Search

Abstract: In this study we synthesized thin films of titanium oxide doped with thulium and/or ytterbium to modify the incident spectrum on the solar cells. This could be achieved either by photoluminescence up-converting devices, or downconverting devices. As down-converter thin films our work deals with thulium and ytterbium-doped titanium dioxide. Thulium and ytterbium will act as sensitizer and emitter, respectively. The rare-earth doped thin films are deposited by aerosol-assisted MOCVD using organo-metallic precursors such as titanium dioxide acetylacetonate, thulium and ytterbium tetramethylheptanedionate solved in different solvents. These films have been deposited on silicon substrates under different deposition conditions (temperature and dopant concentrations for example). Adherent films have been obtained for deposition temperatures ranging from 300°C to 600°C. The deposition rate varies from 0.1 to 1μm/h. The anatase phase is obtained at substrate temperature above 400°C. Further annealing is required to exhibit luminescence and eliminate organic remnants of the precursors. The physicochemical and luminescent properties of the deposited films were analyzed versus the different deposition parameters and annealing conditions. We showed that absorbed light in the near-UV blue range is re-emitted by the ytterbium at 980nm and by a thulium band around 800nm. [Copyright &y& Elsevier]

Vegetables cultivated in kitchen gardens that are strongly contaminated by heavy metals (Pb, Cd) may represent to consumers a means of exposure to these metals. This exposure is more problematic for those families that include a large quantity of home-grown vegetables in their diet. Researchers have shown that the majority of vegetables produced in kitchen gardens in the vicinity of the Metaleurop Nord smelter (Northern France) do not conform to European regulations. This study was carried out in three of these kitchen gardens. The concentrations of Cd and Pb in the topsoils were up to 24 and 3300 mg kg−1 respectively. The method consisted of delineating a surface area of about 50 to 100 m2 for each garden, then removing the contaminated soil and replacing it with a clean one. Seven species of vegetables were cultivated from 2003 to 2005 in the original contaminated soils and the remediated ones. The data showed a clear improvement of the quality of the vegetables cultivated in remediated soils, although 17% of them were still over the European legislative limits for foodstuffs. This suggested that there was a foliar contamination due to contaminated dust fallout coming from the closed smelter site and the adjacent polluted soils. In addition, the measurement of the Cd and Pb concentrations in the dust fallout showed that the substantial rise in metal concentrations in the remediated soil was not only due to atmospheric fallout. These results raise questions about possible technical, economic and sociological problems associated with this kind of remediation. [Copyright &y& Elsevier]

Mixed TiO2—SiO2 thin films were deposited by aerosol atmospheric CVD method by using di-acetoxi di-butoxi silane (DADBS) and Ti tetra-butoxide as precursors. By varying the deposition temperatures between 470 and 600 °C and the ratios between the Si and Ti precursors (Si/Ti) from 2 up to 16, films with different compositions and thicknesses were deposited. The coupled analysis of the results of different characterisation methods was used in order to determine the variation of the composition, the thickness and the density of the films. First EPMA measurements were performed at different acceleration voltages with a Cameca SX50 system. By analysing, with specific software, the evolution of the intensity ratio Ix/Istd versus the voltage, the composition and the mass thickness (product of density by the thickness) were determined. In order to measure independently the density, X-ray reflectometry experiments were performed. By analysing the value of the critical angle and the Kiessig fringes, the density and the thickness of the layers were determined. The refractive index and the thickness of the films were also measured by ellipsometry. By assuming a linear interpolation between the index value of the pure SiO2 and TiO2 films, the film composition was deduced from the refractive index value. XPS measurements were also performed in order to obtain an independent value of the composition. A good agreement between the ways to measure the density is obtained. [Copyright &y& Elsevier]

Résumé: Objectif. – Évaluer par rapport aux recommandations de l’Agence nationale pour le développement et l''évaluation médicale (1996) et de l’Agence française de sécurité sanitaire des produits de santé (2003), la qualité du bilan d’infertilité, la prescription et la surveillance des traitements par citrate de clomifène. Patientes et méthodes. – Étude rétrospective des patientes, âgées de 16 à 50 ans, ayant eu un remboursement de citrate de clomifène entre le 1er avril et le 30 juin 2002. Après réalisation d’un échantillon aléatoire stratifié sur l’âge, les actes et les prescriptions disponibles dans la base de remboursement de l’Assurance Maladie ont été identifiés. Les patientes interrogées par les médecins-conseils ont validé et précisé leur prise en charge. Résultats. – Parmi les 283 femmes incluses, 30 % avaient eu un dosage hormonal de base (FSH, LH, estradiol), 50 % une hystérosalpingographie, 35 % un test de Hühner et 68 % une échographie. 60 % des conjoints avaient eu un spermogramme. 1,5 % des femmes avaient bénéficié de la totalité des examens préconisés avant instauration du traitement. 7 % n''avaient eu aucun examen. Le taux de réalisation de ces examens était comparable chez les patientes avant et après 35 ans. 77 % des traitements ont été instaurés après une attente de conception d’au moins un an. Hormis l’examen clinique, 69 % des femmes avaient eu une surveillance au cours du traitement, autre que clinique. Discussion et conclusion. – La prescription de citrate de clomifène se fait trop souvent sans constat probant d''infertilité et sans bilan étiologique complet. Cette mauvaise utilisation peut être la cause de perte de chances de conception et de complications. [Copyright &y& Elsevier]

Résumé L’immunothérapie des cancers a longtemps représenté une option thérapeutique marginale en cancérologie en dépit de forts arguments documentant le rôle du système immunitaire dans le contrôle de la prolifération des cancers. Les succès récents de l’immunothérapie résultent du fait que l’objectif n’est plus uniquement d’activer le système immunitaire contre les cellules tumorales, mais de tenir compte également du microenvironnement immunosuppresseur induit par la tumeur. Parmi ces mécanismes, les molécules de costimulation inhibitrices (CTLA-4, PD-1, etc.) exprimées par les lymphocytes T dans le stroma des tumeurs pourraient expliquer leur manque d’efficacité à inhiber la croissance tumorale. L’inhibition de l’interaction de ces molécules avec leurs ligands (CD80, PD-L1, etc.) a permis de réactiver ces lymphocytes T anti-tumoraux. Sur le plan clinique, l’administration de l’anticorps anti-CTLA-4 (ipilimumab : Yervoy ® ) a obtenu une autorisation de mise sur le marché pour les patients atteints de mélanomes métastatiques. Les anticorps anti-PD-1 (nivolumab : Opdivo ® , pembrolizumab : Keytruda ® ) ont démontré leur efficacité par comparaison au traitement de référence dans les mélanomes métastatiques, les cancers du poumon avancés et les cancers du rein métastatiques. Dans des essais de phase I et II, une efficacité de ces traitements a également été observée dans d’autres tumeurs (maladie de Hodgkin, cancers de la tête et du cou, cancer de la vessie, cancer de l’estomac, etc.). Ces traitements ont été associés à l’apparition d’effets secondaires de type auto-immun prévisibles de par la levée du frein sur le système immunitaire induit par ces molécules. La recherche de biomarqueurs associés à ces traitements constitue un enjeu d’avenir pour cette nouvelle classe thérapeutique. Cancer immunotherapy has occupied a marginal therapeutic option in cancer despite strong arguments documenting the role of the immune system in controlling the proliferation of cancers. The recent success of immunotherapy results from a change in the past paradigm. From now on, the goal is not only to activate the immune system against tumor, but also to take account of the immunosuppressive tumor microenvironment Among these mechanisms, negative costimulatory molecules (CTLA-4, PD-1, etc.) expressed by T cells in the tumor could explain their lack of effectiveness in inhibiting tumor growth. Blocking these molecules allowed the reactivation of anti-tumor T cells. Clinically, the administration of anti-CTLA-4 antibody (ipilimumab: Yervoy ® ) was granted marketing authorization for patients with metastatic melanoma. The anti-PD-1 antibodies (nivolumab: Opdivo ® , pembrolizumab: Keytruda ® ) have demonstrated clinical efficacy when compared to the standard therapy in metastatic melanomas, advanced lung cancers and metastatic renal cell carcinoma. In phase I and II clinical trials, other tumors (Hodgkin's disease, head and neck cancers, bladder cancer, gastric cancer, etc.) appear to be responsive to these immunomodulators. These treatments were associated with the occurrence of side effects dominated by autoimmunity predictable by unlocking the breaks exerted by immune system to maintain tolerance against self-antigen. The optimization of therapeutic combination based on these molecules and the search for biomarkers associated with these treatments constitute a challenge for the future for this new therapeutic class of drugs for oncology. [ABSTRACT FROM AUTHOR]

Résumé À travers le monde, environ 5 à 10 % de la population est infecté par un Human Papilloma Virus (HPV). Certains de ces virus, à haut risque oncogène (HPV HR) sont responsables d’environ 5 % des cancers, toutes localisations confondues. Il est aujourd’hui acquis que la quasi-totalité des carcinomes du col de l’utérus et de la vulve sont secondaires à une infection par des HPV HR (HPV16 et 18). Cependant, ces mêmes virus sont reconnus pour être impliqués dans la cancérogenèse de nombreux autres cancers (voies aérodigestives supérieures [VADS], pénis, anus). Pour les cancers des VADS, HPV est considéré comme un facteur de bon pronostic relatif. Le rôle des HPV HR dans les cancers anaux est aussi largement étudié dans les populations à risque. La place de l’infection HPV dans la cancérogenèse des cancers de l’œsophage, de la vessie, du poumon, du sein ou la peau est encore discutée. Compte tenu des multiples localisations possibles de l’infection à HPV HR, la question de l’optimisation de la prise en charge des patients ayant un cancer HPV+ se pose par la mise en place d’un suivi global, clinique et biologique. Il en est de même en thérapeutique avec l’existence d’une vaccination prophylactique, entre autres. Worldwide, approximately 5 to 10% of the population is infected by a Human Papilloma Virus (HPV). Some of these viruses, with a high oncogenic risk (HPV HR), are responsible for about 5% of cancer. It is now accepted that almost all carcinomas of the cervix and the vulva are due to an HPV HR (HPV16 and 18) infection. However, these viruses are known to be involved in the carcinogenesis of many other cancers (head and neck [SCCHN], penis, anus). For head and neck cancer, HPV infection is considered as a good prognostic factor. The role of HPV HR in anal cancer is also extensively studied in high-risk patient's population. The role of HPV infection in the carcinogenesis of esophageal, bladder, lung, breast or skin cancers is still debated. Given the multiple possible locations of HPV HR infection, the question of optimizing the management of patients with a HPV+ cancer arises in the implementation of a comprehensive clinical and biological monitoring. It is the same in therapeutics with the existence of a preventive vaccination, for example. [ABSTRACT FROM AUTHOR]

Abstract: Polycrystalline fluorine-doped SnO2 thin films with a given thickness of about 250nm have been grown by ultrasonic spray pyrolysis with a growth temperature in the range of 360–480°C. A texture transition from 〈101〉 to 〈100〉 and 〈301〉 crystallographic orientations has experimentally been found by X-ray diffraction measurements as growth temperature is raised, revealing that a process of abnormal grain growth has occurred. The texture effects have been investigated within a thermodynamic approach considering that grain growth is driven by the minimization of total free energy. The anisotropic character of the physical quantities and the effects of growth temperature have been shown both on the surface energy per unit volume through its dependence on the oxygen chemical potential and on the strain energy density through its variation with the elastic strain and biaxial modulus. Importantly, it is demonstrated by thermodynamic simulations that the oxygen chemical potential increases with growth temperature in the spray pyrolysis conditions, showing that the atmosphere is less and less reducing. For low growth temperature, it is revealed that the 〈101〉 preferred orientation is due to surface energy minimization since the (101) reduced surfaces have a surface energy lower than the (100) reduced surfaces. In contrast, as growth temperature is raised, the 〈100〉 crystallographic orientation becomes predominant owing to strain energy minimization. A texture map is finally determined, revealing the expected texture as a function of elastic strain and oxygen chemical potential. [Copyright &y& Elsevier]

La1−xMnO3+δ (x=0–0.3) nanopowders were prepared at low temperature (825 °C) from a sol–gel method. As results of chemical analyses and X-ray diffraction of products, two ranges of La/Mn ratios can be distinguished: for La/Mn<0.9, a phase separation into La0.9MnO3 and Mn3O4 occurs while single phases with vacancies on both La and Mn sites are obtained for La/Mn>0.9. La and Mn vacancy concentrations were determined from combined Rietveld refinements of X-ray and neutron diffraction data. Correlations between these structural characteristics and magnetic properties were made. Curie temperatures remain constant at a very high value of 295 K for La/Mn<0.9, while they decrease for increasing ratios of La/Mn>0.9. The decrease of Curie temperatures can be related to an increasing amount of Mn vacancies up to a limit corresponding to a La0.93Mn0.93O3 compound with La/Mn=1. For this compound a cluster–glass behaviour is observed. Finally, neutron diffraction was performed as a function of temperature in order to determine the nature of the magnetic interactions. [Copyright &y& Elsevier]

Abstract: Structural and magnetic properties of neodymium-deficient Nd0.7− x □ x Sr0.3MnO3 manganite oxides have been investigated. Nd0.7− x □ x Sr0.3MnO3 powder samples have been elaborated by the conventional solid state reaction at high temperature. Structural studies show that all our samples crystallize in the orthorhombic structure. The unit cell volume decreases with increasing the deficiency content. Magnetization measurements versus temperature at H=500Oe show that all neodymium deficient samples exhibit a paramagnetic–ferromagnetic transition with decreasing temperature. The Curie temperature increases with increasing deficiency content. It is found to increase from 205K to 250K . [Copyright &y& Elsevier]

Background: Various programed death ligand 1 (PD-L1) immunohistochemistry (IHC) assays have been developed and used in clinical trials in association with different drugs. In order to harmonize andmake PD-L1 testing in non-small-cell lung cancer (NSCLC) widely available, we conducted a multicenter study comparing PD-L1 standardized assays and laboratory-developed tests (LDTs). Methods: IHC with five anti-PD-L1 monoclonal antibodies (28-8, 22C3, E1L3N, SP142 and SP263) was performed concomitantly on 41 NSCLC surgical specimens in 7 centers using Dako Autostainer Link 48 (3 centers), Leica Bond (2 centers) or Ventana BenchMark Ultra (2 centers) platforms. For each matching platform, 22C3, 28-8 and SP263 assays were performed. For nonmatching platforms and other antibodies, LDTs were developed in each center. A total of 35 stainings were performed for each case across different platforms and antibodies. PD-L1 staining was assessed in tumor cells and immune cells by seven trained thoracic pathologists. For statistical analysis, 1%, 50% and 1%, 5%, 10% expression thresholds were used for tumor cells and immune cells, respectively. Results: 28-8, 22C3 and SP263 assays were highly concordant for tumor cells staining across the five Dako or Ventana platforms. Among 27 LDTs developed in 7 centers on Dako, Ventana and Leica platforms, 14 (51.8%) demonstrated similar concordance when compared with reference assays for tumor cell staining. Clone SP263 achieved the highest concordance rate across all platforms. Lower concordance was observed for immune cells staining when using a four categories scale. Conclusion: 28-8, 22C3 and SP263 assays had close analytical performance for tumor cell staining across seven centers. Some LDTs on Dako, Ventana and Leica platforms achieved similar concordance, but caution is warranted for their validation. These LDTs will be further validated in order to provide recommendations for the use of assays and LDT for PD-L1 testing in NSCLC. [ABSTRACT FROM AUTHOR]

In industrial solvent extraction units, minimizing the energy input of liquid–liquid contactors is essential. Knowledge of the pressure drop evolution with both geometry and operating conditions is therefore required in order to achieve optimal sizing of the column. In this paper, yet unexplored parameters possibly affecting pressure drop in pulsed columns are investigated, namely the packing mounting clearance and the pulsation features. Their effect on pressure drop is addressed based on an experimental study, otherwise complemented by CFD simulations. The three possible types of flow (permanent flow, oscillating flow, and their combinations) have been actually investigated and compared, for both a disk and doughnut column (DDC) and a perforated plate column (PPC). Our experiments categorically confirm that the pressure drop along the column depends only on the mean fluid velocity, and is independent of the flow-type. This was moreover evidenced regardless of the pulsing device used (mechanical or pneumatical). Additionally, the influence of the mounting clearance required for the assembly of packing elements in industrial columns has been investigated and quantified for the first time. Thanks to an original DDC set-up, we measured the effect of a controlled non-zero gap between the rings and the wall on the pressure drop, hence completing the list and the analysis of parameters influencing the energy consumption in a pulsed column. [ABSTRACT FROM AUTHOR]

This study shows how the structural and morphological properties of sol-gel deposited ZnO films can be precisely tuned and selectively controlled. For that purpose, ZnO films have been deposited through a multilayer sol-gel route using solutions of zinc acetate dihydrate (ZAD) diluted in 1-butanol. The opto-geometrical, morphological, and structural properties of these films have been thoroughly studied in relation to the ZAD concentration in butanol, number of deposited single-layers, and heat-treatment conditions. On this basis, different physical processes occurring over the multilayer deposition procedure have been discussed to explain how the experimental parameters influence the film properties and enable to tune the grain size, texture coefficient, and surface coverage rate in a wide range of values. This work is a first step toward the optimized growth of ZnO nanowires on sol-gel films and their subsequent integration in 2D or 3D nanowire-based biosensors. [ABSTRACT FROM AUTHOR]

Single-crystalline platelets of the nanolaminated V 2 AlC phase have been produced by high-temperature solution growth followed by a slow cooling process, with areas ranging from a few mm 2 up to almost 1 cm 2 . Structural characterization confirms the single-crystalline character of the samples. The surface morphology of the V 2 AlC crystals is flat and devoid of dendrites. Well-defined steps and terraces indicate a step flow growth process. Emphasis is put on the mechanical cleavage of the samples which can be achieved in the basal plane thanks to the existence of the weakly bonded Al atomic planes. The cleavage surface exhibits terraces ending with a triangular shape and with a height equal to an integer number of half-lattice units. [ABSTRACT FROM AUTHOR]

Highlights: [•] YMnO3 films were synthesized on silicon substrates by MOCVD. [•] Microstructural characterization shows hexagonal or orthorhombic structure. [•] TEM and SEM images reveal a columnar growth with two types of morphology. [•] ZFC and FC curves show a spin glass-like behavior at low temperature. [ABSTRACT FROM AUTHOR]

Abstract: Single crystalline platelets of the nanolaminated Cr2AlC phase have been produced by high temperature solution growth, with typical areas in the range of a few mm2. We present a set of characterization experiments which confirm the single crystalline character of the samples and focus on some specific aspects, all related to the nano-lamellar structure of this material. We show that the crystals can be cleaved or delaminated parallel to the basal plane, and we present atomic force microscope observations of those cleaved surfaces. [Copyright &y& Elsevier]

Background Malignant tumours of the salivary glands (MSGT) are rare and pleomorphic entities. Patients with advanced disease may benefit from targeted therapy; however, specific targets for optimising and personalising treatments are yet to be identified. Design Immunohistochemistry for C-KIT, EGFR, HER2, MUC1, phospho-mTOR, androgen/estrogens/progesterone receptors and Ki67 was carried out and evaluated in terms of progression-free and overall survival. High throughput molecular screening of key oncogenes was done in 107 patients using routine diagnostic methods and Sequenom technology. Results Several therapy leads were identified, including high levels of HER2 and androgen receptors in salivary duct carcinomas, C-KIT in myoepithelial carcinomas and EGFR in mucoepidermoid carcinomas. Recurrent mutations involving downstream elements of the EGFR pathway were found in HRAS, notably in tumours with a myoepithelial component, and in other key oncogenes (KRAS/NRAS/PI3KCA/BRAF/MAP2K). On the other hand, <1% of samples had EGFR or HER2 mutations. Conclusion Several tumour subtypes overexpressed targets of directed therapies suggesting potential therapy leads. Genotyping results suggest activation downstream of EGFR in 18 of the 107 samples that could be associated with low efficacy of EGFR inhibitors. Other molecules, such as PI3K/MEK or mTOR inhibitors, may have anti-tumour activity in this subgroup. The high mutation rate in HRAS highlights a novel key oncogenic event in MSGT. [ABSTRACT FROM PUBLISHER]

Abstract: SrCu2O2 (SCO) thin films were obtained by annealing strontium–copper oxide films grown on silicon substrate by metalorganic chemical vapor deposition. The phase transformations occurring in the films during different annealing conditions were studied by in-situ Raman spectroscopy and X-ray diffraction (XRD) combined with ex-situ XRD and Fourier Transformed Infrared Spectroscopy measurements. The first transformation was characterized by the decomposition of SrCO3 and CuO mainly into the Sr14Cu24O41 phase when the films were annealed in oxygen atmosphere. The transformation of this phase into the expected SCO phase was observed after subsequent annealing under Ar. In-situ studies revealed that the SCO phase is preserved at room temperature only when the film is cooled down very quickly. [Copyright &y& Elsevier]

Abstract: In view of developing DNA biochips based on electric detection, well controlled DNA functionalisation of conductive substrate electrode is a challenging process. In this study, the whole process of functionalisation onto home made conductive films with controlled properties has been performed. The latter were Sb doped SnO2 thin films with increasing thickness deposited on oxidized Si using aerosol pyrolysis technique. Their surface morphology shows a roughness increasing with the thickness in association with the polycrystalline microstructure. The silanization process of the as-deposited films was particularly controlled using a combination of different techniques such as wettability and spectroscopic techniques, i.e. X-ray-reflectometry and X-ray photoelectron spectroscopy. The different results confirmed the presence of the silane on the films. The DNA grafting and hybridization to complementary DNA target labelled with fluorescent markers were clearly demonstrated using fluorescence microscopy. The influence of the Sb doped SnO2 film thickness in close relation with the SiO2 thickness on the fluorescence intensity was emphasized. This study has proved the feasibility of a high quality DNA functionalisation of conductive SnO2 films with controlled properties. Moreover, this validates the use of such films as potential substrate electrode for biochips based on the electric detection of DNA hybridization. [Copyright &y& Elsevier]

Lacunar-controlled Nd0.93MnO2.96 orthorhombic perovskite prepared at 1200°C has been studied at low temperature. Magnetization measurements suggest the coexistence below 80 K of ferro- and antiferromagnetic interactions between Mn atoms as in the stoichiometric parent compound NdMnO3. Nevertheless, spontaneous magnetization curves obtained after sample cooling under a magnetic field of 500 Oe (FC) and without magnetic field (ZFC) reveal a much original behavior. Magnetization changes sign twice on ZFC curve; strong negative magnetization is observed below 19 K on FC curve. On the basis of neutron diffraction data, this behavior is interpreted by considering the coexistence of two perovskite phases having chemical compositions and magnetic ordering temperatures slightly different; ferromagnetic components in the clusters of both phases are antiferromagnetically coupled in the range 20–80 K. Ferromagnetic ordering at 19 K of Nd atoms is accompanied by a rearrangement of the Mn ferromagnetic components which become parallel in all the clusters. [Copyright &y& Elsevier]

Introduction La télé-expertise est un des cinq actes de la télémédecine, définie par le décret du 19 octobre 2010, comme un acte médical « qui a pour objet de permettre à un professionnel médical de solliciter à distance l’avis d’un ou de plusieurs professionnels médicaux en raison de leurs formations ou de leurs compétences particulières ». Une plateforme de télé-expertise spécifique à la médecine interne pourrait améliorer la qualité de l’avis donné par le spécialiste en médecine interne aux médecins généralistes et fluidifier le parcours de soins, mais demande un financement supplémentaire propre. L’objectif de notre étude est d’évaluer l’impact médico-économique de la mise en place de ce type de plateforme de télé-expertise en médecine interne. Patients et méthodes Une plateforme de télé-expertise régionale de médecine interne appelée aide régionale des internistes aux médecins (ARIAME) a été créée dans le but d’aider les médecins généralistes confrontés à des situations de diagnostics difficiles. Cette plateforme a été élaborée de façon collaborative avec des médecins internistes et généralistes. Des fiches informatiques adaptées ont été conçues, avec un temps de remplissage court, tout en prenant en compte suffisamment d’éléments pour permettre une expertise par un spécialiste en médecine interne. Il a été décidé d’élaborer la plateforme sur un socle commun de fiches spécifiques correspondant à 17 grands « syndromes » cliniques ou biologiques comme par exemple l’asthénie, les douleurs diffuses, le phénomène de Raynaud, l’hyperferritinémie. Une fois la fiche complétée et validée par le médecin généraliste, le médecin interniste reçoit un courriel l’invitant à se connecter à la plateforme sécurisée entraînant l’ouverture d’un dossier patient. Il donne une réponse dans les 24 heures ouvrables suivant la demande sous la forme d’« un avis simple », d’« une programmation de consultation en médecine interne » ou d’« une hospitalisation en médecine interne ». Une étude observationnelle de type avant/après a permis de comparer l’évolution à 3 mois de patients ayant bénéficié d’un avis sur ARIAME (groupe ARIAME + ) versus des patients appariés de consultation de médecine interne (groupe ARIAME − ). Une étude « minimisation de coût » puis une analyse d’impact budgétaire a été effectuée, prolongées par des analyses de sensibilité. Résultats Actuellement, environ 6 demandes ARIAME sont envoyées par semaine (63,3 % des avis simples, 30,6 % des demandes de consultation de médecine interne, 5,6 % des demandes d’hospitalisations programmées). Entre septembre 2014 et juin 2016, sur les 154 avis simples demandés : 138 (90 %) ont donné lieu à une réponse par avis simple, 8 (5 %) ont abouti à la programmation de consultation ; sur les 74 consultations demandées : 24 (32 %) ont donné lieu à un avis et sur les 12 demandes d’hospitalisations programmées : 5 (42 %) ont abouti à la programmation d’une consultation. Soixante-quatre médecins ont utilisé la plateforme ARIAME depuis l’ouverture de la plateforme en 2014. Le groupe ARIAME + compte 99 patients, et le groupe témoin ARIAME− 204 patients. Le nombre moyen de consultations dans les 3 mois est le même dans les deux groupes (soit de 2,7; p = 0,92), mais le nombre moyen d’hospitalisations est significativement diminué dans le groupe ARIAME + (20 % vs 3 % p = 0,001). L’étude de minimisation de coût met en évidence des déséquilibres de dépenses et de recettes entre l’ARS et le CHU. L’analyse d’impact budgétaire confortée par les analyses de sensibilité montre que la plateforme de télé-expertise entraîne une économie pour l’ARS. Discussion Cette plateforme de télé-expertise offre la possibilité aux patients d’accéder très rapidement à des avis spécialisés de médecine interne au travers de leur médecin généraliste. Par ailleurs, on peut constater que la plateforme de télé-expertise permet de réorienter les demandes initiales du médecin généraliste permettant ainsi une meilleure opportunité des soins. C’est sans doute par la rapidité et la précision de l’avis rendu sur un diagnostic difficile, avec des demandes d’examens complémentaires raisonnées et précises, ou la programmation d’une consultation rapprochée, que la plateforme permet de diminuer les hospitalisations sur un territoire. Conclusion Une plateforme de télé-expertise telle que ARIAME est une interface de communication efficace entre la médecine générale et la médecine interne. La valorisation de l’activité de télé-expertise en médecine interne semble nécessaire afin de pouvoir développer cette activité. [ABSTRACT FROM AUTHOR]