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Resume Objectif de l’etude Bien que la radiotherapie conformationnelle en trois dimensions (RC3D) reste la reference comme traitement a visee curative des carcinomes bronchiques non a petites cellules (CBNPC) lorsque la chirurgie n’est pas retenue, la radiotherapie conformationnelle avec modulation d’intensite (RCMI ou IMRT) est de plus en plus utilisee en routine. L’objectif de cette etude etait d’evaluer l’impact clinique (toxicite immediate) et dosimetrique de la RCMI par rapport a la radiotherapie conformationnelle en trois dimensions dans le traitement des cancers bronchiques non a petites cellules localement evolues (de stades IIIA a IIIC) pris en charge par chimioradiotherapie concomitante, alors que la RCMI etait mise en place dans le cancer du poumon dans le departement de radiotherapie du centre Jean-Perrin. Materiel et methodes Entre mars 2015 et octobre 2019, 64 patients pris en charge par chimioradiotherapie concomitante ont ete inclus retrospectivement. Trente-deux ont beneficie d’une conformationnelle en trois dimensions et 32 d’une RCMI. La prescription de radiotherapie etait de 66 Gy en 33 fractions de 2 Gy. Resultats La RCMI a permis une amelioration de la couverture des volumes cibles (volume recevant 95 % de la dose prescrite, V95, augmente de 14,89 % en RCMI ; p Conclusion La radiotherapie en modulation d’intensite permet, en comparaison a la technique standard en radiotherapie conformationnelle en trois dimensions, une amelioration dosimetrique de la couverture des volumes cibles sans augmenter la dose dans les organes a risque. Elle ameliore egalement la tolerance immediate du traitement en diminuant le nombre de dysphagies tous grades confondus.

Intervention research in population health focuses on actions carried out by researchers in partnership with those involved in the intervention: health professionals, patients, carers, public policy makers and population communities. The diversity of actors shapes PHIR projects, testifies to the richness of this research and gives it a privileged place to analyse and intervene as accurately as possible in different contexts and populations. It also implies the need for a better understanding of how to intervene by considering the determinants of health in these interventions. PHIR in health promotion in the domain of cancer thus proposes a paradigm shift from describing the problem and its causes to intervention. RISP bases its theoretical anchors on the one hand on the contributions and models of public health, health promotion and human and social sciences and on the other hand, on its own contributions to theorise and build its own theoretical and methodological corpus. This presentation will aim to clarify this paradigm shift and five methodological challenges of PHIR: the imperialism of epidemiology as a research model; the evaluation models of PHIR and their polymorphism; the complexity of the objects of study; the partnership dynamics between researchers and field actors without which research cannot be carried out. Finally, the challenges of publication and valorisation of this type of research. Through concrete examples, participants will be invited to understand the challenges of the RISP methodology, and to analyse different concrete perspectives to address them. The first part will focus on identifying the participants’ representations of the methodological difficulties of PHIR. The second part will be an interactive presentation of 12 minutes, the last 2-3 minutes will be devoted to final questions.

BackgroundThirteen drugs with different mechanisms of action may be considered to treat patients with methotrexate (MTX) inadequate response in rheumatoid arthritis (RA). TNF inhibitors (TNFi) are frequently the first choice in this situation. Unfortunately, 30% to 40% of RA patients do not respond to TNFi, resulting in a delay for beginning the appropriate targeted DMARD (tDMARD). Predicting the patient response to TNFi before prescribing the treatment is therefore a major goal and could help physicians to prescribe a tDMARD suited to the patient.ObjectivesWe aimed to build machine learning models based on simple clinical and biological data to predict patient response to TNFi.MethodsWe used data from the ESPOIR early arthritis cohort (1) to train the models, and the ABIRISK cohort (2) to validate the results. We included patients that fulfilled the EULAR/ACR 2010 criteria and that were treated with a TNFi. The models take as inputs patient’s characteristics at treatment initiation and predicts the therapeutic response, defined as the EULAR response 12 months (+/- 6 months) after treatment initiation. We compared the performances of four models (Linear Regression, Random Forest, XGBoost, and Catboost) on the training set by cross-validated them using the Area Under the ROC Curve (AUCROC). The best model was then evaluated on the validation dataset (ABIRISK cohort). We conducted the methodology both on all TNFi together and on etanercept and monoclonal anti-TNF antibodies separated. We analyzed how clinical and biological variables impacted response to provide explainability of the prediction.ResultsWe included 164 patients from the ESPOIR cohort and 118 patients from the ABIRISK cohort. Better results were obtained when etanercept and monoclonal anti-TNF antibodies were analyzed separately.These models predict a probability for a patient to respond to TNFi. This probability is compared to a decision threshold to obtain the binary outcome. Two decision thresholds were tested. The first prioritizes a high confidence when identifying responders (Strategy 1) while the second prioritizes a high confidence when identifying non-responders (Strategy 2). The model’s results are presented in Table 1.Table 1.Sensitivity, Specificity, PPV and NPV are computed on the ABIRISK validation cohort for each strategyDrugAUC(ESPOIR)AUC(ABIRA)STRATEGY 1 (high confidence in response)STRATEGY 2 (high confidence in non-response)SensitivitYSpecificityPPVNPVSensitivitySpecificityPPVNPVOverall TNFi0.720.6518%91%76%42%90%30%67%67%(0.68-0.73)(0.54 - 0.75)(10%-27%)(82%-98%)(54%-95%)(32%-51%)(83%-96%)(18%-44%)(58%-76%(45%-86%Etanercept0.740.7060%73%78%53%95%15%64%67%(0.68-0.75)(0.57- 0.82)(44%-74%)(55%-89%)(63%-92%)(36%-69%)(88%-100%)(4%-30%)(52%-76%)(20%-100%)Monoclonal anti-TNF antibodies0.740.7137%95%92%50%90%40%69%73%(0.69-0.77)(0.55-0.86)(20%-55%)(83%-100%)(73%-100%)(35%-66%)(78%-100%)(19%-62%)(54%-84%)(44%-100%)Using SHAP, we were able to analyze how each variable impacted the predictions. In particular, a DAS28 around 5 had the highest positive impact on response. Higher and lower values of DAS28 had either less impact or even negative impact on the patient response to TNFi treatment (Figure 1). This allows to identify non-linear relations between variables and patient response.ConclusionThe machine learning models developed in this study can predict RA patients’ response to TNFi using exclusively data available in clinical routine. These models also allow to analyze how these variables are used to predict response. Along with similar models for other tDMARDs, such algorithms could lead to a personalized therapeutic strategy.References[1]Combe B, Benessiano J, Berenbaum F, Cantagrel A, Daurès J-P, Dougados M, et al. The ESPOIR cohort: A ten-year follow-up of early arthritis in France.[2]Anon. ABIRISK Anti-Biopharmaceutical Immunization: Prediction and Analysis of Clinical Relevance to Minimize the RISK. 2019.AcknowledgementsFor the first 5 years of the ESPOIR cohort, an unrestricted grant from Merck Sharp and Dohme (MSD) was allocated. Two additional grants from INSERM were obtained to support part of the biological database. The French Society of Rheumatology, Pfizer, AbbVie, Lilly, and more recently Fresenius and Biogen also supported the ESPOIR cohort study. We also wish to thank Nathalie Rincheval (Montpellier) who did expert monitoring and data management and all the investigators who recruited and followed the patients (F.Berenbaum, Paris-Saint Antoine, MC.Boissier, Paris-Bobigny, A.Cantagrel, Toulouse, B.Combe, Montpellier, M.Dougados, Paris-Cochin, P.Fardellone et P.Boumier Amiens, B.Fautrel, Paris-La Pitié, RM. Flipo, Lille, Ph. Goupille, Tours, F. Liote, Paris-Lariboisière, O.Vittecoq, Rouen, X.Mariette, Paris Bicetre, P.Dieude, Paris Bichat, A.Saraux, Brest, T.Schaeverbeke, Bordeaux, J.Sibilia, Strasbourg) as well as S.Martin (Paris Bichat) who did all the central dosages of CRP, IgA and IgM rheumatoid.SB was supported by FHU CARE.Disclosure of InterestsNone declared.

Objectif : Évaluation d’un deuxième traitement conservateur (T) [n = 41] par rapport à une mastectomie totale (M) [n = 93]. Étude rétrospective unicentrique de 134 patientes ayant présenté une récidive mammaire homolatérale isolée et opérable. Résultats : La survie globale à cinq ans est de 82,5 % dans les deux groupes. Pas de différence significative pour la survie spécifique et la survie sans métastase dans les deux groupes. Le contrôle local à cinq ans est de 92,9 % dans le groupe Met de 66,2 % dans le groupe T (RR de nouvelle récidive de 4,48). La présence d’emboles, le caractère multifocal et la révélation clinique de la récidive sont des facteurs pronostiques péjoratifs de survie. Sur l’ensemble de la série (n = 134), 25 (18,6 %) ont conservé leur sein. Conclusion : Pour minimiser le risque de récidive après un second traitement conservateur, on peut envisager cette chirurgie si la récidive est isolée, de petite taille, de bas grade, sans embole, et strictement unifocale. L’acte chirurgical doit assurer des marges saines et un résultat esthétique satisfaisant. La patiente participe au choix du traitement.

Ability to assess flares in osteoarthritis (OA) of the knee and hip (KHOA) is important in clinical care and research. Using mixed methods, we developed a self-reported instrument measuring flare and assessed its psychometric properties.We constructed questionnaire items from semi-structured interviews and a focus group (patients, clinicians) by using a dual-language (English-French) approach. A Delphi consensus method was used to select the most relevant items. Patients with OA from Australia, France and the United States completed the preliminary Flare-OA, HOOS, KOOS and Mini-OAKHQOL questionnaires online. We used a factor analysis and content approach to reduce items and determine structural validity. We tested the resulting questionnaire (score 0-100) for internal consistency, convergent and known-groups validity.Initially, 180 statements were generated and reduced to 33 items in five domains (response 0 = not at all, to 10 = absolutely) by Delphi consensus (50 patients, 116 professionals) and an expert meeting. After 398 patients (mean [SD] age 64 [8.5] years, 70.4% female, 86.7% knee OA) completed the questionnaire, it was reduced to 19 items by factor analysis and a content approach (RMSEA = 0.06; CFI = 0.96; TLI = 0.94). The Cronbach's alpha was0.9 for the five domains and the whole questionnaire. Correlation coefficients between Flare-OA and other instrument scores were as predicted, supporting construct validity. The difference in Flare-OA score between patients with and without flare (31.8) largely exceeded 2 SEM (10.2).Flare-OA is a valid and reliable patient-reported instrument for assessing the occurrence and severity of flare in patients with KHOA in clinical research.

Although three-dimensional conformal radiotherapy (3D-CRT) remains the gold standard as a curative treatment for NSCLC when surgery is not possible, intensity modulated radiotherapy (IMRT) is increasingly used routinely. The purpose of this study was to assess the clinical (immediate toxicities) and dosimetric impact of IMRT compared to 3D-CRT in the treatment of locally advanced (stages IIIA to IIIC) non-small cell lung cancer (NSCLC) treated with concomitant radiochemotherapy, while IMRT in lung cancer was implemented in the radiotherapy department of the Jean-Perrin Center.Between March 2015 and October 2019, 64 patients treated with concomitant radiochemotherapy were retrospectively included. Thirty-two received 3D-CRT and 32 IMRT. The radiotherapy prescription was 66Gy in 33 fractions of 2Gy.IMRT has improved coverage of target volumes (V95 increased by 14.81% in IMRT; P0.001) without increasing doses to OARs and reducing dysphagia (RR=0.67; P=0.027). Low doses to the lung were not significantly increased in IMRT (pulmonary V5 increased by 7.46% in IMRT).Intensity modulated radiotherapy, compared with the standard RC3D technique, improve the coverage of target volumes without increasing the dose to the OARs. It also improves the immediate tolerance of the treatment by reducing the number of dysphagia.

BackgroundMethotrexate (MTX) is the first line of treatment for rheumatoid arthritis (RA) patients. Unfortunately, 30% to 40% of RA patients do not respond to MTX, resulting in uncontrolled joint pain and potential joints destruction. At the same time, many efficient second-line treatments exist and can be given to the inadequate responder patients. Predicting patient response to MTX before prescribing the treatment is therefore a major goal and could enable physicians to directly prescribe second-line treatments if inadequate response to MTX is predicted.ObjectivesWe aimed to build machine learning models based on simple clinical and biological data to predict patient response to MTX.MethodsWe used data from the ESPOIR early arthritis (1) and Leiden cohorts (2) to train the models, and the tREACH cohort to validate the results. We included patients that fulfilled the EULAR/ACR 2010 criteria and that were treated with MTX in monotherapy as their first treatment for RA. The models take as inputs patient’s characteristics at treatment initiation and predict the therapeutic response, defined as the EULAR response 3 to 12 months after treatment initiation. We evaluated four missing data imputation methods (median, mean, MICE, KNN); we used the backward feature selection algorithm to select the most relevant variables; and compared the performances of four models (Linear Regression, Random Forest, XGBoost, and Catboost) on the training set by cross-validated them using the Area Under the ROC Curve (AUCROC). The best model was then evaluated on the validation dataset.ResultsWe included 435 patients from the ESPOIR cohort, 243 patients from the Leiden cohort and 143 patients from the t-REACH cohort. Results of the model are displayed in Table 1. The variables automatically selected to perform prediction were Sex, DAS28, White blood cells, AST, ALT and lymphocytes. Our model performs well on unseen data, this result comes from the fact that we included two different cohorts in our training set which reduces the overfitting of our model and helps him generalize.Table 1.Sensitivity, Specificity, PPV and NPV are computed on the T-REACH validation cohort for each strategyAUC(ESPOIR, LEIDEN)AUC(T-REACH)STRATEGY 1 (High confidence in responders)STRATEGY 2 (high confidence in non-responDeRS)SensitivitYSpecificityPPVNPVSensitivitySpecificityPPVNPV0.720.7320%98%95%40%91%33%71%68%(0.70-0.73)(0.64-0.81)(12%-28%)(83%-100%)(82%-100%)(32%-49%)(85%-97%)(20%-47%)(63%-79%)(48%-86%)Our model predicts a probability for a patient to respond to MTX. This probability is compared to a decision threshold to obtain the final binary outcome. Two decision thresholds were tested. The first prioritizes a high confidence when identifying responders (Strategy 1) while the second prioritizes a high confidence when identifying non-responders (Strategy 2). This second strategy would enable physicians to identify highly probable inadequate responders to methotrexate and propose them directly a targeted DMARD such as TNF inhibitors, while still treating more than 70% of patients with MTX as first-line treatment.ConclusionThe machine learning models developed in this study can predict RA patients’ response to methotrexate with a good accuracy exclusively using data available in clinical routine. It paves the way for personalized therapeutic strategies in rheumatoid arthritis.References[1]Combe B, Benessiano J, Berenbaum F, Cantagrel A, Daurès J-P, Dougados M, et al. The ESPOIR cohort: A ten-year follow-up of early arthritis in France. Joint Bone Spine 2007;74:440–445.[2]van Aken, J., van Bilsen, J. H., Allaart, C. F., Huizinga, T. W., & Breedveld, F. C. The Leiden Early Arthritis Clinic. Clinical and experimental rheumatology, 21(5 Suppl 31), S100–S105.Disclosure of InterestsNone declared.

BackgroundThe study of associations between body composition and osteoarthritis is still incomplete. While fat-related components are associated with pain in cross-sectional studies, longitudinal studies are rare and the impact on other quality of life (QOL) dimensions is not known.ObjectivesThe main objective of the study was to analyze the impact of body composition on the evolution of the perceived health of patients followed for hip and knee osteoarthritis (OA).MethodsLongitudinal data from the Knee and Hip Osteo Arthritis Long-term Assessment (KHOALA) cohort, a multicenter cohort of 878 patients with symptomatic knee and/or hip OA, were used. Body composition measures were obtained from DXA scans at year 3. Only 3 of the 6 investigating centers with Lunar Prodigy Advance DXA equipment recruited patients for this study. The main outcome criteria were the changes in Patient-Reported Outcomes Measures (PROms) (physical functioning, pain, mental health and vitality of the SF-36 0=worst,100=best) between 3 and 7 years of follow up. Body composition variables were as follows: fat mass index (FMI (kg/m2)), percentage of fat mass and trunk to leg fat mass ratio (TFM/LFM), skeletal muscle Mass Index (SMI (kg/m2)) and low lean mass if SMI 2 for men and 2 for women. To account for the correlation of repeated measurements of the same individual, generalized estimating equation (GEE) models were used to assess the associations between body composition measurements and the 4 SF-36 scores. The GEE models were adjusted for potential confusion covariates (age, sex, education level, occupation, smoking, comorbidity, hand OA, number of painful joints, joint of inclusion and Kellgren grade (KL)) showing a significant association at the 0.2 threshold in the bivariate analysis.Results290 patients with knee and 114 patients with hip OA have been included in the analysis: women 254 (66.7%), mean age 60.3 (SD 8.4) years old, IMC 29.5 (5.7), KL grade2 135 (46.6%) for knee OA, 79 (69.3%) for hip OA.The results of the multivariate analysis of associations between anthropometric measures and quality of life dimensions are presented in Table 1.Table 1.Physical functionningBodily painMental healthVitalityβCI* 95%pβCI* 95%pβCI* 95%pβCI* 95%pFMI*-0.02(-0.03;-0.01)-0.007(-0.02;0.002)0.140.0012(-0.006;0.008)0.76-0.01(-0.02;0.002)0.02TLF/LFM*0.06(-0.02;0.14)0.120.03(-0.06;0.12)0.530.09(0.02;0.15)0.0080.08(0.002;0.17)0.04SMI*0.01(0.006;0.02)0.02(0.01;0.02)Low LM-0.21(-0.02;0.02)0.02Positive coefficients indicate that the outcome variable increased more for the observed group than for other participants.*The estimator expresses the variation of risk for an increase of 1 units of the variable.Analyses were adjusted on age, sex, education level, occupation, smoking, comorbidity, hand OA, number of painful jointsConclusionIncreased FMI and the presence of low muscle mass (SMI) were associated with impaired functional ability, but not with pain, the associations of which disappeared after adjustment. Increased TFM/LFM and SMI were associated with improved mental health and vitality over timeDisclosure of InterestsAnne-Christine Rat Speakers bureau: Pfizer, Lilly, Abbvie, Galapagos, novartis, Consultant of: Pfizer, Lilly, Sanofi Genzyme, Abbvie, BMS, Jérémie SELLAM: None declared, Bernard Mazières: None declared, Willy Ngueyon Sime: None declared, PATRICE FARDELLONE: None declared, Francis Guillemin: None declared

Purpose New multiple sclerosis (MS) disease-modifying therapies (DMTs), which exert beneficial effects through prevention of relapse, limitation of disability progression, and improvement of patients’ quality of life, have recently emerged. Nonetheless, these DMTs are not without associated complications (severe adverse events like. progressive multifocal leukoencephalopathy). Patient follow-up requires regular clinical evaluations and close monitoring with magnetic resonance imaging (MRI). Detection of new T2 lesions and potential brain atrophy measurements contribute to the evaluation of treatment effectiveness. Current MRI protocols for MS recommend the acquisition of an annual gadolinium (Gd) enhanced MRI, resulting in administration of high volume of contrast agents over time and Gd accumulation in the brain. Methods A consensus report was established by neuroradiologists and neurologists from the French Observatory of MS, which aimed at reducing the number of Gd injections required during MS patient follow-up. Recommendations The French Observatory of MS recommends the use of macrocyclic Gd enhancement at time of diagnosis, when a new DMT is introduced, at 6-month re-baseline, and when previous scans are unavailable for comparison. Gd administration can be performed as an option in case of relapse or suspicion of intercurrent disease such as progressive multifocal leukoencephalopathy. Other follow-up MRIs do not require contrast enhancement, provided current and previous MRI acquisitions follow the same standardized protocol including 3D FLAIR sequences.

International audience; Background - Research in the field of primary care has dramatically increased in France in recent years, especially since 2013 with the introduction of primary care as a thematic priority for research proposals launched by the Ministry of Health (Direction générale de l'offre de soins). Material and methods - The RECaP (Research in Clinical Epidemiology and Public Health) network is a French research network supported by Inserm, which recently implemented a specific working group focusing on research in primary care, based on a multidisciplinary approach. Researchers from different specialties participate in this group. The first aim of the group was to reach a common definition of the perimeter and of the panel of healthcare professionals and structures potentially involved in the field of primary care. For this purpose, a selection of different data sets of sources defining primary care was analyzed by the group, each participant collecting a set of sources, from which a synthesis was made and discussed. Results - A definition of primary care at different levels (international, European and French) was summarized. A special attention was given to the French context in order to adapt the perimeter to the characteristics of the French healthcare system, notably by illustrating the different key elements of the definition with the inclusion of primary care actors and the type of practice premises. Conclusion - In conclusion, this work illustrates the diversity of primary care in France and the potential offered for research purposes.

It is proposed to delineate the anatomo-clinical target volumes of primary tumor (CTV-P) in ethmoid cancers treated with post-operative radiotherapy. This concept is based on the use of radioanatomy and the natural history of cancer. It is supported by the repositioning of the planning scanner with preoperative imaging for the replacement of the initial GTV and the creation of margins around it extended to the microscopic risk zones according to the anatomical concept. This article does not discuss the indications of external radiotherapy but specifies the volumes to be delineated if radiotherapy is considered.

Resume Objectifs Le but de notre etude est d’evaluer la reponse histologique complete apres une chimiotherapie neoadjuvante associant un taxane a du trastuzumab pour des patientes ayant ete prises en charge pour des cancers du sein a l’institut Jean-Godinot entre 2012 et 2014, et d’evaluer les facteurs associes a cette reponse histologique complete. Methodes Etude retrospective avec analyse des parametres cliniques, radiologiques et anatomopathologiques avant et apres chimiotherapie neoadjuvante. L’analyse statistique etait realisee par le logiciel XL-STAT, le test de Mann-Whitney-Wilcoxon pour les variables quantitatives et des tests de Fisher exact pour les variables qualitatives, le test du coefficient de correlation des rangs de Spearman. Resultats Le taux de reponse histologique complete est de 38,8 %. Le facteur pronostique associe a une reponse histologique complete est un Ki-67 > 44 %. Conclusion Le taux de reponse histologique complete correspond a la moyenne basse internationale. L’importance des donnees manquantes n’a pas permis de degager d’autre facteur pronostique qu’un Ki67 > 44 %.

We study the stationary distribution of a system of two parallel M/M/∞ queues managed by the Join the Shortest Queue load balancing policy; one motivation for characterizing the efficiency of that policy is its potential application to resource allocation issues in cloud computing. For the general system with distinct service rates, we first show that the tail of each marginal queue length distribution exhibits a much faster decay than that of a Poisson distribution. Second, the determination of the joint stationary distribution is shown to reduce to the resolution of a pair of linear integral equations. In the case when service rates are identical (“symmetric case”), that pair of integral equations simplifies to a single Fredholm integral equation of the first kind whose solution is explicitly given in terms of Legendre polynomials; this enables us to entirely determine the stationary distribution of the system. We provide, in particular, asymptotics for the second moment and the tail of the queue length...

Resume Objectif Definir les phases composant la courbe d’apprentissage de l’hysterectomie totale (HT) et de l’hysterectomie elargie avec curage pelvien (HECP) robot-assistee d’un unique operateur sans experience prealable en cœliochirurgie. Methodes Nous avons analyse de facon retrospective 72 procedures (HT, n = 34 et HECP, n = 38) realisees entre 2002 et 2011. L’utilisation de la methode CUSUM a permis l’analyse de la courbe d’apprentissage de l’HT et de l’HECP a partir du temps a la console (TC). Les donnees epidemiologiques, perioperatoires et les complications operatoires ont ete comparees a partir des differentes phases composant la courbe d’apprentissage. Resultats L’analyse CUSUM du temps a la console (CUSUMTC) a permis d’identifier 2 phases d’apprentissage pour le groupe HT (phase 1 : apprentissage initial, phase 2 : augmentation des performances). Pour le groupe HECP, trois phases d’apprentissage ont ete identifiees (phase 1 : apprentissage initial, phase 2 : extension des indications, phase 3 : maitrise technique). Les donnees perioperatoires ainsi que le taux de complications postoperatoires ne differaient pas de facon significative entre les phases d’apprentissage. Le TC diminuait des le 9e cas (p = 0,01) pour le groupe HT et des le 13e cas (p = 0,04) pour le groupe HECP. Conclusion L’etude de la courbe d’apprentissage par la methode CUSUM en chirurgie oncogynecologique robot-assistee a permis de definir deux phases d’apprentissage pour des procedures simples comme l’hysterectomie totale et trois phases d’apprentissage pour des procedures plus complexes comme l’hysterectomie elargie avec curage pelvien.

This paper proposes a method for estimating the process noise covariance matrix, using multiple Kalman filters. The basic idea is to employ the difference between the expected prediction error covariance, calculated in the Kalman filters, and the measured prediction error covariance. The required estimate of the process noise covariance is obtained by solving a least squares problem. One simulated example is used to illustrate the main benefits of the proposed method.

The aim of the study was to determine factors influencing functional ability and quality of life 6 months after surgically treated trochanteric fractures.A multicenter cohort included 459 patients (365 females, 103 males, mean age 80.5 years) in Eastern France. They presented with stable (62%) and unstable (38%) fractures. Six months after surgery, functional ability and quality of life were assessed by Merle d'Aubigné, Harris and Duke Health profile scores, or return to home.In logistic regression analysis, age was the most prominent factor predicting low functional ability and quality of life. The implant material similarly predicted poor functional ability and level of quality of life, probably through the different strategies for care management they involved. The quality of fracture reduction assessed on lateral radiograph as well as post-operative complications were predictors of a better functional ability. A delayed weight bearing was also suggested to predict better quality of life in these patients.

Background NETSARC (netsarc.org) is a network of 26 sarcoma reference centers with specialized multidisciplinary tumor boards (MDTB) aiming to improve the outcome of sarcoma patients. Since 2010, presentation to an MDTB and expert pathological review are mandatory for sarcoma patients nationwide. In the present work, the impact of surgery in a reference center on the survival of sarcoma patients investigated using this national NETSARC registry. Patients and methods Patients’ characteristics and follow-up are prospectively collected and data monitored. Descriptive, uni- and multivariate analysis of prognostic factors were conducted in the entire series (N = 35 784) and in the subgroup of incident patient population (N = 29 497). Results Among the 35 784 patients, 155 different histological subtypes were reported. 4310 (11.6%) patients were metastatic at diagnosis. Previous cancer, previous radiotherapy, neurofibromatosis type 1 (NF1), and Li–Fraumeni syndrome were reported in 12.5%, 3.6%, 0.7%, and 0.1% of patients respectively. Among the 29 497 incident patients, 25 851 (87.6%) patients had surgical removal of the sarcoma, including 9949 (33.7%) operated in a NETSARC center. Location, grade, age, size, depth, histotypes, gender, NF1, and surgery outside a NETSARC center all correlated to overall survival (OS), local relapse free survival (LRFS), and event-free survival (EFS) in the incident patient population. NF1 history was one of the strongest adverse prognostic factors for LRFS, EFS, and OS. Presentation to an MDTB was associated with an improved LRFS and EFS, but was an adverse prognostic factor for OS if surgery was not carried out in a reference center. In multivariate analysis, surgery in a NETSARC center was positively correlated with LRFS, EFS, and OS [P

In our study, we aimed to assess the pathologic complete response after neo-additive chemotherapy that contains a taxan associated to trastuzumab for patients treated from breast cancer at the institute Jean-Godinot between 2012 and 2014, and to evaluate factors associated to this pathologic complete response.Retrospective study with clinical, anatomopathologic and radiologic parameters analysis before and after new adjuvant chemotherapy. The statistical analysis was done on logiciel XL-STAT, the Mann-Whitney-Wilcoxon for quantitative variables and Fisher exact tests for qualitative variables, the Spearman rang test.The rate of pathologic complete response is 38.8%. The prognostic factor associated to pathologic complete response is a Ki-6744%.The pathologic complete response rate corresponds to international lower rate; because of the lack of several data, we found out only one prognostic factor, Ki-6744%.

a Service de radiologie adultes, CHU Nancy-Brabois, rue du Morvan, 54511 Vandœuvre-les-Nancy cedex, France b Service d’imagerie medicale, hopital d’Instruction des Armees Legouest, 27, avenue de Pantieres, 57070 Metz, France c Service de radiodiagnostic, centre regional de lutte contre le cancer de Lorraine Alexis-Vautrin, avenue de Bourgogne, 54511 Vandœuvre-les-Nancy, France d Service d’anatomie pathologique, centre regional de lutte contre le cancer de Lorraine Alexis Vautrin, avenue de Bourgogne, 54511 Vandœuvre-les-Nancy, France e Departement de chirurgie, centre regional de lutte contre le cancer de Lorraine Alexis Vautrin, avenue de Bourgogne, 54511 Vandœuvre-les-Nancy, France

Background Depressive mood has been associated with all-cause mortality in both men and women. This study aimed at exploring gender differences in the association between depressive mood and specific causes of mortality as well as factors that may account for it, including education, marital status, social support, health behaviors, and chronic diseases. Methods A population-based survey including 6043 subjects (2892 men and 3151 women) was conducted in 1996 in the north-east of France with a questionnaire covering education, marital status, social support, health behaviors (smoking status, alcohol consumption, body mass index), and chronic diseases. Depressive mood was measured using the Duke Health Profile questionnaire. Cox regression models were used to examine its association with subsequent natural all-cause mortality, and cardiovascular and cancer mortality. Results During a follow-up of 12.5 years, 406 men and 303 women died from a natural cause. Adjusting for all covariates, depressive mood predicted natural mortality in both men [Hazard Ratio (HR) = 1.30; 95% confidence interval (CI): 1.00–1.69] and women (HR = 1.37; 95% CI: 1.06–1.77). However, this association was significant for cardiovascular mortality in men (HR = 1.63; 95% CI: 1.00–2.65) whereas it was significant for cancer mortality in women (HR = 1.71; 95% CI: 1.11–2.64). Limitations Baseline data were self-reported and the response rate was low. Discussion Preventive strategies aiming at reducing the increased mortality associated with depressive mood should take gender into account. Depressed men may warrant a better screening for cardiovascular risk factors and diseases, whereas depressed women may benefit from better cancer prevention measures.

Fatigue is a frequent symptom of multiple sclerosis (MS). It has been reported to varying degrees at all stages of the disease by 50 to 90% of all MS patients. Fatigue is now recognised as a disabling symptom which negatively impacts daily living. This symptom was underrated until recently but has now been included in clinical practice. Most fatigue scales have been developed in the English language and are culturally specific to their country of origin. The Fatigue Severity Scale is a one-dimensional nine-item scale which briefly assesses the impact of fatigue on the daily lives of MS patients. It has been widely used in different studies, even though it appears to be less relevant than the multi-dimensional 40-item Fatigue Impact Scale which was developed in Canada by Fisk et al (1994). The Fatigue Impact Scale is useful because it assesses different aspects of MS-related fatigue, such as the effects of fatigue on cognitive and physical activities and can include daily living. The Multiple Sclerosis Council for Clinical Practice Guidelines recommends the use of a 21-item Modified Fatigue Impact Scale which is a shortened version of the 40-item Fatigue Impact Scale. Using word-for-word translations of these scales into French would fail because the results would not be interpretable. We first translated and culturally adapted the Fatigue Impact Scale to French-speaking patients. We then evaluated the psychometric properties of this French version (EMIF-SEP). We used the EMIF-SEP scale to study fatigue in French MS patients. We found a significant correlation between higher EMIF-SEP total scores and higher EDSS scores; likewise physical dimension of the EMIF-SEP were linked to disability. But no correlations were found between the cognitive aspects of fatigue and disability. Other studies have failed to show any correlation between fatigue and disability. We suggest that this may be due to differences in sample size, or to the type of instrument used to quantify fatigue. As seen above, some tools do not allow for multi-dimensional assessment of fatigue. The EMIF-SEP scale is useful in that it allows for qualitative and quantitative assessment of fatigue.

This study aims to describe the prevalence and incidence rates of multiple sclerosis (MS) in Lorraine, France, and its secular trend from 1990 to 2002. Cases were sourced from the regional network of MS healthcare workers in the Lorraine region and include all cases with definite or probable MS according to Poser's criteria. We identified 2718 patients with MS on 31 December 2004. The prevalence rate was 120/100 000 (95% confidence interval [CI]: 119—121). Between 1990 and 2002, the average age- and sex-adjusted annual incidence rate was 5.5/100 000 (95% CI: 4.4—6.6). During this same period, there was a significant increase in overall incidence in women but not in men. The mean age at MS onset, disability score five years after onset, number of relapses during the first five years, and proportion of first attack with sequelae or polysymptomatic symptoms were not significantly different between each annual cohort during the study period. The prevalence and incidence rates of MS we found in our study were higher than in previous studies in France. The increase in incidence of MS between 1990 and 2002, mostly in women, was not related to better ascertainment of patients with mild disability. Multiple Sclerosis 2007; 13: 962—967. http://msj.sagepub.com

Purpose Fatigue is a frequent and common symptom of multiple sclerosis (MS) that can interfere with patients' everyday activities. There is no objective scale for assessing fatigue in French MS patients. The objective of this study was to adapt an English language scale for use with French patients. Methods The Fatigue Impact Scale was translated and culturally adapted into French by a committee of medical and linguistic specialists. The psychometric properties of this new instrument, called EMIF-SEP were assessed. Results EMIF-SEP is composed of 40 items. Four dimensions of this scale (cognitive, physical, social role and psychological) were identified by factor analysis. Each dimension had a high internal consistency (Cronbach's alpha >0.80). The test-retest reproducibility was very satisfactory; intra-class correlation coefficients were all above 0.70. Conclusion EMIF-SEP is the first scale for assessing MS-related fatigue which has been adapted to French-speaking patients. It is useful for clinical practice and MS-related research. Multiple Sclerosis 2007; 13: 1026—1032. http://msj.sagepub.com

Bien que la formation universitaire des chirurgiens ne prevoit pas de formation dediee a la cancerologie chirurgicale, celle-ci apparait comme necessaire pour repondre aux specificites de la prise en charge des patients atteints de cancer. L’enseignement de la cancerologie est present dans les specialites d’organes et les internes peuvent s’inscrire au DESC de cancerologie ou au diplome interuniversitaire de pratiques chirurgicales en cancerologie. Dans la pratique, les chirurgiens doivent respecter les criteres de qualite de l’exerese qui sont specifiques de l’organe et de la pathologie en cause. Le geste chirurgical doit aussi etre realise avec l’objectif de preserver au mieux la qualite de vie. Enfin, il doit s’inscrire dans la strategie therapeutique pluridisciplinaire et le chirurgien doit etre un acteur a part entiere de la discussion, ce qui suppose qu’il ait un niveau de connaissance suffisant de la maladie cancereuse. Apres la parution prochaine des decrets d’autorisation pour les traitements du cancer qui s’appliqueront aux etablissements, le chirurgien devra intervenir dans un etablissement autorise et avoir une activite suffisante pour que l’activite de celui-ci soit superieure ou egale a un seuil minimal annuel qui sera determine par organe.

Aims To review a series of 23 consecutive patients with squamous cell carcinomas arising from oropharynx who underwent infra hyoid musculo-cutaneous flap reconstruction including soft palate in alternative to free radial forearm flap or maxillofacial prosthesis. Post operative radiotherapy was performed for all patients. Results Every reconstruction healed quickly without major wound complications. The functional results evaluated by speech and swallowing capacities, were good for 17 patients, fair for 4 patients and bad for 2. Conclusions The infra hyoid musculo-cutaneous flap is a versatile, reliable and convenient flap suitable for repairing small and medium sized defects; it can be used in combination with other flaps, and in selected cases obviates the need for a microvascular free radial forearm flap or maxillofacial prosthesis.

Purpose: Spina bifida (SB) is the most common congenital cause of incontinence in childhood. This study attempts to determine the relationships between urinary/faecal incontinence, methods of management, and Health Related Quality of Life (HRQoL) in people with SB. Patients and method: A total of 460 patients (300 adults and 160 adolescents) from six centres in France have taken part in this cross-sectional study. Clinical outcome measures included walking ability, urinary/faecal continence, and medical management. HRQoL was assessed using the SF36 in adults and the VSP in adolescents and their parents. Univariate and multivariate analysis was used to determine the relationships between clinical parameters and HRQoL. Results: HRQoL were significantly lower than in the general population. Adult women had significantly lower scores than men, and adolescent females had significantly lower scores for psychological well being. We did not found strong relationship between incontinence and HRQoL in this population. Moreover patients surgically managed for urinary/fecal incontinence did not show significantly higher scores of HRQoL. Conclusion: Using generic HRQoL measures, urinary/faecal incontinence and their medical management may not play a determinant role in HRQoL of persons with SB. However many other factors affect HRQoL in these patients. A longitudinal study design is recommended to assess whether incontinence management is associated with improve HRQoL.