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Estimation of the impact of vaccination and non-pharmaceutical interventions (NPIs) on COVID-19 incidence is complicated by several factors, including the successive emergence of SARS-CoV-2 variants of concern and changing population immunity resulting from vaccination and previous infection. We developed an age-structured multi-strain COVID-19 transmission model framework that could estimate the impact of vaccination and NPIs while accounting for these factors. We applied this framework to French Polynesia, which unlike many countries experienced multiple large COVID-19 waves from multiple variants over the course of the pandemic, interspersed with periods of elimination. We estimated that the vaccination programme averted 54.3% (95% CI 54.0-54.6%) of the 6840 hospitalisations and 60.2% (95% CI 59.9-60.5%) of the 1280 hospital deaths that would have occurred in a baseline scenario without any vaccination up to May 2022. Vaccination also averted an estimated 28.4% (95% CI 28.2-28.7%) of 193,000 symptomatic cases in the baseline scenario. We estimated the booster campaign contributed 3.4%, 2.9% and 3.3% to overall reductions in cases, hospitalisations and hospital deaths respectively. Our results suggested that removing, or altering the timings of, the lockdowns during the first two waves had non-linear effects on overall incidence owing to the resulting effect on accumulation of population immunity. Our estimates of vaccination and booster impact differ from those for other countries due to differences in age structure, previous exposure levels and timing of variant introduction relative to vaccination, emphasising the importance of detailed analysis that accounts for these factors.

Estimation of the impact of vaccination and non-pharmaceutical interventions (NPIs) on COVID-19 incidence is complicated by several factors, including the successive emergence of SARS-CoV-2 variants of concern and changing population immunity resulting from vaccination and previous infection. We developed an age-structured multi-strain COVID-19 transmission model framework that could estimate the impact of vaccination and NPIs while accounting for these factors. We applied this approach to French Polynesia, which unlike many countries experienced multiple large COVID-19 waves from multiple variants over the course of the pandemic, interspersed with periods of elimination. We estimated that the vaccination programme averted 54.3% (95% CI 54.0-54.6%) of the 6840 hospitalisations and 60.2% (95% CI 59.9–60.5%) of the 1280 hospital deaths that would have occurred in a baseline scenario without any vaccination up to May 2022. Vaccination also averted an estimated 28.4% (95% CI 28.2-28.7%) of 193,000 symptomatic cases in the baseline scenario. We estimated the booster campaign contributed 3.4%, 2.9% and 3.3% to overall reductions in cases, hospitalisations and hospital deaths respectively. Our results suggested that removing, or altering the timings of, the lockdowns during the first two waves had non-linear effects on overall incidence owing to the resulting effect on accumulation of population immunity. Our estimates of vaccination and booster impact differ from those for other countries due to differences in age structure, previous exposure levels and timing of variant introduction relative to vaccination, emphasising the importance of detailed analysis that accounts for these factors.

Placer un lien pointant vers un site tiers qui publie des œuvres protégées, sans l’autorisation du titulaire du droit d’auteur, constitue-t-il une communication de ces œuvres au public selon l’article 3, paragraphe 1, de la directive 2001/29 ? Telle était la question à laquelle la Cour de justice de l'Union européenne avait à répondre dans sa jurisprudence récente sur les liens hypertexte. Le présent article est destiné à donner un bref aperçu et une analyse critique des réponses avancées par la Cour, particulièrement dans les arrêts Svensson et Gs Media. Dans cette optique, deux cas de figures sont évoqués : dans un premier temps, nous envisageons le cas des liens hypertexte pointant vers des œuvres licitement mises en ligne. Puis, dans un second temps, il est question des liens renvoyant vers un contenu protégé mis illicitement en ligne.

International audience

5 pages, 5 figures; International audience; We report on a two-dimensional (2D) V1–xPtxSe2 alloy that exhibits ferromagnetic order and Rashba spin–orbit coupling. Although ferromagnetism is absent in 1T-VSe2 because of the competition with the charge density wave phase, we demonstrate theoretically and experimentally that the substitution of vanadium by platinum in VSe2 (10–50%) to form a homogeneous 2D alloy restores ferromagnetic order down to one monolayer of V0.65Pt0.35Se2. Moreover, the presence of platinum atoms gives rise to Rashba spin–orbit coupling in (V,Pt)Se2, providing an original platform to study the interplay between ferromagnetism and spin–orbit coupling in the 2D limit.

Objectif Les mouvements mandibulaires (MM) sont desormais consideres comme une mesure diagnostique de l’effort respiratoire et pourraient etre utilises comme methode de depistage des patients eligibles a une polysomnographie (PSG). Nous rapportons ici la faisabilite d’un depistage fonde sur la mesure d’un index respiratoire associe a des mouvements mandibulaires (MM-RDI). Methodes Au total, 4231 patients ont effectue en ambulatoire un test de depistage Brizzy (depist-By) a l’aide un capteur magnetique (Nomics©) ; 918 patients ont simultanement beneficie d’une oxymetrie. Le patient etait considere comme positif et necessitant une PSG si le MM-RDI etait > 13,5/h ou si l’indice de desaturation de l’oxygene (IDO) etait > 18,5/h (sous condition d’une estimation du temps de sommeil total [eTST] > 4 heures). Resultats Parmi les tests, 3,9 % etaient non exploitables en raison d’une defaillance technique. Seulement 3,2 % de la population analysable avait une eTST Conclusion Cette etude preliminaire confirme la faisabilite du MM-RDI comme outil de depistage pour les patients candidats a la PSG. Elle suggere une complementarite de l’oxymetrie et du depist-By.

Background Unintentional leaks (ULs) are frequent adverse effects in CPAP-treated patients. We previously published a novel methodology for analyzing the determinants of UL using polysomnography. We now propose a simplified recording system using a type 3 polygraphic device (Somnolter; Nomics S.A.). Research Question (1) To describe individual UL determinants provided by the Somnolter software in automatic-CPAP-treated OSA patients; (2) To subsequently describe the clinical consensus of four physicians on how to manage each individual UL situation. Study Design and Methods Somnoler recordings performed under nasal automatic-CPAP were automatically analyzed with APIOS software. For each polygraphic recording, APIOS provided the OR and the CIs for potential determinants of UL: mouth opening, CPAP pressure, body position, and mandibular oscillation. Based on these results, each of four physicians was asked to choose one of four strategies: (1) increase or decrease therapeutic pressure; (2) change nasal mask for oro-nasal mask/chinstrap; (3) favor a nonsupine or supine position; (4) no action for individual leak management. Subsequently, a meeting was held to determine a consensus choice for each individual case. Results Seventy-eight consecutive patients underwent home-polygraphy with Somnolter. Fifty recordings were analyzed (16 females; 65 [57-75] years of age; BMI = 31.1 [27.4-35.3]). Individual diagnosis of UL was routinely feasible. The determinants of UL were heterogeneous in the population, and diagnosis of UL was not feasible in 10 patients. Based on the results from this analysis, we established consensus leak management strategies at the individual level. The average Cohen κ coefficient for the four raters was 0.58. Pressure modification was proposed in 36% of patients, no action in 24%, installation of a facial mask/chinstrap in 22%, and positional treatment in 18%. Interpretation The use of type 3 polygraphy for characterizing leak determinants in patients treated with nasal automatic-CPAP is feasible in routine practice. Leak determinants are patient specific. Interrater concordance for determining individual leak management strategies demonstrated a “fair” level of agreement. Trial Registry ClinicalTrials.gov ; No.: NCT03381508; URL: www.clinicaltrials.gov ).

Background Several successive arbovirus outbreaks have affected French Polynesia (FP) in the recent past years due to different dengue serotypes (DENV) present for several decades, Zika (ZIKV) (2013–2014) and chikungunya (CHIKV) (2014–2015) viruses with a potential impact on blood safety and blood supply due to the geographical isolation of these islands. This study reports an assessment of the impact of these outbreaks on blood products supply and infectious safety in FP and discuss the effectiveness of implemented preventive measures. Methods To ensure the infectious safety of blood products during outbreaks, several measures have successively been introduced as the selection of donors suspected of infection, the nucleic acid testing (NAT) and the pathogen reduction of platelets and plasmas. Results The donor deferral rate increased by 6% between 2012 and 2014 without changes in the number of collected donations. NAT excluded five blood donations reactive for DENV RNA, 42 for ZIKV and 34 for CHIKV. As Zika screening could not been implemented before the third month of the outbreak, 36 blood products from ZIKV-infected donors were transfused to 26 recipients. However, no transfusion-transmitted arbovirus has been reported. Conclusion The last past arboviruses outbreaks did not have a significant impact on blood supply in FP. The measures introduced to prevent arbovirus transmission by transfusion were able to maintain infectious safety for all blood products without impairing self-sufficiency.

Background Mycobacterium abscessus infections remain difficult to manage in both cystic fibrosis (CF) and non-CF patients and reported clinical outcomes are largely unsatisfactory. Clinical trial data are limited and no approved therapies are currently available for the management of M abscessus lung diseases. As an alternative, cohort studies may provide insightful information into the management of M abscessus pulmonary disease. Methods Based on a retrospective observational cohort study, we investigated the safety and efficacy of amikacin liposome inhaled suspension (ALIS) as an adjunct to a standard antibiotic regimen for M abscessus lung infection in both CF and non-CF patients. We also assessed the association of patient drug compliance with culture conversion and clinical outcomes. Results Twenty-six patients had long-term follow-up data available. Culture conversion was achieved in 54% (14/26) of the patients with no difference between CF and non-CF patients after an average treatment duration of 10 months. Patient treatment compliance was significantly better in the converter group compared to nonconverters with an odds ratio of 44.78 associated with good compared to poor patient compliance. Overall, 9 patients (35%) experienced an adverse event that led to treatment discontinuation. Conclusions ALIS appears beneficial in both CF and non-CF populations with M abscessus lung disease.

Introduction To date, continuous positive airway pressure (CPAP) remains the cornerstone of obstructive sleep apnoea treatment. CPAP data describing residual sleep-disordered breathing events (ie, the CPAP-measured apnoea–hypopnoea indices (AHI-CPAPflow)) is difficult to interpret because it is an entirely different metric than the polysomnography (PSG) measured AHI gold standard (AHI-PSGgold). Moreover, manufacturer definitions for apnoea and hypopnoea are not only different from those recommended for PSG scoring, but also different between manufacturers. In the context of CPAP initiation and widespread telemedicine at home to facilitate sleep apnoea care, there is a need for concrete evidence that AHI-CPAPflow can be used as a surrogate for AHI-PSGgold. Methods and analysis No published systematic review and meta-analysis (SRMA) has compared the accuracy of AHI-CPAPflow against AHI-PSGgold and the primary objective of this study is therefore to do so using published data. The secondary objectives are to similarly evaluate other sleep disordered breathing indices and to perform subgroup analyses focusing on the inclusion/exclusion of central apnoea patients, body mass index levels, CPAP device brands, pressure titration modes, use of a predetermined and fixed pressure level or not, and the impact of a 4% PSG desaturation criteria versus 3% PSG on accuracy. The Preferred Reporting Items for SRMA protocols statement guided study design. Randomised controlled trials and observational studies of adult patients (≥18 years old) treated by a CPAP device will be included. The CPAP intervention and PSG comparator must be performed synchronously. PSGs must be scored manually and follow the American Academy of Sleep Medicine guidelines (2007 AASM criteria or more recent). To assess the risk of bias in each study, the Quality Assessment of Diagnostic Accuracy Studies 2 tool will be used. Ethics and dissemination This protocol received ethics committee approval on 16 July 2020 (IRB_MTP_2020_07_2020000404) and results will be disseminated via peer-reviewed publications. PROSPERO/Trial registration numbers CRD42020159914/NCT04526366; Pre-results

International audience; Aims Optimizing medical cardiac treatment for sleep apnoea (SA) in patients with chronic heart failure and reduced ejection fraction (HFrEF) is an expert Grade C recommendation based on six studies encompassing a total of 67 patients only. Whether sacubitril-valsartan (SV), a cornerstone of HFrEF medical treatment, impacts SA is unknown and requires evaluation.Methods and results The ENTRESTO-SAS trial is a six-centre, prospective, open-label real-life cohort study (NCT02916160). Ambulatory patients eligible for SV (i.e. HFrEF adults who remain symptomatic despite optimal treatment) were evaluated before and after 3 months of SV (including nocturnal ventilatory polygraphy); 118 patients were final analysed [median age was 66 (IQ 25-75 : 56-73) years, 81.4% male, 36.5% New York Heart Association III-IV, N-terminal pro-B-type natriuretic peptide level of 1564 (701-3376) ng/L, left ventricular ejection fraction of 30 (25-34)%, 60.7% ischaemic HFrEF, 97.5% initially treated with angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, 83.9% with beta-blockers, 64.4% with mineralocorticoid receptor antagonists, and 74.6% with diuretics]. Three groups were defined according to initial central/obstructive apnoea-hypopnoea indices (AHIs): G1 (n = 49, AHI central ≥ 5/h and AHI obstructive < 15/h); G2 (n = 27, AHI obstructive ≥ 15/h); and G3 (n = 42, AHI central < 5/h and AHI obstructive < 15/h). At 3 months, the AHI (main predefined outcome) decreased significantly by À7.10/h (IQ 25-75 : À16.10 to 0.40; P < 0.001) in G1 + G2 without positive airway pressure treatment (45 patients, median initial AHI of 24.20 (IQ 25-75 : 16.40-43.50)/h). Of these, 24.4% presented an AHI decrease ≥50% and 37.78% had a final AHI < 15/h (tendency for improvement from an initial value of 20%: P = 0.0574). For G1 patients (n = 37), AHI significantly decreased from a median of 22.90 (16.00-43.50)/h to 19.20 (12.70-31.10)/h (P = 0.002). For G2 patients (n = 8), AHI decreased from a median of 30.10 (26.40-47.60)/h to 22.75 (14.60-36.90)/h (statistically non-significant, P = 0.059).Conclusions In this real-life population, SV treatment for 3 months in SA patients is associated with a significant decrease in AHI. These results support the current guidelines that recommend first an optimization of the HFrEF treatment in patients with HFrEF and central SA. A potential positive airway pressure sparing effect merits further investigation.

When magnetic atoms are inserted inside a superconductor, the superconducting order is locally depleted as a result of the antagonistic nature of magnetism and superconductivity. Thereby, distinctive spectral features, known as Yu–Shiba–Rusinov states, appear inside the superconducting gap. The search for Yu–Shiba–Rusinov states in different materials is intense, as they can be used as building blocks to promote Majorana modes suitable for topological quantum computing. Here, the first observation of Yu–Shiba–Rusinov states in graphene, a non-superconducting 2D material, and without the participation of magnetic atoms, is reported. Superconductivity in graphene is induced by proximity effect brought by adsorbing nanometer-scale superconducting Pb islands. Using scanning tunneling microscopy and spectroscopy the superconducting proximity gap is measured in graphene, and Yu–Shiba–Rusinov states are visualized in graphene grain boundaries. The results reveal the very special nature of those Yu–Shiba–Rusinov states, which extends more than 20 nm away from the grain boundaries. These observations provide the long-sought experimental confirmation that graphene grain boundaries host local magnetic moments and constitute the first observation of Yu–Shiba–Rusinov states in a chemically pure system. This work was supported by AEI and FEDER under projects MAT2016-80907-P and MAT2016-77852-C2-2-R (AEI/FEDER, UE), by the Fundación Ramón Areces, and by the Comunidad de Madrid NMAT2D-CM program under grant S2018/NMT-4511. J.F.R. acknowledges financial support European Regional Development Fund Project No. NORTE-01-50145- FEDER-000019, and the UTAPEXPL/NTec/0046/2017 projects, as well as Generalitat Valenciana funding Prometeo2017/139 and MINECO Spain (Grant No. MAT2016-78625-C2). J.L.L is grateful for financial support from the Academy of Finland Projects Nos. 331342 and 336243.

Background For some patients, Continuous Positive Airway Pressure (CPAP) remains an uncomfortable therapy despite the constant development of technological innovations. To date, no real life study has investigated the relationship between mask related side-effects (MRSEs) and CPAP-non-adherence (defined as Methods The InterfaceVent-CPAP study is a prospective real-life cross-sectional study conducted in an apneic adult cohort undergoing at least 3 months of CPAP with unrestricted mask-access (34 different masks). MRSEs were evaluated using visual-analogue-scales, CPAP-data using CPAP-software, sleepiness using ESS. Results 1484 patients were included in the analysis (72.2% male, median age 67 years (IQ25–75: 60–74), initial Apnea–Hypopnea-Index (AHI) of 39 (31–56)/h, residual AHIflow was 1.9 (0.9–4) events/h), CPAP-treatment lasted 4.4 (2.0–9.7) years, CPAP-usage was 6.8 (5.5–7.8) h/day, the prevalence of CPAP-non-adherence was 8.6%, and the prevalence of RES was 16.17%. Leak-related side-effects were the most prevalent side-effects (patient-reported leaks concerned 75.4% of responders and had no correlation with CPAP-reported-leaks). Multivariable logistic regression analyses evaluating explanatory-variable (demographic data, device/mask data and MRSEs) effects on variables-of-interest (CPAP-non-adherence and RES), indicated for patient-MRSEs significant associations between: (i) CPAP-non-adherence and dry-mouth (p = 0.004); (ii) RES and patient-reported leaks (p = 0.007), noisy mask (p Conclusion In long-term CPAP-treated patients, leak-related side-effects remain the most prevalent side-effects, but patient-reported leaks cannot be predicted by CPAP-reported-leaks. Patient-MRSEs can be independently associated with CPAP-non-adherence and RES, thus implying a complementary role for MRSE questionnaires alongside CPAP-device-reported-data for patient monitoring. Trial registration InterfaceVent is registered with ClinicalTrials.gov (NCT03013283).

Backgrounds To explain the excess cardiovascular mortality observed in the SERVE-HF study, it was hypothesized that the high-pressure ASV default settings used lead to inappropriate ventilation, cascading negative consequences (i.e. not only pro-arrythmogenic effects through metabolic/electrolyte abnormalities, but also lower cardiac output). The aims of this study are: i) to describe ASV-settings for long-term ASV-populations in real-life conditions; ii) to describe the associated minute-ventilations (MV) and therapeutic pressures for servo-controlled-flow versus servo-controlled-volume devices (ASV-F Philips®-devices versus ASV-V ResMed®-devices). Methods The OTRLASV-study is a cross-sectional, 5-centre study including patients who underwent ASV-treatment for at least 1 year. The eight participating clinicians were free to adjust ASV settings, which were compared among i) initial diagnosed sleep-disordered-breathing (SBD) groups (Obstructive-Sleep-Apnea (OSA), Central-Sleep-Apnea (CSA), Treatment-Emergent-Central-Sleep-Apnea (TECSA)), and ii) unsupervised groups (k-means clusters). To generate these clusters, baseline and follow-up variables were used (age, sex, body mass index (BMI), initial diagnosed Obstructive-Apnea-Index, initial diagnosed Central-Apnea-Index, Continuous-Positive-Airway-Pressure used before ASV treatment, presence of cardiopathy, and presence of a reduced left-ventricular-ejection-fraction (LVEF)). ASV-data were collected using the manufacturer’s software for 6 months. Results One hundred seventy-seven patients (87.57% male) were analysed with a median (IQ25–75) initial Apnea-Hypopnea-Index of 50 (38–62)/h, an ASV-treatment duration of 2.88 (1.76–4.96) years, 61.58% treated with an ASV-V. SDB groups did not differ in ASV settings, MV or therapeutic pressures. In contrast, the five generated k-means clusters did (generally described as follows: (C1) male-TECSA-cardiopathy, (C2) male-mostly-CSA-cardiopathy, (C3) male-mostly-TECSA-no cardiopathy, (C4) female-mostly-elevated BMI-TECSA-cardiopathy, (C5) male-mostly-OSA-low-LVEF). Of note, the male-mostly-OSA-low-LVEF-cluster-5 had significantly lower fixed end-expiratory-airway-pressure (EPAP) settings versus C1 (p = 0.029) and C4 (p = 0.007). Auto-EPAP usage was higher in the male-mostly-TECSA-no cardiopathy-cluster-3 versus C1 (p = 0.006) and C2 (p p = 0.002) and ASV-V (p Conclusions Real-life ASV settings are associated with combinations of baseline and follow-up variables wherein cardiological variables remain clinically meaningful. At the patient level, a hyperventilation risk exists regardless of cluster or ASV-monitoring type, spotlighting a future role of MV-telemonitoring in the interest of patient-safety. Trial registration The OTRLASV study was registered on ClinicalTrials.gov (Identifier: NCT02429986). 1 April 2015.

Objective: There are a number of factors that go into a recommendation to treat non-tuberculous mycobacterial lung infection (NTM-LI). The purpose of the study is to validate consensus recommendations on clinical considerations before treating a NTM-LI. Methods: We engaged respiratory physicians of the "Mycobacterioses" working group, part of the research and teaching group in pulmonology and infectious diseases (GREPI), on behalf of the SPLF (Societe de Pneumologie de Langue Francaise) in a Delphi survey concerning three areas of interest for physicians before they had to decide to treat (Diagnosis, Definition of the level of severity and Clinical assessment before deciding to treat) in order to create a decision algorithm. Each assertion was subjected to rating and free comments by these experts via an online questionnaire. The scores were weighted by the number of patients seen each year by the experts. The assertions having obtained a weighted average greater than 9/10 were validated. Otherwise they were subject to re-evaluation during round 2 until reaching 9/10. Results: A total of 37 experts responded. At first round, 9/38 assertions obtained a strong agreement (median ≥7 and 80% of responses >7). Other assertions from all domains, in particular the definition of the level of severity, were revised and new assertions added for submission to scoring in round 2. Fifty-one assertions were finally assessed. Agreement was strong in 78% of the assertions (40/51); moderate in 22% (11/51). There was no disagreement. Conclusion: We obtained a consensus from physicians about clinical considerations before deciding to treat NTM-LI and we propose a decision algorithm to guide a treatment decision.

Quantum confinement of graphene Dirac-like electrons in artificially crafted nanometer structures is a long sought goal that would provide a strategy to selectively tune the electronic properties of graphene, including bandgap opening or quantization of energy levels However, creating confining structures with nanometer precision in shape, size and location, remains as an experimental challenge, both for top-down and bottom-up approaches. Moreover, Klein tunneling, offering an escape route to graphene electrons, limits the efficiency of electrostatic confinement. Here, a scanning tunneling microscope (STM) is used to create graphene nanopatterns, with sub-nanometer precision, by the collective manipulation of a large number of H atoms. Individual graphene nanostructures are built at selected locations, with predetermined orientations and shapes, and with dimensions going all the way from 2 nanometers up to 1 micron. The method permits to erase and rebuild the patterns at will, and it can be implemented on different graphene substrates. STM experiments demonstrate that such graphene nanostructures confine very efficiently graphene Dirac quasiparticles, both in zero and one dimensional structures. In graphene quantum dots, perfectly defined energy band gaps up to 0.8 eV are found, that scale as the inverse of the dots linear dimension, as expected for massless Dirac fermions, Main Manuscript and Supporting Information

Doping a two-dimensional semiconductor with magnetic atoms is a possible route to induce magnetism in the material. We report on the atomic structure and electronic properties of monolayer WSe$_2$ intentionally doped with vanadium atoms by means of scanning transmission electron microscopy and scanning tunneling microscopy and spectroscopy. Most of the V atoms incorporate at W sites. These V$_W$ dopants are negatively charged, which induces a localized bound state located 140 meV above the valence band maximum. The overlap of the electronic potential of two charged V$_W$ dopants generates additional in-gap states. Eventually, the negative charge may suppress the magnetic moment on the V$_W$ dopants., Comment: 12 pages, 4 figures

Lung surface photos show wounds/haemorrhages caused by transbronchial lung cryobiopsy (TBLC). TBLC bleeding can extensively soil airways with consequences for lung function, stressing the need for bleeding prevention and more research via registries.https://bit.ly/34wWAeR

Hydrogen atom makes graphene magnetic Graphene has many extraordinary mechanical and electronic properties, but it's not magnetic. To make it so, the simplest strategy is to modify its electronic structure to create unpaired electrons. Researchers can do that by, for example, removing individual carbon atoms or adsorbing hydrogen onto graphene. This has to be done in a very controlled way because of a peculiarity of the graphene's crystal lattice, which consists of two sublattices. Gonzales-Herrero et al. deposited a single hydrogen atom on top of graphene and used scanning tunneling microscopy to detect magnetism on the sublattice lacking the deposited atom (see the Perspective by Hollen and Gupta). Science , this issue p. 437 ; see also p. 415

International audience; Background: The aim of this pilot study is to investigate the impact of virtual reality exposure therapy (VRET) on brain metabolism and connectivity. Eighteen patients with acrophobia were assessed by an F-18-FDG PET scan sensitized by virtual exposure before treatment, and nine of them were assessed again after eight sessions of VRET. Statistical Parametric Mapping was used to study the correlations between metabolism and pretherapeutic clinical scores and to compare metabolism before and after VRET (p voxel < 0.005, corrected for cluster volume). Metabolic connectivity was evaluated through interregional correlation analysis. Results: Before therapy, a positive correlation was found between scores on the behavioural avoidance test and left occipital metabolism (BA17-18). After VRET, patients presented increased metabolism in the left frontal superior gyri and the left precentral gyrus, which showed increased metabolic connectivity with bilateral occipital areas (BA17-18-19), concomitant with clinical recovery. Conclusions: This study highlights the exciting opportunity to use brain PET imaging to investigate metabolism during virtual exposure and reports the involvement of the visual-motor control system in the treatment of acrophobia by VRET.

International audience; Congenital Zika virus syndrome consists of a large spectrum of neurologic abnormalities seen in infants infected with Zika virus in utero. However, little is known about the effects of Zika virus intrauterine infection on the neurocognitive development of children born without birth defects. Using a case-control study design, we investigated the temporal association of a cluster of congenital defects with Zika virus infection. In a nested study, we also assessed the early childhood development of children recruited in the initial study as controls who were born without known birth defects,. We found evidence for an association of congenital defects with both maternal Zika virus seropositivity (time of infection unknown) and symptomatic Zika virus infection during pregnancy. Although the early childhood development assessment found no excess burden of developmental delay associated with maternal Zika virus infection, larger, longer-term studies are needed.

Unintentional leaks (ULs) are frequent adverse effects in CPAP-treated patients. We previously published a novel methodology for analyzing the determinants of UL using polysomnography. We now propose a simplified recording system using a type 3 polygraphic device (Somnolter; Nomics S.A.).(1) To describe individual UL determinants provided by the Somnolter software in automatic-CPAP-treated OSA patients; (2) To subsequently describe the clinical consensus of four physicians on how to manage each individual UL situation.Somnoler recordings performed under nasal automatic-CPAP were automatically analyzed with APIOS software. For each polygraphic recording, APIOS provided the OR and the CIs for potential determinants of UL: mouth opening, CPAP pressure, body position, and mandibular oscillation. Based on these results, each of four physicians was asked to choose one of four strategies: (1) increase or decrease therapeutic pressure; (2) change nasal mask for oro-nasal mask/chinstrap; (3) favor a nonsupine or supine position; (4) no action for individual leak management. Subsequently, a meeting was held to determine a consensus choice for each individual case.Seventy-eight consecutive patients underwent home-polygraphy with Somnolter. Fifty recordings were analyzed (16 females; 65 [57-75] years of age; BMI = 31.1 [27.4-35.3]). Individual diagnosis of UL was routinely feasible. The determinants of UL were heterogeneous in the population, and diagnosis of UL was not feasible in 10 patients. Based on the results from this analysis, we established consensus leak management strategies at the individual level. The average Cohen κ coefficient for the four raters was 0.58. Pressure modification was proposed in 36% of patients, no action in 24%, installation of a facial mask/chinstrap in 22%, and positional treatment in 18%.The use of type 3 polygraphy for characterizing leak determinants in patients treated with nasal automatic-CPAP is feasible in routine practice. Leak determinants are patient specific. Interrater concordance for determining individual leak management strategies demonstrated a "fair" level of agreement.ClinicalTrials.gov; No.: NCT03381508; URL: www.clinicaltrials.gov).

Aims Sleep-disordered breathing (SDB) is a highly prevalent co-morbidity in patients with chronic heart failure (CHF) and can play a detrimental role in the pathophysiology course of CHF. However, the best way to manage SDB in CHF remains a matter of debate. Sacubitril-valsartan has been included in the 2016 European Society of Cardiology guidelines as an alternative to angiotensin-converting enzyme inhibitors to further reduce the risk of progression of CHF, CHF hospitalization, and death in ambulatory patients. Sacubitril and valsartan are good candidates for correcting SDB of CHF patients because their known mechanisms of action are likely to counteract the pathophysiology of SDB in CHF. Methods and results The ENTRESTO-SAS trial is a 3-month, multicentric, prospective, open-label real-life cohort study. Patients eligible for sacubitril-valsartan treatment (i.e. adults with left ventricular ejection fraction ≤35%, who remain symptomatic despite optimal treatment with an angiotensin-converting enzyme inhibitor, a beta-blocker, and a mineralocorticoid receptor antagonist) will be evaluated before and after 3 months of treatment (nocturnal ventilatory polygraphy, echocardiography, laboratory testing, and quality-of-life and SDB questionnaires). The primary outcome is the change in the Apnoea-Hypopnoea Index, before and after 3 months of treatment. One hundred twenty patients are required to detect a significant 20% improvement of the Apnoea-Hypopnoea Index with a power of 90% at an alpha risk of 5%. Conclusions In the context of the SERVE-HF study, physicians are waiting for new trials and alternative therapies. We sought to assess in the ENTRESTO-SAS trial whether sacubitril-valsartan could improve the outcome of SDB in CHF patients.

Introduction Les signes d’insuffisance cardiaque droite sont frequents dans l’evolution de la bronchopneumopathie chronique obstructive (BPCO) avec emphyseme sans que les mecanismes en cause soit clairement precises. Notre hypothese de travail est que l’emphyseme en majorant la pression intrathoracique provoque une dysfonction diastolique cardiaque droite a l’exercice en limitant l’expansion ventriculaire. Ainsi, une reduction d’emphyseme pourrait ameliorer la fonction diastolique ventriculaire droite. Methodes Lors du screening des patients BPCO avec emphyseme severe adresses pour une reduction endoscopique d’emphyseme, une evaluation hemodynamique invasive classique et avec un catheter a conductance permettant d’obtenir des boucles Pression/Volume au repos, a l’exercice et durant un test de lever de jambe, etait realise en cas de suspicion d’hypertension pulmonaire. Cette exploration etait repetee apres reduction d’emphyseme. La precharge, la fonction diastolique, la contractibilite, la fonction systolique, la postcharge et le couplage ventriculo-arteriel etaient ainsi enregistrees. Le critere de jugement principal est la compliance ventriculaire apres reduction d’emphyseme qui se traduit par une diminution de la pente relation pression volume telediastolique. Nous ne presentons ici que des donnees preliminaires. Resultats Nous avons pu obtenir la caracterisation hemodynamique de cinq patients dont trois ont eu une evaluation avant et apres reduction d’emphyseme. Concernant notre critere de jugement principal nos resultats preliminaires montrent une diminution de la pente relation pression volume telediastolique de respectivement 0,85 % et 0,95 % chez les deux patients ayant eu une reduction d’emphyseme versus une augmentation de 0,25 % chez le patient controle. Nos resultats secondaires montrent qu’apres reduction d’emphyseme on observe une augmentation de l’index cardiaque a l’effort rapporte a la valeur de repos (+ 55,4 % en post reduction versus + 3,4 % en pre reduction), du volume telediastolique (+ 28,5 % en post reduction versus − 2,3 % en pre reduction) tout en annulant l’augmentation de pression telediastolique a l’effort. Nous n’observons pas d’amelioration de la fonction systolique ni du couplage ventriculo-arteriel. Conclusion Ces premieres donnees permettent d’evaluer grâce a la technique de reference l’hemodynamique des patients BPCO avec emphyseme severe. Nos Resultats preliminaires vont dans le sens d’une amelioration de la fonction diastolique cardiaque droite par augmentation de compliance apres reduction d’emphyseme.

International audience; Few- and single-layer MoS2 host substantial densities of defects. They are thought to influence the doping level, the crystal structure, and the binding of electron-hole pairs. We disentangle the concomitant spectroscopic expression of all three effects, and identify to which extent they are intrinsic to the material or extrinsic to it, \textit{i.e.} related to its local environment. We do so by using different sources of MoS2 --- a natural one and one prepared at high pressure and high temperature --- and different substrates bringing varying amounts of charged impurities, and by separating the contributions of internal strain and doping in Raman spectra. Photoluminescence unveils various optically-active excitonic complexes. We discover a defect-bound state having a low binding energy of 20 meV, that does not appear sensitive to strain and doping, unlike charged excitons. Conversely, the defect does not significantly dope or strain MoS2. Scanning tunneling microscopy and density functional theory simulations point to substitutional atoms, presumably individual nitrogen atoms at the sulfur site. Our work shows the way to a systematic understanding of the effect of external and internal fields on the optical properties of two-dimensional materials.

Backgrounds As a consequence of the increased mortality observed in the SERVE-HF study, many questions concerning the safety and rational use of ASV in other indications emerged. The aim of this study was to describe the clinical characteristics of ASV-treated patients in real-life conditions. Methods The OTRLASV-study is a prospective, 5-centre study including patients who underwent ASV-treatment for at least 1 year. Patients were consecutively included in the study during the annual visit imposed for ASV-reimbursement renewal. Results 177/214 patients were analysed (87.57% male) with a median (IQ25–75) age of 71 (65–77) years, an ASV-treatment duration of 2.88 (1.76–4.96) years, an ASV-usage of 6.52 (5.13–7.65) hours/day, and 54.8% were previously treated via continuous positive airway pressure (CPAP). The median Epworth Scale Score decreased from 10 (6–13.5) to 6 (3–9) (p p 45% in 92.7% of patients. Associated comorbidities/etiologies were cardiac in nature for 75.7% of patients (neurological for 12.4%, renal for 4.5%, opioid-treatment for 3.4%). 9.6% had idiopathic central-sleep-apnea. 6.2% of the patients were hospitalized the year preceding the study for cardiological reasons. In the 6 months preceding inclusion, night monitoring (i.e. polygraphy or oximetry during ASV usage) was performed in 34.4% of patients, 25.9% of whom required a subsequent setting change. According to multivariable, logistic regression, the variables that were independently associated with poor adherence (ASV-usage ≤4 h in duration) were TECSA group versus CSA group (p = 0.010), a higher Epworth score (p = 0.019) and lack of a night monitoring in the last 6 months (p Conclusions In real-life conditions, ASV-treatment is often associated with high cardiac comorbidities and high compliance. Future research should assess how regular night monitoring may optimize devices settings and patient management. Trial registration The OTRLASV study is registered on ClinicalTrials.gov (Identifier: NCT02429986) on 1 April 2015.

International audience; Embodied cognition studies have shown motor resonance during action language processing, indicating that linguistic representations are at least partially multimodal. However, constraints of this activation linked to linguistic and extra-linguistic context, function and timing have not yet been fully explored. Importantly, embodied cognition binds social and physical contexts to cognition, suggesting that more ecologically valid contexts will yield more valid measures of cognitive processing. Herein, we measured cortical motor activation during language processing in a fully immersive Cave automatic virtual environment (CAVE). EEG was recorded while participants engaged in a Go/No-Go task. They heard action verbs and, for Go trials, performed a corresponding action on a virtual object. ERSP (event-related spectral perturbation) was calculated during verb processing, corresponding to the pattern of power suppression (event-related desynchronization-ERD) and enhancement (event-related synchronization-ERS) relative to the reference interval. Significant ERD emerged during verb processing in both the µ (8-13 Hz) and beta band (20-30 Hz) for both Go and No-Go trials. µ ERD emerged in the 400-500 msec time window, associated with lexical-semantic processing. Greater µ ERD emerged for Go compared to No-Go trials. The present results provide compelling evidence in a naturalistic setting of how motor and linguistic processes interact.