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On September 26th 2019, a major fire occurred in the Lubrizol factory located near the Seine estuary, in Rouen-France. Juvenile flounders were captured in the Canche estuary (a reference system) and caged one month in the Canche and in the Seine downstream the accident site. No significant increases of PAHs, PCBs and PFAS was detected in Seine vs Canche sediments after the accident, but a significant increase of dioxins and furans was observed in water and sewage sludge in the Rouen wastewater treatment plant. The proteomics approach highlighted a dysregulation of proteins associated with cholesterol synthesis and lipid metabolism, in fish caged in the Seine. The overall results suggested that the fire produced air borne dioxins and furans that got deposited on soil and subsequently entered in the Seine estuarine waters via runoff; thus contaminating fish preys and caged flounders in the Seine estuary., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Jean Laroche reports financial support was provided by Public Interest Group Seine-Aval., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

This study aimed to develop a multidisciplinary approach to assess the ecological status of six moderate-sized French estuaries. For each estuary, we gathered geographical information, hydrobiological data, chemistry of pollutants and fish biology, including integration of proteomics and transcriptomics data. This integrative study covered the entire hydrological system studied, from the watershed to the estuary, and considered all the anthropogenic factors that can impact this environment. To reach this goal, European flounder (Platichthys flesus) were collected from six estuaries in September, which ensures a minimum residence time of five months within an estuary. Geographical metrics are used to characterize land use in each watershed. The concentrations of nitrite, nitrate, organic pollutants, and trace elements were measured in water, sediments and biota. All of these environmental parameters allowed to set up a typology of estuaries. Classical fish biomarkers, coupled with molecular data from transcriptomics and shotgun proteomics, highlighted the flounder's responses to stressors in its environment. We analysed the protein abundances and gene expression levels in the liver of fish from the different estuaries. We showed clear positive deregulation of proteins associated with xenobiotic detoxification in a system characterized by a large population density and industrial activity, as well as in a predominantly agricultural catchment area (mostly cultures of vegetables and pig breeding) mainly impacted by pesticides. Fish from the latter estuary also displayed strong deregulation of the urea cycle, most probably related to high nitrogen load. Proteomic and transcriptomic data also revealed a deregulation of proteins and genes related to the response to hypoxia, and a probable endocrine disruption in some estuaries. Coupling these data allowed the precise identification of the main stressors interacting within each hydrosystem., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Jean Laroche reports financial support was provided by Office français de la biodiversité (OFB)., (Copyright © 2023 Elsevier B.V. All rights reserved.)

The OPTIMEV (OPTimisation de l'Interrogatoire dans l'évaluation du risque throMbo-Embolique Veineux) study has provided some important and innovative information for the management of lower extremity isolated distal deep vein thrombosis (distal DVT). Indeed, if distal deep-vein thrombosis (DVT) therapeutic management is nowadays still debated, before the OPTIMEV study, the clinical relevance of these DVT itself was questioned. Via the publication of 6 articles, between 2009 and 2022, assessing risk factors, therapeutic management, and outcomes of 933 patients with distal DVT we were able to demonstrate that: - When distal deep veins are systematically screened for suspicion of DVT, distal DVT are the most frequent clinical presentation of the venous thromboembolic disease (VTE). This is also true in case of combined oral contraceptive related VTE. - Distal DVT share the same risk factors as proximal DVT and constitute two different clinical expressions of the same disease: the VTE disease. However, the weight of these risk factors differs: distal DVT are more often associated with transient risk factors whereas proximal DVT are more associated with permanent risk factors. - Deep calf vein and muscular DVT share the same risk factors, short and long-term prognoses. - In patients without history of cancer, risk of unknown cancer is similar in patients with a first distal or proximal DVT. - After 3years and once anticoagulation has been stopped, distal DVT recur twice less as proximal DVT and mainly as distal DVT; However, in cancer patients, prognosis of distal and proximal DVT appear similar in terms of death and VTE recurrence., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

This study investigates the effect of fish density and exposure duration on trace metal elements (TME) bioaccumulation and several biomarkers response. Juvenile flounders were caged at low, medium and high densities and exposed during 15 or 30 days in the Seine estuary. The concentrations of the TME measured in the muscle of the caged fish were all in agreement with their bioavailability percentage in the sediments. Higher concentrations of TME were found in flounders' muscle exposed for 15 days compared with those caged for 30 days. For the same exposure time, the density of fish had no effect on the accumulation of the TME in the flounders' muscle. Biomarkers responses varied according to density and duration of exposure. Special care should be taken in their interpretation. We underline that for an optimal assessment of TME pollution in the field, 15 days with low densities of fish per cage are sufficient., Competing Interests: Declaration of competing interest The authors declare no competing financial interests., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Objectives: To assess: (1) lower limb primary lymphedema or post-thrombotic syndrome patient's pathway in terms of health care professional use and (2) if aetiology of edema has an impact on this pathway., Methods: Ancillary survey of the transversal prospective CHROEDEM pilot study. Forty patients with either lower limb primary lymphedema or post-thrombotic syndrome were invited to participate., Results: Seventy-five percent of primary lymphedema patients and 50% of post-thrombotic patients benefited from a multidisciplinary management (P=0.10) including the general practitioner, the vascular medicine physician and either a physiotherapist (particularly in case of primary lymphedema), a registered nurse (particularly in case of post-thrombotic syndrome). Main ambulatory health care professionals' correspondent of hospital-based vascular medicine physicians were general practitioners (80%) in post-thrombotic patients, and general practitioners (60%) and physiotherapists (45%) in primary lymphedema patients. Pharmacists were also involved in patient education., Conclusion: Management of primary lymphedema and post-thrombotic related chronic edema is usually multidisciplinary. General practitioners and vascular medicine physicians are the cornerstones of this management, that also involves the physiotherapist in case of primary lymphedema and in a lesser extent the registered nurse and the pharmacist. This suggests that these five healthcare professional should play a key role in case of development of standardized patient pathways for primary lymphedema and post-thrombotic syndrome., (Copyright © 2020. Published by Elsevier Masson SAS.)

Estuaries are important areas highly vulnerable to anthropogenic pollutions. Therefore, the assessment of estuarine water quality is a major ecological issue. In this study, we sampled juveniles of the European flounder in the "pristine" Canche estuary, and caged them in Canche and in two polluted sites of the Seine estuary, Rouen and Fosse Nord. After one month, the metal and organic pollutants in these sites were assessed, and we evaluated several phenotypic indicators (condition index, RNA/DNA ratios and genotoxicity), and extracted the proteins in fish livers for analysis using a shotgun proteomics approach. The results showed strong modifications in the fish caged in both sites of the Seine estuary, as compared to those caged in Canche. In particular, many proteins involved in phase I and phase II detoxification reactions were accumulated in the liver of fish caged in the site showing the highest pollution, Rouen. In addition, we observed a general disruption of metabolism, in particular an increase in lipid synthesis and carbohydrate degradation in Rouen, and a decrease in the abundance of proteins associated to translational activity in Fosse Nord. At both sites, several stress proteins were decreased. The proteomic impact of the encagement by itself was also evaluated, by comparing the liver proteome of fish caged in Canche to that of fish stayed in natura during the same time. The results showed proteomic signatures of exposure to stressful conditions (particularly heat stress), most probably related to the micro-habitat in which the cages were placed. In conclusion, the caging technique is of great interest for ecotoxicological assessment of estuarine waters, but should consider that the results are representative of the micro-habitat around the cages, which does not necessarily represent the overall heterogeneity of the estuarine environment., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Introduction: Chronic inflammatory diseases such as systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA), are accompanied by high cardiovascular morbidity and mortality secondary to accelerated and premature atherosclerosis. Atherosclerosis is correlated with chronic systemic inflammation independently of the factors for cardiovascular risk. Vasculitis of large arteries such as Takayasu's disease, are characterized both by chronic systemic inflammation and local parietal vascular inflammation., Methods: We prospectively analyzed in a case-control study, a group of 64 carriers of Takayasu's arteritis patients with a mean age of 41 years [±11.94], a group of 50 RA female patients aged 45 years [±10.27], and a control group with an average age of 44 years [±12.63]. We recorded classic cardiovascular risk factors and used the Framingham equation to calculate the risk. We measured the intima-media thickness (IMT) in the carotids and noted the presence of carotid, aortic and femoral atheroma., Results: The mean calculated cardiovascular risk was 3.5 % in the Takayasu's group. It was 4.4 % in the RA group, and 4.5 % in controls with no significant difference between the three groups (P=0.153). Subclinical atherosclerosis defined by IMT> 0.70mm and/or the presence of atheroma plaque was found in 87 % of Takayasu's patients versus 76 % of RA patients, (P=0.088) and 48 % of controls (P<0.001). Most atherosclerotic plaques were found in the Takayasu group. Compared to the control group the carotid intima-media thickness was significantly higher in the Takayasu group. The average IMT in the Takayasu group was 0.91mm [±0.368], 0.76mm [±0.151] for the PR group, and 0.71mm [±0.141] for controls., Discussion: Atherosclerosis observed in Takayasu's disease was accelerated and premature, occurring in young patients with a low overall cardiovascular risk. Recent data support the central role of inflammation in all stages of atherogenesis from endothelial dysfunction to plaque rupture. Systemic inflammation associated with local parietal inflammation observed in Takayasu's arteritis, appears to be responsible for accelerated and premature atherosclerosis. The results of our study and the literature review favor an active strategy for cardiovascular prevention in Takayasu's disease., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Introduction: The prevalence of abdominal aortic aneurysm (AAA) in the general population in our country is not known, our aim was to evaluate it in patients over 60 years of age, to specify the risk factors and to evaluate the extension of aneurysmal disease and multisite subclinical atherosclerosis., Methods: Descriptive, transversal, study collecting the data of a systematic ultrasound screening of sub-renal AAA in subjects receiving care in two Algerian hospital structures. Epidemiological data, AAA risk factors, cardiovascular disease risk factors (CVD RF) and the personal history (cardiovascular diseases, chronic obstructive pulmonary disease) and family history of AAA were collected during the screening. An abdominal echography was performed in all patients. A biological and morphological assessment was carried out for AAA cases detected. Multivariate logistic regression analysis was used to study the factors associated with AAA., Results: Systematic screening for 600 patients revealed an overall AAA prevalence of 2.2% (n=13). In multivariate analysis a positive association with AAA was observed with active smoking, its duration in years and its intensity in year-packages; with hypertension, dyslipidemia and a history of cardiovascular events. While a negative association was observed with a smoking cessation of more than 20 years, type 2 diabetes and android obesity. The study of detected AAA cases found five cases of aneurysm isolated from the primary iliac artery but no popliteal and/or femoral aneurysm. The carotids were atheromatous in more than 80% of cases and the arteries of the lower limbs in more than one-third of cases., Conclusion: The prevalence of AAA in our population (2.2%) corresponds to the prevalence reported recently in Europe, but it would have been higher if the screening had targeted males and smokers. The factors associated with AAA in our patients are similar to those described in the literature., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

In 2008, we decided to enter the era of direct oral anticoagulants (DOACS). Was that the right decision to make? The answer will depend on how well we meet the conditions of proper use. This means avoiding underdosing and overdosing as well as understanding how DOACS were validated so that our prescriptions fulfill their role in the management of thrombotic disease., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Introduction: Despite the increasing utilization of direct oral anticoagulant (DOAC) prescriptions, vitamin K antagonists (VKAs) remain the treatment of choice for treating and preventing thromboembolic events. The morbidity and mortality of VKAs are partly due to the difficulty of keeping the patient within the therapeutic range. For patients treated by VKA, time in therapeutic range (TTR) is a quality parameter of treatment, widely used in clinical trials but rarely by prescribers. It is well established that its use correlates with the risk of hemorrhage, thrombosis or mortality. We studied this parameter in a cohort of patients to evaluate the quality of their therapeutic follow-up and tried to identify risk factors for low TTR., Methods: The study was made in collaboration with LaboSud Oc Biologie for a duration of 4 months. It included 3387 patients representing 2,4029 INR. We calculated the patients' TTR. The laboratory transmitted to us the sex and age of each patient and the VKA molecule used, the therapeutic range and the specialty of the prescriber. We then analyzed the odds ratio associated with these different factors., Results: The mean TTR was 68%, close to the TTR recommended by scientific societies. Patient's sex was the only statistically correlated factor, with a worse equilibrium in females taking VKAs (OR=1.22, 95% CI: 1.06-1.39, P=0.00552). Many factors usually correlated with poor equilibrium under VKA have not been studied due to lack of information., Conclusion: Given the context of economic restriction and the TTR of our cohort close to the recommended 70%, there would be no benefit in terms of safety to prefer DOAC for the patients involved in this study. Regular monitoring of the individual patient's as well as the cohort's TTR should optimize the management of patients receiving VKAs., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

The quality standards of the French Society of Vascular Medicine for the ultrasonographic assessment of vascular malformations are based on the two following requirements: (1) technical know-how: mastering the use of ultrasound devices and the method of examination; (2) medical know-how: ability to adapt the methods and scope of the examination to its clinical indication and purpose, and to rationally analyze and interpret its results., Aims of the Quality Standards: To describe an optimal method of examination in relation to the clinical question and hypothesis. To homogenize practice, methods, glossary, and reporting. To provide good practice reference points, and promote a quality process., Items of the Quality Standards: The 3 levels of examination; their clinical indications and goals. The reference standard examination (level 2), its variants according to clinical needs. The minimal content of the examination report; the letter to the referring physician (synthesis, conclusion and proposal for further investigation and/or therapeutic management). Commented glossary (anatomy, hemodynamics, semiology). Technical bases. Setting and use of ultrasound devices. Here, we discuss ultrasonography methods of using of ultrasonography for the assessment of peripheral vascular malformations and tumors (limbs, face, trunk)., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

A two months common garden experiment was carried out to explore the potential differences of energy metabolism in northern core (France, 50°N and 47°N) vs southern peripheral (Portugal, 41°N) populations of European flounder Platichthys flesus, submitted to cold condition (CC: water temperature = 10 °C) and to warm and hypoxic condition (WHC: water temperature = 22 °C, and moderate hypoxia with O 2 saturation = 40% during the last 6 days). Convergent growth rates (in length) were observed in the different populations and conditions, when the southern peripheral population of Portugal did not grow under cold conditions. A general reduction in liver lipid storage was observed in all populations subjected to WHC when compared to CC, whereas muscle lipid storage was unaffected. The thermal and hypoxia treatment induced changes in muscle phospholipids (PL) ratios: phosphatidylserine/PL, phosphatidylinositol/PL, between northern and southern populations. Fish from northern estuaries displayed marked anaerobiosis in WHC (increased liver LDH activity) vs marked aerobiosis under CC (higher muscle CS and CCO activities). Contrariwise, fish from the southern estuary displayed equilibrium between anaerobiosis and aerobiosis activities in WHC. Flounders from the southern population exhibited generally lower G6PDH activity (proxy for anabolism and for defense against oxidative damage), tissue-specific anaerobiosis response (muscle LDH activity) and lower CS and CCO muscle activities (aerobiosis markers) when compared to northern populations. Globally, these inter-population differences in bioenergetics suggest that southern peripheral vs northern core populations have developed differential capacity to cope with interacting stressors and that much of this variation is more likely due to local adaptation., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Ultrasound-guided thrombin injection has been shown to be a safe and effective treatment for iatrogenic post-catheterization pseudoaneurysms, but still is underused in France. We report our single-center experience and propose a technical guideline for ultrasound-guided thrombin injection. Ultrasound-guided thrombin injection should be considered to be the first-line treatment of iatrogenic pseudoaneurysms., (Copyright © 2017. Published by Elsevier Masson SAS.)

In the context of global change, ectotherms are increasingly impacted by abiotic perturbations. Along the distribution area of a species, the populations at low latitudes are particularly exposed to temperature increase and hypoxic events. In this study, we have compared the proteomic responses in the liver of European flounder populations, by using 2-D electrophoresis. One southern peripheral population from Portugal vs two northern core populations from France, were reared in a common garden experiment. Most of the proteomic differences were observed between the two experimental conditions, a cold vs a warm and hypoxic conditions. Consistent differentiations between populations were observed in accumulation of proteins involved in the bioenergetics- and methionine-metabolisms, fatty acids transport, and amino-acid catabolism. The specific regulation of crucial enzymes like ATP-synthase and G6PDH, in the liver of the southern population, could be related to a possible local adaptation. This southern peripheral population is spatially distant from northern core populations and has experienced dissimilar ecological conditions; thus it may contain genotypes that confer resilience to climate changes., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Juvenile flounders (Platichthys flesus), collected in two estuaries with similar temperature regimes (the heavily polluted Seine and the moderately contaminated Vilaine), were submitted to a common garden experiment. After an acclimation period, both populations were challenged by a thermal stress (9-24°C for 15days, then maintenance at 24°C for 19days). The condition factor of the Vilaine fish increased in both conditions, while it decreased for the heated Seine flounders after 34days. The expression of genes related to the energetic metabolism was measured in the liver. The expression levels for ATP-F0 and COII were significantly reduced for heated vs. standard fish from both estuaries, while a decrease of the 12S expression was detected only in heated vs. standard fish from the Seine estuary. Thus, it is suggested that highly contaminated fish from Seine could display a lower tolerance to thermal stress, compared to moderately contaminated fish from Vilaine., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Platichthys flesus is often used as a sentinel species to monitor the estuarine water quality. In this study, we carried out an experimental contamination of fish using a PAHs/PCBs mixture, which was designed to mimic the concentrations found in the Seine estuary (C1) and 10 times these concentrations (C2). We used a proteomic approach to understand the molecular mechanisms implied in the response of P. flesus to these xenobiotics. We showed that 54 proteins were differentially accumulated in one or several conditions, which 34 displayed accumulation factors higher than two. 18 of these proteins were identified by MALDI TOF-TOF mass spectrometry. The results indicated the deregulation of oxidative stress- and glutathione metabolism-(GST, GPx) proteins as well as of several proteins belonging to the betaine demethylation pathway and the methionine cycle (BHMT, SHMT, SAHH), suggesting a role for these different pathways in the P. flesus response to chemical contamination., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

A multi-biomarker approach was developed to evaluate responses of European flounder (Platichthys flesus) in three contrasted estuaries over the English Channel: the Canche (pristine site), Tamar (heavy metals and PAHs contamination) and Seine (heavily pollution with a complex cocktail of contaminants). The condition factor and several biomarkers of the immune system, antioxidant enzymes, energetic metabolism and detoxification processes were investigated in young-of-the-year (0+) and one-year-old (1+) flounder. Results underlined the difference between the pristine site and the Seine estuary which showed a lower condition factor, a modulation of the immune system, a higher Cytochrome C oxidase activity, and an up-regulation of BHMT expression. The moderate biomarker responses in the Tamar fish could be linked to the specific contamination context of this estuary. Flounder life history traits were analyzed by otolith microchemistry, in order to depict how the fish use their habitat and thus respond to chemical stress in estuaries., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Venous thromboembolism disease (VTE) is rare in children (5.3 of 10,000 hospitalized children). However, morbidity and mortality are high, especially when the child is already suffering from severe sepsis. We report an analytical study of 24 cases of deep venous thrombosis occurring in children during infection, recorded at the Montpellier University Hospital between 1999 and 2009. Many parameters were studied in each population (age, sex, familial and personal history of thrombosis, history of thrombophilia, the presence of a venous catheter, a causative organism, time to onset of thrombus, topography of lesions, acquired abnormalities of hemostasis, and thrombosis prophylaxis). The children were aged from 1 day of life to 16 years. Thromboses occurred in two clinical contexts: "contact" thrombosis (which appeared near the infection) and disseminated thrombosis. This is an early complication because in most of the cases, it appeared in the first 10 days of sepsis. Infection and coagulation appear to be closely related and the states of latent or decompensated disseminated intravascular coagulation are common. Nevertheless, it is not possible to predict the occurence of a thrombotic event. The presence of risk factors (venous catheters, acquired thrombophilia, or constitutional thrombophilia) may increase the thrombogenic potential of the infection. VTE should always be suspected and sought in case of an unfavorable clinical course, and routine prophylaxis of thrombosis during sepsis should be discussed., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Deep vein thrombosis (DVT) is a common disease. However, unlike that of varicose veins, which have been depicted since antiquity in art and literature, its description was more recent in the history of medicine. The first well-documented case of DVT was reported during the Middle Ages: in 1271, Raoul developed a unilateral edema in the ankle, which then extended to the leg. The number of reported DVT cases steadily increased thereafter, particularly in pregnant and postpartum women. During the first half of the 20th century, well before the discovery of anticoagulants, many therapeutic approaches were used, and arose from the pathologic hypotheses that prevailed at their time. Despite the development of anticoagulants, and the fact that they were thought to dramatically decrease DVT mortality, numerous complementary treatments have also been developed during the last 50 years: they include vena cava clips and surgical thrombectomy, and are intended to decrease mortality or to prevent late complications. Most of these treatments have now been abandoned, or even forgotten. In this review, we recall also the discovery and the use of vitamin K antagonists and heparin, which have constituted the mainstay of treatment for decades. We also bring some perspective to historical aspects of this disease and its treatment, notably regarding elastic compression and early mobilization, but also abandoned and complementary treatments. In these times of change regarding DVT treatment, mainly marked by the arrival of new oral anticoagulants, efforts of physicians through the ages to treat this common disease provide a beautiful example of the history of knowledge., (© 2013 International Society on Thrombosis and Haemostasis.)

Isolated distal deep-vein thromboses (DVT) are infra-popliteal DVT without involvement of proximal veins or pulmonary embolism (PE). They can affect deep calf (tibial anterior, tibial posterior, or peroneal) or muscular (gastrocnemius or soleal) veins. They represent half of all lower limbs DVT. Proximal and distal DVTs differ in terms of risk factor profile, proximal DVT being more frequently associated with chronic risk factors and distal DVT with transient ones. Their natural history (rate of spontaneous proximal extension) is debated leading to uncertainties on the need to diagnose and treat them with anticoagulant drugs. In the long term, the risk of venous thromboembolic recurrence is lower than that of proximal DVT and their absolute risk of post-thrombotic syndrome is unknown. French national guidelines suggest treating with anticoagulants for 6 weeks a first episode of isolated distal DVT provoked by a transient risk factor and treating for at least 3 months unprovoked or recurrent or active cancer-related distal DVT. The use of compression stockings use is suggested in case of deep calf vein thrombosis. Ongoing therapeutic trials should provide important data necessary to establish an evidence-based mode of care, especially about the need to treat distal DVT at low risk of extension with anticoagulants., (Copyright © 2012 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.)

Objectives: To assess the efficiency of a systematically planned compression ultrasonography (SP-CUS) to detect venous thrombotic complications (VTCs) in patients with symptomatic isolated superficial vein thrombosis (SVT)., Design: Post hoc analysis of a prospective, multicentre, cohort study (POST)., Patients: As many as 537 patients with CUS-confirmed isolated SVT undergoing an SP-CUS 8-15 days after the initial CUS., Outcomes: Asymptomatic VTC (extension or recurrence of SVT, deep-vein thrombosis (DVT) of the lower limbs) diagnosed by the SP-CUS and symptomatic thromboembolic complications (VTC and pulmonary embolism (PE)) up to 3 months., Results: VTC was suspected before or on the day of the SP-CUS in 18 patients (3.0%). Among the 519 asymptomatic patients (97%) undergoing SP-CUS, this revealed asymptomatic VTC in 12 patients (2.3%; 4 DVT, 4 SVT recurrences, 4 SVT extensions), none of whom subsequently experienced symptomatic thromboembolic events up to 3 months. Among the 507 patients with a normal SP-CUS, 29 (5.7%) presented symptomatic thromboembolic events during follow-up: 2 PE, 7 DVT, 9 SVT recurrences and 11 SVT extensions., Conclusions: In this study, the SP-CUS detected a few asymptomatic VTC, but failed to identify patients at risk of thromboembolic events during follow-up. Use of an SP-CUS was therefore neither efficient nor cost effective., (Copyright © 2011 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.)

Objectives: This study was designed to assess the accuracy and reliability of a new, portable, fully automated photoplethysmography (PPG) device for toe blood pressure (TBP) measurement., Design: Within-subject comparison with conventional laser Doppler (LD) measurement., Materials and Methods: Four TBP measurements were performed on both lower limbs, alternatively with LD and PPG in 200 patients recruited at the Nîmes University Hospital. Reproducibility was assessed by the intraclass correlation coefficient (ICC). The concordance between the two methods was evaluated by Lin's concordance correlation coefficient (CCC), in the whole population as well as in comorbidity subgroups. A potential bias was investigated with the Bland and Altman method., Results: The ICC was 0.887 (95% confidence interval (CI) 0.852-0.913) and 0.893 (0.860-0.918) on the right side (n = 193), 0.905 (0.875-0.928) and 0.898 (0.866-0.922) on the left side (n = 188) for PPG and LD measurements, respectively. The CCC was 0.913 (0.885-0.934) on the right side and 0.915 (0.888-0.937) on the left side, and remained >0.8 regardless of co-morbidities., Conclusions: This new, fully automatic, photoplethysmographic device yielded reliable TBP measurements and showed good agreement with the reference LD system over a wide range of values., (Copyright © 2010 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.)

In this study, new DNA markers were explored for the flounder Platichthys flesus. cDNA and genomic sequences of the genes encoding the glyceraldehyde-3-phosphate-deshydrogenase (GAPDH), the cytosolic creatine kinase (CK), the prostaglandin D synthase (PGDS) and the betaine homocysteine methyltransferase (BHMT) were characterized. The tumour suppressor p53 gene structure was already described. A PCR-SSCP (Single Strand Conformation Polymorphism) analysis was finally conducted to study the genetic polymorphism of different populations of flounders collected along the French Atlantic coast. Four highly contaminated French estuaries (Seine, Vilaine, Loire and Gironde) were sampled and compared to a reference estuary (Ster) to explore possible selective effect of the environment on specific allelic frequencies. Our results showed that two loci p53 and PGDS, could be potential markers of chemical stress: p53A allele frequency increased in contaminated systems compared to the reference system. In the Vilaine estuary, PGDS polymorphism could be related to pesticide stress.

Necrosis of the penis glans is commonly described after circumcision or strangulation. We report the case of a patient, opioid abuser, who presented an isolated glans necrosis after an injection of buprenorphin. The buprenorphin (Subutex) is a sublingual partial mu-opioid agonist used for the treatment of heroin dependance. Its intravenous or subcutaneous abuse is associated with local infection. The patient require a surgical intervention. After the failure of a mucosal graft, a soft skin graft was done., (Copyright 2009 Elsevier Masson SAS. All rights reserved.)

Purpose: Compression ultrasonography is the reference test for the diagnosis of distal deep venous thrombosis of lower limbs. However, the ways it is performed and the related treatments are very heterogeneous between various countries., Current Knowledge and Key Points: In USA, Canada and Netherlands, compression ultrasonography is restricted to proximal limbs considering that this test is inadequate to explore the distal veins. The strategy consisting of a clinical approach, including the clinical probability and/or a follow-up ultrasonography has demonstrated its efficacy and safety (extension rate to proximal veins of 1.2% at three months and absence of fatal pulmonary embolism). In France, Italy and Spain, lower limb ultrasonography testing includes the examination of calf veins in a so called "complete testing". This procedure leads to the diagnosis of a large number of distal deep venous thrombosis (45-56%) among the 14 to 36% of deep vein thrombosis diagnosed in the setting of clinical suspicion. Recent diagnosis strategy studies have shown that both strategies are effective, but the complete ultrasound strategy doubles the number of anticoagulation treatments. Justification of inappropriate anticoagulation is not evident owing to the relatively low risk of proximal venous-thrombosis extension, the rate of severe hemorrhagic events at three months and the cost excess., Future Prospects and Projects: Prospective comparative clinical trials are necessary in distal-venous thrombosis and ongoing Cactus study addresses this therapeutic dilemma.

In Eastern Québec, two major lipoprotein lipase (LPL) gene mutations, P207L and G188E, lead to complete LPL deficiency in homozygote subjects and contribute to elevated predisposition to hypertriglyceridemia in heterozygotes. First, we determined the allele frequencies of LPL (D9N, G188E, P207L, D250N, N291S, and S447X), APOE (C112R and C158R), PPARalpha (L162V), and PPARgamma2 (P12A) single nucleotide polymorphisms (SNPs) in a random-based cohort of the metropolitan Québec city area. Second, we compared the LPL X447 allele frequencies observed in the random cohort and in a cohort of LPL P207L deficient patients. In the random cohort, the LPL N9 rare allele exhibited a higher prevalence than previously expected (p=0.0001). The LPL X447 allele frequency was lower in the patient cohort (Freq: 4.4%) than in the random cohort (Freq: 11.2%) (p=0.0001). These results reveal the importance of genetic screening for LPL gene mutations D9N and S447X in a population at risk to develop hypertriglyceridemia.

In the absence of thromboprophylaxis, coronary artery bypass graft surgery (CABG), intrathoracic surgery (thoracotomy or video-assisted thoracoscopy), abdominal aortic surgery and infrainguinal vascular surgery are high-risk surgeries for the development of venous thromboembolic events (VTE). The incidence of VTE following surgery of the intrathoracic aorta, carotid endarterectomy or mediastinoscopy is unknown. Data from the litterature are lacking to draw evidence-based recommandations for venous thromboprophylaxis after these three types of surgeries, and the following guidelines are but experts'opinions (Grade D recommendations). Thromboprophylaxis is recommended after CABG (Grade D), with either subcutaneous (SC) low molecular weight heparin (LMWH) or SC or intravenous (i.v.) unfractioned heparin (UH) (PTT target = 1.1-1.5 time control value) (both grade D). This may be combined with the use of intermittent pneumatic compression device (Grade B). After valve surgery. The anticoagulation recommended to prevent valve thrombosis is sufficient in order to prevent VTE. We recommend thromboprophylaxis with either LMWH or low dose UH to prevent VTE after aortic or lower limbs infrainguinal vascular surgery (both grade B and D). Vitamine K antagonists (VKA) are not recommended in this indication (Grade D). We recommend thromprophylaxis following intrathoracic surgery via thoracotomy or videoassisted thoracoscopy (grade C). Either subcutaneous LMWH or subcutaneous or i.v. low dose UH may be used (Grade C). Efficacy of intermittent pneumatic compression device has been demonstrated in a study (grade C). VKA are not recommended (grade D). No further recommendation regarding the duration of thromboprophylaxis after these three types of surgeries can be made.

New insight has recently been obtained into the molecular mechanisms regulating lymphatic development and function during embryogenesis. VEGF-C and D ligands have been shown to stimulate lymphangiogenesis and their lymphatic-specific receptor VEGFR-3 is linked to the human congenital and hereditary lymphedema in humans. Above all, new focus on lymphatic endothelial cells gives opportunities for developing innovative therapies for lymphedema and cancer metastasis.

Continuous wave Doppler, and B-Mode ultrasound allow the diagnosis of deep venous thrombosis with a 96% sensitivity, and a 98% specificity versus venography (1). Therefore, these methods can be extensively used for the detection of deep venous thrombosis, following a new diagnostic algorithm: X ray venography is used only for the assessment of topographic extent of iliac and caval thrombosis, and when non invasive methods give equivocal results. As a result, the number of X ray venographies significantly decreased since 1984 (7) in Nîmes University Hospital. About 75% of patients with a deep venous thrombosis (diagnosed by non invasive methods) were treated without necessity of X ray venography.

Brilliance variations in selected areas of echographic display are recorded in real time thanks to photoconductive integrations from the screen. The areas concerned are: 1) gastroduodenal or colonic wall; 2) intraluminal medium in the same portion of the digestive tract. Simultaneously the pneumogram is recorded with these photometric variations in long period of time (1/2 h-2 h). Visceral displacements or medium echographic modulations give us informations about motricity and hydraulic changes. Several components of frequency are shown: pulse, respiratory interactions and several components of parietal contractions; we can notice the concordance between frequency variations obtained with others technics such as electrosplanchnography or manometry. This possibility of atraumatic confrontations with a visual control allows us new perspectives in physiopathological studies concerning hemodynamic, biomechanic interactions between viscera.