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La médecine vasculaire est maintenant une spécialité. Au cours du cursus, les étudiants devront acquérir, outre les habiletés techniques, des compétences sémiologiques indispensables en consultation. Les examens cliniques objectifs structurés (ECOS) sont considérés comme l’instrument s’approchant de l’évaluation idéale de la compétence clinique. Notre objectif principal est d’évaluer la faisabilité et l’acceptabilité de ce type d’épreuve, secondairement les performances des étudiants.

La thrombose veineuse profonde (TVP) est une pathologie fréquente, multifactorielle, dont les deux complications majeures sont le syndrome post-thrombotique et l’embolie pulmonaire. La connaissance des facteurs de risque transitoires (alitement, chirurgie, immobilisation plâtrée…) ou permanents/persistants (âge, cancer, thrombophilies cliniques ou biologiques…) influence la durée du traitement. La démarche diagnostique repose sur l’évaluation de la probabilité clinique associée à la réalisation d’examens complémentaires. L’examen de confirmation diagnostique de référence actuel est l’écho-Doppler veineux. Les traitements anticoagulants à dose curative, pour une durée d’au moins trois mois en cas de TVP proximale (i.e. TVP poplitée ou plus proximale), constituent la pierre angulaire de la prise en charge thérapeutique. L’avènement des anticoagulants oraux directs, qui ont démontré dans les études cliniques une efficacité et une sécurité d’utilisation au moins équivalentes à celles des traitements antivitamines K, devrait permettre d’optimiser la prise en charge ambulatoire de cette pathologie.

Les anévrysmes infectieux de l’aorte abdominale (AIAA), consécutifs à une infection bactérienne, se développent typiquement sur un vaisseau antérieurement sain mais parfois sur un anévrysme artériel déjà constitué. Nous n’envisagerons pas ici les infections de matériel prothétique. Les facteurs de risque des AIAA sont représentés par des infections systémiques (sepsis, endocardites), des infections loco-régionales, des complications iatrogéniques d’actes interventionnels, la toxicomanie intraveineuse et sont également aggravés par une immunodépression ou un âge élevé. Les manifestations cliniques vont combiner des signes cliniques d’anévrysme abdominal non antérieurement diagnostiqué et un tableau infectieux. Des complications peuvent être révélatrices : syndrome fissuraire, rupture d’anévrysme, fistule aortoduodénale. Les aspects de diagnostic microbiologique et d’imagerie seront traités dans une communication séparée. Deux cas cliniques informatifs permettront d’illustrer une démarche de diagnostic intégré et d’indiquer les apports potentiels de la tomographie par émission de positons (TEPscan) et de l’échographie de contraste. Plusieurs facteurs de mauvais pronostic ont été identifiés, cependant le pronostic global est grave avec une mortalité précoce significative et un taux de survie à 10 ans inférieur à 50 % ce qui souligne l’importance d’un diagnostic précoce et d’une prise en charge précoce et adaptée [1].

L’utilisation des nouveaux anticoagulants oraux (NACO) ou anticoagulants oraux directs (AOD), selon la nouvelle appellation, justifie un accompagnement des prescripteurs en raison des risques de mésusage liés à la perception d’une relative simplicité d’utilisation, qui n’est en fait qu’apparente, cette classe thérapeutique exposant à des accidents constatés déjà en France et dans d’autre pays. Les AOD ont prouvé leur efficacité dans la prise en charge de la fibrillation auriculaire non valvulaire et les événements thromboemboliques veineux (ETEV) avec un haut niveau de preuve et leur utilisation s’accroît au détriment des antivitamines K (AVK). L’absence de surveillance biologique, souvent mise en avant, ne les dispense pas d’effets secondaires, principalement les accidents hémorragiques qui peuvent être graves et aboutir au décès. Le site « www.thromboclic.fr » vient en complément du travail déjà entrepris pour sensibiliser les prescripteurs. Ce site permettrait un accès simple et facile à l’information et réduirait le nombre et la gravité des erreurs médicales en fournissant aux soignants les informations nécessaires au moment qu’ils auront choisi.

La tendance évolutive des D-dimères pourrait être un facteur prédictif de la gravité de cette maladie mais est très peu étudié. Cette étude avait pour objectif d'identifier des phénotypes biologiques d’évolution des D-dimères et leur valeur pronostique sur le risque de décès ou de thrombose chez les patients hospitalisés pour COVID-19.

Objective.Ischemic digital ulcers (DU) are frequent and severe complications of systemic sclerosis (SSc). The purpose of our study was to assess the effect of DU on hand disability and pain in patients with SSc.Methods.The Evaluation of the Impact of Recurrent Ischemic DU on Hand Disability in Patients with SSc (ECLIPSE) is a prospective, multicenter, noninterventional study with a 2-year followup. Patients with SSc who experienced at least 1 DU in the previous year and received bosentan therapy were included between October 2009 and March 2011. This cohort is described at the time of inclusion.Results.There were 190 patients (132 females) from 53 centers. Mean age ± SD was 43 ± 15 years at SSc diagnosis and 53 ± 15 years at inclusion. In 105 patients (56.2%), DU were the first non-Raynaud symptoms of SSc. The mean time interval between the occurrence of Raynaud phenomenon and the first DU episode was 6.6 ± 9.1 years. The mean numbers of active DU and fingers affected per patient for both hands were 2.3 ± 1.8 and 2.2 ± 1.6, respectively. Presence of active DU at inclusion was significantly associated with pain and impaired hand function: Visual Analog Scale for pain (0 to 10) was 6.2 ± 2.6 versus 2.5 ± 2.4 (p < 0.0001) and Cochin Hand Function Scale for hand disability (0 to 90) was 38 ± 20 versus 25 ± 19 (p < 0.0001), respectively.Conclusion.DU represent a major sign of SSc, often affecting multiple fingers and both hands. They are significantly associated with pain and hand disability.

Les D-dimères, marqueurs du risque de thrombose, ont également été identifiés dès le début de la pandémie comme un marqueur du risque de gravité de la COVID-19. Cependant, au-delà du chiffre brut, la tendance évolutive des D-dimères notamment en début d'hospitalisation pourrait être un facteur prédictif de la gravité de cette maladie mais est très peu étudié. Cette étude avait pour objectif d'identifier des phénotypes biologiques d’évolution (trajectoires) des D-dimères et leur valeur pronostique sur le risque de décès ou de thrombose chez les patients hospitalisés pour COVID-19.

Channel catfish Ictalurus punctatusis a highly mobile species and is known to make extensive seasonal movements in lotic systems. Dams have been suggested to detrimentally affect this species, although abundant channel catfish populations are known to occur in many fragmented rivers. To examine factors that allow channel catfish to persist in impounded rivers, we assessed relative abundance of channel catfish in three impounded and three flowing sites of the Fox River, Illinois, USA. Radiotelemetry was used to determine movement and habitat use patterns of channel catfish among flowing and impounded areas. Relative abundance of channel catfish was consistently higher at flowing sites than at impounded sites during summer. Several radio‐tagged channel catfish moved downstream into impounded areas in fall, and all tagged individuals were found in impounded areas during winter. The majority of tagged channel catfish moved upstream into flowing areas during spring. Channel catfish used a wide range of depths (0.28–2.60 m), and were always found in current velocities less than 0.50 m s−1. They selected most strongly for coarse substrates, but were infrequently found near cover. Although low‐head dams restrict the movements of channel catfish, impounded areas appear to provide overwintering habitats that may eliminate the need for seasonal long‐distance movements. Small run‐of‐river impoundments, however, may contain unsuitable conditions for channel catfish during other seasons. Copyright © 2010 John Wiley & Sons, Ltd.

Incorporating potentially important events during the first year of life across multiple environmental conditions is needed to generalize models of fish recruitment. Using previous conceptual models as a framework, we quantified sources of intra- and intersystem variation in recruitment of largemouth bass Micropterus salmoides. We measured age-0 abundances, first-year growth, and potentially important environmental variables across 12 populations and 5–7 year-classes. Interpopulation differences in average recruitment to age 1 were set by variation in number of age-0 fish surviving to the fall. Survival to fall was in turn positively related to density of juvenile bluegills Lepomis macrochirus. First-year growth was positively related to turbidity and adult largemouth bass abundance. For individual lakes, variables explaining a significant amount of intrapopulation variation in recruitment strength were factors associated with either production of age-0 fish from the parental care stage (peak density of age-0 largemouth bass) or prey fish abundance (densities of larval and juvenile bluegills). Abundance of larval bluegills was higher in systems where largemouth bass recruitment to age 1 was not related to bluegill abundance than in lakes where recruitment strength was sensitive to annual fluctuations in prey fish abundance. The relationship between output from the parental care stage and recruitment strength suggests that largemouth bass management should focus on actions designed to influence nest success. Where recruitment is also limited by prey fish availability, management actions can also be directed towards community attributes that influence the growth and production of important prey species.

L'influence des anticorps antiphospholipides (aPL) sur l'apparition du livedo, manifestation cutanée bien connue des patients atteints de lupus érythémateux systémique (LES), est controversé. L'objectif de notre étude était d'estimer le risque de livedo associé aux aPL chez les patients atteints de LES.

La HAS rappelle que la pertinence des soins est un sujet stratégique qui représente une dimension à part entière de la qualité des soins et un enjeu majeur pour la sécurité des patients (rapport bénéfice/risque). Les recommandations de type « choose wisely » (CW) ou « pertinence des soins » venus d’outre-Atlantique sont des documents simples et clairs rédigés par les professionnels de santé (PS). Ils sont un moyen de rationaliser les actes, les traitements et les séjours hospitaliers, et d’éviter les investigations inutiles qui contribuent à l’inflation des dépenses de santé.

Background: Oral estrogen use and elevated body mass index (BMI) increase the risk of venous thromboembolism (VTE). Recent data suggest that transdermal estrogen might be safe with respect to thrombotic risk. However, the impact of transdermal estrogen on the association between overweight (25 kg m−2 < BMI ≤ 30 kg m−2) or obesity (BMI >30 kg m−2) and VTE risk has not been investigated. Methods: We carried a multicenter case–control study of VTE among postmenopausal women aged 45–70 years, between 1999 and 2005, in France. Case population consisted of women with a first documented idiopathic VTE. We recruited 191 hospital cases matched with 416 hospital controls and 62 outpatient cases matched with 181 community controls. Results: The odds ratio (OR) for VTE was 2.5 [95% confidence interval (CI):1.7–3.7] for overweight and 3.9 (95% CI: 2.2–6.9) for obesity. Oral, not transdermal, estrogen was associated with an increased VTE risk (OR = 4.5; 95% CI: 2.6–7.7 and OR = 1.1; 95% CI: 0.7–1.7, respectively). Compared with non‐users with normal weight, the combination of oral estrogen use and overweight or obesity further enhanced VTE risk (OR = 10.2; 95% CI: 3.5–30.2 and OR = 20.6; 95% CI: 4.8–88.1, respectively). However, transdermal users with increased BMI had similar risk as non‐users with increased BMI (OR = 2.9; 95% CI: 1.5–5.8 and OR = 2.7; 95% CI: 1.7–4.5 respectively for overweight; OR = 5.4; 95% CI: 2.1–14.1 and OR = 4.0; 95% CI: 2.1–7.8 respectively for obesity). Conclusions: In contrast to oral estrogen, transdermal estrogen does not confer an additional risk of idiopathic VTE in women with increased BMI. The safety of transdermal estrogen on thrombotic risk has to be confirmed.

Andermann syndrome (OMIM 218000) is an autosomal recessive motor-sensory neuropathy associated with developmental and neurodegenerative defects. The cerebral MRI reveals a variable degree of agenesis of the corpus callosum. Recently, truncating mutations of the KCC3gene (also known as SLC12A6) have been associated with Andermann syndrome.

Background: Lifetime estrogen exposure has been related to breast cancer risk, osteoporosis, and cardiovascular disease but data on venous thromboembolism (VTE) risk are limited. Methods: Data from a hospital‐based case–control study among 608 postmenopausal women (191 with a first episode of idiopathic VTE and 417 age‐matched controls) were used to determine whether estrogen exposure, as assessed by age at menopause [classified as early(≤ 45 years), normal (46–54 years) and late menopause (≥ 55 years)] and parity, was associated with the risk of VTE. Results: After adjustment for potential confounding variables, the risk of VTE was increased with each year's delay in the menopause [odds ratio (OR) = 1.06, 95% confidence interval (CI) = 1.02–1.10, P < 0.0075]. When compared with women with normal menopause used as a reference, the adjusted OR for VTE was 0.59 (95% CI = 0.36–0.97) and 2.53 (95% CI = 1.28–4.99) for women with early menopause and late menopause, respectively (P = 0.001). Adjusted OR for VTE was also higher for women with more than two children when compared with those with less than or equal to two children (1.56, 95% CI = 1.03–2.34, P = 0.03). The lowest risk of VTE was observed in women with early menopause and lower parity (adjusted OR = 0.60, 95% CI = 0.30–1.24), the highest risk was among women with late menopause who have had more than two children (adjusted OR = 3.41, 95% CI = 1.46–9.25). Conclusion: These results show that the longer exposure to endogenous estrogen is associated with an increased VTE risk.

Postinfectious purpura fulminans is a rare disease. Varicella is one of the precipitating conditions and we recently observed such a case. The 4‐year‐old child was found to have a severe transient protein S deficiency. By enzyme‐linked immunosorbent assay and surface plasmon resonance we first demonstrated that anti‐protein S antibodies were present and also transient. Next we characterized the epitopes against which these antibodies were directed and found that they predominantly recognized the N‐terminal part of protein S. Finally we showed by thrombography a transient dramatic hypercoagulable state as a result of thrombin being unregulated by the dynamic protein C inhibitory system: in vitrothrombin generation, in response to a low concentration of tissue factor, was almost insensitive to activated protein C up to 25 nmol L−1on day 4 while it was normally sensitive on day 42. For the first time, we demonstrated a temporal relationship between protein S deficiency, antibodies to protein S and hypercoagulability, thus supporting the pathogenic role of these antibodies.

Ceramic bone substitute materials are often used to fill defects in comminuted articular fractures. In an in vivo study [1], calcium phosphate cements have been injected into highly loaded slot defects in the proximal tibial metaphysis. During healing, cracks were formed mostly in the proximal anterior aspect of the implanted cement and wedge-like gaps formed between the tibial plateau and the cement. Mechanical ex vivo tests were done to investigate the mechanical competence of the bone cement in such a defect situation. Entirely filled defects were loaded with up to 4.5 kN until they failed. Cyclic loading of the proximal tibiae caused micro fragmentation of the cement after 1000 cycles at 1.5–2.0 kN load. This aspect was comparable to cement fragmentation observed in vivo. Large defects in highly loaded areas should therefore additionally be stabilised with metallic implants. The ceramic cement can only be used as a filler material, which can be replaced by new bone upon resorption.

Background: Platelet activation by antistreptokinase (SK) antibodies could impair the clinical effect of SK administration. Objective: To better describe anti-SK antibodies with particular emphasis on procoagulant activities as a result of platelet activation. Patients and methods: Sera were collected from 146 patients with coronary artery disease: non-SK-treated, 95 from mainland France, 31 from French Polynesia; 20 patients from mainland in year 2 after SK treatment. Serum-induced SK-dependent platelet activation resulting in procoagulant activities was assessed with washed platelets from five donors representative of the known patterns of reactivities to IgG. Results: Concentrations (2–5252 µg mL−1) and fibrinolytic neutralization titres (< 10 to > 1280) were found in the expected wide range and correlated (ρ = 0.66, P < 0.0001). Platelet activation was detected with 145 samples, but varied in intensity and pattern (depending on the donors), although there was no systematic hierarchy; it was presumably due to IgG (inhibited by an IgG Fc receptor-blocking antibody and recovered in the IgG fraction) and only partially affected by aspirin. Marked platelet activation could be detected in samples with concentration as low as 2 µg mL−1, and/or no detectable neutralizing titers. The way of immunization to SK was not found to influence the functional profile of antibodies. Conclusion: Anti-SK platelet-activating antibodies are widespread, heterogeneous, poorly predictable on the basis of their antifibrinolytic effect and strong enough to trigger procoagulant activities. Their clinical relevance should be formally assessed, using patients' own platelets for detection owing to the variation of platelet reactivity.

Islet-specific glucose-6-phosphatase (G6Pase) catalytic subunit-related protein (IGRP) is a homolog of the catalytic subunit of G6Pase, the enzyme that catalyzes the terminal step of the gluconeogenic pathway. Its catalytic activity, however, has not been defined. Since IGRP gene expression is restricted to islets, this suggests a possible role in the regulation of islet metabolism and, hence, insulin secretion induced by metabolites. We report here a comparative analysis of the human, mouse, and rat IGRP genes. These studies aimed to identify conserved sequences that may be critical for IGRP function and that specify its restricted tissue distribution. The single copy human IGRP gene has five exons of similar length and coding sequence to the mouse IGRP gene and is located on human chromosome 2q28-32 adjacent to the myosin heavy chain 1B gene. In contrast, the rat IGRP gene does not appear to encode a protein as a result of a series of deletions and insertions in the coding sequence. Moreover, rat IGRP mRNA, unlike mouse and human IGRP mRNA, is not expressed in islets or islet-derived cell lines, an observation that was traced by fusion gene analysis to a mutation of the TATA box motif in the mouse/human IGRP promoters to TGTA in the rat sequence. The results provide a framework for the further analysis of the molecular basis for the tissue-restricted expression of the IGRP gene and the identification of key amino acid sequences that determine its biological activity.

Impact basins on the Moon can serve as a benchmark for timing and intensity of the impact flux in the inner solar system. The basin morphology and morphometry depend on impactor size, mass, and velocity as well as the thermal state of the lunar lithosphere which is a function of the cooling history. Erosion by superimposed impact bombardment has altered the surface expression of basin structures over time, making it difficult to determine the size unequivocally solely based on topographic expression. The gravity signature of basins is thought to be a less altered measure of the size of impact structures. By a systematic study of basin formation using the iSALE‐2D shock‐physics code, we investigate the influence of the lunar thermal state and different impactor properties on the transient crater and final basin size and on the resulting gravity anomaly. As constraints we use gravity data of 16 farside basins and their assumed formation ages to estimate the subsurface temperature related to the cooling history of the Moon. Our modeling results confirm that the thermal state affects the basin formation process and the basin sizes significantly. We provide quantitative relationships between the observed gravity signal, the different basin sizes, and the impactor diameter considering the thermal state of the Moon upon impact, which correlates with the formation ages or periods in the literature. Our study allows for estimating the impactor size from the observed gravity field if the formation age and, thus, the thermal state of the lithosphere is approximately known. Large basin structures testify to the lunar bombardment history by bodies several tens to hundreds of kilometers in diameter. To reconstruct how often the Moon, and thus also Earth, was hit by large cosmic bodies of a given size, it is essential to relate the size of basin structures with impactor size. However, since the surface expression of most known basins on the Moon is not pristine, the definition of the actual basin size is often ambiguous. As an alternative, we use the observed pronounced positive gravity excursion across lunar basins as a measure of basin size. In addition, we consider the thermal evolution of the Moon which is thought to affect the characteristics of the gravity signature of basins. Therefore, the timing when a given basin was formed in the cooling history of the Moon plays an important role. We use the gravity signature and the lunar thermal state as constraints for modeling the formation of the lunar basins as a function of impactor size. Our results allow for estimating the impactor size and thermal state of the Moon for 16 lunar farside basins. The predicted thermal states are in line with proposed absolute ages of the basins. We provide relationships between impactor size, gravity signal, and farside basin size as a function of cooling history and formation timeGravity anomalies serve as a measure of basin size as impacts altered morphology and crustal thickness models simplify subsurface structureOur basin formation models agree with the assumed formation time based on crater chronology and the estimated cooling history of the Moon We provide relationships between impactor size, gravity signal, and farside basin size as a function of cooling history and formation time Gravity anomalies serve as a measure of basin size as impacts altered morphology and crustal thickness models simplify subsurface structure Our basin formation models agree with the assumed formation time based on crater chronology and the estimated cooling history of the Moon

Zusammenfassung: Biomechanische Untersuchungen am dorsalen Beckenring wurden bisher meist an einer geringen Anzahl von Leichenbecken auf sehr unterschiedliche, nichtstandardisierte Weise durchgeführt. Es ließen sich keine signifikanten Stabilitätsunterschiede bei internen Fixationsmethoden instabiler Beckenringfrakturen nachweisen. Die vorgestellte Versuchsmethode orientiert sich möglichst nahe an der physiologischen Belastung des Beckens im Einbeinstand. Sie ermöglicht eine standardisierte und reproduzierbare Testung unterschiedlicher Osteosynthesen am Iliosakralgelenk. Des weiteren kann anhand einer größeren Anzahl analoger Versuche an Kunststoff- und Humanbecken die Eignung von Kunstknochen für derartige Versuche bewertet und die Zahl der an Humanbecken notwendigen Untersuchungen reduziert werden.

To establish whether the bending and torsional stiffness of an implanted nail are influenced by nail design and nail-bolt interface, this study compared two implanted retrograde nail systems: the AO/ASIF unreamed humeral nail (UHN) and the Russell-Taylor (RT) nail.

Abstract: Objective: This retrospective evaluation aimed to assess the adequacy of prophylaxis against thromboembolism prescribed to surgical patients at the authors' institution, and to compare it with generally accepted published guidelines. Aspects considered were indications for prophylaxis, regimens used and monitoring. Methods: Eleven units (nine surgical and two surgical intensive care) took part in the survey on a voluntary basis. The clinical audit system used involved developing a set of criteria based on existing guidelines, comparing observed practice with those recommendations, analysing the factors underlying any deviation and developing corrective measures. Results: When the medical records of 117 patients hospitalized in October 1995 were examined, prophylaxis against deep vein thrombosis was documented in 86 (low molecular weight heparin in 85, dextran in one). No associated physical preventative measures were recorded. Indications and dosage were appropriately handled in 90.7% and 75.2% of patients, respectively. Ninety-five cases were outside the reference criteria: 74 for excluded surgical indications, 13 which involved laparoscopy, and eight in which spinal or epidural anaesthesia was administered. Platelet count was performed in 73.8% of cases before prophylactic treatment, and in 23.1% during its course. Anti-Xa activity was measured in 0.4% of cases. Analysis of causes showed that guidelines were not complied with either because of lack of organization, or because of disagreement with them. Discussion: In this study, indications for prophylaxis were well established and heparin dosages used were not fundamentally flawed. The weak point in practice was a failure to carry out platelet counts, particularly during the course of treatment. Appropriate corrective action consists of disseminating guidelines and relevant information, and using a preoperative checklist to assess thromboembolic risk. Conclusion: Physicians agree that opportunities to improve preventative practices exist, and that the quality improvement programme should be pursued.

The impurity interstitial interactions in diluteW57Co alloys during 3 MeV electron irradiation at 80 K and subsequent isochronal annealing have been studied using Mössbauer technique and electrical resistivity measurements. During 80 K irradiation, the population of one57Co impurity single interstitial complex, two different trapping sites for di-interstitials and three57Co impurity interstitial cluster complexes could be identified by the appearance of six additional absorption lines in the Mössbauer spectra with isomer shifts of +0.72 to +0.41 mm/s relative to the substitutional line and quadrupol splittings ranging from 1.89 to 0.17 mm/s. The trapping behaviour ofW57Co could be described by a nucleation trap model using a trapping radius ratioro/rv. = 0.25 (57Co atom without captured interstitial/vacancy) and assuming an increase of the trapping radius per trapped interstitial ΔLr = r0. Comparing the Mössbauer data and the resistivity data, we found that on an average only about 23% of the interstitials are trapped in the direct vicinity of the57Co impurities, while about 77% are bound farther on shallow traps.The model is supported by the results of the isochronal annealing after irradiation. At annealing temperatures above 190 K, interstitials captured on shallow trap positions become mobile and reach the direct vicinity of the57Co impurities.Furthermore, the annealing behaviour shows that the only57Co impurity single interstitial configuration populated during electron irradiation at 80 K is metastable, and rearranges at 140 K into several more stable configurations, consisting of a57Co impurity with one interstitial trapped in the direct vicinity.

A radioreceptor assay for the determination of ipratropium bromide in human plasma has been developed, using [3H] N-methyl-scopolamine as a radioligand to label muscarinic cholinergic receptors in a membrane preparation of rat cerebral cortex. there was no interference due to the cross-reactivity of 3 metabolites of ipratropium with the parent compound (5.2, 1.5 and 0.004%, respectively). The validity of the assay was checked between 20 pg/ml and 1000 pg/ml drug.

Abstract: The purpose of this article is to make a distinction between (a) a society's ability to generate a scientific and technological potential (generativity), (b) the potential itself and (c) the country's capacity to absorb or receive scientific and technological research results (respectivity). These three complexes are represented by joint indicators covering both levels and structures. A comparison of 30 developing countries (DC) shows, inter alia, that: (a) the polarisation in economic development of the countries considered confirms the view that the future of national development is linked to the scientific and technological potential, (b) joint indicators can interpret better than a comparison of pairs of single indicators, (c) countries with comparable levels of the three capacities (generativity, R & D potential and receptivity) differ mostly in the structures. These structures seem to determine the differences in the use of the capacities, (d) the level of R & D potential is related more closely to the country's ability to absorb scientific and technological results than with its resources for building up this potential.

We studied the prognostic significance of antiphospholipid antibodies for recurrence of venous thromboembolism (VTE), in 71 patients admitted for acute VTE (deep-vein thrombosis or pulmonary embolism) in a single internal medicine unit. Lupus anticoagulant (LA), antibodies directed against β₂-glycoprotein I (β₂GPI) and antibodies against both β₂GPI and a mixture of phospholipids (cardiolipin, phosphatidyl-serine and phosphatidic acid) (APAs) were measured. The patients were followed-up (mean 4.9 years) to determine the time to the next VTE. We found LA in nine patients, anti-β₂GPI antibodies in seven patients and APAs in six patients. The cumulative risk of recurring VTE was higher in patients with β₂GPI-binding antibodies (hazard ratio 12.6, 95% CI 1.5-104.9; p=0.0029). The risk associated with APAs was 11.5 (95% CI 1.3-98.8; p=0.0049) and that for LA was 3.7 (35% CI 0.9-15.6; p=0.055). The risk of VTE recurring was higher both in patients with antibodies directed against β₂GPI, and in patients with antibodies directed against β₂GPI and a mixture of phospholipids, than in patients without these antibodies.

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Following a review of the fundamental aspects of the complement system and analytical methods, the authors discuss the pathology of complement as it relates to the respiratory system. Hereditary angioneurotic edema is a genetically transmitted deficiency in the amount or function of the C 1 esterase inhibitor. This disease is responsable for asphyxia caused by laryngeal edema, and it is now controlled by androgens. Serum complement fractional changes following challenge suggest that complement may play a role in asthma. Also, the authors have observed the presence of C 1 q, C 4, and C 3 in the bronchial mucosa in 18 cases of intrinsic asthma. Experimental studies suggest an Arthus-type phenomenon in the origin of extrinsic allergic alveolitis, with delayed onset of respiratory disorders, presence of precipitins and immune complexes, and anatomic injuries. Other respiratory diseases are dependent on similar mechanisms (rheumatoid pleurisies, collagen diseases, hyaline membrane lesions, and Good-pasture’s syndrome). Complement is thus an essential element of cellular reactions in the immune response and nonspecific inflammation in respiratory pathology.