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L’invention se rapporte à un procédé de stockage et de libération d’énergie thermique par voie thermochimique au moyen d’un composé sous forme solide de formule AOxBy.zH2O, où : A est un élément choisi parmi l’uranium (U) et le thorium (Th) ; est l’élément oxygène ; B est un anion ou un oxoanion ; x est un nombre compris entre 0 et 4 ; y est un nombre compris entre 0 et 2 ; z est un nombre supérieur à 0 et inférieur à 10, étant entendu que l’un au moins de x et y est différent de 0 et que le composé de formule Th(SO4)2.xH2O est exclu.

Background No simple classification system has emerged for 'advanced basal cell carcinomas', and more generally for all difficult-to-treat BCCs (DTT-BCCs), due to the heterogeneity of situations, TNM inappropriateness to BCCs, and different approaches of different specialists. Objective To generate an operational classification, using the unconscious ability of experts to simplify the great heterogeneity of the clinical situations into a few relevant groups, which drive their treatment decisions. Method Non-supervised independent and blinded clustering of real clinical cases of DTT-BCCs was used. Fourteen international experts from different specialties independently partitioned 199 patient cases considered 'difficult to treat' into as many clusters they want (≤10), choosing their own criteria for partitioning. Convergences and divergences between the individual partitions were analyzed using the similarity matrix, K-mean approach, and average silhouette method. Results There was a rather consensual clustering of cases, regardless of the specialty and nationality of the experts. Mathematical analysis showed that consensus between experts was best represented by a partition of DTT-BCCs into five clusters, easily recognized a posteriori as five clear-cut patterns of clinical situations. The concept of 'locally advanced' did not appear consistent between experts. Conclusion Although convergence between experts was not granted, this experiment shows that clinicians dealing with BCCs all tend to work by a similar pattern recognition based on the overall analysis of the situation. This study thus provides the first consensual classification of DTT-BCCs. This experimental approach using mathematical analysis of independent and blinded clustering of cases by experts can probably be applied to many other situations in dermatology and oncology.

International audience; The casein micelle (CM) have been described as a protein assembly held together by interactions between phosphoryl groups from the protein moieties, and several internal calcium phosphate nanoclusters (CCPs). While the presence of protein inhomogeneities at the small scale, sequestering the CCPs, has been widely accepted, the presence of medium scale inhomogeneities, the so-called "Hard" regions, and its relationship with the CCPs, has been object of debate. In the present work, solid state NMR and SAXS data have been combined to study the correlation between the removal of CCPs and the structural modification of the micelle. A << native >> sample and three different demineralized ones; 5% (DM-05), 10% (DM-10), and 25% (DM-25) of calcium in relation with the "native", have been analyzed. NMR data show that the reduction in the total amount of calcium and phosphorous ions (-5%, -10% and -25% respectively) in the samples is not always equivalent to the loss of CCPs as measured by the decrease of the amount of colloidal P-31 (-15 and -17% and -25% respectively) in the samples. NMR data also indicate, that demineralization induces the total depletion of some CCP while leaving the remaining cluster in a rather "native" like structure. SAXS data show a good correlation between the amount of P-31 loss measured by NMR and the decreases in intensity for the SAXS spectral features associated with the nanoclusters. Finally, SAXS data show the demineralization induces a decrease in the amount of the larger inhomogeneities in the micelle (the so called "Hard" regions). However, this decrease is not directly correlated to the decrease in the amount of CCPs (as measured by SAXS and NMR) indicating that these "Hard" regions may be, at least partially, maintained by a large protein-protein interaction network. The data and results are discussed and compared with different structural models of casein micelle.

This study aimed to investigate mitral annular dynamics in atrial fibrillation (AF) and after sinus rhythm restoration, and to assess the relationship between annular dynamics and mitral regurgitation (MR).AF can be associated with MR that improves after sinus rhythm restoration. Mechanisms underlying this atrial functional MR (AFMR) are ill-understood and generally attributed to left atrial remodeling.Fifty-three patients with persistent AF and normal left ventricular ejection fraction were prospectively examined by means of 3-dimensional transesophageal echocardiography before, immediately after, and 6 weeks after electric cardioversion to sinus rhythm. Annular motion was assessed during AF and in sinus rhythm with the use of 3-dimensional analysis software, and the relationship with MR severity was explored.During AF and immediately after sinus rhythm restoration, the mitral annulus behaved relatively adynamically, with an overall change in annular area of 10.3% (95% CI: 8.7%-11.8%) and 12.2% (95% CI: 10.6%-13.8%), respectively. At follow-up, a significant increase in annular dynamics (19.0%; 95% CI: 17.4%-20.6%; P 0.001) was observed, owing predominantly to an increase in presystolic contraction (P 0.001). The effective regurgitant orifice area decreased from 0.15 cmMitral annular dynamics are impaired in AF, with blunted presystolic narrowing that contributes to AFMR. Sinus rhythm restoration allows gradual recovery of presystolic annular dynamics. Improved annular dynamics decrease AFMR severity by optimizing annular-leaflet imbalance, regardless of LA remodeling.

Correctif de l'article : https://univoak.eu/islandora/object/islandora:95715

Mechanistic toxicology is gaining weight for human health risk assessment. Different mechanistic assays are available, such as the comet assay, which detects DNA damage at the level of individual cells. However, the conventional alkaline version only detects strand breaks and alkali-labile sites. We have validated two modifications of the in vitro assay to generate mechanistic information: (1) use of DNA-repair enzymes (i.e., formamidopyrimidine DNA glycosylase, endonuclease III, human 8-oxoguanine DNA glycosylase I and human alkyladenine DNA glycosylase) for detection of oxidized and alkylated bases as well as (2) a modification for detecting cross-links. Seven genotoxicants with different mechanisms of action (potassium bromate, methyl methanesulfonate, ethyl methanesulfonate, hydrogen peroxide, cisplatin, mitomycin C, and benzo[a]pyrene diol epoxide), as well as a non-genotoxic compound (dimethyl sulfoxide) and a cytotoxic compound (Triton X-100) were tested on TK-6 cells. We were able to detect with high sensitivity and clearly differentiate oxidizing, alkylating and crosslinking agents. These modifications of the comet assay significantly increase its sensitivity and its specificity towards DNA lesions, providing mechanistic information regarding the type of damage.

Strain is extensively used to controllably tailor the electronic properties of materials. In the context of indirect band-gap semiconductors such as silicon, strain lifts the valley degeneracy of the six conduction band minima, and by extension the valley states of electrons bound to phosphorus donors. Here, single phosphorus atoms are embedded in an engineered thin layer of silicon strained to 0.8% and their wave function imaged using spatially resolved spectroscopy. A prevalence of the out-of-plane valleys is confirmed from the real-space images, and a combination of theoretical modelling tools is used to assess how this valley repopulation effect can yield isotropic exchange and tunnel interactions in the xy-plane relevant for atomically precise donor qubit devices. Finally, the residual presence of in-plane valleys is evidenced by a Fourier analysis of both experimental and theoretical images, and atomistic calculations highlight the importance of higher orbital excited states to obtain a precise relationship between valley population and strain. Controlling the valley degree of freedom in engineered strained epilayers provides a new competitive asset for the development of donor-based quantum technologies in silicon.

Recent evaluations of the French education system point to its difficulty in making students from socially disadvantaged backgrounds achieve at school. The aim of this paper is to describe the principles underlying socioconstructivist and explicit teaching in order to understand to what extent their application in the classroom allows priority education students’ school achievement. Mirroring these two types of teaching involves comparing the principles of explicit teaching (Northern American approach) and the so-called «teaching more explicitly» orientation (French approach). This comparison is necessary to help REP and REP+ teachers to understand and to integrate the professional actions expected to increase students’ academic achievement. The practical purpose of this article is to support teachers in choosing their pedagogical strategies according to the needs of their students.; Les évaluations récentes du système éducatif français pointent sa difficulté à faire réussir les élèves issu·e·s des milieux socialement défavorisés. L’objectif de cet article est d’exposer les principes sous-jacents à l’enseignement socioconstructiviste et à l’enseignement explicite afin de comprendre dans quelle mesure leur déclinaison en classe permet la réussite des élèves de l’éducation prioritaire. La mise en miroir de ces deux types d’enseignement implique la comparaison des principes de l’enseignement explicite (acception nord-américaine) et de l’orientation « enseigner plus explicitement » (acception française). Cette comparaison est nécessaire pour aider les enseignant·e·s des REP et REP+ à comprendre et intégrer les gestes professionnels attendus pour une meilleure réussite des élèves. La visée pratique de cet article est d’accompagner les enseignant·e·s à opérer leur choix de stratégies pédagogiques en fonction des besoins de leurs élèves.

To study the antikinetoplastid 3-nitroimidazo[1,2-a]pyridine pharmacophore, a structure-activity relationship study was conducted through the synthesis of 26 original derivatives and their in vitro evaluation on both Leishmania spp and Trypanosoma brucei brucei. This SAR study showed that the antitrypanosomal pharmacophore was less restrictive than the antileishmanial one and highlighted positions 2, 6 and 8 of the imidazopyridine ring as key modulation points. None of the synthesized compounds allowed improvement in antileishmanial activity, compared to previous hit molecules in the series. Nevertheless, compound 8, the best antitrypanosomal molecule in this series (EC50 = 17 nM, SI = 2650 & E° = -0.6 V), was not only more active than all reference drugs and previous hit molecules in the series but also displayed improved aqueous solubility and better in vitro pharmacokinetic characteristics: good microsomal stability (T1/2 > 40 min), moderate albumin binding (77%) and moderate permeability across the blood brain barrier according to a PAMPA assay. Moreover, both micronucleus and comet assays showed that nitroaromatic molecule 8 was not genotoxic in vitro. It was evidenced that bioactivation of molecule 8 was operated by T. b. brucei type 1 nitroreductase, in the same manner as fexinidazole. Finally, a mouse pharmacokinetic study showed that 8 displayed good systemic exposure after both single and repeated oral administrations at 100 mg/kg (NOAEL) and satisfying plasmatic half-life (T1/2 = 7.7 h). Thus, molecule 8 appears as a good candidate for initiating a hit to lead drug discovery program.

International audience; Li2O-Al2O3-SiO2 (LAS) glass-ceramics have important industrial applications and bulk nucleation is usually achieved by using nucleating agents. In particular, P2O5 is an efficient agent in glasses containing a low level of Al2O3 but its role in the first stages of nucleation is not well established. In this study, we combine structural investigations from local to mesoscales to describe the structural evolution during crystallization of LAS glass-ceramics. Local environment is probed using 29Si and 31P MAS-NMR, indicating organization of P in poorly crystallized Li3PO4 species prior any crystallization. To better understand the detailed nanoscale changes of the glass structure, 31P-31P DQ-DRENAR homo-nuclear correlation experiments have been carried out, revealing the gradual segregation of P atoms associated with the formation of disordered Li3PO4. Small-angle neutron scattering data also show the apparition of nanoscale heterogeneities associated with Li3PO4 species upon heating treatments and allow the determination of their average sizes. These new structural information enhance our understanding of the P role in nucleation mechanisms. Nucleation is initiated by gradual change in P environment implying P segregation upon heating treatments, forming disordered Li3PO4 heterogeneities. The segregation of P atoms enables the precipitation of meta-and di-silicate phases.; Les vitro-céramiques Li2O-Al2O3-SiO2 (LAS) ont des applications industrielles importantes et la nucléation en volume est généralement obtenue en utilisant des agents nucléaires. En particulier, P2O5 est un agent efficace dans les verres contenant une faible teneur en Al2O3, mais son rôle dans les premières étapes de la nucléation n’est pas bien établi. Dans cette étude, nous combinons des études structurales depuis l'échelle locale jusqu'à la méso-échellle pour décrire l’évolution structurale lors de la cristallisation des vitrocéramiques LAS. L’environnement local est sondé à l’aide de la RMN-MAS de 29Si et 31P, montrant que l’organisation de P dans des espèces Li3PO4 mal cristallisées avant toute cristallisation. Pour mieux comprendre les changements détaillés à l’échelle nanométrique de la structure du verre, des expériences de corrélation homonucléaire 31P-31P DQ-DRENAR ont été réalisées, révélant la ségrégation progressive des atomes P associés à la formation de Li3PO4 désordonné. Les données de diffusion des neutrons à petit angle montrent également l’apparition d’hétérogénéités à l’échelle nanométrique associées aux espèces Li3PO4 lors des traitements de chauffage et permettent de déterminer leur taille moyenne. Ces nouvelles informations structurelles nous améliorent notre compréhension du rôle de P dans les mécanismes de nucléation. La nucléation est initiée par un changement progressif dans l’environnement P impliquant la ségrégation des atomes de P lors des traitements de chauffage, formant des hétérogénéités désordonnées de Li3PO4. La ségrégation des atomes de P permet la précipitation des phases de méta et di-silicate.

Breast reconstruction with implants has long-term disadvantages and is leading an increasing number of patients to request secondary corrective surgery. Two surgical strategies are possible: implant replacement (associated with capsulectomy/capsulotomy and/or lipofilling procedures) and implant removal associated with the provision of autologous tissue (flap and/or lipofilling).Between 2010 and 2018, 54 patients underwent secondary surgery for correction of a first implant breast reconstruction. The reasons for dissatisfaction with the initial reconstruction, the procedures performed, and postoperative complications were analysed. Patient well-being and satisfaction were evaluated using the BREAST-Q questionnaire.Thirty-four patients benefited from a prosthesis change and 20 patients benefited from a permanent removal of their prosthesis combined with the addition of autologous tissue. The presence of a periprosthetic shell, pain, fixed appearance of the breast and breast asymmetry were the most frequent reasons for dissatisfaction. With a mean follow-up of 2.6 years, autologous conversion patients were generally more satisfied with the appearance of their breasts than patients who retained a breast implant (P0.0001).In cases of poor esthetic or functional outcomes of implant-based breast reconstruction, removal of the prosthesis in combination with autologous reconstruction provides better results in terms of well-being and satisfaction than implant replacement.

High harmonic spectroscopy relies on high harmonic generation (HHG) in aligned molecules. The first step of HHG is the ionization of the molecule in the intense femtosecond laser field. Here we present measurements of both ionization yield and high harmonic yield as a function of molecular angle in N₂ and CO₂ molecules. Measurements were done at two wavelengths, 800 and 1200 nm, and for a range of laser intensities, to study the sensitivity of laser conditions on both processes. The behavior of N₂ was relatively insensitive to laser conditions. However in CO₂, a minimum in high harmonic emission was observed that was sensitive to both laser intensity and wavelength, and was attributed to interference in emission from the HOMO and HOMO-2 orbitals.

Annales Pharmaceutiques Francaises - Sous presse. Manuscrit accepte. Disponible en ligne depuis le samedi 20 juin 2020

The dynamic response of excitons in solids is central to modern condensed-phase physics, material sciences, and photonic technologies. However, study and control have hitherto been limited to photon energies lower than the fundamental band gap. Here we report application of attosecond soft x-ray and attosecond optical pulses to study the dynamics of core-excitons at the L2,3 edge of Si in silicon dioxide (SiO2). This attosecond x-ray absorption near-edge spectroscopy (AXANES) technique enables direct probing of the excitons' quasiparticle character, tracking of their subfemtosecond relaxation, the measurement of excitonic polarizability, and observation of dark core-excitonic states. Direct measurement and control of core-excitons in solids lay the foundation of x-ray excitonics.

Introduction La fabrication des antibiotiques (AB) dans des pays emergents pose le probleme d’une protection environnementale deficiente. La presence en concentration importante de ces molecules dans les effluents des usines de production est un facteur majeur de l’apparition et dissemination de la resistance a travers le monde. Nous avons souhaite faire un etat des lieux de la position des firmes pharmaceutiques distribuant les AB prescrits en France, des instances nationales et des groupements d’achats de medicaments. Materiels et methodes Nous avons interroge les delegues et directeurs medicaux des 10 principaux laboratoires pharmaceutiques, l’ANSM, la DGS, le comite national d’ethique, et UniHA, plateforme nationale d’achats hospitaliers de la majorite des AB. Les questions posees ont ete : savez-vous ou sont fabriques les AB que vous proposez ? Le cahier des charges de production contient-il des normes de protection environnementale ? Resultats Aucun delegue n’a pu repondre aux questions, etant limites par une charte dans la diffusion d’information ou ne disposant pas de ces informations. Certains directeurs medicaux ont donne des reponses purement declaratives, d’autres ont oppose le secret industriel. La direction d’UniHA se dit prete a discuter de ces enjeux. Les referents toulousains du marche AB national precisent que l’origine de fabrication est demandee aux firmes mais non obligatoire et rarement donnee. Si des regles de bonne pratique de fabrication sont theoriquement requises pour les pays exportateurs envers le marche europeen, l’insuffisance d’inspection explique leur non respect. Depuis les annees 2000, les entreprises sont soumises a la responsabilite societale des entreprises, basee sur une demarche volontaire, et qui se developpe notamment sous la pression des parties prenantes. Elle integre les filieres d’approvisionnement, la sous-traitance, l’impact ecologique, des criteres de developpement durable et d’ethique. Parmi d’autres initiatives interessantes, citons l’indice PBT (persistance, bio-accumulation et toxicite) suedois pour les prescripteurs, ou la RSP, responsabilite etendue aux producteurs. Le 31/01/2020 pour la premiere fois, dans le cadre de la fabrication en France de substances interdites sur le sol national mais vendues a l’exportation, le Conseil Constitutionnel reconnait que « la protection de l’environnement » peut justifier des « atteintes a la liberte d’entreprendre ». Conclusion L’externalisation des chaines de production des AB en Asie pour des raisons de cout, limite la maitrise nationale et europeenne de la resistance liee aux rejets. Tous les acteurs doivent comprendre la necessite d’integrer des criteres environnementaux, dans la politique d’octroi d’autorisation de mise sur le marche, d’achats publics et de prescription. Face aux enjeux sanitaires (morbi-mortalite), ethiques, moraux et economique de l’antibioresistance, une reponse d’ampleur, politique, industrielle et medicale, est indispensable et urgente.

Resume Objectifs Les systemes de navigation chirurgicale (SNC) sont maintenant largement utilises en chirurgie endoscopique endonasale ; le benefice apporte par ces systemes n’a neanmoins ete que partiellement etudie. L’objectif de cette etude etait d’evaluer de facon prospective et multicentrique l’impact de l’utilisation d’un SNC sur le deroulement du geste chirurgical et sur la satisfaction du chirurgien. Materiels et methodes Etude prospective multicentrique portant sur les patients operes d’une chirurgie endoscopique endonasale avec le SNC electromagnetique DigiPointeur® (DGP) dans 16 centres hospitaliers francais. Le cahier d’observation etait rempli par le chirurgien immediatement apres la fin de l’intervention. Les donnees recueillies incluaient en particulier le type d’intervention, les eventuels changements dans la strategie ou dans l’etendue du geste chirurgical lies a l’utilisation du SNC, et le niveau de satisfaction du chirurgien, evalue a partir d’une echelle analogique et de l’autoevaluation du stress ressenti durant l’intervention. Resultats L’etude permettait d’inclure 311 patients operes par 36 chirurgiens dans 16 hopitaux et cliniques francais. L’ethmoidectomie etait le geste le plus souvent pratique, dans 90 % des cas. Une exerese tumorale etait realisee dans 5,1 % des cas. L’utilisation du SNC permettait d’effectuer un geste chirurgical plus complet dans 81 % des cas, en particulier en permettant d’identifier et d’ouvrir des cellules supplementaires dans 57 % des cas. Le niveau moyen de satisfaction evaluee sur une echelle analogique etait de 8,6/10 ; le chirurgien ressentait une diminution du stress chirurgical attribuee a l’utilisation du SNC dans 95 % des cas. Conclusion Dans cette etude observationnelle, le recours a un SNC permettait d’augmenter l’etendue du geste chirurgical dans 81 % des cas, et avait un impact positif sur le stress ressenti par le chirurgien dans 95 % des cas.

Laurine Robert,1 Grégoire Ficheur,2 Sophie Gautier,3 Alexandre Servais,1 Michel Luyckx,4 Julien Soula,1 Bertrand Decaudin,5 François Glowacki,6 François Puisieux,1 Emmanuel Chazard,2 Jean-Baptiste Beuscart1 1Univ. Lille, CHU Lille, EA2694, Lille, F-59000, France; 2Univ. Lille, CHU Lille, EA2694, Public Health Department, Lille, F-59000, France; 3Univ. Lille, CHU Lille, UMR 1171, Department of Pharmacology, Lille, F-59000, France; 4Univ. Lille, EA7365, F-59000 Lille, CH Denain, Department of Pharmacy, Denain, F-59220, France; 5Univ. Lille, CHU Lille, EA7365, Department of Pharmacy, Lille, F-59000, France; 6Univ. Lille, CHU Lille, EA4483 IMPECS, Department of Nephrology, Lille, F-59000, FranceCorrespondence: Laurine RobertCERIM – EA 2694, Faculté de Médecine - Pôle Recherche, 1 Place de Verdun, Lille Cedex 59045 FranceEmail laurine.robert.etu@univ-lille.frPurpose: Community-acquired acute kidney injury (CA-AKI) is a frequent and severe adverse drug reaction (ADR) among older patients. The combination of drugs and other CA-AKI risk factors was barely evaluated. The objectives of our study were to both accurately identify CA-AKI induced by drugs in older patients, and to describe their combination with other risk factors.Patients and methods: We conducted a retrospective, single-center study in a general hospital over a two-year period. An automated detection identified CA-AKI according to KDIGO criteria, amongst 4,767 eligible inpatient stays among patients aged 75 years or older. Two independent experts reviewed all CA-AKI events to adjudicate drug involvement (Naranjo scale), identify inappropriate prescriptions (STOPP criteria), evaluate avoidability (Hallas criteria) and identify combined risk factors.Results: An expert review confirmed 713 CA-AKI (15.0% of inpatient stays) and determined that 419 (58.8%) CA-AKI were induced by drugs. A multifactorial cause (i.e., at least one drug with a precipitating factor) was found in 63.2% of drug-induced CA-AKI. Most of the drug-induced events were avoidable (66.8%), mainly in relation to a multifactorial cause.Conclusion: Drug-induced CA-AKI were frequent, multifactorial events in hospitalized older patients and their prevention should focus on combinations with precipitating factors.Keywords: adverse drug reactions, elderly, prevention, acute kidney injury

Background Previous studies on asthma mortality and hospitalizations in Reunion Island indicate that this French territory is particularly affected by this pathology. However, no estimates are provided on the prevalence of asthma among adults. In 2016, a cross-sectional survey was conducted to estimate the prevalence of asthma and to identify its associated factors in the adult population of Reunion Island. Methods A random sample of 2,419 individuals, aged 18-44 years, was interviewed by telephone using a standardized, nationally validated questionnaire. Information was collected on the respiratory symptoms, description of asthma attacks and triggering factors for declared asthmatics, as well as data on the indoor and outdoor home environment. “Current asthma” was defined as an individual declaring, at the time of the survey, having already suffered from asthma at some point during his/her life, whose asthma was confirmed by a doctor, and who had experienced an asthma attack in the last 12 months or had been treated for asthma in the last 12 months. “Current suspected asthma” was defined as an individual presenting, in the 12 months preceding the study, groups of symptoms suggestive of asthma consistent with the literature. Results The estimated prevalence of asthma was 5.4% [4.3-6.5]. After adjustment, women, obesity, a family member with asthma, tenure in current residence and presence of indoor home heating were associated with asthma. The prevalence of symptoms suggestive of asthma was 12.0% [10.2-13.8]. After adjustment, marital status, passive smoking, use of insecticide sprays, presence of mold in the home and external sources of atmospheric nuisance were associated with the prevalence of suspected asthma. Conclusions Preventive actions including asthma diagnosis, promotion of individual measures to reduce risk exposure as well as the development of study to improve knowledge on indoor air allergens are recommended. Key messages Individuals with suspected asthma who have not been medically diagnosed have been identified. Consequently, the development of a strategy to improve the diagnosis of asthma on Reunion is recommended. Aerating homes to reduce indoor moisture and mould growth, maintaining hygiene standards through cleaning, limiting the use of spray insecticides and household cleaning sprays at home.

Background Aortic valve stenosis is associated with age and comorbidities, which require exploring less invasive therapeutic approach to improve patient outcome. We previously demonstrated in vitro and in vivo that pulsed cavitational ultrasound therapy (PCUT) can improve calcified bioprosthesis stenosis by softening leaflets remotely. To apply this technique noninvasively we aim to test PCUT transthoracicalyin a swine model targeting aortic valve. Because calcified aortic valve model doesn't exist, we tested this technique on a normal valve. Objective Primary objective was to estimate the feasibility and safety of PCUT. Secondary objectiveswere to evaluate occurrence, severity and evolution of cardiovascular side effects during therapy and within follow-up period (30±5 days) with and without double antithrombotic treatment. Methods All the experiments were performed on normal aortic valves (n=19) of swine. The system was composed of a high-power multi-element transducer with electronic steering and 2D echocardiographic probe embedded in the center. Swine were divided in three groups: one with PCUT and no anti thrombotic treatment (n=10), a second with PCUT and one-month treatment of aspirin and clopidogrel (n=5) and third group sham (n=4). All groups were followed up after 30 days. Results The primary feasibility endpoint was successful in 100% of tests performed (n=16). A maximal amplitude of 70 MPa and −19 MPa respectively for positive and negative peak pressure was found at the focus point. Survival at 30 days was 100% and no life-threatening arrhythmia was recorded and no sustained ventricular arrhythmia (SVT >30 s) was noticed. For the secondary safety objectives,we recorded acutely, at the time of procedure, NSVT in 7 pigs which corresponded to a cumulated duration of 2.1 out of the 485.3 min of the total US delivery (0.4% of time). Mean cycle of NSVT was slow 428.9 ms in average (139.6 bpm). The interruption or decrease of power of US delivery allowed immediate cessation of cardiac arrhythmia in all cases. There was no evidence of damage to the valve and no observation of impairment of valvular function by echocardiography. Only one animal showed side effects (RV dilatation) and the RV returned to normal after cessation of the therapy with no sequelae at follow up. At follow up no significant findings biology disturbance or valve thrombosis was observed (creatinine, CK MB, hemoglobin, hematocrit, haptoglobin or red blood cell numbers). Antithrombotic treatment didn't demonstrate any advantage at follow up. Conclusion We demonstrated in vivo feasibility and safety of transthoracic PCUT targeting aortic valve without any serious adverse event and no significant histopathology damage. We hope that this first-time transthoracic delivery of very focused ultrasound at high power will pave the way to new non invasive approach of valve softening in case of human aortic valve calcified stenosis.

The aim of this study was to assess the effect of congestion and decongestive therapy on left atrial (LA) mechanics and to determine the relationship between LA improvement after decongestive therapy and clinical outcome in immediate or chronic heart failure with reduced ejection fraction (HFrEF).LA mechanics are affected by volume/pressure overload in decompensated HFrEF.A total of 31 patients with HFrEF and immediate heart failure (age 64 ± 15 years, 74% male, left ventricular ejection fraction 20 ± 12%) underwent serial echocardiography during decongestive therapy with simultaneous hemodynamic monitoring. LA function was assessed by strain (rate) imaging. Patients were re-evaluated 6 weeks after discharge and prospectively followed up for the composite endpoint of heart failure readmission and all-cause mortality.LA reservoir function was markedly reduced at baseline and improved with decongestion (peak atrial longitudinal strain from 6.4 ± 2.2% to 8.8 ± 3.0% and strain rate from 0.29 ± 0.11 sLA reservoir and booster function, while severely impaired during immediate decompensation, significantly improve during and after decongestive therapy. Poor LA reservoir function after decongestion is associated with worse outcome.

Objectives Surgical navigation systems (SNS) are now widely used in endoscopic endonasal surgery. Benefit, however, has not been fully studied. The objective of this study was to evaluate the impact of an SNS in terms of performance of the surgical procedure and of surgeon satisfaction, in a prospective multicenter study. Materials and methods A multicenter prospective study included patients undergoing endoscopic endonasal surgery using the electromagnetic DigiPointeur® (DGP) SNS in 16 French hospitals. An observation form, completed by the surgeon immediately at end of procedure, included type of procedure, and any changes in strategy or extent of surgery related to use of the SNS. Surgeon satisfaction was rated on an analog scale, with self-assessment of stress experienced during the procedure. Results The study included 311 patients operated on by 36 surgeons in 16 French hospitals. Ethmoidectomy was the most frequent procedure (90%); tumor resection was performed in 5.1% of cases. The SNS enabled more extensive surgery in 81% of cases, in particular by identifying and opening additional cells (57% of cases). Mean satisfaction was 8.6/10; surgeons reported decreased surgical stress thanks to the SNS in 95% of cases. Conclusion In this observational study, the use of an SNS increased the extent of surgery in 81% of cases, and had a positive impact on the stress perceived by the surgeon in 95% of cases.

Background It is now well documented that moonlight affects the life cycle of invertebrates, birds, reptiles, and mammals. The lunisolar tide is also well-known to alter plant growth and development. However, although plants are known to be very photosensitive, few studies have been undertaken to explore the effect of moonlight on plant physiology. Results Here for the first time we report a massive transcriptional modification in Coffea arabica genes under full moonlight conditions, particularly at full moon zenith and 3 h later. Among the 3387 deregulated genes found in our study, the main core clock genes were affected. Conclusions Moonlight also negatively influenced many genes involved in photosynthesis, chlorophyll biosynthesis and chloroplast machinery at the end of the night, suggesting that the full moon has a negative effect on primary photosynthetic machinery at dawn. Moreover, full moonlight promotes the transcription of major rhythmic redox genes and many heat shock proteins, suggesting that moonlight is perceived as stress. We confirmed this huge impact of weak light (less than 6 lx) on the transcription of circadian clock genes in controlled conditions mimicking full moonlight.

Not to burn one's bridges. This is the basic principle that comes immediately to the mind of the plastic surgeon when one brings up the secondary surgery of pressure ulcers, which is a common pathology in the spinal cord injured patients. Which ones are good candidates for surgical treatment? When? What preoperative, infectious, rehabilitative management is most likely to minimize the number of failures and recurrences? Which operative technique to prefer in first intention? And in case of secondary surgery, how to choose the best strategy? We will see that some cases can be treated by primarily closing or flap remobilization but, in case of greater loss of substance the realization of a flap from another anatomical region will be essential.

Unlike secondary mitral regurgitation (MR) in the setting of left ventricular (LV) disease, the occurrence of functional MR in atrial fibrillation (AF) and/or heart failure with preserved ejection fraction (HFpEF) has remained largely unspoken. LV size and systolic function are typically normal, whereas isolated mitral annular dilation and inadequate leaflet adaptation are considered mechanistic culprits. Moreover, the role of left atrial and annular dynamics in provoking MR is often underappreciated. Because of this peculiar pathophysiology, atrial functional MR benefits from a different approach compared with secondary MR. Although both AF and HFpEF-two closely related disease epidemics of the 21st century-are held responsible, current guidelines do not emphasize the need to differentiate atrial functional MR from (ventricular) secondary MR. This review summarizes the prevalence and prognostic importance of atrial functional MR, providing mechanistic insights compared with those of secondary MR and suggesting potential therapeutic targets.

Supplemental material, DS_10.1177_0022034519857714 for Systemic Immunologic Consequences of Chronic Periodontitis by D.K. Gaudilliere, A. Culos, K. Djebali, A.S. Tsai, E.A. Ganio, W.M. Choi, X. Han, A. Maghaireh, B. Choisy, Q. Baca, J.F. Einhaus, J.J. Hedou, B. Bertrand, K. Ando, R. Fallahzadeh, M.S. Ghaemi, R. Okada, N. Stanley, A. Tanada, M. Tingle, T. Alpagot, J.A. Helms, M.S. Angst, N. Aghaeepour and B. Gaudilliere in Journal of Dental Research

International audience; BACKGROUND:Previous studies on asthma mortality and hospitalizations in Reunion Island indicate that this French territory is particularly affected by this pathology. Epidemiological studies conducted in schools also show higher prevalence rates in Reunion than in Mainland France. However, no estimates are provided on the prevalence of asthma among adults. In 2016, a cross-sectional survey was conducted to estimate the prevalence of asthma and to identify its associated factors in the adult population of Reunion Island.METHODS:A random sample of 2419 individuals, aged 18-44 years, was interviewed by telephone using a standardized, nationally validated questionnaire. Information was collected on the respiratory symptoms, description of asthma attacks and triggering factors for declared asthmatics, as well as data on the indoor and outdoor home environment. "Current asthma" was defined as an individual declaring, at the time of the survey, having already suffered from asthma at some point during his/her life, whose asthma was confirmed by a doctor, and who had experienced an asthma attack in the last 12 months or had been treated for asthma in the last 12 months. "Current suspected asthma" was defined as an individual presenting, in the 12 months preceding the study, groups of symptoms suggestive of asthma consistent with the literature.RESULTS:The estimated prevalence of asthma was 5.4% [4.3-6.5]. After adjustment, women, obesity, a family member with asthma, tenure in current residence and presence of indoor home heating were associated with asthma. The prevalence of symptoms suggestive of asthma was 12.0% [10.2-13.8]. After adjustment, marital status, passive smoking, use of insecticide sprays, presence of mold in the home and external sources of atmospheric nuisance were associated with the prevalence of suspected asthma.CONCLUSION:Preventive actions including asthma diagnosis, promotion of individual measures to reduce risk exposure as well as the development of study to improve knowledge on indoor air allergens are recommended.