDOT semi-IPNs lead to interesting optical reflective properties in the IR between 0.8 and 25 μm. Reflectance contrasts up to 35% are observed when, after swelling in an ionic liquid, a low voltage is applied between the two sides of the film. The PEO/NBR IPN as a thin fi...

Compliance raises very specific questions in dermatology related to the frequent use of local treatments: creams or ointments, including topical corticosteroids. The adherence in dermatology is a complex issue. It is difficult to quantify objectively because of the patient subjectivity, the constant adaptation to changes in the course of the disease, and due to the lack of adapted device. Moreover poor compliance may be related to topical corticosteroid phobia, defined as a fear vis-a-vis the topical corticosteroids, rational or not. The topical corticosteroid phobia is very common in the management of chronic inflammatory skin diseases especially in atopic dermatitis.

The recent development of in-situ monitoring devices, such as UV-spectrometers, makes the study of short-term stream chemistry variation relevant, especially the study of diurnal cycles, which are not yet fully understood. Our study is based on high-frequency data from an agricultural catchment (Studienlandschaft Schwingbachtal, Germany). We propose a novel approach, i.e. the combination of cluster analysis and Linear Discriminant Analysis, to mine from these data nitrate behavior patterns. As a result, we observe a seasonality of nitrate diurnal cycles, that differs from the most common cycle seasonality described in the literature, i.e. pre-dawn peaks in spring. Our cycles appear in summer and the maximum and minimum shift to a later time in late summer/autumn. This is observed both for water- and energy-limited years, thus potentially stressing the role of evapotranspiration. This concluding hypothesis on the role of evapotranspiration on nitrate stream concentration, which was obtained through data mining, broadens the perspective on the diurnal cycling of stream nitrate concentrations.

Introduction La dermatose a IgA lineaire (DIgAL) est la dermatose bulleuse auto-immune la plus frequente de l’enfant. Le pronostic est favorable et la duree moyenne d’evolution est de 2 ans. Les associations pathologiques sont rares : quelques cas rapportes d’enteropathies inflammatoires chroniques, affections malignes (notamment hemopathies) et maladies dysimmunitaires (connectivites, endocrinopathies). Le syndrome de Di George (MIM 188400 ) est un syndrome sporadique du a une deletion 22q11.2 associant dysmorphie faciale, anomalies cardiaques, deficit immunitaire avec hypoplasie thymique et sur-risque de maladies auto-immunes. Nous rapportons une DIgAL grave et resistante associee a un syndrome de Di George. Observation Il s’agissait d’un enfant âge de 6 ans, ayant comme principal antecedent un syndrome de Di George, avec deficit des populations T CD3+ (211/mm3) et CD4+ (122/mm3), vu pour une eruption vesiculo-bulleuse etendue, avec vesicules en rosette, sans atteinte muqueuse. Le diagnostic de DIgAL etait evoque, confirme par l’etude en immunofluorescence directe montrant un depot lineaire d’anticorps anti-IgA au niveau d’une annexe pilaire et en immunofluorescence indirecte trouvant un anti-membrane basale de classe IgA marquant le versant epidermique sur peau clivee. Un traitement par dapsone (1 mg/kg/jour) etait alors debute, mais la survenue d’un syndrome d’hypersensibilite medicamenteuse en contre-indiquait la poursuite. Les differentes lignes therapeutiques suivantes n’entrainaient qu’une amelioration mineure transitoire : corticoides topiques puissants, corticotherapie orale a 0,5 puis 1 mg/kg/jour pendant 4 mois, ciclosporine orale (3,5 mg/kg/jour) seule pendant 4 mois puis associee a des perfusions d’immunoglobulines IV (6 cures), salazopyrine (100 mg/kg/jour) sans efficacite satisfaisante a 6 mois de traitement malgre amelioration initiale, methotrexate a 5 mg puis 7,5 mg par semaine pendant 3 mois et enfin rituximab (375 mg/m2), 2 cures, sans efficacite. Apres 2 ans d’evolution, il etait alors decide, a la demande des parents, d’interrompre tout traitement. Aujourd’hui, 4 ans apres le debut des signes, la maladie est toujours evolutive avec plus d’une cinquantaine de bulles quotidiennes. Discussion Cette observation est originale du fait de la gravite de la maladie, de la duree d’evolution et de la resistance aux nombreuses lignes de traitements immunosuppresseurs. Les patients atteints de syndrome de Di George ont un risque accru de developper des maladies auto-immunes (notamment cytopenies, hypothyroidie et arthrite juvenile idiopathique). Les mecanismes a l’origine des maladies auto-immunes au cours de ce syndrome ne sont pas elucides mais pourraient etre en lien avec une tolerance thymique centrale inappropriee favorisant la proliferation de clones lymphocytaires auto-reactifs. Il s’agit du premier cas rapporte de DIgAL de l’enfant associee a un syndrome de Di George.

Introduction Notre etude avait pour objectif de decrire l’impact d’un programme structure d’education therapeutique (ETP) sur la consommation des soins medicaux (CSM) et les scores de qualite de vie (mini-Asthma Quality of Life Questionnaire, m-AQLQ) et de controle (Asthma Control Test, ACT), dans l’asthme, sur un premier groupe de 30 patients ayant termine le programme. Methodes Un programme structure d’ETP a ete approuve par l’Agence regionale de sante Rhone-Alpes en avril 2013 pour les patients atteints d’asthme persistant. Apres selection par les pneumologues hospitaliers, les patients etaient pris en charge par la structure educative (une infirmiere, une psychologue, une conseillere medicale en environnement interieur et un medecin) pour une formation initiale de 4 seances s’etalant sur 6 a 12 mois. Au terme des 4 premieres annees de fonctionnement du programme (2013–2017), une evaluation a ete conduite sur les 30 premiers patients ayant parcouru l’ensemble du cycle educatif. La CSM a ete etudiee a partir du nombre de cures annuelles de corticoides oraux (CO), et du nombre de passages aux urgences ou d’hospitalisations pour asthme, pour 2 periodes successives : durant les 12 mois precedant le debut du programme, et durant les 6 a 12 mois suivant l’inclusion dans le programme. Les scores m-AQLQ et ACT ont ete etudies en debut et en fin de programme. Les analyses ont ete uniquement descriptives, compte tenu du nombre limite de patients et de la duree variable de suivi. Resultats Notre cohorte comprenait 24 femmes et 6 hommes, d’un âge moyen de 51 ans. Sur les 12 mois precedant l’ETP, 50 %, 37 % et 20 % des patients ont eu de 1 a 3 cures de CO, sont passes par les urgences, ou ont ete hospitalises, respectivement. Les scores moyens des questionnaires m-AQLQ et ACT etaient de 3,9 (IC95 % = 3,5–4,4) et de 15,2 (IC95 % = 13,7–16,6). Apres demarrage de l’ETP, 40 %, 3 % et 3 %, des patients ont eu de 1 a 3 cures de CO, sont passes par les urgences, ou ont ete hospitalises, respectivement. Au terme du programme, les scores moyens m-AQLQ et ACT etaient de 4,9 (IC95 % = 4,4–5,3) et 17,8 (IC95 % = 15,9–19,6), respectivement. Conclusion Sur les 30 premiers patients inclus dans le programme ETP asthme de l’hopital de la Croix-Rousse, l’ensemble des variables etudiees suggere un effet favorable de l’ETP, avec une baisse de la CSM, en parallele a l’amelioration des scores de qualite de vie et de controle de l’asthme. Ces donnees encourageantes sont a confirmer sur un echantillon plus large, au cours de 2 periodes de duree comparable.

International audience; A bottom-up approach is used here to combine carbon nanotubes synthesized by CVD and organically capped platinum nanoparticles electrocatalyst exhibiting a direct electrochemical activity towards oxygen reduction. Both nano-objects are handled in liquid suspension and are associated together in a controlled way. The nanocomposite liquid dispersions can be precisely controlled in terms of platinum nanoparticles to carbon nanotubes weight ratios (NP/NT) which correspond to different coverages of nanotubes by nanoparticles. Electrodes with low to ultra-low platinum loadings can then be prepared on porous fuel cell carbon supports by filtration. The direct electrochemical activity towards aqueous oxygen reduction reaction (ORR) of electrodes with platinum loadings ranging from about 1 to 60 mu g/cm(2) is reported without any activation step in order to keep the features of the nanoparticles intact. Before that, we studied the responses obtained when impregnating our hydrophobic electrodes by a voltamperometric gas consumption procedure. These responses are also dependent of the composition of our electrodes. Whereas our results are of particular interest with respect to the optimization of platinum loading in fuel cell electrodes, the specific behaviour of these capped platinum nanoparticles towards proton adsorption-desorption reveals the difficulty to determine reliable active surface area with related regard to the platinum loading and point to the necessity to determine other characteristic parameters for the electrodes.

Introduction La sclerodermie localisee en coup de sabre (SLcs) est caracterisee par une sclerose lineaire des tissus cutanes et sous-cutanes de la region frontoparietale et de la face. L’atteinte osseuse est l’une des complications possibles. Les defects osseux crâniens complets sont neanmoins exceptionnels. Nous rapportons deux observations de SLcs de l’adulte associees a un defect osseux complet crânien. Observations Une patiente de 59 ans etait suivie pour une SLsc depuis 1990, atteignant le front, la levre superieure, et la region mentonniere, initialement traitee par corticotherapie locale, et n’evoluant pas depuis plusieurs annees. Elle consultait en mai 2015 pour l’apparition en quelques mois d’une lesion ulceree de 8 × 8 mm frontale mediane avec presence de materiel d’allure calcifie au sein de l’ulceration. Quelques jours plus tard la patiente se plaignait des cephalees inhabituelles d’aggravation progressive associees a des troubles visuels, puis des signes neurologiques avec un ralentissement ideomoteur, des troubles du comportement, et un leger deficit de l’hemicorps gauche. Le scanner et l’IRM cerebrales mettaient en evidence un abces frontal droit avec œdeme peri-lesionnel, en regard d’une solution de continuite de la voute crânienne au niveau de la plaque ulceree. Une ponction de l’abces permettait d’identifier un Streptocoque pneumoniae . L’evolution etait favorable sur le plan infectiologique sous antibiotherapie pendant 3 mois. Une patiente de 51 ans etait suivie pour une plaque alopeciante du cuir chevelu apparue en 2010, prurigineuse, d’evolution non-favorable malgre un traitement par corticotherapie locale et minoxidil. Elle etait hospitalisee fin 2014 devant l’apparition d’une nouvelle plaque frontale a la lisiere du cuir chevelu. Le diagnostic de SLcs etait confirme cliniquement et la biopsie mettait en evidence une fibrose du derme. On notait cliniquement une depression osseuse en regard de la lesion localisee au vertex. Le scanner cerebral mettait en evidence en regard de cette lesion une atrophie dermique et hypodermique ainsi qu’un defect osseux crânien de 15 × 12 mm atteignant les tables externe et interne. Un traitement par methotrexate etait initie devant le caractere localement invasif des lesions. Discussion La SLcs est souvent diagnostiquee chez l’enfant mais peut se reveler a l’âge l’adulte. L’atteinte osseuse est rare mais ne doit pas etre meconnue. Comme l’illustre l’une de nos observations, une effraction osseuse discrete peut passer inapercue cliniquement et a la lecture trop rapide de l’imagerie cerebrale et induire une complication tres grave de par la breche osteomeningee. L’atteinte infectieuse cerebrale secondaire a l’osteolyse crânienne n’est a notre connaissance pas decrite dans la litterature. Une chirurgie reparatrice par greffe de peau, injection de tissu graisseux et greffe osseuse peut etre discutee dans ces formes graves.

International audience; Recently developed measurement technologies can monitor surface water quality almost continuously, creating high-frequency multiparameter time series and raising the question of how best to extract insights from such rich data sets. Here we use spectral analysis to characterize the variability of water quality at the AgrHys observatory (Western France) over time scales ranging from 20 min to 12 years. Three years of daily sampling at the intensively farmed Kervidy-Naizin watershed reveal universal 1/f scaling for all 36 solutes, yielding spectral slopes of 1.05 ± 0.11 (mean ± standard deviation). These 36 solute concentrations show varying degrees of annual cycling, suggesting different controls on watershed export processes. Twelve years of daily samples of SO4, NO3, and dissolved organic carbon (DOC) show that 1/f scaling does not continue at frequencies below 1/year in those constituents, whereas a 12-year daily record of Cl shows a general 1/f trend down to the lowest measurable frequencies. Conversely, approximately 12 months of 20 min NO3 and DOC measurements show that at frequencies higher than 1/day, the spectra of these solutes steepen to slopes of roughly 3, and at time scales shorter than 2−3 h, the spectra flatten to slopes near zero, reflecting analytical noise. These results confirm and extend the recent discovery of universal fractal 1/f scaling in water quality at the relatively pristine Plynlimon watershed in Wales, further demonstrating the importance of advective-dispersive transport mixing in catchments. However, the steeper scaling at subdaily time scales suggests additional short-term damping of solute concentrations, potentially due to in-stream or riparian processes.

Species are often composed of discrete breeding units (i.e. populations or stocks) which, while not reproductively isolated from other such groups, may have limited opportunities to exchange genetic material because of geographic distance, barriers to migration, or spawning asynchrony. Low levels of gene flow between stocks may result, over time, in their genetic divergence, and species that are subdivided into morphologic or genetically distinct stocks are said to be structured. The aim of our investigation was to test whether or not Penaeus stylirostris from the Gulf of California (Mexico) was structured into genetically distinct populations. Shrimp samples were collected in 1996 from six regions of the Gulf where specimens with distinct morphologic characteristics had previously been identified. Statistical analysis of 324 RAPD loci (randomly amplified polymorphic DNA), resolved through polyacrylamide gels and scored for each of 78 specimens, permitted the quantification and comparison of between-stock genetic differences. The finding that genetically discrete stocks of P. stylirostris can be found in a small portion of the geographic distribution range of the species, disagrees with the long-held perception that this resource is panmictic in nature. This new evidence is not only of interest for selective breeding programs in the shrimp aquaculture industry, but is also relevant to the management of the Mexican shrimp fishery which, at present, is perceived and managed as a single stock.

Semicrystalline polymers gelled from thermally quenched semidilute solutions can, in some cases, be supercritically dried to produce nano-structured foams of exceedingly high specific surface area. This article investigates the nano-morphology of these semicrystalline foams. The common morphological feature that these systems display in small-angle scattering can be described by uncorrelated lamellar platelets. The morphological details, which can be obtained using microscopy and small-angle scattering, indicate that these low-density systems occupy a morphological niche between polymeric crystallites from dilute solutions, and spherulitic crystals derived from concentrated solutions and melts. Because these crystalline morphologies occur in concentration ranges between dilute and concentrated, they may offer simple insight into the mechanisms available for distortion of ideal, dilute-solution-derived crystallites as polymer concentration is increased. Several mechanisms for the observed distortions are proposed.

The applicability of explicit time integration in structural dynamics is often limited by a restrictively small solution time increment. This paper presents a mass penalty technique whereby the highest natural frequencies of a dynamic system can be preferentially lowered with only a minimal effect on the structural modes. Because the critical time increment is inversely proportional to the highest natural frequency, a dramatic increase in the solution time increment may be achieved. An expression is developed for the frequency shift and a number of useful properties of this technique are derived analytically for linear systems. Its utility in non-linear analyses is demonstrated with several examples.

Assessing the impact of human pressures on water quality is difficult. First, there is a high temporal and spatial variability of climate and human activity. Second, chemical elements have their own characteristics mixing short and long term dynamics. High frequency, long-term and multi-element measurements are required. But, such data series are scarce. This paper aims at determining what the hydro-chemical particularities of a livestock farming catchment are in a temperate climatic context. It is based on an original and never published time series, from Kervidy-Naizin headwater catchment. Stream chemistry was monitored daily and shallow groundwater roughly every four month, for 10 yr and five elements (nitrate, sulphate, chloride, and dissolved organic and inorganic carbon). The five elements present strong but different seasonal patterns. Nitrate and chloride present a seasonal flush, all along or at the beginning of the wet season, respectively. Sulphate, organic and inorganic carbon present storm flushes, with constant or decreasing peaks throughout the wet season. These depicted nitrate and chloride patterns are typical of a livestock farming catchment. There, nitrate and chloride coming from organic fertilisation have been accumulating over years in the shallow groundwater. They are seasonally flushed when the groundwater connects to the stream. Sulphate, organic and inorganic carbon patterns do not seem specific to agricultural catchments. These elements are produced each year and flushed by storms. Finally, a generic classification of temporal patterns and elements is established for agricultural catchments. It is based on the distance of the source component to the stream and the dominant controlling process (accumulation versus production). This classification could be applied to any chemical element and help assessing the level of water disturbances.

This paper considers the optimal tendon configuration of a tendon control system for a two-dimensional, eleven-bay truss. With the criterion for optimal tendon configuration being controllability and robustness of the tendon control system, the optimal tendon configuration problem can be formulated as a constrained optimization problem which can be solved using dynamic programming; therefore, a solution to the optimal tendon configuration problem can be obtained efficiently. The robustness of the resulting tendon control system with respect to modeling imperfections is studied.

Microcellular carbon foams have been prepared by the high-temperature carbonization of polyacrylonitrile (PAN) foams in an inert atmosphere. The PAN precursor foams were first prepared by thermally induced phase separation of PAN solutions followed by gelation/extraction or freezing/freeze-drying processes. The resulting carbon foams have low densities and open-celled morphologies. We have developed two complementary techniques to characterize objectively carbon foam morphologies, BET surface area measurements and mercury porosimetry. These two measurement techniques, when used in conjunction with known stereological rules, allow us to calculate densities and average cell sizes or cell size distributions. As a bonus, values of the bulk modulus for low-density carbon foams also can be determined from mercury porosimetry. Unlike other techniques, our determinations do not require carefully prepared surfaces (such as for microscopy) or an assumed morphological model (required for most other techniques).

The structural coarsening of demixed polystyrene/cyclohexane solutions was studied by using a quick freeze/freeze-dry technique. Quenches of near-critical solutions were bicontinuous; however, the coarsening law was found to be consistent with a diffusive coarsening mechanism. A quantitative model of the diffusive coarsening process was developed specifically for demixed polymer solutions to predict the structural sizes and the concentration dependence of coarsening

The numerical sensitivity of a constant-feedback-gains controller to random structural imperfections is examined using the results of a series of finite element analyses. The basic finite element model, which uses linear beam-column elements, is a two-dimensional simplification of a large (10 m long) three-dimensional frame currently undergoing testing at Cornell University. The cross-sectional properties, nodal coordinates, and masses of the models were randomly varied within four different ranges of maximum imperfection. Twenty transient dynamic analyses were run for each range of structural perturbation. Each analysis used a different random distribution of imperfections. The results of the finite element analyses show that the optimal control configuration, found by dynamic programming, exhibited unacceptable sensitivity to small perturbations of the structural model. A second, nearly optimal, control configuration was found to be more robust with respect to structural imperfections.

Introduction Le syndrome de Wallenberg est un syndrome alterne neurologique resultant d’une atteinte postero-laterale du bulbe rachidien. Il s’exprime initialement par un grand vertige associe, du cote homolateral a la lesion, a un nystagmus, un syndrome cerebelleux, un syndrome de Claude Bernard-Horner (CBH), une paralysie du voile du palais et une atteinte du nerf trigemine. S’y ajoute une atteinte spino-thalamique controlaterale a type d’anesthesie thermo-algique epargnant la face. Nous decrivons le cas d’un patient avec une fonte cartilagineuse de l’aile narinaire sans ulceration cutanee, d’evolution lentement progressive, responsable d’une retraction dans les suites d’un accident vasculaire cerebral (AVC) du bulbe rachidien. Observations Un patient de 65 ans etait adresse en consultation de dermatologie en 2013 pour retraction de l’aile du nez gauche a type de fonte cartilagineuse. Il avait presente en 2001 un syndrome de Wallenberg avec syndrome cerebelleux statique et cinetique gauche, CBH gauche, nystagmus gauche, anesthesie du territoire de la branche V1 du nerf trijumeau gauche et hypoesthesie de l’hemicorps droit. En 2002, il avait presente une keratite neurotrophique gauche a type d’ulcerations micro-ponctuees superficielles avec atteinte lacrymale complete associee a une hypoesthesie corneenne. En 2006, persistance d’un CBH gauche modere. Il etait par ailleurs suivi en ORL pour retraction narinaire gauche depuis 2008. La biopsie realisee en 2009 etait normale. A noter que le patient ne consommait pas de drogue par voie inhalee. Discussion Se pose donc, a travers ce cas, la question d’une neurotrophie trigeminee cartilagineuse sequellaire d’un syndrome de Wallenberg par atteinte de la branche V2 du trijumeau, sans donnee a ce sujet dans la litterature. Les atteintes du nerf trigemine habituellement rapportees dans la litterature sont des ulcerations cutanees d’origine neurotrophique rapportees sous le terme syndrome trophique trigemine, faisant suite a une atteinte centrale ou peripherique du nerf trijumeau. La physiopathologie du syndrome trophique trigemine reste mal comprise, certains auteurs suggerant des traumatismes repetes favorises par les paresthesies et l’hypoesthesie. De tels traumatismes n’etaient pas retrouves chez notre patient. D’autre part, il n’y avait pas d’argument pour une polychondrite atrophiante ni pour une cause infectieuse, inflammatoire (vascularite), tumorale ou toxique. Conclusion Nous decrivons une nouvelle manifestation d’atteinte de l’aile du nez dans le cadre du syndrome trophique trigemine a type de fonte cartilagineuse de l’aile du nez sans ulceration.