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The main objective was to assess the performance of the neutrophil-lymphocyte ratio (NLR) for early prediction of delayed neurological impairment and cerebral contusion worsening in patients with mild-to-moderate traumatic brain injury (TBI).Over a 3-year period, every adult patient triaged to our level 1 trauma center with brain contusion and Glasgow Coma Scale (GCS) of 10 or greater were retrospectively included. The main study outcome was the occurrence of delayed clinical deterioration, defined as a GCS10 and/or a secondary need for mechanical ventilation, within 5 days after TBI. The performance of NLR for prediction of delayed clinical deterioration was assessed by receiver operating characteristic (ROC) curve.Overall, 115 patients were included and 16 (14%) presented a delayed clinical deterioration. Overall, the NLR at ED admission was higher in patients who developed a delayed clinical deterioration (18 [12-29] vs 8 [5-13], p = 0.0003). The area under the ROC curves for NLR at ED admission in predicting delayed clinical deterioration was 0.79 [0.65-0.93] and NLR15 was found to be independently associated with the occurrence of delayed clinical deterioration (adjusted OR = 10.1 [95%CI: 2.3-45.6]).The NLR at ED admission was independently associated with the occurrence of delayed clinical deterioration, although limited by a poor discriminative value by itself. Further studies are needed to test the predictive value of composite scoring systems including NLR for prevention of under-triage of patients with mild-to-moderate TBI.

OBJECTIVE Our aim was to determine independent risk factors of clinical bleeding of hepatocellular adenoma (HCA) to define a better management strategy. SUMMARY BACKGROUND DATA HCA is a rare benign liver tumor with severe complications: malignant transformation that is rare (5%-8%) and more often, hemorrhage (20%-27%). To date, only size > 5 cm and histological subtype (possibly sonic hedgehog) are associated with bleeding, but these criteria are not clearly established. METHODS We retrospectively collected data from a cohort of 268 patients with HCA managed in our tertiary center, from 1984 to 2020 and focused on clinical bleeding. Hemorrhage was considered severe when it required intensive care and moderate when bleeding symptoms required a hospitalization. We included 261 patients, of whom 130 (49.8%) had multiple HCAs or liver adenomatosis. All surgical specimen and liver biopsy were reviewed by an experienced liver pathologist and reclassified in the light of the current immunohistochemistry. Mean duration of follow-up was 93.3 months (range 1-363). We analyzed type, frequency, consequences of bleeding, and risk factors among clinical data and HCA characteristics. RESULTS Eighty-three HCA (31.8%) were hemorrhagic. There were 4 pregnant women with 1 newborn death. One patient died before treatment. Surgery was performed in 78 (94.0%) patients. Mortality was nil and severe complications occurred in 11.5%. Multivariate analysis identified size (OR 1.02 [1.01-1.02], P < 0.001), shHCA (OR 21.02 [5.05-87.52], P < 0.001), b-catenin mutation on exon 7/8 (OR 6.47 [1.78-23.55], P = 0.0046), chronic alcohol consumption (OR 9.16 [2.47-34.01], P < 0.001) as independent risk factors of clinical bleeding. CONCLUSIONS This series, focused on the hemorrhagic risk of HCA, shows that size, but rather more molecular subtype is determinant in the natural history of HCA.

Background and Aims : Through an exploratory proteomic approach based on typical hepatocellular adenomas (HCAs), we previously identified a diagnostic biomarker for a distinctive subtype of HCA with high risk of bleeding, already validated on a multicenter cohort. We hypothesized that the whole protein expression deregulation profile could deliver much more informative data for tumor characterization. Therefore, we pursued our analysis with the characterization of HCA proteomic profiles, evaluating their correspondence with the established genotype/phenotype classification and assessing whether they could provide added diagnosis and prognosis values. Approach and Results : From a collection of 260 cases, we selected 52 typical cases of all different subgroups on which we built a reference HCA proteomics database. Combining laser microdissection and mass-spectrometry–based proteomic analysis, we compared the relative protein abundances between tumoral (T) and nontumoral (NT) liver tissues from each patient and we defined a specific proteomic profile of each of the HCA subgroups. Next, we built a matching algorithm comparing the proteomic profile extracted from a patient with our reference HCA database. Proteomic profiles allowed HCA classification and made diagnosis possible, even for complex cases with immunohistological or genomic analysis that did not lead to a formal conclusion. Despite a well-established pathomolecular classification, clinical practices have not substantially changed and the HCA management link to the assessment of the malignant transformation risk remains delicate for many surgeons. That is why we also identified and validated a proteomic profile that would directly evaluate malignant transformation risk regardless of HCA subtype. Conclusions : This work proposes a proteomic-based machine learning tool, operational on fixed biopsies, that can improve diagnosis and prognosis and therefore patient management for HCAs.

CONTEXT Chronic environmental pollutions are one of the most striking examples of negative externalities of intensive agriculture. To address this issue, an agroecological transition is necessary, requiring new design methods: While most design methods are suited to the field or farm scale, some innovations require an approach at the scale of the territory. OBJECTIVE In this article, we propose a new method to design an agricultural territory aiming to overcome an environmental pollution issue, i.e. to identify one or more combinations of agricultural practices, implemented by the farmers of the territory that reduce water pollution. METHODS We implemented the new method following three steps: first, we used a sociotechnical diagnosis to identify cognitive biases that prevent the actors from innovating in a disruptive way. Second, we used the K C method (based on C K theory) to allow actors to innovate in a disruptive way. Third, we used a serious game to continue the design of the innovations and to test and assess them in a safe place. We implemented this new method in the Galion River watershed in Martinique (French West Indies) whose river is polluted by herbicides. RESULTS AND CONCLUSION Using the method, actors have overcome existing path dependencies. Based on this, the method made it possible to design different innovations across scales in a participative way and with a systemic territorial point of view. Here, actors designed 15 innovations that enhance either the territory or the pooling of its resources. Among these, there was the sharing of the service of an itinerant breeder or the implementation of an ecotouristic circuit. Actors combined innovations across scales into three scenarios that created a new agricultural territory with fewer agricultural herbicides in the river. SIGNIFICANCE We suggest adding two participatory steps to improve the level of genericity of the method: a first step to discuss the initial question and the general organisation of the participatory process, followed by a second step dealing with how to insert the designed innovations in the serious game. Finally, we recommend this method in other territories requiring collective practice changes.

International audience; Background & aims: Two-dimensional shear wave elastography (2D-SWE) is an accurate method for the non-invasive evaluation of liver fibrosis. We aimed to determine the reliability criteria and the number of necessary reliable measurements for 2D-SWE.Methods: 788 patients with chronic liver disease underwent liver biopsy and 2D-SWE examination in three centers. The 4277 2D-SWE measurements performed were 2:1 randomly divided into derivation (n = 2851) and validation (n = 1426) sets. Reliability criteria for a 2D-SWE measurement were defined in the derivation set from the intrinsic characteristics given by the device (mean liver stiffness, standard deviation, diameter of the region of interest), with further evaluation in the validation set.Results: In the whole population of 4277 measurements, AUROC for bridging fibrosis was 0.825 ± 0.006 and AUROC for cirrhosis was 0.880 ± 0.006. Mean stiffness and coefficient of variation (CV) were independent predictors of bridging fibrosis or cirrhosis. From these two parameters, new criteria were derived to define a reliable 2D-SWE measurement: stiffness

After liver transplantation (LT), the role of preformed donor-specific anti-human leukocyte antigen antibodies (pDSAs) remains incompletely understood. We conducted a retrospective, case-control analysis to determine the impact of pDSAs after LT in 3 French transplant centers (Bordeaux, Lyon, and Toulouse). Among the 1788 LTs performed during the study period, 142 (7.9%) had at least 1 pDSA. The patient survival rate was not different between patients who received an LT with pDSAs and the matched-control group. A liver biopsy was performed 1 year after transplantation in 87 recipients. The metavir fibrosis score did not differ between both groups (1 ± 0.8 versus 0 ± 0.8; P = 0.80). However, undergoing a retransplantation (hazard ratio [HR] = 2.6, 95% confidence interval [CI], 1.02-6.77; P = 0.05) and receiving induction therapy with polyclonal antibodies (HR = 2.5; 95% CI, 1.33-4.74; P = 0.01) were associated with a higher risk of mortality. Nonetheless, high mean fluorescence intensity (MFI) donor-specific antibodies (ie, >10,000 with One Lambda assay or >5000 with Immucor assay) were associated with an increased risk of acute rejection (HR = 2.0; 95% CI, 1.12-3.49; P = 0.02). Acute antibody-mediated rejection was diagnosed in 10 patients: 8 recipients were alive 34 (1-125) months after rejection. The use of polyclonal antibodies or rituximab as an induction therapy did not reduce the risk of acute rejection, but it increased the risk of infectious complications. In conclusion, high MFI pDSAs increase the risk of graft rejection after LT, but they do not reduce medium-term and longterm patient survival. The use of a T or B cell-depleting agent did not reduce the risk of acute rejection.

Networks are well-established representations of social systems, and temporal networks are widely used to study their dynamics. Temporal network data often consist in a succession of static networks over consecutive time windows whose length, however, is arbitrary, not necessarily corresponding to any intrinsic timescale of the system. Moreover, the resulting view of social network evolution is unsatisfactory: short time windows contain little information, whereas aggregating over large time windows blurs the dynamics. Going from a temporal network to a meaningful evolving representation of a social network therefore remains a challenge. Here we introduce a framework to that purpose: transforming temporal network data into an evolving weighted network where the weights of the links between individuals are updated at every interaction. Most importantly, this transformation takes into account the interdependence of social relationships due to the finite attention capacities of individuals: each interaction between two individuals not only reinforces their mutual relationship but also weakens their relationships with others. We study a concrete example of such a transformation and apply it to several data sets of social interactions. Using temporal contact data collected in schools, we show how our framework highlights specificities in their structure and temporal organization. We then introduce a synthetic perturbation into a data set of interactions in a group of baboons to show that it is possible to detect a perturbation in a social group on a wide range of timescales and parameters. Our framework brings new perspectives to the analysis of temporal social networks.

International audience; 3D printing aims at building a three-dimensional object from a computer-aided design model. More recently, (4D)-printing has appeared; it adds to (3D)-printing, a transformation of the printed material over time. (3D)-printing applied to foods has a unique potential to create geometric complex structures, enabling mass production while having economic and environment benefits. It permits to create personalized food based with specific properties related to nutritional needs, calorie intake, specific shape, texture, color, or flavor, for example. Currently, four types of 3D food printing technology have been explored: extrusion, inkjet, binder jetting, and selective sintering. In the literature, most of the investigations focus on improving the quality of the resolution of printed food whereas very few studies focus on developing technology that will give access large scale production systems. This review proposes a state-of-the-art major recent investigations in the 3D food printing field and its future perspectives.

Microwave heating (MW) is the most important method in bread baking owing to its efficiency in terms of space, speed, and ability to produce crustless bread. However, MW has some unfavorable effect...

Electronic ISBN: 978-3-030-74602-5 This book presents the proceedings of the 21st Congress of the International Ergonomics Association (IEA 2021), held online on June 13-18, 2021; International audience; To reach their desirable vision of what actors mean by sustainable agri-food systems, transition processes take place in which the work activities evolve. The present paper investigates such an evolution through the conceptual framework of organizational design in ergonomics. It aims to understand how evolves the work of actors involved in the transition towards more “localized” production, distribution and consumption of food. We propose to consider the sustainability transition of agri-food systems as an inter-organizational design process, a process by which people redesign rules that guide coordination between organizations. We approach local food systems at the territorial scale to grasp the news forms of coordination in their cultural, spatial, economic, technical, political and ecological context. We consider the inter-organizational design process as the meso-level of actions, which articulates with the micro-level (work activities) as well as the macro-level (public policies, norms in food consumption). The paper presents the case of the association C, which manages catering for a public organization on the Paris-Saclay Plateau. We investigate the ecosystem of actors of the association C, as well as the way by which the catering manager develops and redesigns coordination at the various levels of actions.

Background: Screening T2DM for NASH fibrosis using specific markers is mandatory, as liver enzymes are often normal despite advanced fibrosis. LIVERFASt (LF), a serum marker with CPT code for assessing liver fibrosis (LF-Fib), activity and steatosis had high performance for identifying severe NASH in T2DM. Aim: To demonstrate that LF-Fib is an alternative to biopsy (LB) for the estimation of the transition rate to fibrosis [F1 stage or more (TRF1)], in T2DM NAFLD with better performances than transient elastography (TE) and FIB4. Methods: TRF1 was evaluated using Cox-Mantel HazardRatios [HR(95%CI), logrank comparison] with a modeling of hazard from birth to age of LB, in prospectively collected NAFLD pts with concomitant LB and LF, TE, FIB4. Results: N=583pts were included, 52% T2DM, 56%males, median (range) age 59.5% (18-85), HbA1c 6.6% (4.7-12), BMI 31.5 (20-54)kg/m2 (obesity 59%). The estimation of TRF1 [HR(95%CI)] using LF-Fib was similar to that of LB in both T2DM [0.67 (0.56-0.80) vs. 0.65( 0.54-0.79)], and no-T2DM [1.50 (1.26-1.78) vs. 1.54 (1.27-1.86)], respectively, with earlier TRF1 in no-T2DM (logrank p Conclusion: Validated biomarkers such as LIVERFASt should allow a powerful analysis of fibrosis progression in T2DM similar to LB and better screening strategies for stratifying T2DM. Disclosure V. Deledinghen: None. M. Munteanu: Consultant; Self; Fibronostics. I. Alam: Advisory Panel; Self; Fibronostics. A. Delamarre: None. B. Lebail: None. H. Marraud-des-grottes: None. M. Irles-depe: None. M. Decraecker: None. J. Foucher: None. J. Hiriart: None. R. Quiambao: Employee; Self; Fibronostics.

Summary Background and aims Stopping oral contraceptives following nodule detection usually prevents further hepatocellular growth (HCA); rare cases of growth have been reported after surgery. The aim of the study was to review our resected HCA cases and their outcomes and more specifically, growth. Methods We retrieved all HCA cases that required a second intervention and HCA growth cases of none resected HCA after resection of one or several HCAs. Results Out of the 210 resected classified HCA cases, a second resection was performed in 5 cases, 4 of which were in women with HNF1alpha-inactivated adenomatosis (H-adenomatosis) and had a favorable outcome. The fifth case was the occurrence of an inflammatory HCA, 3 years after resection of a previous one. Of the 65 resected HNF1-inactivated HCAs (H-HCAs), the nodules that remained continued to increase very slowly in 3 adenomatosis cases. After surgery, the liver became dysmorphic years later in one case, and the nodules grew but not significantly in another case. After the diagnosis of adenomatosis, progressive growth leads to surgery 12 years later in the last case. Conclusion These results confirm that, in rare H-adenomatosis, size of nodules may increase very slowly, probably in part through coalescence of micro H-HCAs and leading occasionally to a second resection.

Hepatocellular adenomas (HCA) are rare benign hepatocellular tumors occurring mainly in women taking oral contraceptives with 2 major complications: severe bleeding and malignant transformation that can be avoided if nodules exceeding 5 cm are resected. This simple attitude has been challenged in the recent years with HCA in men, in young adolescent, in aged persons, and complications in hepatocellular adenomas below 5 cm. The discovery of specific mutations leading to specific phenotypes has modified the clinical spectrum of the disease. The phenotypic immune classification of HCA based on the molecular classification is being widely used in liver referral centers. The aim of this snapshot is to briefly present for each subtype the clinical, pathological, immuno-pathological criteria as well as the risk of complications and guidelines for treatment and management.

SummaryBackground The accuracy of available non-invasive tools for staging severe fibrosis in patients with nonalcoholic fatty liver disease (NAFLD) is still limited. Aim To assess the diagnostic performance of paired or serial combination of non-invasive tools in NAFLD patients. Methods We analysed data from 741 patients with a histological diagnosis of NAFLD. The GGT/PLT, APRI, AST/ALT, BARD, FIB-4, and NAFLD Fibrosis Score (NFS) scores were calculated according to published algorithms. Liver stiffness measurement (LSM) was performed by FibroScan. Results LSM, NFS and FIB-4 were the best non-invasive tools for staging F3-F4 fibrosis (AUC 0.863, 0.774, and 0.792, respectively), with LSM having the highest sensitivity (90%), and the highest NPV (94%), and NFS and FIB-4 the highest specificity (97% and 93%, respectively), and the highest PPV (73% and 79%, respectively). The paired combination of LSM or NFS with FIB-4 strongly reduced the likelihood of wrongly classified patients (ranging from 2.7% to 2.6%), at the price of a high uncertainty area (ranging from 54.1% to 58.2%), and of a low overall accuracy (ranging from 43% to 39.1%). The serial combination with the second test used in patients in the grey area of the first test and in those with high LSM values (>9.6 KPa) or low NFS or FIB-4 values (

Some evidence suggests an interference of obesity and alanine aminotransferase (ALT) levels on the diagnostic accuracy for advanced fibrosis of noninvasive tools such as liver stiffness measurement (LSM) by FibroScan, Fibrosis-4 (FIB-4), and nonalcoholic fatty liver disease fibrosis score (NFS). We assessed whether the diagnostic accuracy of LSM, Fibrosis-4 (FIB-4), and NFS and strategies based on the combination of these tools is affected by obesity and/or ALT levels.METHODS:We analyzed data from 968 patients with a histological diagnosis of nonalcoholic fatty liver disease. FIB-4, NFS, and LSM by FibroScan were measured.RESULTS:LSM was better than both FIB-4 and NFS for staging F3-F4 fibrosis area under the receiver operating characteristic curve test (AUC) 0.863, 0.777, and 0.765, respectively; P < 0.001 for both), showing higher accuracy and higher negative predictive value (NPV), but lower positive predictive value (PPV). LSM worked less well in high ALT (>100 IU) (AUC 0.811 vs 0.877, P = 0.04; PPV 57.5% vs 62.4%; NPV 90.7% vs 94%) or obese patients (AUC 0.786 vs 0.902, P < 0.001; PPV 58.7% vs 64.8%; NPV 88.3% vs 95.2%), the latter not being affected by the M or XL probe. Consistently, LSM worked better in terms of AUC and accuracy compared with both FIB-4 and NFS only in nonobese or high ALT patients, even with always keeping a slightly lower PPV. A serial combination of FIB-4 or NFS with LSM as the second test in patients in the gray area of the first test retained - in most scenarios - similar PPV and NPV compared with LSM alone. These strategies also increased the diagnostic accuracy of about 20% in all groups of patients, even if with a lower overall accuracy in obese patients (71.3% and 67.1% for FIB-4 and NFS as the first test, respectively) compared to nonobese patients (81.9% and 82.4% for FIB-4 and NFS as the first test, respectively).CONCLUSIONS:All tested noninvasive tools have overall better NPV than PPV. LSM has a better diagnostic accuracy for advanced fibrosis than both FIB-4 and NFS only in nonobese and/or low ALT patients. Serial combination strategies are better than a single tool strategy, regardless of obesity and ALT levels, although the accuracy is lower in obese patients.

The Continuous Very Long Baseline Interferometry (VLBI) Campaign 2017 (CONT17) was observed from November 28 to December 12, 2017 and featured three independent observing networks. Two legacy S/X networks of nominally 14 stations each observed in parallel for the full 15 days of the campaign. One of them was made possible in large part by the participation of the ten-station very long baseline array network of the long baseline observatory. Furthermore, for the 5-day period from December 4 to 8, 2017, a six-station broadband network continuously recorded VLBI global observing system data. The different networks will help probe the accuracy of the VLBI estimates of the Earth orientation parameters and investigate possible network biases. We describe the organizational efforts undertaken to realize CONT17, including the analysis of resources such as recording media, electronic data transfer, and correlation, the assignment of stations to the three networks, and source selection and schedule writing.

BackgroundThe Annals of Internal Medicine (AIM) has adopted a policy encouraging data-sharing since 2007.ObjectiveTo explore the impact of the AIM data-sharing policy for randomized controlled trials (RCTs) in terms of output from data-sharing (i.e. publications re-using the data).DesignRetrospective study.SettingAIM.ParticipantsRCTs published in the AIM between 2007 and 2017 were retrieved on PubMed. Publications where the data had been re-used were identified on Web of Science. Searches were performed by two independent reviewers.InterventionsIntention to share data (or not) expressed in a data-sharing statement.MeasurementsThe primary outcome was any published re-use of the data (i.e. re-analysis, secondary analysis, or meta-analysis of individual participant data [MIPD]), where the first, last and corresponding authors were not among the authors of the RCT. Components of the primary outcome and analyses without any author restriction were secondary outcomes. Analyses used Cox (primary analysis) models adjusting for RCT characteristics.Results185 RCTs were identified. 106 (57%) mentioned willingness to share data and 79 (43%) did not. 208 secondary analyses, 67 MIPD and no re-analyses were identified. No significant association was found between intent to share and re-use where the first, last and corresponding authors were not among the authors of the primary RCT (adjusted hazard ratio = 1.04 [0.47-2.30]). Secondary outcomes also showed no association between intent to share and re-use.LimitationsPossibility of residual confounding and limited power.ConclusionOver ten years, RCTs published in AIM expressing an intention to share data were not associated with more extensive re-use of the data.Registrationhttps://osf.io/8pj5e/Funding SourceGrants from the Fondation pour la Recherche Médicale, Région Bretagne, and French National Research Agency.

International audience; Herbicides used in agriculture pollute water worldwide. However, several weed management alternatives can reduce herbicide applications. The understanding of interactions between agronomics and the learning and social processes that favor changes in practices on a territorial scale is still far from complete. Despite the call for systemic change approaches, most studies are still based on technology transfer. Research and extension services provide references on alternative weed management practices and promote their use among farmers. We surveyed 33 farmers in a 45 km(2) tropical catchment plus five institutional extension services. We analyzed changes in weed management practices on the 33 farms belonging to three different agricultural chains: local diversified horticulture, sugarcane, and export banana. For each change, we analyzed the learning processes and the networks involved in information exchanges. First, we show that the complexity of the practices promoted by extension services limits their adoption. Second, we show that simple practices adopted by farmers are part of a slow trajectory of change involving the gradual acquisition of knowledge. A redesign of cropping systems can emerge as the result of a gradual adding of complexity in practices and/or a specific systemic change on a cropping system scale. Sharing knowledge and resources in a non-competitive way speeds up changes among farmers sharing resources and promotes the redesigning of cropping systems. Third, we show that the structure and functioning of relational networks limit changes in practices on a watershed scale. We thus recommend that innovation design should incorporate co-designing of the pathway of change, by designing a succession of simple changes rather than a complex final system only. We recommend including non-competitive resource pooling among farmers in the co-designing of innovation.

International audience; AbstractSome chemical herbicides used by farmers in Martinique contaminate rivers. Agroecological innovations exist, some of which are known by the stakeholders but are not systematically used at the scale of the watersheds concerned. Our hypothesis is that the sociotechnical agricultural supply chain system built over the last 30 years restricts innovations for herbicide use in weed management systems, blocking the sustainable transition of territories. The sociotechnical system theory was chosen as the analysis framework to identify obstacles in supply chains. As the issue cut across the supply chains at the scale of the territory, this framework was completed, for the first time, by a study of the existing links between supply chain innovation strategies and the territory through its spatial, organisational and conceptual dimensions. Interviews with supply chain actors and a review of the grey literature were analysed using this framework. We show that the development of innovations, their type and the network of actors producing them were defined within each supply chain, according to their own objectives, with few exchanges at all levels of the territory. The efficiency of such development depended on the extent to which the supply chains are structured and, particularly, on their degree of integration and the strength of relationships between stakeholders. Indeed, watershed scale objectives are not taken into consideration in changes of practice. In this way, we identified lock-in constraining innovations design taking into account the objectives of the impact area (watershed) across supply chains for the first time.

The structure of cereals and snack foods during processing is developed according to structural changes at various levels of matter organization. At macroscopic scale, two main consecutive mechanisms rule these changes: (1) the transition from a powder (the flour) to a viscoelastic liquid (the dough, the paste) and (2) the transition from a liquid to a solid, soft or rigid. At mesoscopic scale, these changes can be first captured through state diagrams that represent the material rheological properties as functions of the composition. These diagrams and functions can be enriched with the paths followed by the food product along processing. All together, these representations, called basic knowledge models, can provide scientists and engineers with a comprehensive basis to predict the development of structure and final properties of the food. In this chapter, we will strive to apply basic knowledge models for predicting texture properties to several types of airy cereal and snack foods (bread, biscuits, cakes, and extruded snacks taken as examples). A specific effort is devoted to build a generic approach of structure development that can be applied to the design of cereal foods with targeted sensory and nutritional properties.

International audience; Food freezing is a complex process, involving heat transfer and a series of physical and chemical changes which may profoundly affect the product quality. Several novel freezing methods have been developed in recent times taking into account the energy saving and/or quality preservation to a greater extent upon thawing. Electro-freezing technique, especially electric field assisted freezing is gaining momentum among them; it offers less energy intensive freezing conditions (higher set point ambient temperature, lower air velocity), and allows better quality retention. In the present short review article, a focused overview of the main findings and the latest studies regarding the applications of electro-freezing in food is given.

This article focuses on the practice of French cuisine in Shanghai and questions the permanence of this professional niche. It combines an anthropological approach to culinary techniques with a sociological approach to workforce migration, tracing the ways in which the discourse and practices of chefs and maîtres d’hôtel working in French cuisine’s restaurants employ forms of ethnocultural and technical legitimacy. The case of Shanghai, a city undergoing rapid transformation in its modes of consumption, provides a clear illustration of the shifts that have occurred over the last ten years in the hierarchy of Western migrants and Chinese locals: the symbolic and material privileges offered to the former are beginning to disappear, and professional recognition is increasingly becoming based on savoir-faire and a strong work ethic.

e21030 Background: Despite recent advances in non-small cell lung cancer (NSCLC) treatment, a need remains for treatment options at disease progression. Tusamitamab ravtansine (SAR408701) is an antibody-drug conjugate of a humanized CEACAM5-specific monoclonal antibody linked to the maytansinoid DM4, a potent anti-tubulin agent. In a Phase 1/2 study, tusamitamab ravtansine showed promising antitumor activity in pretreated advanced non-squamous NSCLC (NSQ NSCLC) patients with high CEACAM5 expression, defined as ≥ 50% of the tumor cells per specimen with CEACAM5 positive staining at ≥ 2+ intensity (Gazzah A et al. J Clin Oncol 2020;38[15]: 9505). Sanofi and Agilent have partnered to develop an immunohistochemical (IHC) assay, CEACAM5 IHC 769, for detection of CEACAM5 protein in formalin-fixed paraffin-embedded (FFPE) NSQ NSCLC tissue using the EnVision FLEX visualization system on Dako Omnis. This assay is in development for the assessment of patients for whom tusamitamab ravtansine is being considered. Methods: CEACAM5 IHC 769 is a qualitative IHC assay using mouse monoclonal anti-CEACAM5 clone 769. Murine anti-CEACAM5 clone 769 is based on tusamitamab ravtansine, with the same specificity as the drug for CEACAM5. The clone was developed by Sanofi and used to evaluate CEACAM5 expression in a Phase 1/2 trial. The CEACAM5 IHC 769 scoring algorithm defines positive staining as any partial or complete tumor cell plasma membrane staining at ≥ 2+ intensity. Membrane staining may be linear or punctate. Staining may appear as complete or partial staining involving the basal, lateral, or basolateral aspects of the membrane, or as apical staining of the luminal aspect of the cell. CEACAM5 IHC 769 is being validated by Agilent Technologies for NSQ NSCLC at the cutoff of ≥ 50% at ≥ 2+ intensity. Internal studies included sensitivity, specificity, intra-block heterogeneity, observer precision, laboratory repeatability/precision, and robustness. Results: Sensitivity studies demonstrated detection across a dynamic range of CEACAM5 expression. Specificity studies indicated that the antibody is specific for CEACAM5. An intra-block heterogeneity study showed good overall diagnostic agreement for sections from the same tumor (point estimate ≥ 85%). Inter- and intra-observer precision, laboratory repeatability/precision, and robustness validation studies met acceptance criteria; the lower bound of the two-sided 95% confidence interval was ≥ 85% for positive, negative, and overall percent agreement. Conclusions: Internal validation studies demonstrated that CEACAM5 IHC 769 is sensitive, specific, precise, reproducible and robust in evaluating CEACAM5 expression in NSQ NSCLC tissue at the cutoff of ≥ 50% at ≥ 2+ intensity. CEACAM5 IHC 769 is being used for patient selection/stratification in ongoing Phase 2 and 3 clinical trials of tusamitamab ravtansine.

Introduction To investigate the technical feasibility of optical biopsy (probe-based confocal laser endomicroscopy [pCLE]) during laparoscopy and by the vaginal route in the exploration of pelvic gynecological cancers. Methods Prospective study including 31 patients undergoing laparoscopic hysterectomy (benign or malignant indication). Confocal microlaparoscopy (analysis of tubes, ovaries, and depending on the type de cancer, pelvic adenopathies) and optical biopsy of the endometrium were first carried out by the vaginal route under general anesthesia. The surgical procedure was then carried out. Results Thirty-one consecutive patients were included (16 for benign hysterectomy, 12 for endometrial cancer and 3 for ovarian carcinoma). pCLE offered dynamic pictures that were correlated with the histopathological images. Discussion and conclusion pCLE provides high resolution imaging of cancerous and benign tissues in real-time similar to histopathological results. Both feasibility and safety were confirmed.

Large Marine Ecosystems located around the margins of the continents provide a countless number of goods and services that sustain and fulfill human life and activities: seafood; habitats; energy sources; nutrient cycling and primary production; weather and climate regulation; coastal protection; water detoxification; sediments trapping; and cultural and economic services, among others. Of 66 Large Marine Ecosystems, ten LMEs are located along the coasts of Latin America – California Current, Gulf of California, Gulf of Mexico, Pacific Central American Coastal, Caribbean Sea, Humboldt Current, Patagonian Shelf, South Brazil Shelf, East Brazil Shelf and North Brazil Shelf. Each one possesses different characteristics that make it unique and essential for local populations. Unfortunately, these Large Marine Ecosystems are threatened by several factors such as coastal population growth, pollution, overexploitation and climate change, but most of all poor governance practice. The concept of Ecosystem Based Management aims to consider ecosystems health and importance in all aspects of the recovery and sustainability of LME goods and services. This chapter introduces a general description of the Large Marine Ecosystem approach to sustainable development of coastal ocean resources, presents the concept of Ecosystem Based Management, describes some goods and services provided by Large Marine Ecosystems and draws a picture of each Latin American Large Marine Ecosystem.

Background This study assessed the preliminary safety, pharmacokinetics (PK) and anti-tumor effects of aflibercept in combination with 5-fluorouracil, leucovorin and irinotecan (FOLFIRI) in Chinese patients with previously-treated advanced solid malignancies. Patients and Methods This open-label single-arm Phase I study conducted at two centers in China included adult (≥18 years) patients with metastatic or unresectable solid malignancies who had received ≥1 prior treatment. Patients received aflibercept 4 mg/kg IV on Day 1 followed by FOLFIRI over Days 1 and 2 every 2 weeks, and were assessed for safety, tumor response, PK parameters and immunogenicity. Post-hoc analyses included calculation of progression-free survival (PFS) for patients with colorectal cancer (CRC). Results A total of 20 patients were enrolled. The most common Grade 3/4 adverse events included neutropenia (35%), hypertension (30%), stomatitis (20%) and proteinuria (20%), and no anti-aflibercept antibodies were detected. Six patients achieved a partial response, and in 15 patients with CRC median PFS was 5.95 months (95% CI: 5.29–8.77). Free aflibercept remained in excess of VEGF-bound aflibercept for the majority of the study treatment duration. The mean free aflibercept values for Cmax (64.8 μg/mL) AUC (291 μg.day/mL), CL (0.92 L/day) and Vss (5.9 L) were similar to those measured in Caucasian patients. The addition of aflibercept did not influence the PK of the chemotherapy agents. Conclusion For Chinese patients with pre-treated advanced solid malignancies, 4 mg/kg of aflibercept in combination with FOLFIRI was well-tolerated, demonstrated preliminary anti-tumor activity and had a PK profile consistent with that in Caucasian patients.

Background: In-hospital mortality of ST-segment–elevation myocardial infarction (STEMI) has decreased drastically. In contrast, prehospital mortality from sudden cardiac arrest (SCA) remains high and difficult to reduce. Identification of the patients with STEMI at higher risk for prehospital SCA could facilitate rapid triage and intervention in the field. Methods: Using a prospective, population-based study evaluating all patients with STEMI managed by emergency medical services in the greater Paris area (11.7 million inhabitants) between 2006 and 2010, we identified characteristics associated with an increased risk of prehospital SCA and used these variables to build an SCA prediction score, which we validated internally and externally. Results: In the overall STEMI population (n=8112; median age, 60 years; 78% male), SCA occurred in 452 patients (5.6%). In multivariate analysis, younger age, absence of obesity, absence of diabetes mellitus, shortness of breath, and a short delay between pain onset and call to emergency medical services were the main predictors of SCA. A score built from these variables predicted SCA, with the risk increasing 2-fold in patients with a score between 10 and 19, 4-fold in those with a score between 20 and 29, and >18-fold in patients with a score ≥30 compared with those with scores P for trend Conclusions: At the early phase of STEMI, the risk of prehospital SCA can be determined through a simple score of 5 routinely assessed predictors. This score might help optimize the dispatching and management of patients with STEMI by emergency medical services.

Background Cardiovascular risk factors (CVRF) are associated with an increased risk of atherosclerosis and ST-segment elevation myocardial infarction (STEMI). Sudden cardiac arrest (SCA) is currently the most feared complication of STEMI. The impact of CVRF on the rate of SCA is still unknown. Purpose To assess the association between CVRF and pre-hospital SCA during acute STEMI. Methods Data were taken between 2006 and 2014 from the e-MUST study that enrolls all STEMI managed by EMS in the Greater Paris Area, including those dead before hospital admission. Characteristics of patients who presented SCA were compared to those of patients who did not, and multivariable logistic regression was developed including all variables that differed between the two groups, in order to identify characteristics associated with an increased risk of SCA. Results Over the study period, 13,253 STEMI patients were included (median age 60.1 [51.4 - 73.0], 78.1% males). Among them, 7,513 patients (58.1%) had ≥2 CVRF, 3,979 (30.8%) had 1 CVRF, and 1,432 (11.1%) did not present any CVRF. Pre-hospital SCA witnessed by emergency medical services occurred in 749 (5.6%) patients. SCA victims were younger compared to the non-SCA group (58.0 vs. 60.3 years (P Conclusion The prevalence of CVRF is high among patients presenting STEMI. However, once STEMI has occurred, presence of CVRF is associated with a lower rate of SCA per STEMI, creating a risk factor paradox in STEMI-related SCA.

Background L-type calcium channel (LTCC) trafficking controls LTCC density at T-tubule levels for optimal Excitation-Coupling (EC) and resultant adaptive heart work. In some forms of heart failure (HF), abnormalities in calcium-induced calcium-release have been proposed to arise from alteration of T-tubular dyad architecture (LTCC-RyRs) associated with impaired LTCC density. Recently, the R7W-MP peptide, working as a binder of the LTCC Cavβ2 chaperone, was shown to restore the altered density of LTCC current by both promoting forward and reducing reverse trafficking, which consequently improved cellular calcium homeostasis. Accordingly, R7W-MP improved the impaired cardiomyocyte calcium current density and the reduced Ejection Fraction (EF%) in a pharmacologically-induced diabetes model (STZ mice). We aimed to investigate further the benefit to improve LTCC trafficking pathway with R7W-MP in a more physiological model of HF (senescent mice) and in a Dilated Cardiomyopathy (DCM) model (HO MYBPC3 targeted KI mutant). Methods Senescent male C57Bl/6J mice (26 months) or HO MYBPC3 KI male mice (2 months) were treated with R7W-MP (3 mg/kg/d IP for 3 days). Echocardiographies (echo) were conducted before treatment and 4-hours after the last injection. When applied, Pressure-Volume (PV)-loop investigations were conducted one day post-echo 4 hours following an additional R7W-MP injection. Results In senescent mice population, HF was characterized by a midrange ejection fraction (EF%= 43±2 vs 55±1 for young adult mice) associated with enlarged ventricles and decreased cardiac contractility. In contrast to a scrambled peptide (scrP), R7W-MP markedly increased EF% monitored by echo (+38%, 63±3 vs 45±1 for scrP, p≤0.001, n=6–7) without modification of heart rate. EF% improvement was confirmed by PV-loop analysis (78±3 vs 51±4 for scrP (+54%), p≤0.001, n=5), associated with a marked, although not significant, 2.5-fold increase in myocardial contractility [end systolic pressure volume relationship (ESPVR) = 12.1±3.6 vs 4.9±1.3 for scrP, p=0.10, n=4]. Stroke volume, cardiac output and end diastolic volume tended to decrease suggesting an impaired LV filling at this dose regimen. In the DCM model, HF was more severe with a dramatically low EF% (26±1, n=8), impaired myocardial contractility and a pronounced left ventricle enlargement. R7W-MP significantly increased EF% (+17%, reaching 31±1, p≤0.01, n=8) without altering heart rate. Stroke volume was significantly increased by 36% (32±3 vs 24±3 mL at baseline, p≤0.01), without any impairment of diastolic function. All parameters returned to baseline after a 2 week-washout period. Conclusions R7W-MP displays potent positive inotrope properties in senescent or DCM mice models. Although further asses tsments of diastolic function are needed (different dosing and duration), these data underline the potential benefit brought by LTCC trafficking modulation to treat severe dilated cardiomyopathy.

Massive Machine Type Communication (mMTC) technologies are key to addressing communication requirements of various emerging IoT applications. In this work, a multisite mMTC test network is designed and implemented in order to investigate the long-term communication quality and sensor data of LoRa and NB-IoT. This is essential for remote network maintenance operations, because it allows distinguishing communication quality defects from software/hardware failures. Moreover, it provides additional information about the communication link quality for network management. The test network is geographically scattered over a large area in Finland and experimented both in private and public networks. Measurements on LoRaWAN test networks revealed that higher SNRs and RSSIs are generally achieved for devices with lower spreading factors. Comparison of NB-IoT and LoRaWAN shows that NB-IoT has better communication quality performance. Overall, this paper provides first long-term multi-site and multi-technology mMTC measurements and corresponding performance analysis that are not available in the existing literature.

Background & Aims Advanced liver fibrosis is an important diagnostic target in non-alcoholic fatty liver disease (NAFLD) as it defines the subgroup of patients with impaired prognosis. The non-invasive diagnosis of advanced fibrosis is currently limited by the suboptimal positive predictive value and the grey zone (representing indeterminate diagnosis) of fibrosis tests. Here, we aimed to determine the best combination of non-invasive tests for the diagnosis of advanced fibrosis in NAFLD. Methods A total of 938 patients with biopsy-proven NAFLD were randomized 2:1 into derivation and validation sets. All patients underwent liver stiffness measurement with vibration controlled transient elastography (VCTE) and blood fibrosis tests (NAFLD fibrosis score, Fibrosis-4 [FIB4], Fibrotest, Hepascore, FibroMeter). FibroMeterVCTE, which combines VCTE results and FibroMeter markers in a single test, was also calculated in all patients. Results For the diagnosis of advanced fibrosis, VCTE was significantly more accurate than the blood tests (area under the receiver operating characteristic curve [AUROC]: 0.840 ± 0.013, p ≤0.005). FibroMeter was the most accurate blood test (AUROC: 0.793 ± 0.015, p ≤0.017). The combinatory test FibroMeterVCTE outperformed VCTE and blood tests (AUROC: 0.866 ± 0.012, p ≤0.005). The sequential combination of FIB4 then FibroMeterVCTE (FIB4-FMVCTE algorithm) or VCTE then FibroMeterVCTE (VCTE-FMVCTE algorithm) provided an excellent diagnostic accuracy of 90% for advanced fibrosis, with liver biopsy only required to confirm the diagnosis in 20% of cases. The FIB4-FMVCTE and VCTE-FMVCTE algorithms were significantly more accurate than the pragmatic algorithms currently proposed. Conclusion The sequential combination of fibrosis tests in the FIB4-FMVCTE and VCTE-FMVCTE algorithms provides a highly accurate solution for the diagnosis of advanced fibrosis in NAFLD. These algorithms should now be validated for the diagnosis of advanced liver fibrosis in diabetology or primary care settings. Lay summary The evaluation of liver fibrosis is mandatory in non-alcoholic fatty liver disease (NAFLD), as advanced fibrosis identifies the subgroup of patients with impaired prognosis. FibroMeterVCTE is a new fibrosis test combining blood markers and the result of vibration controlled transient elastography (VCTE) into a single diagnostic test. Our results show that FibroMeterVCTE outperforms other blood fibrosis tests and VCTE alone for the diagnosis of advanced fibrosis in a large multi-centric cohort of 938 patients with biopsy-proven NAFLD. Sequential algorithms using a simple blood test or VCTE as a first-line procedure, then FibroMeterVCTE as a second-line test accurately classified 90% of patients.

International audience; Because only a minority of patients with nonalcoholic fatty liver disease (NAFLD) have advanced fibrosis and would eventually develop liver-related complications, current guidelines recommend initial assessment with noninvasive tests of fibrosis.1-3 Most previous studies focused on overweight and obese patients. Despite a strong association between obesity and NAFLD, 3%-30% of people with relatively normal body mass index (BMI) may still have NAFLD.4,5 Hence, this study aims to evaluate the performance of the common noninvasive tests in non-obese (BMI

Freezing is an efficient and widely used method of food preservation. However, it can also cause irreversible damages at cellular level which in turn degrade the overall quality of the frozen food products. Therefore, qualitative and quantitative methods and technologies that will be able to evaluate with accuracy the freeze damage are of great importance. This review paper provides a comprehensive study of the methods that have been used to evaluate the freeze damage in fruits and vegetables. Further than the principles and the applications of those methods, the advantages and the limitations are also being discussed.

ObjectivesThe primary objective of this study is to determine the current level of patient medication exposure in Level 3 Neonatal Wards (L3NW). The secondary objective is to evaluate in the first month of life the rate of medication prescription not cited in the Summary of Product Characteristics (SmPC). A database containing all the medication prescriptions is collected as part of a prescription benchmarking program in the L3NW.Material and methodsThe research is a two-year observational cohort study (2017-2018) with retrospective analysis of medications prescribed in 29 French L3NW. Seventeen L3NW are present since the beginning of the study and 12 have been progressively included. All neonatal units used the same computerized system of prescription, and all prescription data were completely de-identified within each hospital before being stored in a common data warehouse.ResultsThe study population includes 27,382 newborns. Two hundred and sixty-one different medications (International Nonproprietary Names, INN) were prescribed. Twelve INN (including paracetamol) were prescribed for at least 10% of patients, 55 for less than 10% but at least 1% and 194 to less than 1%. The lowest gestational ages (GA) were exposed to the greatest number of medications (18.0 below 28 weeks of gestation (WG) to 4.1 above 36 WG) (pConclusionNeonates remain therapeutic orphans. The consequences of polypharmacy in L3NW should be quickly assessed, especially in the most immature infants.

Background Cardiac surgeons at our hospital asked the pharmacy for a new device to reduce bleeding during aortic suture. HEMO-SEAL (ETHICON) suture offers a decrease in the ratio of needle-to-suture diameters that would reduce needle-hole bleeding. This device is more expensive than an equivalent classic suture. According to the only study available from ETHICON, a 67% reduction in bleeding was observed with this technology. Purpose The purpose of this work was to compare in vitro a classic suture and a HEMO-SEAL (HS) suture. Material and methods We used two equivalent sutures: a classic and a HS suture of the same diameter (USP 5/0), with identical needle characteristics (tip geometry, curvature, length). First, we compared the two sutures with a binocular loupe. Then, we developed an experimental model to compare the bleeding with the two sutures. We created a circuit with water sent at a pressure of 90 mmHg into a vascular prosthesis in which we passed each suture model without making a knot. We collected the water that flowed from the holes in our suture through our prosthesis over 5 min. Then, we compared the weight of water collected with the two sutures. A sample size of n=6 was completed for each group. Results are expressed in terms of mean ±standard deviation. Results The two sutures both strictly look the same with the binocular loupe, except the region at the needle attachment of the HS suture, which had a smaller diameter. The average weight of the water collected was 28 g (±5) and 8 g (±1) for the classic suture and HS suture, respectively. We obtained a 71% reduction with the HS suture (p Conclusion The HS suture really seems to reduce needle-hole bleeding. In order to get as close as possible to the in vivo conditions, it would be interesting to repeat tests with anastomoses performed by a surgeon. Furthermore, clinical impact of this reduction in bleeding remains to be assessed. References and/or acknowledgements https://www.ncbi.nlm.nih.gov/pubmed/?term=needle+to+suture+ration%2C+as+well+as+suture+material# No conflict of interest.

Background During the urology device tender, a new ureteral catheter (UC) was proposed: the UROTECH’s MAGNETIC BLACK-STAR kit, which is three times more expensive than the traditional UC (non-magnetic rigid polyurethane double loop UC). Its bladder side magnet allows its removal thanks to a magnetic recovery device. As this new technique is faster and requires no endoscope or re-sterilisable equipment, the additional cost of purchase would be offset during the withdrawal, and the discomfort would be reduced for the patient, according to the manufacturer. Purpose We wanted to estimate the overall cost differences for our hospital between the BLACK-STAR UC and a traditional UC, and compare our results with an estimation made by the manufacturer to another hospital. Material and methods The estimation is based on the time spent by the nurse and surgeon, and the exhaustive listing of the devices used during the removal procedure of the two UC, in men and women. The estimated costs of using re-sterilisable medical devices include depreciation and sterilisation. For the flexible endoscope, this was evaluated in 2015 in our hospital by also integrating the maintenance cost. As the placement technique is identical for both UC, the cost of the equipment used was not evaluated. Results In men the cost is estimated at €209 for the usual UC removed by flexible cystoscopy versus €124 for the magnetic UC (gain of €85 with the magnetic UC, higher than the €63 announced). In women, the cost is estimated at €84 for the usual UC removed by rigid cystoscopy, versus €124 for the magnetic UC (€40 more expensive with the magnetic UC, contrary to the gain of €32 announced). Since the magnetic UC was placed but not yet removed, this estimation does not include the cost of hospital staff. Conclusion The economic evaluation conducted in our hospital is largely in favour of the use of the magnetic UC in men. Although this is not the case for women, its referencing to replace the current UC could save more than €12 000 per year in our hospital, based on 2017 consumption. Patient satisfaction also remains to be assessed. References and/or acknowledgements No conflict of interest.

Legume cultivation has been declining for several decades in France and in Europe as a whole. This is the result of the agri-food system lock-in around major crops, which has led to a strong simplification of cropping systems and a specialization of territories, in which legumes have been marginalized. Introducing or increasing legume production on farms has become a key issue in many European countries. Studies investigating the process of change of farmers growing legumes are missing. We analyze here the trajectories of farms cultivating legumes, with a view to understanding how and why farmers have modified their practices over the long term and to what extent this can help to support further introduction of legumes on farms. We interviewed 26 farmers growing legumes, in two French regions (Burgundy and Pays de la Loire), to understand the changes of their practices in terms of legume introduction over time. We developed a methodology to analyze farmers' trajectories based on the identification of (1) agronomic-coherence phases during which practices are stable and (2) the process of change from one coherence phase to another. The analysis of the 26 trajectories allowed us to distinguish four transitional pathways according to the speed of change, the type of legumes cultivated, and the level of legume introduction. Here, we show for the first time that the transition to a high and sustainable level of legume introduction in farms, whether progressive or as a rupture, required the combination of three levers: (1) the stability of outlets (on-farm consumption or market opportunities), (2) knowledge and local references on the preceding crop effect of legumes, and (3) the farmer's involvement in peer-networks. Our results constitute a fruitful pathway to encouraging changes for both individual and collective support for farmers to facilitate the introduction of legumes.

OBJECTIVE Mortality in patients with ST-segment elevation myocardial infarction (STEMI) has been associated with the volume of activity of percutaneous coronary intervention (PCI) facilities. This observational study investigated whether the coronary reperfusion-decision rate is associated with the volume of activity in a prehospital emergency setting. METHODS Prospectively collected data for the period 2003-2013 were extracted from a regional registry of all STEMI patients handled by eight dispatch centers (SAMUs) in and around Paris [41 mobile ICU (MICUs)]. A possible association between volume of activity (number of STEMIs) and coronary reperfusion-decision rate, and subsidiarily between volume of activity and choice of technique (fibrinolysis vs. primary PCI), were investigated. Explanatory factors (patient age, sex, delay between pain onset and first medical contact, and access to a PCI facility) were analyzed in a multivariate analysis. RESULTS Overall, 18 162 patients; male/female 3.5/1; median age 62 (52-72) years were included in the analysis. The median number of STEMIs per MICU was 339 (IQ 220-508) and that of reperfusion-decisions was 94% (91-95). There was no association between the decision rate and the number of STEMIs (P = 0.1). However, the decision rate was associated with age, sex, delay, and access to a PCI facility (P < 0.0001) in a highly significant way. Fibrinolysis was a more frequent option for low-volume (remoter PCI facilities) than high-volume MICUs (30 vs. 16%). CONCLUSION The decision of coronary reperfusion in a prehospital emergency setting depended on patient characteristics, delay between pain onset and first medical contact, and access to a PCI facility, but not on volume of activity. Promoting fibrinolysis use in underserved areas might help increase the reperfusion-decision rate.

Background: Mortality of ST-segment–elevation myocardial infarction (STEMI) decreased drastically, mainly through reduction in inhospital mortality. Prehospital sudden cardiac arrest (SCA) became one of the most feared complications. We assessed the incidence, outcome, and prognosis’ predictors of prehospital SCA occurring after emergency medical services (EMS) arrival. Methods and Results: Data were taken between 2006 and 2014 from the e-MUST study (Evaluation en Médecine d’Urgence des Strategies Thérapeutiques des infarctus du myocarde) that enrolls all STEMI managed by EMS in the Greater Paris Area, including those dead before hospital admission. Among 13 253 STEMI patients analyzed, 749 (5.6%) presented EMS-witnessed prehospital SCA. Younger age, absence of cardiovascular risk factors, symptoms of heart failure, extensive STEMI, and short pain onset-to-call and call-to-EMS arrival delays were independently associated with increased SCA risk. Mortality rate at hospital discharge was 4.0% in the nonSCA group versus 37.7% in the SCA group ( P P Conclusions: More than 1 of 20 STEMI presents prehospital SCA after EMS arrival. SCA occurrence is associated with a 10-fold higher mortality at hospital discharge compared with STEMI without SCA. PCI is the strongest survival predictor, leading to a twice-lower mortality. This highlights the persistently dramatic impact of SCA on STEMI and the major importance of PCI in this setting.

Background: Pre-operative chemotherapy for colorectal liver metastasis (CRLM) is thought to be the cause of hepatotoxicity of non-tumoural parenchyma. Studies on hepatotoxicity are contradictory. We investigated the impact of a single-line pre-operative chemotherapy on non-tumoural liver analysed by an expert hepatico-pancreatico-biliary pathologist, and the consequences on surgical outcomes. Patients and methods: Patients operated for CRLM, after a pure first-line pre-operative chemotherapy, were retrospectively included. Two comparative histopathological analyses were performed for vascular toxicity and steatohepatitis. Results: Between 2003 and 2015, 147 patients were included. Chemotherapy was based on oxaliplatin (40.1%), irinotecan (55.8%), or both (4.1%). The expert pathologist described 38.8% of vascular lesions including dilation, nodular regeneration, and peliosis. In multivariate analysis, vascular lesions correlated to male sex ( P = .01), pre-operative platelets 0.36 ( P = .02). Steatohepatitis was observed in 15 patients (10.2%), more frequently after irinotecan (14.8% vs 3.4%, P = .01; odds ratio [OR] = 7.3; 95% confidence interval [CI] = [1.5-34.7]), and for patients with body mass index (BMI) >25 kg/m2 ( P = .004; OR = 10.0; 95% CI = [2.1-47.5]). A total of 29 patients (19.7%) developed major complications with 2 risk factors: portal vein obstruction (PVO) and septic surgery. Reproducibility assessment of steatohepatitis and dilated lesions by 2 pathologists showed moderate agreement (Kappa score 0.53 and 0.54, respectively). Conclusions: There is a probable association between non-alcoholic steatohepatitis (NASH) and irinotecan. Oxaliplatin seems to lead to higher vascular lesions. Except in the presence of pre-existent comorbidities, liver toxicities should not restrain the use of pre-operative chemotherapy prior to parenchymal-sparing surgery.

Introduction: Recent studies reported a decrease in the incidence of acute myocardial infarction. This favorable evolution does not extend to young women. The interaction between gender, risk factors and myocardial infarction incidence remains controversial. Objective: To compare the evolution of the age pyramid of patients with ST-elevation myocardial infarction (STEMI) according to gender. Methods: Data from patients with STEMI managed in pre-hospital settings prospectively collected in the greater Paris area. Evolution of patient demographics and risk factors was investigated. Results: 28,249 patients with STEMI were included in the registry between 2002 and 2014, 21,883 (77%) males and 6,366 (23%) females. The sex ratio did not significantly vary over the study period (p = 0.4). Median patient age was 60.1 years (51.1&ndash, 73.0) and was significantly different between males and females, respectively 57.9 (50.0&ndash, 68.3) vs. 72.9 years (58.3&ndash, 82.2) (p = 0.0004). The median age of males significantly (p = 0.0044) increased from 57.6 (50.1&ndash, 70.0) in 2002 to 58.1 years (50.5&ndash, 67.8) in 2014. The median age of females significantly (p = 0.0006) decreased from 73.7 (57.9&ndash, 81.8) to 69.6 years (57.0&ndash, 82.4). The median gap between the age of men and women significantly (p = 0.0002) decreased, from 16.1 to 11.5 years. Prevalence of risk factors was unchanged or decreased except for hypertension which significantly increased in males. The rate of STEMI without reported risk factors increased in both males and females. Conclusion: The age of STEMI onset significantly decreased in females, whereas it significantly increased in males. The prevalence of risk factors decreased in males, whereas no significant variation was found in females.

Background & Aims Controlled attenuation parameter (CAP) can be performed together with liver stiffness measurement (LSM) by transient elastography (TE) and is often used to diagnose fatty liver. We aimed to define the validity criteria of CAP. Methods CAP was measured by the M probe prior to liver biopsy in 754 consecutive patients with different liver diseases at three centers in Europe and Hong Kong (derivation cohort, n = 340; validation cohort, n = 414; 101 chronic hepatitis B, 154 chronic hepatitis C, 349 non-alcoholic fatty liver disease, 37 autoimmune hepatitis, 49 cholestatic liver disease, 64 others; 277 F3-4; age 52 ± 14; body mass index 27.2 ± 5.3 kg/m2). The primary outcome was the diagnosis of fatty liver, defined as steatosis involving ≥5% of hepatocytes. Results The area under the receiver-operating characteristics curve (AUROC) for CAP diagnosis of fatty liver was 0.85 (95% CI 0.82–0.88). The interquartile range (IQR) of CAP had a negative correlation with CAP (r = −0.32, p

Persistence of rubella live vaccine has been associated with chronic skin granuloma in 3 children with primary immunodeficiency. We describe 6 additional children with these findings, including 1 with visceral extension to the spleen.

Background and Aim Controlled attenuation parameter (CAP) evaluated with transient elastography (FibroScan) is a recent method for non-invasive assessment of steatosis. Its usefulness in non-alcoholic fatty liver disease (NAFLD) is unknown. We prospectively investigated the performance of CAP for the diagnosis of steatosis in NAFLD, factors associated with discordances between CAP and steatosis grades, and relationships between CAP and clinical or biological parameters. Methods All CAP examinations performed in NAFLD patients with a liver biopsy performed within 1 week of CAP measurement were included. Liver biopsies were assessed for activity and fibrosis stage, NAFLD activity score, and steatosis graded as follows: S0, steatosis 66%. Results Two hundred sixty-one patients (59% male, age 56 years) from two ethnic groups were included. No patient had steatosis 310 dB/m. Conclusion The association of CAP with steatosis, especially in patients with non-alcoholic steatohepatitis, and with elevated BMI could be useful for the diagnosis and follow-up of NAFLD patients.

Epidemiological studies have shown a relationship between endometriosis and clear cell/endometrioid ovarian cancers (named "Endometriosis Associated Ovarian Cancer" or EAOC). The recent discovery of signaling pathways (especially the SWI/SNF and PI3K/AKT/mTOR pathways) that linked endometriosis and EAOC could lead to the development of specific biomarkers as ARID1A to screen benign to premalignant endometriosis and to new targeted treatment. Moreover, the better understanding of the pathogenesis of the epithelial ovarian cancer arising from the Fallopian tube could allow new early prevention strategies that will be described in this review.

Salt reduction in food is a major concern for public health authorities but remains a challenge for the food industry. Aims of this study are to modulate salt distribution between the ingredients of salt-reduced pizza (−30%) by modifying the salt content of each ingredient without changing the total salt content of pizza using mixture experimental design, to demonstrate its impact on sensory properties, and to determine the formulation with sensory properties, evaluated by Quantitative Descriptive Analysis, closest to the reference product. In this study, pizzas are made of dough, ham, cheese and sauce in constant proportions. Obtained results underline the consequences of modulating salt distribution on perception of multi-component foods. The distribution of salt between ingredients affects taste and texture perception and predictive models are established for each discriminating attributes. An optimal formulation, determined by multi-response analysis, is found with sensory properties closest to the reference product allowing compensating salt reduction. This formulation is composed of 20% of salt from cooked ham, 47.5% from mozzarella-style cheese, 0% from dough and 32.5% from tomato sauce. Salt should thus be located preferentially within mozzarella-style cheese and tomato sauce whereas it can be extensively reduced in dough. Practical Applications In addition to being used as a taste and flavour enhancer, salt is involved in (1) food preservation by decreasing water activity; (2) in food structure by modifying the protein network and interactions between proteins and components of food; and (3) in the variation of enzyme activity This is why, reducing the salt content in food products without affecting their organoleptic properties constitutes a major challenge for the manufacturers. This work presents the feasibility of modulating salt distribution between ingredients of salt-reduced pizza (−30%) by modifying the salt content of each ingredient without changing the total salt content of pizza as an efficient way to maintain sensory perceptions as reference product allowing compensating salt reduction.