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BackgroundIn contrast with the setting of acute myocardial infarction, there are limited data regarding the impact of diabetes mellitus on clinical outcomes in contemporary cohorts of patients with chronic coronary syndromes. We aimed to investigate the prevalence and prognostic impact of diabetes according to geographical regions and ethnicity.Methods and resultsCLARIFY is an observational registry of patients with chronic coronary syndromes, enrolled across 45 countries in Europe, Asia, America, Middle East, Australia, and Africa in 2009–2010, and followed up yearly for 5 years. Chronic coronary syndromes were defined by ≥1 of the following criteria: prior myocardial infarction, evidence of coronary stenosis >50%, proven symptomatic myocardial ischaemia, or prior revascularization procedure.Among 32 694 patients, 9502 (29%) had diabetes, with a regional prevalence ranging from below 20% in Northern Europe to ∼60% in the Gulf countries. In a multivariable-adjusted Cox proportional hazards model, diabetes was associated with increased risks for the primary outcome (cardiovascular death, myocardial infarction, or stroke) with an adjusted hazard ratio of 1.28 (95% confidence interval 1.18, 1.39) and for all secondary outcomes (all-cause and cardiovascular mortality, myocardial infarction, stroke, heart failure, and coronary revascularization). Differences on outcomes according to geography and ethnicity were modest.ConclusionIn patients with chronic coronary syndromes, diabetes is independently associated with mortality and cardiovascular events, including heart failure, which is not accounted by demographics, prior medical history, left ventricular ejection fraction, or use of secondary prevention medication. This is observed across multiple geographic regions and ethnicities, despite marked disparities in the prevalence of diabetes.ClinicalTrials identifierISRCTN43070564

Introduction Malignant hypertension, the most severe form of hypertension, is characterized by acute and diffuse microvascular damage. The ophthalmological, renal and cardiological consequences are well described. Brain damage is considered rare and poorly known, although it is one of the main causes of death. Method We performed a systematic cerebral MRI on patients of the Bordeaux cohort with malignant hypertension between 2008 and 2018, regardless of their neurological symptoms. A subgroup of patients benefited from a second cerebral MRI. All MRI were analysed by the same trained operator. Results 92 patients were included, 67.5% male, mean age 47.8 ± 12 years. On admission, 41.5% of the patients were totally asymptomatic from a neurological aspect. Cerebral MRI was normal in 18.5% of patients. A posterior reversible encephalopathy syndrom was found in 16.5% of patients, 33.5% had an ischemic or hemorrhagic stroke. Patients had marked microvascular impairment (SVD score 2 or higher) in 59% of cases. In asymptomatic patients or patients with headaches only, MRI found PRES in 15.5% of cases, recent ischemic or hemorrhagic stroke in 29% of cases, and SVD score 2 or higher in 51.5% of cases. Conclusion Most patients with malignant hypertension have brain injuries, regardless of their symptoms. This warrants systematic cerebral MRI, as the results may impact on their management. The consequences of these severe lesions, which are disproportionately severe for young patients, raise questions about the need for cognitive assessment and management.

Introduction Malignant hypertension still remains a severe condition that requires early recognition and treatment. The therapy has evolved from extreme measures in the first 70 years of the last century to intravenous treatment with modern antihypertensive treatment. Today, in the absence of trials and solid evidences, there are no formal guidelines on how to treat MHT. There is a relative consensus on a treatment based on intravenous infusion of antihypertensive treatments in the first days. This review summarizes the historical background and pathophysiological evidences which led to the actual most common pharmacological management of this condition but also can contribute to challenge this management. Oral treatment starting with low dose angiotensin converting enzyme inhibitors appears as a solid option and may improve the management of malignant hypertension in low-income countries where this form of hypertension remains relatively frequent. Future developments are considered according to the latest progress on the topic.

Background Malignant arterial hypertension is a poorly known pathology, with a poor prognosis in absence of adequate emergency care. Since 1995, the excellence center in Bordeaux University Hospital has been implementing a therapeutic protocol based on rapid titration of angiotensin converting enzyme inhibitor for the management of these acute patients. This “Bordeaux protocol” has demonstrated its effectiveness and safety but its widespread use is limited by the fear of complications in patients with renal artery stenosis. Objectives The objective of this study is to compare the protocol safety and efficacy in patients with renovascular and non-renovascular malignant hypertension. Method Our retrospective case-control study compared 2 groups of patients from the Bordeaux cohort of malignant hypertension since 2008. The first group included patients with renovascular malignant hypertension and the second one the rest of the cohort. We excluded patients managed in non-urgent basis. Results We included 10 patients with renovascular malignant hypertension and 74 control patients. No serious adverse events occurred in both groups (acute kidney failure requiring dialysis, threatening hyperkalemia, sudden drop in blood pressure requiring immediate attention). Discontinuation of ACE inhibitors for significant elevation of creatinine occurred once in each group (P = 0.22). Blood pressure drop between admission and discharge was similar in the 2 groups (-73mmHg ± 43 mmHg vs. −75mmHg ± 31.7 in the control group, P = 0.9). One-month prevalence of normotensive patients was also comparable (85% vs. 73% in the control group, P = 0.67). Conclusions Efficacy and safety of the “Bordeaux Protocol” is maintained in patients with renovascular malignant hypertension, thanks to close monitoring. These results need to be replicated to be widespread.

Malignant hypertension (MHT) still exists, leading young people to a poor prognosis. Yet, we lack clear guidelines, mainly because data are scarce. We initiated the first MHT multicentric network to assess these issues. We built a 28 centers network so far, aiming for 40–50 French centers end 2020, and European participation in 2021. We prospectively recruit patients with severe hypertension (> 180/110) and severe hypertensive retinopathy (common definition) or 3-target organ damage among heart, kidney, brain and thrombotic microangiopathy (MOD HTN definition). We hope to recruit 500 patients in 5 years, with a 5 years follow up. We currently collect clinical and examination data, aiming for building a biobank and a target organ damage corelab to entirely reconsider the disease. During the first 6 months, we recruited as planned 58 patients, 41% were male, 49.1 ± 15 years old. Half of them were not known hypertensive, and one third presented a secondary hypertension. Non-observance was reported in 25% of patients as a trigger. Mean blood pressure was 219 ± 29//119 ± 20 mmHg. Patient care pathway was very different according to initial symptoms, target organ damage and centers: hypertension, neurology, nephrology, cardiology, internal medicine, intensive care unit and emergency department. Target organ damage was respectively 70%, 33%, 25% and 25% for kidney, heart, brain and thrombotic microangiopathy, mostly improving during follow up. Most of patients (70%) benefited from intravenous antihypertensive treatment and saline infusion. Length of stay was on average 8 days. Malignant Hypertension clearly didn’t disappear, but was diluted between the different specialities and forgotten. This most severe presentation has to be considered once again to better manage our patients. The unique HAMA network should make it possible to gather high-quality data to improve our knowledge and rediscover the disease.

A high temporal hydro-biogeochemical monitoring based on daily discharges and Total Suspended Solids concentrations and on a three-day frequency survey of nutrients (NO3, PO4, SiO2) and algal biomass pigments was carried out during 2012 at three strategic stations in the Loire River. In a context of a strong eutrophication history, this survey aimed at observing temporal variability and deciphering biogeochemical processes at a fine temporal scale such as nutrients uptake by different phytoplankton species, P-limitation, N losses, and the impact of hydrological events on algal biomass.

The partial discharge plays an important role in the ageing and the rupture process of solid or mixed insulation systems. It has been recognized that the failure of this insulation can be joined to the presence of partial discharge often in inclusions sparkling. Liquid filled cavities can be considered as the most likely defects that can exist in capacitors. In this paper we describe the partial discharge evolution at low temperatures in all-PP film capacitors according to the time and the applied voltage. We distinguish two regimes of discharges for all the range of temperature and the low temperatures encourage the breakdown of capacitors at weak voltage, we assign this phenomenon to the increase of the viscosity of filling liquid.

Resume Les regles hygienodietetiques constituent un element important de la prise en charge de l'hypertendu et doivent etre adaptees a chaque patient. Les conseils visent d'une part a diminuer les chiffres tensionnels (reduction de la consommation d'alcool et de sel, exercice physique, perte de poids) et d'autre part a lutter contre les autres facteurs de risque eventuellement associes (tabac, hypercholesterolemie, diabete…). Ces conseils doivent etre formules des le debut de la prise en charge de l'hypertendu, et peuvent parfois eviter ou retarder la necessite d'un traitement medicamenteux. La principale difficulte consiste a faire accepter ces modifications a des sujets souvent asymptomatiques.

Background: The interactions between ultrasound and cardiac muscle can be exploited to characterize abnormalities of myocardial structure in echocardiography. Two different methods permit an objective assessment of myocardial tissue characterization: analysis of the radiofrequency signal and videodensitometry. We conducted a videodensitometric study using a new practical semiautomatic software applied on digital signal to evaluate gray level cyclic variations of myocardial walls. The aim was to determine parameters differentiating healthy and hypertrophic myocardium in hypertensive patients. Methods and results: Echocardiographic examinations were performed on 30 hypertensives vs 30 healthy controls using second harmonic imaging. Dynamic 2D sequences were recorded in digital form and transferred on computer. Region of interest (ROI) was selected on interventricular septum (IVS) and the software automatically analyzed its systolo-diastolic displacements. ROI echo intensity and its cyclic variations were computed. Values were normalized with blood backscatter. The hypertensives had a smaller amplitude of gray level cyclic variation than did the controls (22 � 6v s 27� 11; P ¼ 0:02), and this parameter was correlated in multivariate analysis with left ventricle fractional shortening (P ¼ 0:032) and diastolic pressure (P ¼ 0:014). Conclusions: Magnitude of gray level cyclic variation of IVS can be studied easily with this new semi-automatic software, is altered in hypertensives and correlated with parameters of systolic function. (Eur J Echocardiography 2003; 4: 292–299)

Resume Introduction. – La distensibilite est la capacite des grosses arteres elastiques a faire varier leur diametre de la diastole a la systole. Lˈune des methodes les plus validees pour la mesurer est la velocite de lˈonde de pouls (VOP), qui peut etre mesuree par divers procedes dont le QKd. Exegese. – Le QKd est lˈintervalle de temps compris entre lˈonde Q de lˈelectrocardiogramme et lˈenregistrement du deuxieme bruit de Korotkoff au niveau de lˈartere humerale, correspondant a la tension arterielle diastolique. Il est mesure par un holter tensionnel et electrocardiographique specifique (normale superieure a 200 ms). La distensibilite arterielle semble interessante pour predire les evenements cardiovasculaires. Il a ete montre que les hypertendus âges avec QKd altere font plus dˈevenements cardiovasculaires que les autres. Le QKd est a lˈetude comme predicteur de la progression des sclerodermies (etude ERAMS). Conclusion. – Le QKd est une methode non invasive et ambulatoire qui couple les mesures de distensibilite et de tension arterielle.

The equivalent series resistance of polypropylene capacitors has been determined under rated voltage, in the range 1 kHz–1 MHz, between 220 K and 370 K by a calorimetric technique. The original feature of this determination of capacitor losses lies in the use of the isothermal calorimetry and in the measurement of an electrical power and not of a temperature increase. The frequency dependence of the equivalent series resistance, at various temperatures, enables to separate the losses in the conducting material from those in the dielectric and to get their respective variations as a function of frequency and temperature. These variations of the equivalent series resistance with frequency at a given temperature have been reproduced by using an equivalent circuit composed of resistors, inductors and capacitors. This model has been verified for non-sinusoidal waveforms such as those met with in a filtering circuit and is used to evaluate by simulation the losses of the capacitor.

The time dependence of the surface potential of an insulating material is theoretically investigated in the case of simultaneous surface and volume ohmic conduction. When the material presents a constant surface conductivity, the first part of the decrease with time of the surface potential is strongly influenced by the initial distribution of charges and cannot be used to determine the surface conductivity. On the other hand, at rather long times after the surface has been charged, the potential of the surface follows an exponential variation with time, the expression of the corresponding time constant is given in different cases. This model is found in good agreement with experiments performed with photo-oxidized epoxy resins placed in a humid atmosphere.

Resume La chirurgie cardiaque mise a part, la dysfonction aigue de la diastole ventriculaire gauche survient preferentiellement chez le sujet âge. Elle represente actuellement 30 a 40 % des insuffisances cardiaques congestives, mais avec une mortalite moindre que pour les dysfonctions systoliques aigues. On distingue generalement les troubles de la relaxation, mecanisme actif proto-mesodiastolique et les anomalies de compliance, reflet de la relation pression/volume telediastolique. Si l'exploration invasive reste la methode de reference, l'echocardiographie Doppler, de par son innocuite, tient actuellement une place grandissante dans l'evaluation des performances diastoliques. Si, dans la plupart des cardiopathies, les anomalies de relaxation surviennent precocement, les troubles de compliance sont plutot l'apanage des cardiopathies evoluees. Au cours d'une anesthesie, certaines circonstances intercurrentes (passage en fibrillation auriculaire, hypovolemie) peuvent aggraver une situation fragile. Les agents anesthesiques interferent sur la diastole ventriculaire, notamment les halogenes. Le traitement de fond des anomalies diastoliques fait appel a des agents faisant regresser l'hypertrophie ventriculaire gauche. En revanche, en situation aigue, le traitement n'est pas encore codifie.

Resume Les regles hygienodietetiques constituent un element important de la prise en charge de l'hypertendu et doivent etre adaptees a chaque patient. Les conseils visent d'une part a diminuer les chiffres tensionnels (reduction de la consommation d'alcool et de sel, exercice physique, perte de poids) et d'autre part a lutter contre les autres facteurs de risque eventuellement associes (tabac, hypercholesterolemie, diabete…). Ces conseils doivent etre formules des le debut de la prise en charge de l'hypertendu, et peuvent parfois eviter ou retarder la necessite d'un traitement medicamenteux. La principale difficulte consiste a faire accepter ces modifications a des sujets souvent asymptomatiques.

Resumen Las medidas higienicodieteticas representan un elemento importante del tratamiento de la hipertension y se deben adaptar a cada paciente. Las recomendaciones tienen como objetivo disminuir las cifras tensionales (limitacion del consumo de alcohol y de sal, ejercicio fisico, perdida de peso) y combatir otros factores de riesgo asociados eventualmente (tabaco, hipercolesterolemia, diabetes, etc.). Estos consejos se deben impartir desde el comienzo del tratamiento de la hipertension, y a veces pueden evitar o retrasar la necesidad de tratamiento farmacologico. La mayor dificultad es conseguir que estos pacientes, la mayoria de ellos asintomaticos, acepten estas modificaciones.

Three types of dysfunction of the coronary circulation have been described in experimental models of hypertension associated with left ventricular hypertrophy : (1) reduced coronary reserve, (2) a relative decrease in perfusion of subendocardial layers, (3) a shift to the right, i.e. to higher pressures, of the circulation pressure autoregulation range. These abnormalities are also observed in hypertensive patients, although it is significant that they do not appear to be related to the extent of left ventricular hypertrophy. The exact causes of these abnormalities have yet to be elucidated. Left ventricular hypertrophy does not seem to be an essential factor, although in certain experimental models of hypertension, there does appear to be a mismatch between the development of the coronary vasculature and hypertrophy of the myocytes. The stresses in vessels due to the increase in systolic, and especially intraventricular diastolic pressure can be viewed as additional aggravating factors. The essential abnormalities are structural and/or functional alterations in arterial walls. The structural alterations are reflected by a narrowed lumen due to parietal thickening. This may result from growth of muscle fibres (hypertrophy or hyperplasia) or collagen tissue and/or remodelling of tissues with no overall change in mass. Functionally, the reduced ability of the arteries to stretch, resulting from endothelial alterations may also play a role in the abnormalities observed in hypertensive patients. In our studies, we examined the effect of the antihypertensive drug perindopril on the coronary circulation in the renovascular hypertensive rat (two kidneys-1 clip). We found that this inhibitor of angiotensin converting enzyme (ACE) led to a regression of left ventricular hypertrophy with a return to normal of the coronary reserve. Other studies using either this model or the spontaneously hypertensive rat have also pointed to a beneficial action of ACE inhibitors and other antihypertensive agents on the coronary circulation with reversal of the structural alterations in arterioles. Coronary disease is the main cause of mortality in hypertensive patients. Ironically, antihypertensive therapy has yet to live up to its promise of reducing significantly either the incidence or severity of coronary disease in such patients. Specific alterations of the coronary circulation may account for the relative failure of antihypertensive drugs, despite their proven efficacy in other systems (e.g. stroke prevention). The coronary circulation is unique in certain important respects. It is tightly regulated, maintaining an almost constant flow rate over a wide range of aortic arterial pressures (40-160 mmHg). Extraction of oxygen by the myocardium is almost maximal under resting conditions, and so the circulatory reserve depends almost entirely on the capacity to increase blood flow. This reserve is quite large since there may be a 4 to 5-fold increase in coronary flow rate in response to effort. Another significant detail is that myocardial contraction may lead to an interruption of coronary flow, especially in the deep subendocardial layers, which thus tend to be perfused solely during diastole. This last factor can be seen as the Achilles heel of the coronary circulation, which may be severely limited by myocardial hypertrophy, especially in patients with hypertension.

Left ventricular hypertrophy (LVH), defined as an abnormal increase in left ventricular mass (LVM), is detected by echocardiography in 16-19% of a general population. Its prevalence is strongly associated with age, systolic blood pressure and obesity. In addition to the assessment of LVM, echocardiography allows different forms of left ventricular remodelling in hypertension to be described: eccentric or concentric, and symmetric or asymmetric LVH. The significance of the different forms, however, is not yet well defined. Increased LVM is now recognized as a powerful, independent risk factor for all cardiovascular diseases. This observation is at variance with the general concept that LVH is a useful adaptation of the left ventricle to chronic overload. To explain this paradox, three hypotheses are proposed: LVH serves as a marker, a limited adaptative process, or a pathological process. Each hypothesis implies different therapeutic approaches; thus it is necessary to clarify the reasons why LVH is such an important risk factor.

The electrical conduction of purified aromatic liquids in the tip-plane electrode geometry was studied for high electric fields. The current voltage curves, the current pulses were measured for dc applied voltage in toluene, benzyltoluene, and in the saturated hydrocarbon ndecane. In n-decane, current pulses are similar to corona discharges in electronegative gases and to pulses previously studied in liquid cyclohexane. In aromatic liquids, a discontinuity in the current-voltage curve was also observed for an electric field of 4.5±0.5 MV.cm -1 whereas current pulses were detected for higher fields. This behavior is attributed to the ionization and electronic attachment of aromatic molecules

The great influence of O 2 on the electrical aging of polypropylene films. The lifetime of the capacitor model with 2x13.6 μm-thick PP films is about 25 h with O 2 saturated liquid and more than 1500 h without O 2 . Two different degradation are obtained on a given film and good agreement is shown between electrical (breakdown voltage) and physicochemical measurements (FTIR spectroscopy)

A post hoc analysis was performed to assess the magnitude of the early morning blood pressure surge (EMBPS), which is associated with peak cardiovascular risk, in untreated hypertensive patients enrolled in two sister studies (Prospective, Randomised Investigation of the Safety and efficacy of MICARDIS vs. ramipril using ambulatory blood pressure monitoring I and II) with identical design.In adults with a mild-to-moderate primary hypertension and no significant comorbidities, 24-h ambulatory blood pressure monitoring was conducted after a 2- to 4-week placebo run-in period and before treatment initiation. Individual blood pressure measurements at 20-min intervals were analysed.In 1419 hypertensive patients with normal sleeping times, blood pressure displayed a typical circadian rhythm, with a mean EMBPS of 29/24 mmHg. An EMBPS ofor= 25 mmHg was observed in around 60% of patients. The surge was significantly increased with smoking, alcohol consumption, longer sleep, later waking times, and increased blood pressure variability during waking and sleeping. The magnitude of the EMBPS was significantly reduced in Black vs. White patients. The surge was not affected by gender, body mass index or duration of hypertension. Further analysis showed that ethnicity, alcohol consumption and smoking were all found to have a significant impact on surge around waking and age, sleep duration and sleep blood pressure variability were all found to have an effect on the prewake surge.In untreated hypertensive patients, the magnitude of the EMBPS is significant when compared with the 24-h mean and is affected by individual patient characteristics. In light of these findings, physicians should understand the importance of 24-h blood pressure control and the modification of certain lifestyle factors as ways of reducing the EMBPS.

Dans environ 5 a 10% des cas, la cause de l’hypertension arterielle estidentifiee. Parmi ces causes, une des plus frequentes est l’hypertension arterielle renovasculaire. L’hypertension renovasculaire se definit comme une elevation des chiffres tensionnels, potentiellement curable, liee a une stenose significative de l’artere renale.

In many big rivers at the low-water mark major phytoplankton or microscopic algae development can be seen living and being moved along by the current.Unlike what is seen in many lakes at the end of Spring this algae development does not usually exhaust the stock of easily assimilated phosphorus contained in the water. Thus phosphorus is not a factor that limits the growth of phytoplankton and this is why we have the proliferation of plant life if other nutrients are not lacking. Since digital modelling is capable of taking into account hydrometerological conditions over several years it is an efficient instrument for assessing the reduction of waste being introduced into the catchment area that is necessary in order to obtain limiting conditions. Applications are given for the Doubs and the Moselle rivers for which we show that a large scale dephosphatization effort would be required in order to achieve a major reduction in the concentration of phytoplankton.

Eplerenone (Inspra, Pfizer, New York, USA), a 9,11-epoxy derivative of spironolactone, is the secondaldosterone antagonist commercially available forthe present time. In the USA, it received Food andDrug Administration approval in September 2002for the treatment of hypertension, and in July 2003for post-myocardial infarction congestive heartfailure.The medical profession has been looking forwardto this new inhibitor of aldosterone receptors asit appears to present significantly fewer adverseeffects than does spironolactone, owing to a moreselective binding to the mineralocorticoid receptor.

On 23 May 2012, a 41-year-old patient was admitted to hospital following a convulsive episode and severe hypertension. She had been treated for multiple sclerosis by interferon-beta since 2002. Her usual blood pressure (BP) values were unknown. She did not have any other cardiovascular risk factors. On admission to the emergency unit her BP was 220/140 mm Hg, and she was in a convulsive state. On initial evaluation, there was hemolysis, low serum potassium (3.2 mmol l−1), secondary hyperaldosteronism, and an elevation of cardiac, hepatic and pancreatic enzymes (Table 1). The electrocardiogram and the echocardiography were normal. There was no evidence of renal artery stenosis on Doppler echography, and adrenals, liver and pancreas were normal on computed tomography scan. Magnetic resonance imaging (MRI) of the brain showed ‘posterior regressive encephalopathy syndrome’ (PRES), and on fundal examination there was grade III hypertensive retinopathy. The patient was admitted to the intensive care unit and required intubatation and ventilation. Interferon-beta was stopped and she was given nicardipine IV to control BP, but the hemolysis persisted with worsening renal function. After extubation on 26 May she was started on bisoprolol. After the acute phase, the patient was transferred to the kidney unit on 05/06/2012. Blockers of the renin–angiotensin aldosterone system were titrated (progressive introduction of ramipril up to 10 mg per day followed by irbesartan up to 300 mg per day along with atenolol 100 mg per day). Amlodipine 10 mg was then administered reducing the BP below 140/90 mm Hg; all biologic parameters were normalized in 4 weeks (Table 1).

The authors have investigated the high field conduction of aromatic liquids (toluene and benzyltoluene) in the tip-plane geometry and compared it to the conduction of n-decane under the same experimental conditions. For various tip radii they have determined the threshold field E/sub s/ for which current becomes space-charge controlled, the threshold field in the case of which current pulses are detected, the charge of each pulse and their repetition rate. Results on DC and AC voltage have been compared. It is shown that the basic prebreakdown phenomenon in aromatic liquids, i.e., electron avalanche in the liquid phase, is similar to that in aliphatic liquids. The main difference in the high field behavior of aliphatic and aromatic liquids comes from a deposit on the tip formed by polymerization of the liquid in the ionization region. Thus, after a very short period of voltage application during which the tip surface changes, current pulses are observed for about a two-fold higher electric field.

Partial discharges in a capacitor-type structure have been registered with a digital discharge analyzer for increasing voltages up to breakdown. The capacitor contained two 13.6 /spl mu/m thick PP films pressed between two plane electrodes. The discharges were located by FTIR mapping at the edge of the electrodes. At high applied voltages, electrochemiluminescence and discharges give light emission, the first phenomenon being predominant. The variations with time of the light emitted by the discharges have been correlated with the phase-distributions of their number and charge.

The electrical conduction of purified toluene, in liquid and gaseous states for negative point-plane electrode geometry, has been studied for high electric field. In toluene liquid, the results depend greatly on the previous use of the point. After a long use of the point, electrical conduction is influenced by an organic deposit at the used tip. This deposit is due to the polymerization of toluene. In toluene vapor, the polymerization by electric field becomes significant. The visualization of the phenomenon at the extremity of the cathode point shows the formation and the growth of a solid filament which consists of aliphatic and aromatic groups.

The charging of SiO/sub 2//glass samples under pulsed electron irradiation have been experimentally studied. More specifically, results about the secondary electron emission yield of the uncharged surface have been obtained and successfully compared to a semiempirical model. Moreover, we have pointed out a strong deviation of the evolution of the secondary emission yield (during a series of pulsed irradiation) compared to the theoretical expected one; these contradictory behaviors are explained by the influence of the trapped charges on the secondary electron emission from the charged sample surface.

We report a case of mitochondrial myopathy (MM), assessed by histological and biochemical studies. This illness was diagnosed in a 69-year-old patient with myocardiopathy revealed by ventricular arrhythmias. The originality of this case lies in the patient's age, the mode of onset and the biochemical features (i.e. normal mitochondrial enzymatic complexes but very low respiration when using glutamate as a substrate).

The SILVER (Study of Irbesartan in Left VEntricular hypertrophy Regression) trial is designed to test the hypothesis that the newly developed angiontensin-II receptor antagonist, irbesartan, will produce a greater reduction in left ventricular (LV) mass than felodipine ER, in a population of hypertensive patients defined by seated diastolic blood pressure (SeDBP) in the range 95-115 mmHg or seated systolic blood pressure (SeSBP) in the range 160-200 mm Hg. A population of 360 men and women of non-childbearing potential,18 years of age, with hypertension, newly diagnosed or after a 3-week washout from previous anti-hypertensive or vasodilator therapies, will be randomised at approximately 80-90 European sites. Add-on therapy with hydrochlorothiazide and atenolol will be allowed for blood pressure control. Patients will be studied by two-dimensional and M-mode echocardiography at baseline (central validation of LV hypertrophy), on randomisation day, and after 6 and 12 months randomised therapy. Blinded analysis of echocardiograms will be performed at a central laboratory, which will provide measurements of the LV mass index (LVMI), determined by M-mode readings according to Devereux formula and using the Penn convention. The primary end-point of the study will be the change in LVMI from baseline to 12 months. The study power is 90% to detect differences between groups from baseline of approximately 8 g/m2.

A wide range of definitions is used to distinguish subjects in whom blood pressure (BP) falls at night (dippers) from their counterparts (nondippers). In an attempt to standardize the definition of nondipping, we determined the nocturnal BP fall and night-day BP ratio by 24-hour ambulatory monitoring in 4765 normotensive and 2555 hypertensive subjects from 10 to 99 years old. In all subjects combined, the systolic/diastolic nocturnal fall and corresponding ratio averaged (+/- SD) -16.7 +/- 11.0/ -13.6 +/- 8.1 mm Hg and 87.2 +/- 8.0%/83.1 +/- 9.6%, respectively. In normotensive subjects, the 95th percentiles were -0.3/-1.1 mm Hg for the nocturnal fall and 99.7%/98.3% for the night-day ratio. Both the fall and ratio showed a curvilinear correlation with age. The smallest fall and largest ratio were observed in older (or = 70 years) subjects. A higher BP on conventional sphygmomanometry was associated with a larger systolic (partial r = .11) and diastolic (r = .12) nocturnal BP fall. The diastolic (r = .08) but not the systolic night-day ratio increased with higher conventional BP. The nocturnal BP fall was larger and the corresponding night-day ratio smaller in oscillometric (n = 5884) than in auscultatory (n = 1436) recordings, in males (n = 3730) than in females (n = 3590), and in Europe (n = 4556) than in the other continents (n = 2764). The distributions of the nocturnal BP fall and night-day ratio showed considerable overlap among normotensive and hypertensive subjects, but the overlap tended to be larger for the ratio than for the fall. Of all subjects, 3.2% had systolic and diastolic ratios of 100% or more. With adjustments applied for confounders, the probability of being a nondipper increased 2.8 times (95% confidence interval, 2.0-4.0) from 30 to 60 years and 5.7 times (4.4-7.4) from 60 to 80 years. The odds ratios were 1.0 (0.8-1.4) for males versus females. 1.6 (1.2-2.1) for subjects with definite hypertension versus normotensive subjects, 2.4 (1.2-4.7) for Asians (n = 2213, 96% Japanese) versus inhabitants of the other continents, and 2.4 (1.5-3.8) for subjects examined with auscultatory versus oscillometric devices. In conclusion, the mathematical definition of nondipping, ie, having a night-day ratio of 100% or more for systolic and diastolic BPs, closely approximated the 95th percentiles of the night-day ratio in normotensive subjects. The ratio depends less on BP level than the nocturnal BP fall and is therefore to be preferred in the definition of dipping status. Notwithstanding the present findings, the reproducibility of nondipping and its prognostic significance need further clarification.

Doppler echocardiography is being used increasingly in the follow-up of patients with valvular heart prostheses because it provides unique hemodynamic information about flow through prosthetic valves. A baseline checkup about 3 months after implantation is now recommended. We therefore now supply each patient with an identity and follow-up card for each particular prosthesis.

M mode echocardiography is certainly an adequate method to evaluate left ventricular hypertrophy (LVH) regression in hypertensive patients, provided that some important conditions are fulfilled. Left ventricular mass assessment can be made only with non-distorted ventricles, as usually encountered in non-complicated hypertensive patients. The main problem is to limit all sources of variability for serial measurements and all sources of subjectivity in their interpretation. So, we propose some guidelines that should be useful when designing and completing such studies. Two-dimensional echocardiography offers the potential advantage of allowing assessment of left ventricular mass even when the left ventricle is far from its usual shape. However, a standardization of methods and studies of its reproducibility are still required before this method could be recommended in studies of LVH regression.

Resume Des cas familiaux d'anticoagulant circulant de type antiprothrombinase ont ete rarement decrits. Nous rapportons une observation d'anticoagulant circulant de type antiprothrombinase chez deux sœurs, l'une atteinte de purpura thrombopenique immunologique et l'autre de lupus erythemateux dissemine.