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There is a high demand and expectation for subseasonal to seasonal (S2S) prediction, which provides forecasts beyond 2 weeks, but less than 3 months ahead. To assess the potential benefit of artificial intelligence (AI) methods for S2S prediction through better postprocessing of ensemble prediction system outputs, the World Meteorological Organization (WMO) coordinated a prize challenge in 2021 to improve subseasonal prediction. The goal of this competition was to produce the most skillful forecasts of precipitation and 2-m temperature globally averaged over forecast weeks 3 and 4 and over weeks 5 and 6 for the year 2020 using artificial intelligence techniques. The top three submissions, described in this article, succeeded in producing S2S forecasts significantly more skillful than the bias-corrected ECMWF operational reference forecasts, particularly for precipitation, through improved calibration of the ECMWF raw forecast outputs or multimodel combination. These forecast improvements should benefit the use of S2S forecasts in applications. The authors thank the Swiss Data Science Center (SDSC) and the European Centre for Medium-Range Weather Forecasts (ECMWF) for their support to this competition. The CRIMS2S team acknowledges support from the Ministère de l’économie, innovation et exportation (MEIE) of Gouvernement du Québec. The UConn team would like to acknowledge contributions from Krishna Pattipati and Peter Willett from the University of Connecticut, Jason Nachamkin from the Naval Research Laboratory Marine Meteorology Division, and Paolo Braca and Leonardo Millefiori from the NATO STO CMRE. The authors thank the three anonymous reviewers for their suggestions and comments that helped improve the manuscript. Peer Reviewed "Article signat per 22 autors/es: F. Vitart, A. W. Robertson, A. Spring, F. Pinault, R. Roškar, W. Cao, S. Bech, A. Bienkowski, N. Caltabiano, E. De Coning, B. Denis, A. Dirkson, J. Dramsch, P. Dueben, J. Gierschendorf, H. S. Kim, K. Nowak, D. Landry, L. Lledó, L. Palma, S. Rasp, S. Zhou"

International audience; This paper introduces the use of the Proper Generalized Decomposition (PGD) method for the optical flow (OF) problem in a classical framework of Sobolev spaces, i.e. optical flow methods including a robust energy for the data fidelity term together with a quadratic penalizer for the regularisation term. A mathematical study of PGD methods is first presented for general regularization problems in the framework of (Hilbert) Sobolev spaces, and their convergence is then illustrated on OF computation. The convergence study is divided in two parts: (i) the weak convergence based on the Brézis-Lieb decomposition, (ii) the strong convergence based on a growth result on the sequence of descent directions. A practical PGD-based OF implementation is then proposed and evaluated on freely available OF data sets. The proposed PGD-based OF approach outperforms the corresponding non-PGD implementation in terms of both accuracy and computation time for images containing a weak level of information, namely low image resolution and/or low Signal-To-Noise Ratio (SNR).

Resume Introduction L’infection urinaire (IU) constitue la deuxieme cause d’infection bacterienne communautaire chez le sujet âge. Ce diagnostic est difficile car les symptomes sont souvent atypiques. Nous presentons les caracteristiques des patients ayant une IU parmi une population geriatrique (signes fonctionnels urinaires et/ou syndrome infectieux). Nous avons egalement evalue la sensibilite et la specificite de la bandelette urinaire (BU) pour le diagnostic d’IU dans cette population. Patients et methode Nous avons realise une etude observationnelle, prospective, monocentrique, d’avril 2017 a janvier 2018, incluant tous les patients hospitalises en geriatrie, presentant des signes fonctionnels urinaires et/ou un syndrome infectieux sans point d’appel, pour lesquels un examen cytobacteriologique des urines (ECBU) a ete demande. Une BU etait systematiquement realisee pour tous ces patients. Les caracteristiques cliniques et biologiques des patients ont ete etudiees selon le diagnostic definitif. En outre, les resultats des BU ont ete compares a ceux des ECBU en cas de diagnostic final d’IU. Resultats Au total, 165 patients ont ete inclus. Parmi eux, 67 (40,6 %) avaient une IU et 98 (59,4 %) avaient un autre diagnostic. Il y avait significativement plus de femmes ( p p La BU presentait une sensibilite elevee (92 %) et une VPN elevee (91 %) interessantes dans notre population. Conclusion En cas d’IU chez le sujet âge, peu de criteres sont discriminants avec une autre origine. Par ailleurs, une BU negative suggere l’absence d’IU en raison de sa bonne valeur predictive negative.

En 2017, le Canada célèbre son 150e anniversaire et mettra sans doute l'accent sur le succès de son modèle de fédéralisme, de sa dualité linguistique, de sa diversité multiculturelle et de son récent traitement plus favorable des Premières nations, entre autres. Derrière ce visage se cachent beaucoup de tensions historiques et de luttes sociales incarnées dans la Charte canadienne des droits et libertés, adoptée en 1982. Au sujet de la dualité linguistique, l'article 23 de la Charte garantit aux minorités des deux langues officielles l'accès à l'éducation dans leur langue maternelle. Sans une mise en application vigoureuse, une telle garantie demeure lettre morte. De fait, il existe six régimes linguistiques au Canada et le respect de l'article 23 s'obtient souvent de gouvernements récalcitrants à force de recours judiciaires. Ceux-ci ont généré 156 jugements depuis l'adoption de la Charte, dont 15 de la Cour suprême du Canada. Nous analysons le cas d'un gouvernement particulièrement réticent à mettre en application l'article 23, c'est-à-dire celui du territoire du Yukon, afin d'expliquer comment toute cette jurisprudence n'arrive pas à régler définitivement et avec une certaine finalité la question des droits de l'article 23. Au-delà des différences de régime linguistique, les jugements pertinents de cette cause yukonnaise manifestent aussi une confrontation des paradigmes idéologiques des intervenants, entre une idéologie majoritaire dominante et restrictive versus une idéologie large et libérale fondée sur le principe de la dualité linguistique.

We reviewed Canadian federal, provincial, and territorial policies related to the health of official language minorities (OLMs) and found important provincial and territorial differences as well as policies penalizing OLMs, which thus contribute significantly to health disparities and to the low vitality of OLM communities. These findings suggest the need for more aggressive, hands-on, and concerted federal and provincial/territorial government efforts to address social inequities and health disparities. Increased policy coherence between these levels of government will not only increase the health and vitality of these populations but also help close the disparity gap and lead to better health and well-being for all Canadians.

IF 11.855; International audience; BackgroundOutcome of intermediate risk rectal cancer may be improved by the addition of oxaliplatin during 5-fluoruracil concomitant neoadjuvant chemoradiotherapy. The purpose of this study is to analyze the main clinical results of the ACCORD12 trial (NCT00227747) in rectal cancer after 5 years of follow-up.Patients and methodsInclusion criteria were as follows: rectal adenocarcinoma accessible to digital examination staged T3-T4 Nx M0 (or T2 Nx distal anterior rectum). Two neoadjuvant chemoradiotherapy regimens were randomized: CAP45 (RT 45 Gy + capecitabine) and CAPOX50 (RT 50 Gy + capecitabine and oxaliplatin). Main end point was sterilization of the operative specimen. Acute and late toxicities were prospectively analyzed with dedicated questionnaires.ResultsBetween November 2005 and July 2008, 598 patients were included in the trial. After a median follow-up of 60.2 months, there was no difference between treatment arms in multivariate analysis either for disease-free survival or overall survival (OS) [P = 0.9, hazard ratio (HR)=1.02; 95% confidence interval (CI), 0.76–1.36 and P = 0.3, HR = 0.87; 95% CI, 0.66–1.15, respectively]. There was also no difference of local control in univariate analysis (P = 0.7, HR = 0.92; 95% CI, 0.51–1.66). Late toxicities were acceptable with 1.6% G3 anal incontinence, and

Introduction L’incidence des infections fongiques invasives (IFI) chez les patients d’hematologie a haut risque sous posaconazole est Une etude retrospective monocentrique de tous les tests GM chez les patients allogreffes de moelle sous prophylaxie par posaconazole ou voriconazole entre le 01/2013 et le 12/2015 a ete conduite afin d’evaluer l’efficience d’une strategie ciblee chez les patients symptomatiques. Materiels et methodes Un test GM (Platelia Aspergillus® par Bio-Rad) etait positif (+) si l’index etait ≥ 0,7 sur un serum ou ≥ 0,5 sur 2 serums consecutifs. Deux episodes de GM + etaient consideres independants s’il y avait un GM negatif entre les 2 episodes, separes d’un intervalle ≥ 15 jours. Les donnees clinicoradiologiques, mycologiques, therapeutiques ainsi que les conclusions du comite de la cellule aspergillaire ont ete collectees. Chaque episode independant a ete classe en aspergillose (AI) possible/probable/prouvee/exclue selon les criteres 2008 EORTC/MSG. La sensibilite (Se) et valeur predictive positive (VPP) du test GM ont ete calculees. Resultats Sur 1358 GM, 279 GM+ ont ete inclus, correspondant a 43 patients, 70 episodes independants. Une AI etait exclue dans 66/70 episodes (94 %). Les 3 patients/4 episodes ou le GM+ correspondait a un vrai+ avaient des symptomes d’IFI. Chez les patients avec des GM negatifs, 5 avaient une AI possible et 1 une AI probable. La Se etait de 40 % (IC : 9 ; 61), avec une VPP de 6 % (IC : 1,5 ; 13,4). Pour les patients avec des GM+ 74 % ont eu un scanner, 12 % une IRM cerebrale et 7 % une fibroscopie bronchique. Conclusion Le test GM a une tres faible VPP chez le patient allogreffe sous prophylaxie primaire par posaconazole ou voriconazole, et entraine des investigations couteuses. Il reste interessant en cas de suspicion clinique d’IFI. Dans cette population, le GM serique ne devrait plus etre utilise en screening systematique mais en test cible chez des patients symptomatiques.

Objective Thermal therapies are rapidly gaining importance in oncology as an alternative to radiotherapy and surgery. The possibility to locally deposit thermal energy in a non-invasive way opens a path towards new therapeutic strategies with improved reliability and reduced associated trauma leading to improved efficacy, reduced hospitalisation and costs. Liver and kidney tumors represent a major health problem because not all patients are suitable for curative treatment with surgery. Currently, radiofrequency is the most used method for percutaneous ablation and the development of a completely non-invasive method based on MR-guided high intensity focused ultrasound (HIFU) treatments is of particular interest, since the energy source is located outside the body. This project addressed technological challenges for the treatment of liver and kidney, related to their motion and their location within the thoracic cage. Material and methods This project proposed safe and non-invasive methods for MR-guided thermal ablation of malignant tumors of liver and kidney with HIFU. Real-time MRI was used to precisely control heat deposition with HIFU within the targeted pathological area despite the motion of these organs, in order to provide an effective treatment with a reduced duration and an increased level of safety for the patient. New technologies were studied for the development of matrix transducers able to generate high acoustic power. Discussion 3D Real-Time MRI guidance of a HIFU intervention as well as intercostal firing were realized in vivo in pig liver during breathing under real-time MR-thermometry over sustained periods of several minutes. The ability to generate acoustic power as high as up to five time the usual level was demonstrated in vitro thanks to the development of the new transducer technology proposed in this project. Conclusion A fully MR-integrated HIFU treatment platform dedicated to the treatment of cancer in mobile abdominal organs was developed.

The aging of our population and the frequent occurrence of cancer warrants the adaptation of our management strategies in medical and surgical geriatric oncology. Geriatric assessment, including knowledge of the autonomy of patients and their comorbidities is needed to consider the best treatment, including when it comes to surgery. Delirium is the most common complication observed in the postoperative period. Knowledge of risk factors for the occurrence of this syndrome should be a part of good practice. Proximity between surgeons, anesthesists and geriatricians should improve the quality of care given to elderly patients with cancer.

L’Alsace a ete choisie comme departement pilote pour le depistage du cancer colorectal (CCR) en raison de l’incidence de ce cancer dans cette region. Cet article traite de l’experience d’une equipe pluri-disciplinaire de Colmar sur le CCR. Les aspects psychologiques du CCR sont communs a tous les cancers: revelation parfois traumatisante, peur de la mort et des sequelles, operation, chimiotherapie. Le CCR a pour particularite de mettre en danger l’intimite de la fonction excretrice, si importante symboliquement lors des apprentissages de l’enfant, dans son affirmation en tant que moi distinct. L’atteinte du colon, du rectum et de l’anus reactualise des mecanismes de defense infantiles notamment, par la regression necessaire pour accepter de se laisser soigner, mais vite refoulee par ceux qui souhaitent rester autonomes pour prendre soin de leur stomie et de sa cicatrisation. Les consequences du traitement de ce cancer sur la sexualite sont d’autant plus importantes qu’elles impliquent une intervention du partenaire, parfois concrete, en forme d’accompagnement dans la regression sollicitant un role maternel et de soutien envers le conjoint dans le registre de la tendresse.

International audience; This study investigated the long-term outcome of patients with tuberculosis (TB) as a complication of tumour necrosis factor (TNF)-alpha blocker therapy. All TB cases (n = 21) complicating TNF-alpha blocker therapy from French university hospitals were collated between January 2000 and September 2002. Outcome was assessed via a postal questionnaire during September 2005. The mortality rate after 4 years was 4.8%, and one patient had relapsed and six (29%) patients had recommenced TNF-alpha antagonist treatment, after appropriate anti-TB therapy, without reactivation. These data support the concept that TNF-alpha antagonists can be restarted in TB patients provided that adequate anti-TB treatment has been completed.

Cet article fait le point sur le traitement palliatif des deux principaux symptomes engendres par la carcinose peritoneale : l’ascite et l’occlusion. Il propose une strategie therapeutique fondee sur l’analyse de la litterature et l’experience des equipes specialisees en soins palliatifs. Il aborde la place respective des diuretiques, des ponctions et des drainages par catheter intraperitoneal pour le traitement de l’ascite. Il fait le point sur le traitement medicamenteux de l’occlusion et evalue les places respectives des traitements desobstructifs, chirurgical ou endoscopique, et des traitements de decharge par sonde nasogastrique ou par gastrostomie.

Background/Aims: To determine patterns of loss of abilities in instrumental activities of daily living (IADL) in community-dwelling women with Alzheimer’s disease (AD). Methods: Sixteen French university hospitals included 471 consecutive women with mild to moderately severe AD (Mini-Mental State Examination scores between 10 and 26) from April 2000 to June 2002 in the noninterventional REAL cohort. At inclusion, 6 and 12 months, IADL were assessed with the Lawton scale. Patterns of loss of abilities in the 8 IADL of the Lawton scale were described using Lawton binary grading. Results: At inclusion, 56.7% of the patients shared the same pattern of loss of abilities and 84.3% had this pattern or variants of it. Frequencies of the 8 incapacities were: 80.7% to do the grocery shopping, 76.0% to take medication, 72.2% to prepare meals, 41.4% to travel on public transportation even when assisted, 40.6% to manage purchases, 30.1% to launder small items, 14.2% to participate in some housekeeping tasks and 11.0% to answer the telephone. Conclusion: In this study including 471 community-dwelling women with AD of the French REAL cohort, the loss of the 8 IADL, assessed with the Lawton binary grading, was homogeneous for more than four fifths of the patients.

Objectives To compare the coverage for the third dose and the compliance to two hepatitis B vaccination schedules: 0,1,4 versus 0,1,6 months, in commercial sex workers (CSW) in Belgium; to compare the immunogenicity of the actually administered schedules. Methods In seven health centres in Belgium, hepatitis B vaccination was offered free of charge to CSW. In a randomised, prospective study a commercialised hepatitis B vaccine (Engerix-B™ 20 mcgr) was offered according to one of both schedules. After complete vaccination, bleeding was performed to assess immunogenicity. Results Between June 2003 and September 2004, 615 non-immune CSW were enrolled, of whom 52% in the 0,1,4 month schedule (n = 322). Coverage of the third dose was 57% overall, 59% (0,1,4) and 54% (0,1,6), respectively. Age, the health centre and drug use significantly influenced the compliance and the coverage of dose 3, whereas the planned vaccination did not. When comparing the immunogenicity results as a function of the actually administered vaccination schedule, immune responses did not significantly differ between CSW receiving the third dose 4–6 months and those receiving it at least 6 months after the first dose. In total, 19 persons (8%) were not protected after a full vaccination course (anti-HBs Conclusions In this highly mobile at-risk population, a 0,1,4 month schedule is more easy to offer and confers equal protection within a shorter period of time. We therefore propose this 0,1,4 month schedule to vaccinate CSW in the future.

Summary. In industrialized countries, transmission of hepatitis C occurs primarily through injecting drug use. Transmission of hepatitis C in injecting drug users is mainly associated with the sharing of contaminated syringes/needles, although evidence for risk of hepatitis C infection through sharing of other injecting paraphernalia is increasing. In this paper, the independent effects of sharing paraphernalia other than syringes/needles have been estimated. The prevalence and force of infection were modelled using three serological data sets from drug users in three centres in Belgium as a function of the sharing behaviour. It was found that sharing of materials other than syringes/needles indeed seemed to contribute substantially to the spread of hepatitis C among injecting drug users.

A 10-year-old, neutered male Cairn terrier was examined after experiencing intermittent vomiting of several months' duration and sudden onset of acute depression. Abdominal ultrasound examination revealed an adrenal mass invading the suprarenal part of the caudal vena cava. The vascular invasion could not be corrected so en bloc ligation/excision of the adrenal neoplasm and the suprarenal part of the vena cava was performed. Microscopic examination identified an adrenal phaeochromocytoma. The dog recovered well and had no significant vascular or renal dysfunction at follow-up 20 months after surgery. To the authors' knowledge, this is the first report of a dog surviving long term after resection of the suprarenal caudal vena cava.

Of 176 invasive Streptococcus pneumoniae isolates from children in Malawi, common serotypes were 1 (23%), 6A/B (18%), 14 (6%), and 23F (6%). Coverage with the 7-valent pneumococcal conjugate vaccine (PCV) was 39%; PCV10 and PCV13 increased coverage to 66% and 88%, respectively. We found chloramphenicol resistance in 27% of isolates and penicillin nonsusceptibility in 10% (by using meningitis breakpoints); all were ceftriaxone susceptible.

Some long work or shift work schedules necessitate an elevated and prolonged level of vigilance and performance but often result in sleep deprivation (SD), fatigue and sleepiness, which may impair efficiency. This study investigated the effects of a slow-release caffeine [(SRC) at the daily dose of 600 mg] on vigilance and cognitive performance during a 64 h continuous wakefulness period. Sixteen healthy males volunteered for this double-blind, randomised, placebo controlled, two-way crossover study. A total of 300-mg SRC or placebo (PBO) was given twice a day at 21:00 and 9:00 h during the SD period. Vigilance was objectively assessed with continuous electroencephalogram (EEG), the multiple sleep latency tests (MSLT) and wrist actigraphy. Cognitive functions (information processing and working memory), selective and divided attention were determined with computerised tests from the AGARD-NATO STRES Battery (Standardised Tests for Research with Environmental Stressors). Attention was also assessed with a symbol cancellation task and a Stroop’s test; alertness was appreciated from visual analogue scales (VAS). Tests were performed at the hypo (02:00–04:00 h, 14:00–16:00 h) and hypervigilance (10:00–12:00 h, 22:00–00:00 h) periods during SD. Central temperature was continuously measured and safety of treatment was assessed from repeated clinical examinations. Compared with PBO, MSLT showed that SRC subjects were more vigilant from the onset (P=0.001) to the end of SD (P

MR spectroscopy of the posterior fossa is pitted with numerous technical difficulties. It is, however, of great clinical interest in the study of the degenerative diseases and tumors of this area. We have developed a method to perform 2D CSI of this area, by using a sagittal slice and a careful positioning of outer volume saturation. We performed this acquisition in 30 healthy volunteers to determine the normal metabolic ratios in five voxels of this area (mesencephalon, pons, medulla oblongata, vermis, cerebellar white matter). The main technical difficulty was magnetic field inhomogeneity in the lower brainstem generated by dental alloys. However, 88% of the voxels were of sufficient quality to be analyzed. The statistically significant regional variations were a higher NAA/Cr ratio in the pons than in the medulla oblongata, higher Cho/Cr in the pons than in the mesencephalon and higher Cho/Cr in the cerebellar white matter than in the vermis. We conclude that 2D CSI of the brainstem, although technically delicate can be performed in most patients.

We report a case of a 71-year-old woman with carcinoid heart disease admitted in ICU after tricuspid valve replacement. She quickly developed a acute heart right failure. Optimal medical treatment failed and we implanted ventricular assistance. After 10 days of support, patient improved and the right ventricle recovered. Temporary devices can provide a successful bridge to cardiac recovery. However, the risk of infection that is a major prognosis factor should be carefully considered particularly when temporary assistance implanted on immunosuppressed patients.

We consider a parametric nonlinear regression model with independent and Gaussian errors. We assume that the number of observations is fixed and that the variance of errors tends to zero; we then derive the properties of confidence intervals for the parameters. These confidence intervals are calculated using both the quantiles of the estimator's asymptotic law and the quantiles of the estimator's bootstrap distribution. We show that if the pseudo-errors are simulated using the Gaussian distribution, then bootstrap can be applied successfully. The usual reduction in coverage error of confidence intervals is not, however, verified. A simulation study for a biadditive model shows the superiority of bootstrap when calculating confidence intervals for the interaction parameters.

Atmospheric general circulation models (GCMs) are characterized by many features but especially by: (1) the manner of discretizing the governing equations and of representing the variables involved at a given resolution, and (2) the manner of parameterizing unresolved physical processes in terms of those resolved variables. These two aspects of model formulation are not independent and it is difficult to untangle their intertwined effects when assessing model performance. The attempt here is to separate these aspects of GCM behaviour and to ask, “Given a perfect parameterization of the physical processes in a model, what resolution is needed to capture the dominant dynamical aspects of the atmospheric climate?” Alternatively, “At what resolution do the dynamics of a GCM converge”? The perfect parameterization approach assumes that the calculation of the physical terms returns the “correct” result at all resolutions. In the idealized case, a time-independent forcing is one of the simplest that satisfies this condition. However, experiments show that it is difficult for the dynamics of a GCM to balance a time-independent forcing with atmosphere-like flows and structures. The model requires, and the atmosphere presumably includes, physical feedback mechanisms which act so as to maintain the kinds of flows and structures that are observed. Resolution experiments are performed with a simplified forcing function for the thermodynamic equation which combines a dominant time-independent specified forcing with a weak linear relaxation feedback. These experiments show that the dynamics of the GCM have essentially converged at T32 and certainly by T63 which is the next resolution considered. This is shown by the constancy of structures, variances, covariances, transports and energy budgets with increasing resolution. Experiments with an alternative forcing proposed by Held and Suarez, which has the form of a linear relaxation, show somewhat less evidence of convergence at these resolutions. In both cases the “physics” are known by assumption. However, the form and nature of the forcing is different, as is the behaviour with resolution. The implication for the real system is that the resolution required for simulating the dynamical aspects of climate is rather modest. The simulated climate does, however, apparently depend on the ability to correctly and consistently parameterize the physical processes in a GCM, involving both forcing and feedback mechanisms, as a function of resolution.

RÉSUMÉLe mouton d'Ouessant est bien connu, en raison notamment de sa petite taille. Son nom est d'apparition récente (moins de 50 ans) : auparavant, on connaissait le “Mouton breton” qui comprenait trois variétés et de nombreux types intermédiaires. Le plus commun était le “Mouton des Landes de Bretagne” qui semble avoir présenté des similitudes avec les moutons autochtones ayant peuplé toute la moitié nord de la France. La “Race de deux” doit son nom à sa prolificité, obtenue par croisement du Mouton des Landes de Bretagne avec la Flamande à la fin du 18ème siècle. Les plus petits animaux ont été regroupés beaucoup plus tard sous l'appellation “Ouessant” Contrairement à l'opinion courante, le “Mouton des Landes de Bretagne” et la “Race de deux” n'ont pas disparu mais subsistent avec des effectifs très faibles. Les principales caractéristiques des trois variétés sont sommairement présentées et leur intérêt, souligné.

Computer programs for the interpretation of electrocardiograms (ECGs) are now widely used. However, a systematic assessment of various computer programs for the interpretation of ECGs has not been performed.We undertook a large international study to compare the performance of nine electrocardiographic computer programs with that of eight cardiologists in interpreting ECGs in 1220 clinically validated cases of various cardiac disorders. ECGs from the following groups were included in the sample: control patients (n = 382); patients with left ventricular hypertrophy (n = 183), right ventricular hypertrophy (n = 55), or biventricular hypertrophy (n = 53); patients with anterior myocardial infarction (n = 170), inferior myocardial infarction (n = 273), or combined myocardial infarction (n = 73); and patients with combined infarction and hypertrophy (n = 31). The interpretations of the computer programs and the cardiologists were compared with the clinical diagnoses made independently of the ECGs, and the computer interpretations were compared with those of the cardiologists.The percentage of ECGs correctly classified by the computer programs (median, 91.3 percent) was lower than that of the cardiologists (median, 96.0 percent; P less than 0.01). The median sensitivity of the computer programs was also significantly lower than that of the cardiologists in diagnosing left ventricular hypertrophy (56.6 percent vs. 63.9 percent, P less than 0.02), right ventricular hypertrophy (31.8 percent vs. 46.6 percent, P less than 0.01), anterior myocardial infarction (77.1 percent vs. 84.9 percent, P less than 0.001), and inferior myocardial infarction (58.8 percent vs. 71.7 percent, P less than 0.0001). The median total accuracy level (the percentage of correct classifications) was 6.6 percent lower for the computer programs (69.7 percent) than for the cardiologists (76.3 percent; P less than 0.001). However, the performance of the best programs nearly matched that of the most accurate cardiologists.Our study shows that some but not all computer programs for the interpretation of ECGs perform almost as well as cardiologists in identifying seven major cardiac disorders.

Two hundred and seventy patients, under 71 years of age and suffering from a less than 4 h infarction diagnosed according to clinical and electrocardiographic criteria, were included: two 90-patient groups were randomized and then treated with either anistreplase (30 mg iv over 5 min) or alteplase (10 mg bolus injection + 5000 IU heparin bolus injection, followed by 90 mg alteplase over 3 h), and compared with a consecutive control series of 90 patients treated with streptokinase (1.5 million U over 1 h). Intravenous heparin and aspirin (250 mg day-1) were then prescribed routinely. The three groups were comparable as regards age (55.2 +/- 10 years), male/female ratio (10.4), the site of the infarction (42% anterior, 55% inferior) and initial clinical seriousness (Killip I = 90%, II = 8%, III = 2%). The patients were thrombolysed in 17 community hospitals, and then referred to a university hospital with catheterization facilities. An efficacy score was determined, based on four parameters: two obtained from coronary angiography and left ventriculography performed on day 6 +/- 2 (N = 252) (asynergic score and patency of the infarct-related artery), one from Tl-tomography performed at rest (infarct size) and one from radionuclide angiography (global left ventricular ejection fraction) performed between day 15 and day 21 (N = 242). The score (range: 0-24 per patient) was 17.8 +/- 6.4 for alteplase, 17.7 +/- 6.0 for anistreplase and 18.1 +/- 6.0 for streptokinase respectively (NS).(ABSTRACT TRUNCATED AT 250 WORDS)

The effect of 6 months of treatment with indapamide (IND, 2.5 mg/day) on regression of left ventricular hypertrophy (LVH), an independent predictor of poor prognosis in hypertension, was compared by echocardiography to that of nifedipine (NFD, 40 mg/day), enalapril (ENL, 20 mg/day), atenolol (ATL, 100 mg/day), and hydrochlorothiazide (HCTZ, 25 mg/day) in four parallel double-blind studies in 151 hypertensive patients with a diastolic blood pressure between 95 and 120 mm Hg and a raised left ventricular mass index (LVMI) (mg/m2) (Devereux). Patients were randomized to IND or comparator following a 2-week washout (1 month in the IND vs. ATL study). Respective baseline and 6-month LVMI values (mg/m2) were: IND (n = 20) vs. HCTZ (n = 20): 151.4 +/- 6.3 and 125.70 +/- 4.6 (p0.001) vs. 141.3 +/- 6.6 and 135.6 +/- 8.3 (p = N.S.); IND (n = 22) vs NFD (n = 19): 144.1 +/- 5.3 and 125.1 +/- 4.3 (p0.001) vs. 170.4 +/- 6.6 and 148.2 +/- 6.2 (p0.001); IND (n = 9) vs. ENL (n = 9): 155.1 +/- 6.3 and 143.4 +/- 5.2 (p0.001) vs. 142.0 +/- 6.7 and 130.0 +/- 5.9 (p0.001); IND (n = 17) vs. ATL (n = 12): 146.2 +/- 5.1 and 130.8 +/- 6.5 (p0.001) vs. 156.7 +/- 8.4 and 142.9 +/- 10.3 (p0.01). All drugs significantly reduced diastolic blood pressure, and all except HCTZ induced a significant and similar reduction in left ventricular mass.

A 27-year-old man presented with bilateral testicular pain and enlargement of the right testis caused by a cystic mass. Histological examination of a frozen section at exploration excluded malignancy and the final diagnosis after local excision was benign epidermoid cyst. The patient remained well three years later.