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The Jules Horowitz Reactor, a new material testing reactor, is currently under construction on the CEA Cadarache site (in the South of France). A nuclear heating rate unequaled in Europe will be provided: 20 W.g−1 for a nominal thermal power of 100 MW. There is no differential calorimeter in the state of the art that measures such a nuclear heating rate. This article presents a new differential calorimeter configuration dedicated to this very high nuclear heating rate. On the one hand, the chosen configuration is validated and calibrated experimentally under laboratory conditions by using a new heating system, allowing the application of a wide range of electrical power never tested in the literature and ten times higher compared to that commonly used. Then the calorimetric cell response is estimated under real conditions with an analytical model. Finally, 3-D thermal numerical simulations of the whole calorimeter are performed under real conditions. Some parameters, such as the size of the cell, the intercell space, and the nature of the sample, are tuned to propose a very compact differential calorimeter. [ABSTRACT FROM AUTHOR]

The Jules Horowitz Reactor, a new material testing reactor, is currently under construction on the CEA Cadarache site (in the South of France). A nuclear heating rate unequaled in Europe will be provided: 20 W.g−1 for a nominal thermal power of 100 MW. There is no differential calorimeter in the state of the art that measures such a nuclear heating rate. This article presents a new differential calorimeter configuration dedicated to this very high nuclear heating rate. On the one hand, the chosen configuration is validated and calibrated experimentally under laboratory conditions by using a new heating system, allowing the application of a wide range of electrical power never tested in the literature and ten times higher compared to that commonly used. Then the calorimetric cell response is estimated under real conditions with an analytical model. Finally, 3-D thermal numerical simulations of the whole calorimeter are performed under real conditions. Some parameters, such as the size of the cell, the intercell space, and the nature of the sample, are tuned to propose a very compact differential calorimeter. [ABSTRACT FROM AUTHOR]

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SUMMARY Aims To assess by a survey the management of prisoners with diabetes treated with insulin in French prisons. Methods A questionnaire was sent to the head of healthcare services for prisoners of every French prison. Information was obtained on prevalence of insulin-treated diabetes prisoners and diabetes care in prison. The number of episides of ketoacidosis and hypoglycaemia needing hospital admissions were evaluated during the past year. Results Among the 163 questionnaires sent, 115 were returned, giving an overall response rate of 69%. At the time of the study the prison population was 38 175 people. One hundred and sixty-nine prisoners were treated by insulin (0.4%). Self-monitoring of blood glucose was available only for 94 (55.6%) insulin-treated prisoners. A total of 130 (76.9%) prisoners performed two insulin injections daily or less, 105 (62.1%) prisoners were not allowed to keep their insulin delivery systems with them. Of the prisoners who treated themselves, 14 (12.1%) used syringes and 42 (36.5%) used pen devices. Ninety-two (55.1%) prisoners had had access to a diabetes specialist during the previous year. Diabetic diets were available in only 65 (60.7%) prisons. From June 1998 to June 1999, there were 20 hospital admissions for a diabetic ketoacidosis and 14 for hypoglycaemia. Conclusions This study shows that prison decreases the autonomy of diabetic prisoners who often cannot self-inject or test their blood. Access to visiting consultant diabetologists and specialist nurses to educate both prisoners with diabetes and prison staff could improve diabetic care. [ABSTRACT FROM AUTHOR]

Examines the effect of amoxycillin and cefotaxime on Streptococcus pneumoniae in France. Correlation between cefotaxime and penicillin-resistant pneumococci; Determination of the minimal inhibitory concentrations of beta-lactams; Distinction between microbroth dilution method and agar dilution method.

This work was carried out under the aegis of the CNGOF (Collège national des gynécologues et obstétriciens français) and proposes guidelines based on the evidence available in the literature. The objective was to define the diagnostic and surgical management strategy, the fertility preservation and surveillance strategy in Borderline Ovarian Tumor (BOT). No screening modality can be proposed in the general population. An expert pathological review is recommended in case of doubt concerning the borderline nature, the histological subtype, the invasive nature of the implant, for all micropapillary/cribriform serous BOT or in the presence of peritoneal implants, and for all mucinous or clear cell tumors (grade C). Macroscopic MRI analysis should be performed to differentiate the different subtypes of BOT: serous, seromucinous and mucinous (intestinal type) (grade C). If preoperative biomarkers are normal, follow up of biomarkers is not recommended (grade C). In cases of bilateral early serous BOT with a desire to preserve fertility and/or endocrine function, it is recommended to perform a bilateral cystectomy if possible (grade B). In case of early mucinous BOT, with a desire to preserve fertility and/or endocrine function, it is recommended to perform a unilateral adnexectomy (grade C). Secondary surgical staging is recommended in case of serous BOT with micropapillary appearance and uncomplete inspection of the abdominal cavity during initial surgery (grade C). For early-stage serous or mucinous BOT, it is not recommended to perform a systematic hysterectomy (grade C). Follow up after BOT must be pursued for more than 5 years (grade B). Conservative treatment involving at least the conservation of the uterus and a fragment of the ovary in a patient wishing to conceive may be proposed in advanced stages of BOT (grade C). A new surgical treatment that preserves fertility after a first non-invasive recurrence may be proposed in women of childbearing age (grade C). It is recommended to offer a specialized consultation for Reproductive Medicine when diagnosing BOT in a woman of childbearing age. Hormonal contraceptive use after serous or mucinous BOT is not contraindicated (grade C)., (Copyright © 2020. Published by Elsevier Masson SAS.)

Introduction: The present study proposes to validate the Driver Ecological Glare Test (DEGT), a test developed to measure the benefit of a headlight glare Advanced Driver Assistance System (ADAS), by comparing it to a laboratory glare test., Method: Twenty-four participants, aged from 55 to 70 years, were recruited to complete a visual examination, including monocular halo size measurement for both eyes using Vision Monitor device (MonCv3; Metrovision). An on-field evaluation took place at night at the UTAC CERAM test track to obtain disability glare measures using the DEGT., Results: A significant correlation was found between the two glare tests and Bland-Altman analysis reveals a good agreement with a bias of 73.7 arcmin between the halo size measurements obtained from the DEGT and Vision Monitor. The results of the present study demonstrate that the DEGT is a valid method to test halo size and is adapted to evaluate the benefits of an antiglare device for drivers in an ecological situation., (Copyright © 2019 National Safety Council and Elsevier Ltd. All rights reserved.)

We performed two experiments to investigate how monocular vision and a monocular generalized reduction in vision (MRV) impact driving performance during racing. A total of 75 visually normal students or professional racing drivers, were recruited for the two experiments. Driving performance was evaluated under three visual conditions: normal vision, simulated monocularity and simulated monocular reduction in vision. During the driving scenario, the drivers had to detect and react to the sudden intrusion of an opponent's racing car into their trajectory when entering a turn. Generalized Linear Mixed Models (GLMMs) and ANOVA were then used to explore how monocular vision and monocular reduction in vision affect drivers' performance (crash and reaction time) while confronting them with critical situations. The results show that drivers under monocular condition are from 2.1 (95% CI 1.11-4.11, p = .024) to 6.5 (95% CI 3.91-11.13; p = .0001) times more likely to collide with target vehicles compared with their baseline (binocular) condition, depending on the driving situation. Furthermore, there was an average increase in reaction time from 64 ms (p = .029) to 126 ms (p = .015) under monocular condition, depending on the critical driving situation configuration. This study objectively demonstrates that monocularity has a significant impact on driving performance and safety during car racing, whereas performance under monocular reduction in vision conditions is less affected., Competing Interests: I have read the journal's policy and some authors of this manuscript have the following competing interests: José-Alain Sahel: Funding Sources: LabEx LIFESENSES (ANR-10-LABX-65), ERC Synergy "HELMHOLTZ" (ERC Grant Agreement #610110), Banque publique d'Investissement (Sightagain BPI-2014-PRSP-15), University-Hospital Institute “FOReSIGHT ((ANR-18-IAHU-01)”, Foundation Fighting Blindness (C-CL-0912-0600-INSERM01; C-GE-0912-0601-INSERM02). Consultant: Pixium Vision; GenSight Biologics; SparingVision. Personal Financial Interests: GenSight Biologics, Prophesee, Chronolife, Pixium Vision, Tilak Healthcare, Sparing Vision. Bahram Bodaghi is consultant for the Medical Commission of the FIA. Neil R. Miller is study director for the QRK207 Clinical Treatment Trial for acute NAION (Quark Pharmaceuticals) and consultant to the Regenera pharmaceutical company. Gérard Saillant is President of the Medical Commission of the FIA. The other authors do not have any conflicts of interest to disclose. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Objectives: To characterize and describe treatment with ulipristal acetate (UPA) in a preoperative setting and to evaluate the safety, effectiveness, and Health Related Quality of Life (HRQoL) outcomes in a French population treated according to standard clinical practice., Materials and Methods: Multicentre, prospective, non-interventional study (PREMYA) of patients diagnosed with moderate to severe symptoms of uterine fibroids and undergoing a preoperative treatment with UPA 5mg (Esmya ® ). Patients were followed for a total of 15months (3months UPA treatment and 12months after). Data were collected approximatively every 3months according to centre usual visit schedule., Results: A total of 206 women were enrolled in France, of whom 197 were found to be eligible for data analysis. Physicians' assessments of patients' overall symptomatic changes, as measured on the Clinical Global Impression-Improvement (CGI-I) scale, indicated that 83.7% of patients were improved at end of treatment (month 3). On the patients' treatment benefit scale (PTBS), 94.7% of patients reported an improvement. These 2 measurements, pain and quality of life, remained improved after treatment cessation and during the entire period of follow-up. Only 58.4% of patients underwent surgery within the timeframe of the study follow-up of which the majority were of a conservative/minimal invasive nature., Conclusion: Many patients did not undergo surgery during the planned 12months follow-up period after treatment whereas all patients had an indication of surgery. All measurements of treatment outcome were markedly improved by 3 months of UPA 5mg treatment., Clinical Trial Number: NCT01635452., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

Purpose: Computing trauma scores in the field allows immediate severity assessment for appropriate triage. Two pre-hospital scores can be useful in this context: the Triage-Revised Trauma Score (T-RTS) and the Mechanism, Glasgow, Age and arterial Pressure (MGAP) score. The Trauma Revised Injury Severity Score (TRISS), not applicable in the pre-hospital setting, is the reference score to predict in-hospital mortality after severe trauma. The aim of this study was to compare T-RTS, MGAP and TRISS in a cohort of consecutive patients admitted in the Trauma system of the Northern French Alps(TRENAU)., Materials and Methods: From 2009 to 2011, 3260 patients with suspected severe trauma according to the Vittel criteria were included in the TRENAU registry. All data necessary to compute T-RTS, MGAP and TRISS were collected in patients admitted to one level-I, two level-II and ten level-III trauma centers. The primary endpoint was death from any cause during hospital stay. Discriminative power of each score to predict mortality was measured using receiver operating curve (ROC) analysis. To test the relevancy of each score for triage, we also tested their sensitivity at usual cut-offs. We expected a sensitivity higher than 95% to limit undertriage., Results: The TRISS score showed the highest area under the ROC curve (0.95 [CI 95% 0.94-0.97], p<0.01). Pre-hospital MGAP score had significantly higher AUC compared to T-RTS (0.93 [CI 95% 0.91-0.95] vs 0.86 [CI 95% 0.83-0.89], respectively, p<0.01). MGAP score<23 had a sensitivity of 88% to detect mortality. Sensitivities of T-RTS<12 and TRISS<0.91 were 79% and 87%, respectively., Discussion/conclusion: Pre-hospital calculation of the MGAP score appeared superior to T-RTS score in predicting intra-hospital mortality in a cohort of trauma patients. Although TRISS had the highest AUC, this score can only be available after hospital admission. These findings suggest that the MGAP score could be of interest in the pre-hospital setting to assess patients' severity. However, its lack of sensitivity indicates that MGAP should not replace the decision scheme to direct the most severe patients to level-I trauma center., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Objective: To describe the factors associated with outcome after accidental deep hypothermia., Methods: We conducted a retrospective cohort study on patients with accidental hypothermia (core temperature <28 °C) admitted to a Level I emergency room over a 10-year period., Results: Forty-eight patients were included with a median temperature of 26 °C (range, 16.3-28 °C) on admission. The etiology of hypothermia was exposure to a cold environment (n = 27), avalanche (n = 13) or immersion in cold water (n = 8). Mean age was 47 ± 22 years, and 58% were males. Thirty-two patients had a cardiac arrest (CA): 15 patients presented unwitnessed cardiac arrest (UCA) and 17 patients presented rescue collapse (RC). Extracorporeal life support (ECLS) was implemented in 21 patients with refractory cardiac arrest and in two patients with hemodynamic instability. Overall mortality was 50%. For cardiac arrest patients, only three out of 15 patients with UCA survived at day 28, whereas eight out of 17 patients with RC survived. The cerebral performance category score was 4 for all the survivors of UCA and 1 [range, 1-2] for survivors of RC. Patients with poor outcome presented more UCA, a lower pH, a higher serum potassium, creatinine, serum sodium or lactate level as well as more severe coagulation disorders., Conclusion: Cardiac arrest related to rescue collapse was associated with favorable outcome. On-scene rescue collapse should prompt prolonged resuscitation and ECLS rewarming in all CA patients with deep hypothermia. Conversely, unwitnessed cardiac arrest was associated with unfavorable outcome and will likely not benefit from ECLS., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Introduction: Pre-hospital triage is a key element in a trauma system that aims to admit patients to the most suitable trauma center, and may decrease intra-hospital mortality. We evaluated the performance of a pre-hospital procedure in a regional trauma system through measurements of the quality of pre-hospital medical assessment and the efficacy of a triage protocol., Methods: Our regional trauma system included 13 hospitals categorized as Level I, II or III trauma centers according to their technical facilities. Each patient was graded A, B or C by an emergency physician, according to the seriousness of their injuries at presentation on scene. The triage was performed according to this grading and the categorization of centers. This study is a registry analysis of a three-year period (2009 to 2011)., Results: Of the 3,428 studied patients, 2,572 were graded using the pre-hospital grading system (Graded group). The pre-hospital gradation was closely related with injury severity score (ISS) and intra-hospital mortality rate. The triage protocol had a sensitivity of 92% (95% confidence interval (CI) 90% to 93%) and a specificity of 41% (95% CI 39% to 44%) to predict adequate admission of patients with ISS more than 15. A total of 856 patients were not graded at the scene (Non-graded group). Undertriage rate was significantly reduced in the Graded group compared with the Non-graded group, with a relative risk of 0.47 (95% CI 0.40 to 0.56) according to the definition of the American College of Surgeons Committee on Trauma (P <0.001). Where adjusted for trauma severity, the expected mortality rate at discharge from hospital was higher than observed mortality, with a difference of +2.0% (95% CI 1.4 to 2.6%; P <0.01)., Conclusions: Implementation of a regional trauma system with a pre-hospital triage procedure was effective in detecting severe trauma patients and in lowering the rate of pre-hospital undertriage. A beneficial effect on outcome of such an organization is suggested.

Purpose: Global mortality of polytraumatised patients presenting pelvic ring fractures remains high (330%), despite improvements in treatment algorithms in Level I Trauma Centers. Many classifications have been developed in order to identify and analyse these pelvic ring lesions. However, it remains difficult to predict intra-pelvic haemorrhage. The aim of this study was to identify pelvic ring anatomical lesions associated with significant blood loss, susceptible to lead to life-threatening haemorrhage., Material and Method: This study focused on a retrospective analysis of patients' medical files, all of whom were admitted to one of the shock rooms of Grenoble University Hospital, France, between January 2004 and December 2008. Treatment was given according to the institutional algorithm of the Alps Trauma Center and Emergency North Alpine Network Trauma System (TRENAU). Different hemodynamical parameters at arrival were measured, and the fractures were classified according to Young and Burgess, Tile, Letournel and Denis. One hundred and ninety seven patients were analysed. They were subdivided into two groups, embolised (Group E) and non-embolised (Group NE)., Results: Group NE included 171 patients with a mean age of 40.2 ± 8.7 years (15-90). Group E included 26 patients with a mean age of 41.6 ± 5.3 years (18-67). Twenty-six patients died during the initial treatment phase. Eleven belonged to Group E and 15 to Group NE. Mortality was significantly higher in Group E (42.3% vs 8.8% in Group NE) (p < 0.05). There were significantly many more Tile C unstable fractures in Group E (p = 0.0014), and anterior lesions, according to Letournel, with pubic symphysis disruption were significantly more likely to lead to active bleeding treated by selective embolisation (p = 0.0014). Posterior pelvic ring lesions with iliac wing fracture and transforaminal sacral fractures (Denis 2) were also more frequently associated with bleeding treated by embolisation (p = 0.0088 and p = 0.0369 respectively)., Discussion/conclusion: It appears that in our series the primary identification and classification of osteo-ligamentous lesions (according to Letournel and Denis' classifications) allows to anticipate the importance of bleeding and to adapt the management of patients accordingly, in order to quickly organise angiography with embolisation., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Transvaginal pelvic ultrasound is the first-line imaging examination for presumed benign ovarian tumors (PBOT) in adult women (Grade A). Ultrasound is sufficient for characterizing a unilocular anechoic cyst smaller than 7cm (Grade A). Magnetic resonance imaging is the recommended second-line investigation for indeterminate masses or masses larger than 7cm (Grade B). Serum CA-125 assay is not recommended for first-line diagnosis in adult women (Grade C). In women with a unilocular anechoic cyst, hormone therapy is ineffective and not recommended (Grade A). Ultrasound-guided aspiration is not recommended (Grade B). Abstention is an option in adult women with a unilocular asymptomatic anechoic cyst smaller than 10cm and no history of cancer (Grade B). If symptoms develop, laparoscopy is the gold standard for surgical treatment of PBOT (Grade A). Conservative surgical treatment (cystectomy) should be preferred to oophorectomy in pre-menopausal women without a previous history of cancer (Grade C). In cases of suspected adnexal torsion, laparoscopic surgical exploration is recommended (Grade B). Conservative treatment or detorsion without oophorectomy is recommended for pre-menopausal women regardless of the estimated torsion duration and macroscopic appearance of the ovary (Grade B). During pregnancy, expectant management is recommended for unilocular asymptomatic anechoic cysts smaller than 6cm (Grade C)., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Oxidative stress is a leading cause of neuronal damage in ischemic stroke. Melatonin may play a role in the antioxidant response. Melatonin and its metabolites may be involved in the modulation of oxidative stress in human acute stroke. No data are available in humans to establish this relationship. In this context, on the first and the fifth days post-stroke, we assessed serum total antioxidant capacity (TAC) and urine levels of melatonin, 6-sulfatoxymelatonin (aMT6S), and N1-acetyl-N2-formyl-5-methoxykynuramine (AFMK), the last compound being produced in the brain after reaction of melatonin with reactive oxygen species. Compared to controls' values, TAC and levels of melatonin and aMT6S were reduced, without difference between the first and the fifth days post-stroke, whereas AFMK levels remained in the normal range at both time points. Melatonin catabolism might be speeded up in acute ischemic stroke in order to increase the antioxidant response., (Copyright © 2013. Published by Elsevier Ireland Ltd.)

Since the 1993 French consensus conference on uncomplicated pelvic inflammatory diseases (uPID), new antibiotics appeared and bacterial resistances did evoluate. This methodic analysis of the literature updates different aspects of its treatment. Antibiotherapy must be established early (EL3). Inpatient and intravenous treatment is not superior to outpatient and oral treatment (EL1). Ofloxacine+metronidazole association can be proposed in first intention (EL1). If case of Neisseria gonorrhoeae infection, one ceftriaxone injection must be associated (EL4). All the other antibiotics associations have shown to be efficient except the metronidazole+doxycycline association, which is not indicated (EL2). Two weeks treatment seems to be a sufficient duration. Laparoscopic treatment in first intention is not justified except for diagnostic doubts or unfavorable evolution of the medical treatment (EL4). Neither non-steroidic antiinflamatorries, nor corticosteroids, have been proved to be efficient to decrease the adherence risk in uPID (EL3). Early extraction of an intra uterine device (IUD) allows symptomatologic improvement (EL2). Partners treatment with azithromycin improves the 4 months bacteriologic results (EL2). HIV positive patients do not need specific treatment (EL3)., (Copyright © 2012. Published by Elsevier Masson SAS.)

Objectives: The main objective was to estimate the nature, severity and medical care of severe trauma injuries following mountain activities as compared to severe trauma following traffic accident in a mountain area., Study Design: We conducted a prospective comparative monocentric observational study at a University Hospital located in the northern Alps area, using the First national study database (French intensive care recorded in severe trauma)., Patients and Methods: Three hundred and thirty-seven patients were included during a 2-year-period from January 2005 to December 2006. Three hundred and thirty-seven patients, including 223 traffic accidents and 114 mountain accidents were included. The survey data was achieved with a standardized method on a period of 30 days after the accident, and recorded in a computerized file for optimal completeness., Results: The study did not show higher severity or mortality rates in patients with mountain accidents. In both groups, we found a peak of mortality for young adults and similar causes of death. However, spinal cord injuries were statistically more frequent in mountain accidents., Conclusion: So, it seems important to continuously warn population about dangers of this playground., (2011 Elsevier Masson SAS. All rights reserved.)

Objective: The therapeutic role of lymphadenectomy on the survival in patients with ovarian cancer is controversial. The aim of this study was to evaluate the survival impact of lymphadenectomy, depending on the disease stage and extent of the surgery., Design: The surveillance, epidemiology, and end results (SEER) registry provided ovarian cancer data from 17 registries., Setting: Surveillance, Epidemiology, and End Results database., Population: The study population comprised 49,783 patients., Methods: Survival was studied according to the number of lymph nodes removed, with stratifications on disease stage and extent of surgery., Main Outcome Measure: The 5-year cause-specific survival rate., Results: The median follow up for patients alive at the last follow-up visit was 39 months. The five-year cause-specific survival rates were 37, 62, and 71% for the groups in which no lymph nodes were examined, in which between one and nine nodes were examined, and in which ten or more nodes were examined, respectively (P< 0.001). Avoiding lymphadenectomy was deleterious in all stages of the disease. It was maximal for International Federation of Gynecology and Obstetrics (FIGO) stage-II patients, but there was no significant interaction between stage and extent of lymphadenectomy. The cause-specific survival was found to significantly increase when more nodes were resected, even if the surgical procedure consisted of debulking surgery or a pelvic exenteration., Conclusion: Our study suggests a beneficial effect of lymphadenectomy in epithelial ovarian tumours, regardless of the stage of disease and extent of surgery. However, potential biases inherent to this retrospective methodology, such as staging migration, defining the extent of residual disease, and the possibility that thorough lymphadenectomy may reflect the quality of cytoreductive surgery, preclude any formal conclusions on the therapeutic role of lymphadenectomy., (© 2010 The Authors Journal compilation © RCOG 2010 BJOG An International Journal of Obstetrics and Gynaecology.)

Residents' feelings towards their care in temporary care homes. Elderly people cared for in institutions are obviously the best placed to talk about the quality of care and treatment they receive. As part of a positive treatment approach, it is the opinions of the residents themselves which carry most weight in assessing what they value most on a day-to-day basis. Results of a survey of voluntary residents in a temporary care home in the North of France.

Tomb Nr 1 of the ancient cemetery of Costebelle, attributed to the 4th century AD, contained the skeleton of a pregnant female and that of her foetus in the pelvic cavity. This was aged seven months, was almost complete and showed an exceptional example of bony lesions suggestive of infection. Its etiology suggested the likelihood of early congenital syphilis. This case raises the question of the theory of the importation of venereal disease into Europe, about a 1000 years later, by the crews of Christopher Columbus. The foetus of Costebelle is not an isolated example : other osteo-archaeological findings make a case for the existence of a treponeme (venereal or non venereal) in Europe before 1493.

Objectives: To describe a population of high risk pregnancies transported to a regional perinatal care centre (level III) and to analyze the advantages and limitations of the organization of this perinatal care network., Methods: Retrospective study of 263 patients transported to the University Hospital of Bordeaux between September 1996 and September 1998., Results: Maternal transport mainly came from the Gironde department (53%) and from level I care hospitals (66%). The rate of multiple pregnancies was 17%. Principal indications were preterm labor with or without rupture of fetal membranes (52%) and preeclampsia with or without intrauterine growth restriction (28%). The rate of returns to the referring care centre was 2%. The mean term at delivery was 32 WA. Forty-one percent of patients delivered within 24 hours of transport. The rate of caesarean sections was 55%. There were 303 live births. The mean duration of hospitalization of the neonates was 28 days. The rate of perinatal mortality was 6.2%. Among the 96 pregnancies beyond 32 WA, 17 (6.5%) could have been transported to some level IIb care hospitals, nearby the patient's residence, without changing maternal and neonatal prognosis. Neonatal mortality was not significantly different for maternel transport (18%) or neonatal transport (14%) in the group of premature infants born prior to 31 WA in our study., Conclusion: Our organization is currently trying to improve transport management (non-emergency situations, collaboration of level II care hospitals) and to increase the rate of returns to the referring care centres.

This study reports the fatty acid composition of subcutaneous adipose tissue in French women with special emphasis on the content of trans fatty acids originating from two main dietary sources, ruminant fats and partially hydrogenated vegetable oils (PHVO). Adipose tissue trans fatty acid levels from 71 women, recruited between 1997 and 1998, were determined using a combination of capillary gas chromatography and silver nitrate thin-layer chromatography. Results indicate that on average cis monounsaturates accounted for 47.9% of total fatty acids, saturates for 32.2%, and linoleic acid for 14.4%. Cis n-3 polyunsaturates represented only 0.7%. Total content of trans fatty acids was 2.32 +/- 0.50%, consisting of trans 18:1 (1.97 +/- 0.49%), trans 18:2 (0.28 +/- 0.08%), and trans 16:1 (0.06 +/- 0.03%). Trans 18:3 isomers were not detectable. The level of trans fatty acids found in adipose tissue of French women was lower than those reported for Canada, the United States, and Northern European countries but higher than that determined in Spain. Therefore, trans fatty acid consumption in France appears to be intermediate between that of the United States or North Europe and that of Spain. Based on the equation of Enig et al., we estimated the mean daily trans 18:1 acid intake of French women at 1.9 g per person. The major trans 18:1 isomer in adipose tissue was delta11 trans, as in ruminant fats. Estimates of relative contribution of trans fatty acid intake were 55% from ruminant fats and 45% from PHVO. This pattern contrasts sharply with those established for Canada and the United States where PHVO is reported to be the major dietary source of trans fatty acids.

A survey was conducted in 1707 sixth grade school children in the Calvados department of France. A self-administered questionnaire was filled out by the children in the presence of a school nurse. The cumulative prevalence of asthma was 14.9%. There was no significant difference between children living in urban or rural areas. There was however a significant difference by sex: 18% of the boys had asthma and 11% of the girls. The cumulative prevalence of wheezing was 25.4% (current prevalence 12.9%). The current prevalence of dry nocturnal cough, respiratory infections excluded, was 33.3%; that of exercise-induced asthma, 27%. Severity was evaluated on the basis of the number of wheezing episodes since the beginning of the school year (> 3 episodes: 4.5%), the number of awakenings at night per week (several per week: 2.2%), and aggravations severe enough to bother speech (4.3%). The rate of missed school days was 18.5% and that of asthma-related hospitalization 1.8%. One asthmatic child out of 4 had undergone pulmonary function tests and 1 out of 2 had a specific treatment for asthma. The high prevalence of childhood asthma in Calvados, with high morbidity, a significant number of missed school days, the exceptional nature of satisfactory pulmonary function testing, and the inconsistency of specific treatments, emphasizes the need for educational programs for parents and their family and improved physician training.

Background: A positive influence of anticoagulant treatment in small cell lung cancer (SCLC) has been suggested by experimental and clinical data., Methods: In a multicenter clinical trial, 277 patients with SCLC were randomized either to receive or not to receive subcutaneous heparin injections for 5 weeks at effective doses, which were monitored by blood coagulation tests. All patients received one of the two chemotherapy regimens studied in this trial, for eight courses in the case of patients with complete or partial response, and subsequently were randomized to receive delayed thoracic radiotherapy after these eight courses., Results: In comparison to the 139 patients who did not receive heparin, the 138 patients who received anticoagulant treatment obtained better complete response rates (37% vs. 23%, P = 0.004), better median survival (317 days vs. 261 days, P = 0.01), and better survival rates at 1, 2, and 3 years (40% vs. 30%, 11% vs. 9% and 9% vs. 6%, respectively). At subgroups analysis, the results on survival were obtained for limited forms (P = 0.03) but not for extensive diseases (P = 0.31). No important bleeding or thrombocytopenia was related to heparin treatment., Conclusions: These results confirm the value of anticoagulant treatment in SCLC, already suspected for warfarin and now proven for heparin, but the modes of administration and the biologic explanations for this activity still warrant further investigation.

Between 1967 and 1977, the systematic research of keratinophiles of the ground in a radius of 30--50 km around Lyon, has shown the ubiquitarian predominance of Microsporum nanum, which is probably the most ancient occupant of the ground. The most intensive areas of human and animal occupation in the Rhodanian tract show the predominance of Microsporum gypseum, which is scarcely found in man. Sporadic localizations, tightly limites, bound to cirulcation axes and international gathering, let us detect Microsporum cookei, Trichophyton verrucosum, Trichophyton mentagrophytes, Chrysosporium keratinophilum, and Keratinomyces ajelloi. However, in the last years, a progressive extension of recently imported kinds and a decrease in native kinds appears to have occurred.