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Resume Introduction Les personnes trans sont moins bien pris en charge par la communaute medicale que la population cisgenre probablement a cause d’un manque de connaissance, d’enseignement et de confort de la part des professionnels de sante. Le but de cette etude etait d’evaluer les connaissances et le confort ressentis par les professionnels de sante dans la prise en charge des personnes trans dans un centre hospitalo-universitaire (CHU) francais. Methodes Un auto-questionnaire a ete envoye par mail a des professionnels de sante travaillant dans des services habituellement impliques dans la prise en charge de personnes transgenres dans un CHU francais « non specialise » dans la transition hormono-chirurgicale trans. Le questionnaire comprenait des questions demographiques et des echelles de Likert concernant leur connaissance et leur confort ressentis dans la prise en charge des personnes trans. Les reponses des echelles de Likert de 7 degres etaient reparties selon des groupes « faible », « moyen » et « eleve » et celles de 5 degres etaient reparties selon des groupes « en faveur », « neutre » et « en defaveur ». Resultats Cent-deux (29 %) professionnels ont repondu au questionnaire. La moitie travaillaient en chirurgie (urologie, chirurgie plastique, gynecologie), 24 % travaillaient en medecine (endocrinologie, PMA, cytogenetique) et 26 % travaillaient en psychiatrie. La majorite (60,3 %) evaluaient leur niveau de connaissance comme « faible » et 39,7 % comme « moyen ». Seize pour cent evaluaient leur niveau de confort dans la prise en charge des trans comme « faible », 72,5 % comme « moyen » et 11,5 % comme « eleve ». Une majorite (77,5 %) etaient en faveur d’une prise en charge par la securite sociale de la transition hormonale, chirurgicale ou d’un soutien psychologique, 16,4 % etaient neutres et 6 % etaient en defaveur. Les sentiments concernant la transition hormono-chirurgicale etaient tres majoritairement (96,4 %) en faveur ou neutre et 91 % souhaitaient plus de formation. Conclusion Le manque de confort des professionnels de sante d’un CHU non specialise dans la prise en charge des personnes transgenres semble etre en rapport avec un manque de connaissance et de formation et non pas avec un desaccord concernant la necessite de l’offre de soins aux personnes transgenres. Niveau de preuve 3.

The pathophysiological link between adiposity and blood pressure is not completely understood, and evidence suggests an influence of sex and genetic determinants. We aimed to identify the relationship between adiposity and blood pressure, independent of a robust set of lifestyle and metabolic factors, and to examine the modulating role of sex and Angiotensin-Converting Enzyme (ACE) insertion/deletion (I/D) polymorphisms. In the Relationship Between Insulin Sensitivity and Cardiovascular Disease (RISC) study cohort, 1211 normotensive individuals, aged 30 to 60 years and followed-up after 3.3 years, were characterized for lifestyle and metabolic factors, body composition, and ACE genotype. Body mass index (BMI) and waist circumference (WC) were independently associated with mean arterial pressure, with a stronger relationship in women than men (BMI: r =0.40 versus 0.30; WC: r =0.40 versus 0.30, both P ID and II ACE genotypes in both sexes ( P ACE genotype only in women ( P =0.03). A 5 cm larger WC at baseline increased the risk of developing hypertension at follow-up only in women (odds ratio, 1.56 [95% CI, 1.15–2.10], P =0.004) and in II genotype carriers (odds ratio, 1.87 [95% CI, 1.09–3.20], P =0.023). The hypertensive effect of adiposity is more pronounced in women and in people carrying the II variant of the ACE genotype, a marker of salt sensitivity.

International audience; No abstract available

Systemic sclerosis (SSc) is a rare autoimmune connective tissue disease characterized by a microangiopathy and fibrosis of the skin and internal organs. No treatment has been proved to be efficient in case of early or advanced SSc to prevent or reduce fibrosis. There are strong arguments for a key role of topo-I in the pathogenesis of diffuse SSc. Irinotecan, a semisynthetic derivative of Camptothecin, specifically target topo-I. This study was undertaken to evaluate the effects of noncytotoxic doses of irinotecan or its active metabolite SN38 on collagen production in SSc fibroblasts. Dermal fibroblasts from 4 patients with SSc and 2 healthy donors were cultured in the presence or absence of irinotecan or SN38. Procollagen I release was determined by ELISA and expression of a panel of genes involved in fibrosis was evaluated by qRT-PCR. Subcytotoxic doses of irinotecan and SN38 caused a significant and dose-dependent decrease of the procollagen I production in dermal fibroblasts from SSc patients, respectively − 48 ± 3%, p p = 0.0097. Both irinotecan and SN38 led to a global downregulation of genes involved in fibrosis such as COL1A1, COL1A2, MMP1 and ACTA2 in dermal fibroblasts from SSc patients (respectively − 27; − 20.5; − 30.2 and − 30% for irinotecan and − 61; − 55; − 50 and − 54% for SN38). SN38 increased significantly CCL2 mRNA level (+ 163%). The inhibitory effect of irinotecan and its active metabolite SN38 on collagen production by SSc fibroblasts, which occurs through regulating the levels of expression of genes mRNA, suggests that topoisomerase I inhibitors may be effective in limiting fibrosis in such patients.

Objective Microprolactinomas are currently treated with dopamine agonists. Outcome information on microprolactinoma patients treated by surgery is limited. This study reports the first large series of consecutive non-invasive microprolactinoma patients treated by pituitary surgery and evaluates the efficiency and safety of this treatment. Design Follow-up of a cohort of consecutive patients treated by surgery. Methods Between January 2008 and October 2020, 114 adult patients with pure microprolactinomas were operated on in a single tertiary expert neurosurgical department, using an endoscopic endonasal transsphenoidal approach. Eligible patients presented with a microprolactinoma with no obvious cavernous invasion on MRI. Prolactin was assayed before and after surgery. Disease-free survival was modeled using Kaplan–Meier representation. A cox regression model was used to predict remission. Results Median follow-up was 18.2 months (range: 2.8–155). In this cohort, 14/114 (12%) patients were not cured by surgery, including ten early surgical failures and four late relapses occurring 37.4 months (33–41.8) after surgery. From Kaplan–Meier estimates, 1-year and 5-year disease free survival was 90.9% (95% CI: 85.6–96.4%) and 81% (95% CI: 71.2–92.1%) respectively. The preoperative prolactinemia was the only significant preoperative predictive factor for remission (P < 0.05). No severe complication was reported, with no anterior pituitary deficiency after surgery, one diabetes insipidus, and one postoperative cerebrospinal fluid leakage properly treated by muscle plasty. Conclusions In well-selected microprolactinoma patients, pituitary surgery performed by an expert neurosurgical team is a valid first-line alternative treatment to dopamine agonists.

International audience; The aim of this review was to update the recommendations for optimal pain management after open and laparoscopic or robotic prostatectomy. Optimal pain management is known to influence postoperative recovery, but patients undergoing open radical prostatectomy typically experience moderate dynamic pain in the immediate postoperative day. Robot-assisted and laparoscopic surgery may be associated with decreased pain levels as opposed to open surgery. We performed a systematic review using Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) with PROcedure SPECific Postoperative Pain ManagemenT (PROSPECT) methodology. Randomised controlled trials (RCTs) published in the English language, from January 2015 until March 2020, assessing postoperative pain, using analgesic, anaesthetic and surgical interventions, were identified from MEDLINE, EMBASE and Cochrane Databases. Of the 1797 studies identified, 35 RCTs and 3 meta-analyses met our inclusion criteria. NSAIDs and COX-2 selective inhibitors proved to lower postoperative pain scores. Continuous intravenous lidocaine reduced postoperative pain scores during open surgery. Local wound infiltration showed positive results in open surgery. Bilateral transversus abdominis plane (TAP) block was performed at the end of surgery and lowered pain scores in robot-assisted procedures, but results were conflicting for open procedures. Basic analgesia for prostatic surgery should include paracetamol and NSAIDs or COX-2 selective inhibitors. TAP block should be recommended as the first-choice regional analgesic technique for laparoscopic/robotic radical prostatectomy. Intravenous lidocaine should be considered for open surgeries.

Background Mycoplasma genitalium (MG) is an emerging pathogen among men who have sex with men (MSM) with raising rates of antibiotic resistance. This study assessed the prevalence and incidence of MG infection in MSM enrolled in the open-label phase of the ANRS IPERGAY trial with on-demand tenofovir disoproxil fumarate/emtricitabine for human immunodeficiency virus prevention and the impact of doxycycline post-exposure prophylaxis (PEP). Methods 210 subjects were tested at baseline and at 6 months by real-time PCR assays for MG detection in urine samples and oropharyngeal and anal swabs. Resistance to azithromycin (AZM), to fluoroquinolones (FQs), and to doxycycline was investigated in the French National Reference Center of Bacterial Sexually Transmitted Infections (STIs). Results The all-site prevalence of MG at baseline was 10.5% (6.3% in urine samples, 4.3% in anal swabs, 0.5% in throat swabs) and remained unchanged at 6 months whether or not PEP was used: 9.9% overall, 10.2% with PEP, 9.6% without. The overall rate of MG resistance (prevalent and incident cases) to AZM and FQs was 67.6% and 9.1%, respectively, with no difference between arms. An in vivo mutation of the MG 16S rRNA, which could be associated with tetracycline resistance, was observed in 12.5% of specimens tested. Conclusions The prevalence of MG infection among MSM on pre-exposure prophylaxis was high and its incidence was not decreased by doxycycline prophylaxis with a similar high rate of AZM and FQ resistance, raising challenging issues for the treatment of this STI and supporting current recommendations to avoid testing or treatment of asymptomatic MG infection.

The affiliation details for Geltrude Mingrone are corrected below.

Objective The ENVOL study was designed to assess the psychosocial impact of disease and therapy in a French cohort of cryopyrin-associated periodic syndromes (CAPS) patients (and caregivers) treated with canakinumab. Methods The ENVOL study was a multicenter, observational study of CAPS patients given ≥1 canakinumab dose. Data were collected before treatment, at 6 and 12 months afterward, and at the last visit. Patients and caregivers completed questionnaires assessing changes from the 12 months of pretreatment to 12 months prior to interview. Data were analyzed retrospectively. Results The study included 10 physicians and 68 patients (53 adults, 15 children). Sixty-five patients (95.6%) were still receiving canakinumab at the last visit (median 5 years after starting therapy). The mean ± SD score for patient-reported general health increased from 7 ± 2.9 before canakinumab to 2.7 ± 2.7 after treatment (P 40% of respondents. Caregivers spent a median of 3 versus 0.5 hours/week on care in the 12 months of pretreatment versus 12 months prior to interview (P

With approximately 67 million individuals affected worldwide, autism spectrum disorder (ASD) is the fastest growing neurodevelopmental disorder (United Nations, 2011), with a prevalence estimated to be 1/100. In France ASD affects approximately 600,000 individuals (from childhood to adulthood, half of whom are also mentally retarded), who thus have a major handicap in communication and in adapting to daily life, which leads autism to be recognized as a national public health priority. ASD is a neurodevelopmental disorder that affects several domains (i.e., socio-emotional, language, sensori-motor, executive functioning). These disorders are expressed early in life with an age of onset around 18 months. Despite evidence suggesting a strong genetic link with ASD, the genetic determinant remains unclear. The clinical picture is characterized by impairments in social interaction and communication and the presence of restrictive and repetitive behaviors (DSM-5, ICD-10). However, in addition to these two main dimensions there is significant comorbidity between ASD and other neurodevelopmental disorders such as attention deficit hyperactivity disorder or with genetic and medical conditions. One of the diagnostic features of ASD is its early emergence: symptoms must begin in early childhood for a diagnosis to be given. Due to brain plasticity, early interventions are essential to facilitate clinical improvement. Therefore, general practitioners and pediatricians are on the front line to detect early signs of ASD and to guide both medical explorations and early rehabilitation.

Il blocco del plesso cervicale ha come indicazione principale l’anestesia per la chirurgia carotidea. Consente, inoltre, la chirurgia minore del collo. La conoscenza dell’anatomia e essenziale. Gli spazi di diffusione delimitano tre tipi di blocco del plesso cervicale (BPC): superficiale, intermedio e profondo. Quest’ultimo puo essere ottenuto mediante una o piu iniezioni, con o senza neurostimolatore. Piu moderna, la guida ecografica rende il BPC intermedio una tecnica sicura e facile da eseguire. L’apprendimento della tecnica anestetica e necessario per ridurre il rischio di sviluppare complicanze. Le complicanze sono principalmente correlate alla puntura vascolare, a un’iniezione peri- o intradurale e alla tossicita degli anestetici locali il cui assorbimento plasmatico e intenso in questa zona.

Background: Calcific aortic valve stenosis (CAVS) is a frequent and life-threatening cardiovascular disease for which there is currently no medical treatment available. To date, only 2 genes, LPA and PALMD , have been identified as causal for CAVS. We aimed to identify additional susceptibility genes for CAVS. Methods: A GWAS (genome-wide association study) meta-analysis of 4 cohorts, totaling 5115 cases and 354 072 controls of European descent, was performed. A TWAS (transcriptome-wide association study) was completed to integrate transcriptomic data from 233 human aortic valves. A series of post-GWAS analyses were performed, including fine-mapping, colocalization, phenome-wide association studies, pathway, and tissue enrichment as well as genetic correlation with cardiovascular traits. Results: In the GWAS meta-analysis, 4 loci achieved genome-wide significance, including 2 new loci: IL6 (interleukin 6) on 7p15.3 and ALPL (alkaline phosphatase) on 1p36.12. A TWAS integrating gene expression from 233 human aortic valves identified NAV1 (neuron navigator 1) on 1q32.1 as a new candidate causal gene. The CAVS risk alleles were associated with higher mRNA expression of NAV1 in valve tissues. Fine-mapping identified rs1800795 as the most likely causal variant in the IL6 locus. The signal identified colocalizes with the expression of the IL6 RNA antisense in various tissues. Phenome-wide association analyses in the UK Biobank showed colocalized associations between the risk allele at the IL6 lead variant and higher eosinophil count, pulse pressure, systolic blood pressure, and carotid artery procedures, implicating modulation of the IL6 pathways. The risk allele at the NAV1 lead variant colocalized with higher pulse pressure and higher prevalence of carotid artery stenosis. Association results at the genome-wide scale indicated genetic correlation between CAVS, coronary artery disease, and cardiovascular risk factors. Conclusions: Our study implicates 3 new genetic loci in CAVS pathogenesis, which constitute novel targets for the development of therapeutic agents.

International audience; Les tumeurs de l’orbite représentent une pathologie relativement fréquente et posent des problèmes de diagnostic et de prise en charge. Elles peuvent être bénignes ou malignes. Tous les tissus contenus dans l’orbite peuvent être le siège d’un développement tumoral et de ce fait, elles sont très nombreuses. Parmi les tumeurs bénignes, on retiendra chez l’adulte les méningiomes et les hémangiomes caverneux et pour les tumeurs malignes, les lymphomes, les métastases, les tumeurs d’origine ORL, les tumeurs de la glande lacrymale. Elles se manifestent en général par une symptomatologie peu spécifique, le syndrome orbitaire, associant exophtalmie, troubles oculomoteurs, signes inflammatoires, douleurs et parfois masse palpable. L’imagerie (scanner RX, imagerie par résonance magnétique ou échographie Doppler couleur) confirme l’existence d’une tumeur, précise son siège, son extension, l’existence d’éventuelles métastases. La biopsie et l’examen anatomique et cytopathologique confirment le type bénin ou malin de la tumeur. À partir de ces trois éléments : clinique, imagerie et anatomie pathologique, la prise en charge est décidée, le plus souvent chirurgicale, selon l’avis d’une réunion de concertation pluridisciplinaire en cas de tumeur maligne. La radiothérapie et la chimiothérapie peuvent compléter le traitement.

Introduction An extrafine pMDI formulation of the long-acting beta agonist formoterol fumarate (FF) was developed, and its efficacy and safety evaluated in a controlled clinical setting. Methods A double-blind, double-dummy, single dose, randomised, 4-way crossover, placebo controlled study was conducted to evaluate efficacy and safety of FF (6 µg) one puff or two puffs versus Foradil Aerolizer (FOR) 12 µg or placebo in moderate to severe asthmatic patients. Primary endpoint was 12 hour average FEV1. Secondary efficacy endpoints were onset and duration of action. Safety endpoints were vital signs, QTc, serum potassium and glucose. Results 53 asthmatic patients (mean age 34.4 years, 32 male and 21 female) were randomized and 52 were evaluable. Average FEV1 and peak FEV1 increased significantly after FF 6 and 12 µg, with a trend toward greater efficacy with the higher FF dose. Equivalence between FF 12 µg and FOR 12 µg was demonstrated. Median time to 15% onset was 10, 15 and 10 min for FF 12 µg, FF 6 µg and FOR, respectively confirming the rapid onset of action. Median time to 15% offset was 718, 480, 719 and 240 min for FF 12 µg, FF 6 µg, FOR and Placebo respectively suggesting that FF 12 µg provides an improved coverage of the 12 hour administration interval and demonstrating a marked dose-response. No clinically significant changes were observed for blood pressure and heart rate. Serum potassium and glucose remained within normal limits for the majority of subjects. QTcB was similar for all treatments and no values exceeded 470 m/sec. There were no serious adverse events. Frequency of treatment emergent adverse events was similar in the four treatments, with tremor the most common, as expected. Conclusions This study demonstrates that extrafine FF has similar efficacy and safety as compared to FOR. FF 12 µg shows a greater and more prolonged bronchodilation compared to FF 6 µg, and confirms a marked dose–response relation for FF. This has to be considered when assessing the most appropriate therapeutic dose of FF in asthmatics.

Many cancer predisposition syndromes are preceded or accompanied by a range of typical skin signs. Gorlin syndrome is a rare multisystem inherited disorder which can predispose to basal cell carcinomas (BCCs), childhood medulloblastomas in addition to various developmental abnormalities; the majority of cases are due to mutations in the PTCH1 gene. Approximately 5% of cases have been attributed to a mutation in the SUFU gene. Certain phenotypic features have been identified as being more prevalent in individuals with a SUFU mutation such as childhood medulloblastoma, infundibulocystic BCCs and trichoepitheliomas. Recently hamartomatous skin lesions have also been noted in families with childhood medulloblastoma, a "Gorlin like" phenotype and a SUFU mutation. Here we describe a family previously diagnosed with Gorlin syndrome with a novel SUFU splice site deleterious genetic variant, who have several dermatological features including palmar sclerotic fibromas which has not been described in relation to a SUFU mutation before. We highlight the features more prominent in individuals with a SUFU mutation. It is important to note that emerging therapies for treatment of BCCs in patients with a PTCH1 mutation may not be effective in those with a SUFU mutation.

International audience; A portable stereo gamma camera has been built, based on two hybrid pixelated detectors, each of them comprising a 1 mm thick CdTe substrate bump-bonded to the Timepix readout chip, a pixelated CMOS ASIC consisting of 256 × 256 pixels with 55 µm pitch.The technique described in this paper allows the automatic estimation of the distances between the prototype and the located radioactive sources by using triangulation based on epipolar geometry. The 3-D Cartesian coordinates of the sources are provided even when they are hidden behind an occluding material, such as a wall, or inside a barrel. Furthermore, the combination of the prototype with a depth sensor enables a wide range of applications, including the 3-D volumetric reconstruction of the scene under study as well as the capability of autonomously determining if an object is occluding the located radioactive sources.We discuss here the main features of the whole methodology developed and we also present the experimental results obtained at laboratory scale.

This paper presents the studies made on the definition and design of a decentralized and modular electrical architecture of Power Conditioning Unit (PCU). The modular PCU is able to cover a large range of mission demands by adapting the number of power modules (PM) while the electrical interfaces remain the same. A decentralized architecture is proposed where each module is able to control the solar arrays and to manage the batteries. It appears that this kind of architecture becomes feasible thanks to digital circuits and using a communication bus [1]. Breadboards are being tested in order to validate the concept. Reliability and robustness aspects are studied and a redundant architecture is tested.

Background The application of safety principles from the aviation industry to the operating room has offered hope in reducing surgical complications. This study aimed to assess the impact on major surgical complications of adding an aviation-based team training programme after checklist implementation. Methods A prospective parallel-group cluster trial was undertaken between September 2011 and March 2013. Operating room teams from 31 hospitals were assigned randomly to participate in a team training programme focused on major concepts of crew resource management and checklist utilization. The primary outcome measure was the occurrence of any major adverse event, including death, during the hospital stay within the first 30 days after surgery. Using a difference-in-difference approach, the ratio of the odds ratios (ROR) was estimated to compare changes in surgical outcomes between intervention and control hospitals. Results Some 22 779 patients were enrolled, including 5934 before and 16 845 after team training implementation. The risk of major adverse events fell from 8·8 to 5·5 per cent in 16 intervention hospitals (adjusted odds ratio 0·57, 95 per cent c.i. 0·48 to 0·68; P < 0·001) and from 7·9 to 5·4 per cent in 15 control hospitals (odds ratio 0·64, 0·50 to 0·81; P < 0·001), resulting in the absence of difference between arms (ROR 0·90, 95 per cent c.i. 0·67 to 1·21; P = 0·474). Outcome trends revealed significant improvements among ten institutions, equally distributed across intervention and control hospitals. Conclusion Surgical outcomes improved substantially, with no difference between trial arms. Successful implementation of an aviation-based team training programme appears to require modification and adaptation of its principles in the context of the the surgical milieu. Registration number: NCT01384474 (http://www.clinicaltrials.gov).

Resume Le diabetologue est confronte a une multiplication des options therapeutiques pour le diabete de type 2, ce qui complexifie les choix medicamenteux et met en exergue l’importance d’une reevaluation appropriee du traitement antidiabetique. Il existe une heterogeneite dans la reponse glycemique avec les antidiabetiques, en particulier avec les dernieres classes therapeutiques. La necessite d’une evaluation rigoureuse de l’efficacite mais aussi de la tolerance du traitement instaure s’est impose dans les recommandations internationales pour la prise en charge du diabete de type 2 comme le NICE. Les criteres d’evaluation les plus importants sont l’amplitude de la reduction de l’HbA 1c (au moins 0.5 % a 6 mois), l’effet sur le poids, la tolerance et l’evitement des hypoglycemies, la preservation de la qualite de vie. Une telle reevaluation permet de lutter contre l’inertie clinique, source de perte de temps et de chances pour le patient.

Background: The prevalence of anemia has been studied in well-defined populations, but no large study is available for less restricted populations with various disorders. Design: Two-phase nationwide study: (i) a cross-sectional study including 1351 patients aimed to define the prevalence and characteristics of anemic patients seen in France, and (ii) a prospective longitudinal study of 398 anemic patients aimed to define factors associated with survival. Results: Anemia was present in 874 (65%) patients according to WHO criteria, and 573 (42%) patients had hemoglobin levels

The present paper deals with specific safety issues resulting from the coupling of a nuclear reactor (very high temperature reactor, VHTR) with a hydrogen production plant (HYPP). The first part is devoted to the safety approach consisting in taking into account the safety standards and rules dedicated to the nuclear facility as well as those dedicated to the process industry. This approach enabled two main families of events to be distinguished: the so-called internal events taking place in the coupling circuit (transients, breaks in pipes and in heat exchangers) and the external events able to threat the integrity of the various equipments (in particular the VHTR containment and emergency cooling system) that could result from accidents in the HYPP. By considering a hydrogen production by means of the iodine/sulfur (IS) process, the consequences of the both families of events aforementioned have been assessed in order to provide an order of magnitude of the effects of the incidents and accidents and also in order to propose safety provisions to mitigate these effects when it is necessary. The study of transients induced by a failure of a part of the HYPP has shown the possibility to keep the part of the HYPP unaffected by the transient under operation by means of an adapted regulation set. Moreover, the time to react in case of transfer of corrosive products in the VHTR containment has been assessed as well as the thermohydraulic loading that would experience the coupling pipes in case of very fast uncoupling of the facilities aiming at avoiding an excessive pressurization of the VHTR containment. Regarding the external events, by applying a method used in the process industries, the bounding representative scenarios have been identified on the basis of their consequences but also on the basis of their occurrence frequency. The consequences of the selected bounding scenarios, calculated taking into the source-term, the atmospheric dispersion and the pressure and toxic effects induced respectively by a hydrogen unconfined vapour cloud explosion (UVCE) and a sulfur dioxide release have been assessed. The resulting safety distance of about 100 m for the UVCE is fairly acceptable in terms of performance (head loss and thermal loss) of the coupling system. However, the longer safety distance (about 1.5 km) calculated for a SO 2 release implies to foresee a long distance to settle the control room of the site or to foresee provisions able to stop very fast the SO 2 leak.

The aims of the present study were to estimate the prevalence of renal impairment (RI) among HIV-infected adult patients and to investigate the associated factors.A cross-sectional survey was conducted in a French hospital-based cohort. Clearance of creatinine (CC) was calculated using the Cockcroft-Gault formula. Four stages of RI were defined: mild (60-90 mL/min), moderate (30-60), severe (15-30) and end stage (15). Logistic regression models were used to investigate factors associated with RI.The male/female ratio of the 2588 patients enrolled was 3:1 and the median age was 42 years. At the time of assessment of CC, the median CD4 count was 430 cells/microL and HIV plasma viral load (VL) was50 copies/mL in 60%. The overall prevalence of RI was 39.0%: 34.2% mild, 4.4% moderate, 0.3% severe and 0.2% end-stage. Mild RI was associated with female gender [odds ratio (OR)=3.3: 95% CI 2.6-4.3)], age50 years (OR=9.8: 7.4-13.0) and 40-50 years (OR=1.9: 1.5-2.4), body mass index (BMI)22 kg/m(2) (OR=3.3: 2.7-4.3) and tenofovir exposure (OR=1.4: 1.0-1.9 for1 year and OR=1.5: 1.2-2.0 for1 year). Advanced RI (CC60 mL/min) was associated with age50 years (OR=5.6: 2.9-10.9) and 40-50 years (OR=2.2: 1.1-1.4), BMI22 kg/m(2) (OR=1.5: 1.0-2.4), hypertension (OR=2.5: 1.4-2.5) and indinavir (IDV) exposure1 year (OR=2.3: 1.5-3.6).This survey confirms the high prevalence of RI in HIV-infected patients and indicates the importance of the investigation of renal function especially in women, older patients, those with a low BMI or treated with tenofovir or IDV.

Il existe au cours du diabete un remodelage precoce de la structure arterielle, avec une hypertrophie de la media liee a une accumulation de collagene. On observe chez l’animal un epaississement de l’adventice precedant le developpement des lesions d’atherosclerose de l’intima qui est lie a une accumulation de collagene et une augmentation de la densite des vasa vasorum. Nous avons retrouve chez l’homme, par echographie, une augmentation significative de l’epaisseur de l’adventice chez des diabetiques par rapport a des temoins. Le role physiopathologique des modifications structurales de l’adventice sur la survenue des evenements cardiovasculaires doit etre etudie chez le diabetique.

CT dacryocystography: normal findings and pathology CT dacryocystography, performed under sterile technique and following local anesthesia, is well tolerated by patients. It is the imaging technique of choice in patients with persistent tearing following clinical examination with non-invasive procedures when patency of the lacrimal drainage system remains uncertain, when a dacryolith or tumor is suspected or following unseccessful dacryocystorhinostomy. Two techniques are available: instillation or direct cannulation, either initially or after non-visualization of the nasolacrimal system after contrast instillation. Non-specific idiopathic stenosis at the mid portion of the nasolacrimal duct is the most frequent etiology in patients over 50 years old; dacryoliths are present in 5 to 20% of cases of nasolacrimal duct stenosis. CT dacryocystography also allows evaluation of surrounding structures (medicolegal) to identify variants and anomalies when surgery is contemplated to avoid potential complications.

Background More than 10 years after the introduction of combination antiretroviral therapy (cART), we examined the trend in the proportion of deaths caused by end-stage liver disease (ESLD) in HIV-infected adults in France between 1995 and 2005. Design and methods In 2005, 34 departments prospectively recorded all deaths in HIV-infected patients who were followed in those departments (around 24 000). Results were compared with those of four previous cross-sectional surveys conducted since 1995 using the same methodology. Results Among 287 reported deaths in 2005, 100 (35%) were related to AIDS, and 48 (17%) to ESLD. Three out of four patients who died from ESLD-related causes had chronic hepatitis C. Excessive alcohol consumption was reported in approximately half of the patients (48%). At death, 62% of patients had undetectable HIV viral load and the median CD4 count was 237 cells/μL. From 1995 to 2005, the proportion of deaths caused by ESLD increased from 2 to 17% (P

We present our experience, spanning more than 10 years of teaching a course on ‘ethics and engineering’ for a group of MSc programmes in applied sciences at Delft University of Technology. The course is taught by a team of teachers from the faculty of Applied Sciences and from the department of Philosophy of the Faculty of Technology, Policy and Management, on a basis of complementarity and equality. We call it the Joint Venture teaching model. We conclude that the Joint Venture teaching model, in combination with the contents and teaching methods of the course, are successful. The course is a positively perceived element in the curricula. But we also point to a threat to the Joint Venture teaching model. As it may not be very attractive for staff from a technical faculty to participate in this kind of teaching, the availability of motivated and qualified staff from a technical faculty may be a problem. Mitigation of this threat requires sustained commitment from a technical faculty, and hence this is a n...

The purpose of benchmarking is to settle improvement processes by comparing the activities to quality standards. The proposed methodology is illustrated by benchmark business cases performed inside medical plants on some items like nosocomial diseases or organization of surgery facilities. Moreover, the authors have built a specific graphic tool, enhanced with balance score numbers and mappings, so that the comparison between different anesthesia-reanimation services, which are willing to start an improvement program, is easy and relevant. This ready-made application is even more accurate as far as detailed tariffs of activities are implemented.

The main idea developed in this paper is a novel biconverter structure to supply a doubly fed induction machine (DFIM). Two voltage source inverters (VSIs) feed the stator and rotor windings. The outputs of the two VSIs are combined electromechanically in the machine, and as a result, novel features can be obtained. For example, for high power drive applications, this configuration uses two inverters dimensioned for a half of the DFIM power. A new dual direct torque control is developed with flux model of DFIM. Two switching tables linked to VSI are defined for stator and rotor flux vector control. The satisfactory experimental and simulation results are shown, and they confirm good dynamic behavior in four quadrants of the speed-torque plane. Moreover, experimental results show the correct flux vector control behavior and speed tracking performances.

Les auteurs ont realise une etude multicentrique en ouvert pour evaluer l’efficacite et la tolerance de Gripponyl®, medication phytotherapique a base de quinquina, de saule et de the vert. Le produit est administre par voie orale a des patients atteints de symptomes grippaux.

Resume Les auteurs rapportent une observation de perte de substance complexe de la verge chez un enfant de 15 ans. L'utilisation de la technique du Vacuum-Assisted Closure® (VAC®) a permis une detersion efficace de la plaie ainsi que l'apparition tres rapide d'un tissu de granulation permettant la couverture par lambeau locoregional.

Vacuum-Assisted Closure (VAC) technique has been used in the treatment of acute and chronic wounds. The authors report a case of large thoracic defect, where the VAC was used to cover an exposed Gore Tex prosthesis after the failure of a latissimus dorsi flap. The VAC managed to save the Gore Tex prosthesis before a delayed reconstruction.

La principal indicacion anestesica del bloqueo del plexo cervical es la cirugia de la carotida, aunque tambien se indica para la cirugia menor del cuello (tiroplastia). El bloqueo puede interesar el plexo cervical superficial o profundo. El del plexo profundo se puede realizar con una o varias inyecciones, y con neuroestimulador o sin el. El conocimiento de la anatomia y de los espacios de difusion es indispensable. Es necesario aprender la tecnica anestesica para disminuir el riesgo de complicaciones, que basicamente consisten en una puncion vascular, una inyeccion peridural o intradural y en la toxicidad de los anestesicos locales, cuya absorcion plasmatica es intensa en esta region.

Polydactyly is the most common congenital limb anomaly occurring both as an isolated defect or as part of a syndrome. However mirror foot is an exceptional abnormality (14 cases reported). The authors describe two sporadic cases of mirror foot. The first case presents a mirror polydactyly of the left foot, an hexadactyly of the right foot and a central polysyndactyly of both hands. The second case presents a mirror polydactyly of both feet. Mirror foot is a very rare defect. Both sporadic and familiar cases have been reported. This malformation can affect one or both feet. Some cases are associated with other congenital anomalies. The definition of mirror foot is warying according to the authors and the review of literature shows an important variability in the patterns of mirror polydactyly. Mirror duplication of hands and feet result of aberrant positioning of the zone of polarizing activity in relation to the apical ectodermal ridge during limb bud development. Different genes encoding limb pattern have been described.

Resume Objectif Analyser les causes de deces chez les adultes infectes par le VIH survenues au cours de l’annee 2000. Methode A partir d’une enquete nationale, notre etude decrit et analyse les causes et les caracteristiques des deces des patients en succes immunologique et virologique (CD4 > 200/mm 3 , ARN-VIH plasmatique Resultats Parmi un total de 964 deces notifies, des informations detaillees etaient disponibles pour 864 patients. 149 patients (17 %) etaient en succes immunovirologique. La cause sous-jacente du deces etait pour 36 un cancer non classant sida (24 %) dont 16 cancers du poumon, 7 hepatocarcinomes et 3 neoplasies colorectales, pour 22 une pathologie classant sida (15 %) dont 10 lymphomes malins non hodgkiniens et 3 carcinomes du col, pour 22 une maladie cardiovasculaire (15 %), pour 16 une insuffisance hepatique post-hepatite C (11 %), pour 16 un suicide (11 %), pour 14 une infection bacterienne (9 %). En comparant les caracteristiques de ces 149 patients a ceux des 715 autres patients, les repondeurs etaient significativement plus souvent co-infectes par le VHC (45 vs 33 %), toxicomanes (40 vs 27 %), alcooliques (38 vs 28 %), dyslipidemiques (19 vs 11 %). En 2000, pres de 20 % des deces notifies en France parmi les patients infectes par le VIH, sont survenus sous traitement en succes immunovirologique. Conclusion Pour reduire la mortalite parmi ces patients traites efficacement, une attention doit etre portee sur des causes curables comme l’hepatite C, les dyslipidemies et sur la prevention des cancers comme ceux du poumon, du col uterin ou de l’intestin.

In France, watr services are under municipal responsibility. They can be managed, either by municipalities themselves, or by private companies through delegation contracts. Whatever the situation is, water management remain under state control. The law of 29 January 1993 known as “Sapin Act” limits the duration of the contracts of delegation and imposes a procedure of publicity and consultation preliminary to their conclusion or their renewal. A study has been led from 1998 by our laboratory on the impact of this competition between private companies on the delegation contracts and their price. The main conclusions are the following:Including water and wastewater contracts, the procedure of competition led to an average fall of 10% of the price paid to the contractor. The most significant falls concern services of more than 20 000 inhabitants;If the global distribution of the contracts between the three major companies in this sector is not basically modified, one notes an increasingly marked presence of independent private operators;The duration of the contracts is in reduction, on average, from 17 to 11 years. Then, it appears that the procedure instituted by the law of 29 January 1993 allowed a better exercise of competition between the private companies. The municipalities, mainly the smallest, encounter difficulties in the course of the procedure, and this is the reason why they expressed strong expectations in regard to the services of consulting. The progressive development of associations of municipalities makes it possible for the municipalities to obtain more favourable contractual conditions. This study makes it possible to follow the evolution of the number of procedures initiated pursuant to the law of 29 January 1993: nearly 300 in 1997, 582 in 1998 and 684 in 1999. In 2005, most of the 12,000 French contracts would have been renegotiated, a figure which shows the economical impact on water services.