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Resume Introduction Le TIBOLA est une rickettsiose due principalement a R. slovaca, inoculee par une tique du genre Dermacentor. Nous en rapportons cinq observations, rappelant les caracteristiques de ce syndrome. Observations Dans trois cas, le diagnostic a ete porte au stade initial inflammatoire (œdeme cutane, escarre d’inoculation, adenites, fievre) et chez deux patients, au stade des sequelles (asthenie persistante, alopecie cicatricielle). Dans un seul cas, la preuve microbiologique de l’infection a pu etre apportee. Discussion Le TIBOLA est une rickettsiose en expansion en Europe. Le diagnostic clinique est souvent tardif du fait de symptomes peu bruyants et de la meconnaissance des cliniciens. Les tests microbiologiques (serologie, PCR et culture a partir de l’escarre ou du sang circulant) sont mis en defaut dans plus d’un tiers des cas. Le traitement de reference fait appel aux antibiotiques efficaces sur les germes intracellulaires, cyclines et macrolides.

Resume Objectifs Certains allo-anticorps et leurs combinaisons peuvent conduire a des retards voire a une impasse transfusionnelle, en raison de la necessite de trouver des concentres de globules rouges compatibles. L’objectif de cette etude etait de determiner les specificites d’allo-anticorps les plus courantes, ainsi que les associations les plus frequentes. Materiels et methodes Une etude retrospective a analyse les allo-anticorps erythrocytaires identifies en 2008 dans les laboratoires d’immunohematologie de l’Etablissement francais du sang Auvergne-Loire. Les donnees suivantes ont ete etudiees : frequence, specificites des allo-anticorps, date de leur decouverte, âge et sexe des patients. Resultats Mille huit cent quinze allo-anticorps etaient identifies chez 1575 patients (âge median : 63,5 ans, ratio femme/homme : 3,03). Les allo-anticorps les plus frequents etaient diriges contre les antigenes suivants : RH3/E (18,7 %), KEL1/K (17,3 %), RH1/D (16,4 %), MNS1/M (9,4 %), FY1/Fya (6,9 %), RH2/C (6,1 %), KEL3/Kpa (4,7 %), JK1/Jka (4,3 %) et RH4/c (4,1 %). Chez 13,1 % des patients, au moins deux allo-anticorps etaient identifies. Les paires d’associations les plus communes etaient anti-RH1/RH2, anti-RH3/RH4 et anti-RH3/KEL1. Conclusion Des associations specifiques d’allo-anticorps ont ete identifiees. Les principales associations apportent des indications sur le choix des CGR dans un stock pour un patient particulier. Les donnees recueillies dans notre etude montrent que lors d’apparition d’un anticorps quel qu’il soit, il est recommande pour les episodes transfusionnels ulterieurs de respecter le phenotype RH 1 a 5 (D, C, E, c, e) et KEL1 (K) du patient, ainsi que si possible les antigenes JK1 (Jka) et FY1 (Fya), et dans une moindre mesure l’antigene MNS3 (S). Une connaissance detaillee des mecanismes immunologiques aboutissant a la formation de ces allo-anticorps et de leurs associations permettrait une meilleure prevention de l’allo-immunisation erythrocytaire.

The Helium Cooled Lithium Lead Test Blanket Module (HCLL-TBM) is one of the two European TBMs, representative of DEMO blanket technology, that shall be ready for installation in ITER starting from the first day of operation. It is developed by the CEA in the framework of the activities of the Test Blanket Module Consortium of Associates and under contract with the European Joint Undertaking Fusion For Energy (F4E). A series of 4 different HCLL-TBMs will be installed into one of the ITER equatorial ports during the experimental campaign. This paper aims at presenting the development process and design status of HCLL-TBM, with particular focus on the so-called “integral-TBM (IN-TBM)”, which will include all the main features of the corresponding DEMO blanket module. The design of such a complex component already poses considerable issues and is complicated by the peculiarities of the ITER environment (high temperature, radiation damage, pulsed plasma operation), which are not always addressed in present nuclear design codes. After recalling the main features of the HCLL IN-TBM, supporting design analyses are presented and manufacturing techniques are discussed. © 2011 Elsevier B.V. All rights reserved.

Resume Objectifs Le metapneumovirus humain (hMPV) est responsable d’infections respiratoires hivernales de l’enfant. Le but de notre etude etait de decrire l’epidemiologie et la semiologie clinique des infections a hMPV du jeune enfant. Patients et methodes Une etude prospective a ete menee de novembre 2007 a avril 2008 chez les enfants de moins de 2 ans hospitalises au CHU de Tours et ayant beneficie d’un prelevement nasopharynge pour recherche virale. Les donnees epidemiologiques et cliniques des infections a hMPV ont ete comparees a celles des infections respiratoires a virus respiratoire syncytial (VRS) ou negatives pour ces 2 virus (groupe NEG). Resultats Nous avons inclus 374 enfants, dont 22 (6 %) infectes par le hMPV, 177 (47 %) par le VRS et 175 (47 %) NEG. L’infection a hMPV avait 1 pic epidemique au mois de decembre, semblable a celui du VRS, et etait rare a partir du mois de fevrier. La majorite des enfants hMPV avait moins d’1 an. Un diagnostic de bronchiolite etait pose chez plus de 90 % d’entre eux ; les signes cliniques respiratoires etant au premier plan. La severite de l’infection, estimee par la necessite d’une assistance nutritionnelle ou respiratoire, etait similaire a celle de l’infection a VRS et superieure a celle du groupe NEG. L’existence d’une maladie chronique sous-jacente ou d’1 antecedent de bronchiolite etait 1 facteur de risque d’infection a hMPV. Conclusion Ces resultats confirment la place importante du hMPV dans les infections respiratoires hivernales du jeune enfant, avec une severite similaire a celle du VRS.

The Helium-Cooled Lithium-Lead and the Helium-Cooled Pebble Bed are the two breeding blankets concepts for the DEMO reactor which have been selected by EU to be tested in ITER in the framework of the Test Blanket Module projects. They both use a 9%CrWVTa Reduced Activation Ferritic–Martensitic steel, called EUROFER, as structural material and helium as coolant. This paper gives an overview of the status of the EUROFER qualification program and discusses the future needs for design criteria requirements and fabrication validation.

We represent an organization of transfusionnel advice at a regional level and we develop arguments and stages having allowed us to lead to this choice. This target was reached in two stages, which took place over 3 years. The regional transfusionnel advice leans on three fundamental points: a planned permanent organization, skilled and formed actors as well as adapted tools. Tending to a homogeneous organization between every blood bank center seems to be coherent towards the current configuration of blood donation in France.

In the Helium Cooled Lithium Lead (HCLL) blanket concept, the lithium lead plays the double role of breeder and multiplier material, and the helium is used as coolant. The HCCL blanket modules are made of steel boxes reinforced by stiffening plates. These stiffening plates form cells in which the breeder is slowly flowing. The power deposited in the breeder material is recovered by the breeder cooling units constituted by parallel cooling plates. All the structures such as first wall, stiffening and cooling plates are cooled by helium. Due to the complex geometry of these parts and the high level of pressure and temperature loading, thermomechanical phenomena expected in the “HCLL blanket concept” have motivated the present study. The aim of this study, carried out in the frame of EFDA Workprogram, is to validate the manufacturing technologies of HCLL blanket module by testing small scale mock-up under representative operating conditions. The experimental program is carried out on the DIADEMO facility at CEA Cadarache. This experimental device allows the coupling of a PbLi test section and an He cooling loop (pressure of 80 bar, maximum temperature of 500 °C, mass flow rate of 150 g/s) taking advantage of synergies with the gas-cooled fission reactor R&D program. The first step of the test program aims at exposing a simplified HCLL cooling plate mock-up in a fusion blanket environment (i.e. in PbLi and cooled by pressurized Helium) to ITER relevant conditions with thermal transients simulating plasma shut down. Three thousands thermal transient cycles have been performed in about 3 months, without any external visible damages on the mock-up. Post tests analyses are underway in order to investigate the behaviour of the cooling plate mock-up.

This paper gives an overview of the last progresses in terms of system design, calculations, safety and R&D done these last 2 years for the reference Test Blanket Modules developed in Europe, namely the Helium Cooled Lithium-Lead (HCLL) breeder blanket and the Helium Cooled Pebble Bed (HCPB), in order to cope with the ambitious objective to introduce two EU TBM systems for day-1 of ITER operation. The engineering design of the two systems is mostly concluded and the priority is now on the development and qualification of the fabrication technologies. From calculations point of view, the last modelling efforts related to the thermal–hydraulic of the first wall, the tritium behaviour, and the box thermal and mechanical resistance in accidental conditions are presented. Last features of the TBM and cooling system designs and integration in ITER reactor are highlighted. In particular, this paper also describes the safety and licensing analyses performed for each concept to be able to include the TBM systems in the ITER preliminary safety report (RPrS). Finally, overview of recent R&D progresses in fabrication, tritium experiments and test facilities development is given.

One of the two blanket concepts developed by the EU for testing in ITER is the helium cooled lithium–lead (HCLL) concept. Four types of HCLL test blanket modules are defined in a way that they will provide a progressive qualification of the HCLL blanket line up to an integral demonstration in the final TBM. In this paper the latest design of the final TBM is presented. The most recent developments consist in geometrical optimisations and modifications needed to have a realistic manufacturing sequence, in defining the attachments to the port frame, and in assessing the integration of the testing instrumentation required for each mock-up. The status of studies on sub-components fabrication is presented. Preliminary proposals for the design of the initial TBM are also discussed.

Within the scope of the design and qualification of a helium-cooled lithium–lead (HCLL) blanket module for DEMO, test blanket modules (TBM), have to be designed and inserted in ITER for testing. Several different TBMs will be tested in order to achieve the different testing objectives, according to the ITER operating scenario. This paper aims at presenting the design status of the so-called “integral-TBM (IN-TBM)”, which will include all main features of the corresponding DEMO blanket module, such as design architectures, Eurofer structural material, functional parameters, and all relevant manufacturing processes.

Ferritic martensitic steels show limited swelling and susceptibility to helium effects and can be made with low activation chemical compositions. These properties make them the reference steel for the development of breeding blankets in fusion power plants. EUROFER97 is the European implementation of such a steel, where experience gained from an IEA co-operation with Japan and the US is also implemented. Results obtained so far show that EUROFER steel has attractive mechanical properties even after long ageing times. Compatibility tests in water and PbLi17 are in progress. Oxidised aluminium is the most effective protective layer in PbLi17. The displacement damage and helium formation strongly influence the hydrogen transport in the steel. Present experiments should be backed by tests in a more fusion relevant environment, e.g. IFMIF. The 2.5 dpa neutron irradiations at low temperatures result in a higher DBTT. High dose irradiations, up to 80 dpa, are underway. The early results of ODS grades with EUROFER steel composition show potential of these grades for increasing the operating temperature with 100–150 K.

We report a case of a woman who presented anaphylaxis to polyethylene glycol (PEG) associated with positive skin tests to a pegylated drug. To the best of our knowledge, this is the first case, which suggests a potential allergy to pegylated drugs in patients with anaphylaxis to PEG. With the increasing use of pegylated drugs, physicians and patients should be informed of this potential allergy because drug databases do not always clearly indicate that pegylated drugs contain PEG.

In two recent irradiation experiments in the HFR Petten, tritium permeation rates through representative materials to be used as cooling tubes of the water-cooled lithium-lead blanket have been measured in-pile. These latest experiments in the EXOTIC 8 series (E 8.9 and E 8.10) are made of a double wall tube (DWT) and a T91 tube with an Fe–Al/Al2O3 layer acting as tritium permeation barrier (TPB). These tubes contain annular pebble beds of ceramic breeder materials for the helium-cooled pebble bed concept blanket as tritium breeding material. Both experiments are built up of two concentric and independently purged containments allowing on-line tritium release rate and permeation rate measurements. In-pile operation has ended in March 2001 after 450 full power days and resulted in an irradiation damage of approximately 2.6 and 3.2 dpa, respectively in T91 steel. This paper reports on the experimental results obtained for in-pile tritium permeation and discusses the influence of purge gas compositions, temperature and irradiation on tritium permeation through the DWT and TPB.

Casting and hot isostatic pressing (HIP) techniques are attractive for the fabrication of internally cooled complex shape components. Their applications to fusion first wall (FW) components are currently considered: advantages and drawbacks of such techniques are reviewed. In order to (i) improve the reliability of the manufacturing and the performance of the component and (ii) reduce the cost of the fabrication, a combined powder/solid HIP processes is proposed: progresses made in the design and manufacturing of demonstration mock-ups using this technique are presented. In addition, the technical and metallurgical issues are identified and discussed.

Thermal fatigue experiments on tungsten mock-ups have been carried out by an electron beam facility. Different designs of W monoblock mock-ups as well as a W macrobrush mock-up showed very good performance at maximum power densities between 14 and 20 MW/m2 (absorbed). For two plasma-sprayed tungsten mock-ups, failure limits were reached at 6.5 MW/m2. But from the test results, it can be concluded that these failure limits could be increased by improvement of the production methods. Vertical displacement event (VDE) simulation experiments followed by a thermal fatigue test were performed on a tungsten macrobrush mock-up. No indication of failure was observed from the macroscopic inspections or from the infrared images. But in the metallographic inspection, some cracks were observed at the interface between the tungsten teeth and the soft copper layer.

Two new irradiation projects are being performed at the HFR Petten, named EXOTIC-8.9 and EXOTIC-8.10. Issues such as tritium release from candidate ceramic breeder pebbles for the HCPB blanket and tritium permeation through cooling tubes of the WCLL blanket are investigated simultaneously. In EXOTIC-8.9, the tritium release behaviour of a Li 2 TiO 3 pebble bed is measured along with the tritium-permeation rate through a double-wall tube (DWT) of T91 with a Cu interlayer. In EXOTIC-8.10, the tritium release behaviour of a Li 4 SiO 4 pebble bed is measured along with the tritium permeation rate through a T91 tube with a Fe–Al/Al 2 O 3 coating as tritium permeation barrier (TPB). Tritium permeation phenomena are studied by variations of temperatures and purge gas conditions. This paper reports on the results of the first 100 irradiation days.

In the frame of the development of blanket manufacturing technologies for DEMO, European associations FZK and CEA have worked on the diffusion welding of ferritic–martensitic (FM) steels. Satisfactory joint microstructure and properties are obtained when specific surface preparation procedures are followed. Different fabrication techniques including machining, bending and hot isostatic pressing-diffusion welding (HIP-DW) are proposed.

The aim of this study is to measure the hydrogen/deuterium transport and inventory parameters in the double-wall tubes (DWT) material for the water-cooled Pb–17Li DEMO blanket. Measurements are conducted using a time dependent permeation method over the temperature range 473–723 K, with hydrogen and deuterium driving pressures in the range 1–10 5 Pa (0.01–1000 mbar). The samples are also characterised using optical microscopy, SEM, microhardness measurements and mechanical tests. An effective permeability of about 12 times lower than 2.1 mm of bare F82H steel at 573 K and three times lower than 2.1 mm of bare F82H steel at 723 K have been measured. This result is close to the theoretical prevision (multi-layer model).

The development of the water cooled lithium lead (WCLL) DEMO fusion reactor requires the production of a material capable of acting as a tritium permeation barrier (TPB). In the DEMO blanket reactor permeation barriers on the structural material are required to reduce the tritium permeation from the Pb–17Li or the plasma into the cooling water to acceptable levels (

The European helium-cooled pebble bed (HCPB) blanket is a solid breeder blanket concept for the future DEMO reactor. The HCPB test module for ITER corresponds, with respect to the general design and functions, to the DEMO blanket. In this paper the most important manufacturing and assembly steps, including inspection methods for the ITER test module, are pointed out. The manufacturing processes for these different steps are discussed, and a summary of the main results that have been achieved in the current development programs is given. The encouraging results that have been obtained so far for all manufacturing steps confirm the feasibility of the ITER test module. A short survey of the future development work in the current programs and the work on alternative fabrication techniques for the manufacturing of the first wall are presented.

Resume Une insuffisance renale aigue reversible est survenue au decours d’une chirurgie retinienne chez une patiente de 55 ans sans facteurs de risque preoperatoires. L’association postoperatoire d’un traitement diuretique (mannitol-acetazolamide) et d’un traitement anti-inflammatoire non steroidien (ketoprofene) a probablement ete responsable d’une necrose tubulaire aigue d’origine ischemique. Les suites de la chirurgie du segment posterieur de l’œil representent certainement une situation a risque nephrologique particulier du fait de la prescription frequente d’un traitement diuretique par les ophtalmologistes. En depit de leur efficacite pour l’analgesie postoperatoire, les anti-inflammatoires non steroidiens devraient etre evites si possible dans cette indication.

Cette etude retrospective et prospective rapporte les protocoles de 2 CHU francais sur l’accoutumance aux proteines de lait de vache. Introduction L’allergie aux proteines de lait de vache est frequente. Les regimes d’eviction sont contraignants et leur benefice est remis en cause. Le principe de l’accoutumance est de reintroduire un allergene chez un patient allergique pour induire une tolerance clinique. Cette tolerance disparait si l’ingestion de l’allergene est interrompue. Patients et methodes Indication : allergies depuis plus de 3 ans, de grade 1/2/3, environnement familial fiable. Patients âges de plus de trois ans, dont l’allergie IgE dependante (prick-tests positifs et/ou IgE positives) a ete prouvee. A Tours : phase d’induction a domicile avec du lait dilue au 1/25 puis lait pur : jusqu’a la dose optimale (200 mL) quotidienne du lait ou equivalent. Angers : phase d’induction a hopital (jusqu’a 1 mL de lait) puis poursuite de l’augmentation des doses au domicile jusqu’a 200 mL. Resultats CHU de Tours : 21 enfants âges de 3 a 13 ans dont 6 tolerants a 200 cm 3 (46 %), 1 tolerance partielle, 5 echecs et 8 en cours. Pas de reaction severe mais survenue frequente de toux, crise d’asthme moderee et vomissements. CHU d’Angers : 12 enfants de 2 a 17 ans dont 4 tolerants a 200 cm 3 (34 %), 8 echecs (66 %). Discussion/perspectives Caminiti a montre 70 % de tolerance en debutant au 1/25 de lait. Jimenez a obtenu 77 % de guerison a 2 ans avec un ultrarush au lait de vache. La question de l’espacement des prises de lait se pose, et l’equipe de Pajno a montre qu’il n’y avait pas plus d’incident si des enfants prenaient 200 mL de lait quotidiennement ou 2 fois/semaine. D’autres discussions sont necessaires concernant une accoutumance avec des traces de lait chez des nourrissons. La question des IgE comme outil de suivi de tolerance necessite d’etre soulevee. Conclusion Resultats similaires pour les deux CHU. L’accoutumance limite les reactions severes en cas de prise accidentelle, avec des effets indesirables moderes pendant le protocole. Cette accoutumance necessite une equipe rigoureuse et un entourage familial fiable pour atteindre l’objectif defini.

Resume Les regles generales de l'antibioprophylaxie chirurgicale sont actuellement bien definies : celle-ci est limitee aux patients ayant soit un risque eleve d'infections post-operatoires lie a l'intervention elle-meme (chirurgie propre contaminee et chirurgie contaminee sale), soit un risque lie au danger potentiel d'une infection sur un terrain fragile. Le choix de l'antibiotique est base sur le spectre antibacterien, les possibilites d'obtenir une diffusion tissulaire adaptee au niveau du site operatoire, la toxicite potentielle, le risque ecologique et le cout. L'administration doit se faire en intraveineuse. La duree maximale de l'antibioprophylaxie doit etre de 24 heures. Les constations operatoires peuvent amener a moduler l'utilisation de l'antibiotherapie qui pourra devenir curative, notamment apres chirurgie contaminee sale. En chirurgie digestive, les indications sont actuellement assez bien codifiees chez l'adulte. Chez l'enfant, les tres rares etudes concernent la chirurgie appendiculaire. Des schemas peuvent etre proposes, mais des etudes specifiques a cette situation sont souhaitables.