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SUMMARYThe aim of this study was to assess the seroprevalence of the Toxoplasma gondii parasite in pork produced in France, and to determine infection risk factors. An innovative survey was designed based on annual numbers of slaughtered pigs from intensive and outdoor farms in France. A total of 1549 samples of cardiac fluids were collected from pig hearts to determine seroprevalence using a Modified Agglutination Test. Of those, 160 hearts were bio-assayed in mice to isolate live parasites. The overall seroprevalence among fattening pigs was 2·9%. The adjusted seroprevalence in pigs from intensive farms was 3·0%; the highest in sows (13·4%); 2·9% in fattening pigs and 2·6% in piglets. Adjusted seroprevalence in fattening animals from outdoor farms was 6·3%. Strains were isolated from 41 animals and all were genotyped by Restriction Fragment Length Polymorphism as type II. Risk-factor analysis showed that the risk of infection was more than three times higher for outdoor pigs, and that sows’ risk was almost five times higher than that of fattening animals. This study provides further evidence of extensive pork infection with T. gondii regardless of breeding systems, indicating that farm conditions are still insufficient to guarantee ‘Toxoplasma-free pork’.

Questionnaire used to collect epidemiological data. (DOCX 23Â kb)

Resume Objectifs Comme la degradation du cisatracurium ne semble pas affectee par la mise a temperature ambiante, la conservation se fait le plus souvent dans ces conditions, contrairement aux recommandations de stockage a 4 °C. Aucune etude clinique n’a etudie l’effet d’un stockage a temperature ambiante sur le delai d’action du cisatracurium. L’objectif etait de comparer le delai d’action du cisatracurium, a la dose de 0,15 mg/kg, selon que celui-ci etait conserve au froid (entre 2 et 8 °C) ou a temperature ambiante. Type d’etude Etude prospective, monocentrique, controlee, randomisee et en double insu. Patients et methode Trente patients ont ete randomises en deux groupes selon la temperature de conservation du cisatracurium. Le critere de jugement principal etait le delai d’installation du bloc neuromusculaire. Resultats Le delai d’action moyen du cisatracurium a ete de 235 (180–292) secondes dans le groupe « ambiant » et de 240 (210–292) secondes dans le groupe « froid » ( p = 0,51). Aucune difference dans le delai d’action du cisatracurium n’a ete retrouvee selon que celui-ci etait conserve a temperature ambiante depuis une, deux ou trois semaines. Les conditions d’intubation ont ete excellentes dans 100 % des cas apres obtention d’une curarisation complete. Conclusion Cette etude montre que la conservation du cisatracurium a temperature ambiante pour des durees inferieures ou egales a 21 jours n’a pas d’effet sur son delai d’action. La forte variabilite interindividuelle du delai d’action du cisatracurium peut etre monitoree pour permettre des conditions d’intubation optimales.

EDF exploite un reseau de points d’observation hydroclimatologique centre sur les massifs montagneux francais. Ce reseau permet une surveillance operationnelle de la neige, de la pluie et des debits dans une optique de prevision de debit au droit des ouvrages hydroelectriques. A titre indicatif, on peut rappeler que 50 % des stations hydrometriques et 60 % des stations pluviometriques gerees par EDF sont situees a une altitude superieure a 600 metres. Cet article propose un etat des lieux du reseau EDF particulierement axe sur la strategie d’observation adaptee au milieu montagnard et presente les dernieres evolutions methodologiques concernant la mesure de debit par dilution d’un traceur fluorescent qui reste bien adaptee aux difficultes inherentes a la realisation de jaugeages en conditions d’ecoulements torrentiels.

Resume La toxoplasmose est une maladie largement distribuee a travers le monde. Elle est due a Toxoplasma gondii , un protozoaire ayant les felides comme hote definitif (le chat) et les vertebres homeothermes comme hotes intermediaires. L’infection humaine se fait principalement par voie orale, soit par l’ingestion d’oocystes excretes par voie fecale par les chats, soit par l’ingestion de kystes tissulaires qui peuvent etre presents dans une grande variete de produits carnes. La transmission directe a partir d’un chat a son proprietaire n’est probablement pas frequente, mais les populations de chats sont plutot a l’origine d’une contamination environnementale large et durable. En France, des plans de surveillance dans les viandes ovines, bovines et porcines, destinees a la consommation humaine ont permis de mettre en evidence une seroprevalence de Toxoplasma gondii qui se situe, selon l’espece et l’origine des viandes, entre 2,46% pour les porcelets hors-sol et 69,5% pour les ovins adultes d’origine francaise. Le role des animaux sauvages en tant qu’hotes intermediaires du parasite est egalement a prendre en compte dans l’epidemiologie de la toxoplasmose, principalement comme facteur de dispersion du parasite et, secondairement, comme agent de contamination humaine. En Guyane, l’hypothese de l’existence d’un cycle sauvage de Toxoplasma gondii est evoquee depuis quelques annees, mettant en jeu les felides sauvages et leurs proies, mammiferes et oiseaux, dont certaines especes peuvent etre des produits de chasse pour les humains.

UNLABELLED In previous years, several publications have reported cases of infants presenting neurological and gastrointestinal symptoms after ingestion of star anise tea. Such teas are sometimes given in various cultures for the treatment of infant colic pains. In most cases, the cause of intoxication was contamination of Chinese star anise (Illicium verum) by Japanese star anise (Illicium anisatum). Indeed, the toxicity of Illicium anisatum, also known as Shikimi, is caused by its content in potent neurotoxins (anisatin, neoanisatin, and pseudoanisatin), due to their activity as non-competitive antagonists of GABA receptors. The main reasons explaining the frequent contaminations are the strong macroscopic resemblance of the 2 substances, as well as the fact that the fruits are often sold partially broken or in ground form. Therefore, in most cases, chemical analysis is required to determine the possible adulterations. CASE REPORT A 2-month-old infant, in good general health, was brought to the emergency unit after 3 consecutive episodes of central cyanosis and tetany of the limbs with spontaneous recovery the same afternoon. The child was also very irritable, regurgitated a lot, and positioned himself in opisthotonos. Between these episodes, the neurological exam showed some perturbations (horizontal nystagmus and Bell's phenomenon, hypertony of the extensor muscles, and mild hypotony of the axial flexor muscles) with slow improvement over the following hours. The remaining clinical exam, the laboratory work (complete blood count, renal, hepatic, and muscular tests, capillary blood gas, plasmatic amino acids, and urinary organic acids), and the electroencephalogram findings were all normal. In the course of a detailed interview, the parents reported having given 3 bottles to their child, each one containing 200 mL of an infusion with 4 to 5 fruits of star anise, in the hours preceding the symptoms to relieve colic pains. The last seizure-like event took place approximately 8h after the last ingestion. We could prove the ingestion of anisatin, the toxic substance found in Japanese star anise, and the contamination of Chinese star anise by the Japanese species. Indeed, the anisatin analysis by liquid chromatography and mass spectroscopy (LC-MS) in a urine sample taken 22 h after the last infusion ingestion showed trace amounts of the substance. In another urine sample taken 33 h after ingestion, no anisatin could be detected. Furthermore, the analysis of the fruit sample gave an anisatin concentration of 7800 μg/kg while the maximum tolerance value in Switzerland is 1000 μg/kg. CONCLUSION The evaluation of ALTE in infants should always include the possibility of intoxication. Star anise is generally considered a harmless medicine. Nevertheless, it can sometimes cause a severe intoxication resulting in various neurological and gastrointestinal symptoms. To prevent such events, not only the parents, but also the care personnel and pharmacists must be informed about the possible adverse effects caused either by the overdose of Chinese star anise or by the eventual contamination of herbal teas with Japanese star anise. A better control of the substances by the health authorities is also necessary.

Aim The aim of this study was to discuss about the Dementia Quality of Life (DQoL) psychometric properties and the contributions stemming from the French language version. Methods To assess the psychometric properties of the French language DQoL transcultural validation, 155 patients with mild to moderate dementia (Mini Mental State Examination score≥10) were recruited in seven French-speaking hospitals. Feasibility and acceptability were assessed by the time required to complete the questionnaire, the rate of refusal to participate, and the rates of abandon or non-response. Internal consistency and test-retest reliability were assessed respectively by Cronbach's alpha coefficient and Intraclass Correlation Coefficient. The discriminant validity was tested by evaluating the influence of severity of cognitive decline, dependence, existence of depression or behavioural troubles, as well as caregiver burden. Results Of the 155 eligible patients, 46 patients (29.7%) failed the screening procedure but completed the questionnaire nonetheless. The remaining 109 patients had an average age of 81±6 years, average Mini Mental State Examination (MMSE) score was 20.8±4.4. No patient refused to participate or abandoned. The French DQoL showed acceptable internal consistency (Cronbach's alpha ranging from 0.70 to 0.87) and good reliability (Intraclass Correlation Coefficient [ICC]: 0.96–1.00). Cognitive status, humour and behavioural troubles had an impact on Quality of Life (QoL), whereas dependence and caregiver burden did not. Psychometric properties did not differ for the group who passed the screening test ( n =109) and for the whole population ( n =155). Conclusion The French-language version of DQoL showed comparable psychometric properties to the original version. According to our findings, all patients with mild to moderate dementia can undergo evaluation with the French adaptation of the DQoL. We suggest transforming the screening procedure into a training step.

From 2004 to 2007, 148 limb free flaps were performed in a series of 138 patients at the University Hospital in Nantes, France. Flaps were successful in 127 instances (rate: 86%; group A) and failed in 21 (group B). An analysis of the various factors (pre-, intra-, and postoperative) in both groups that may have influenced the outcome of surgery identified the following: operating time, cold ischemia time, and the interval before reoperation. This report is based on our experience in managing 21 free flap failures during reconstructive surgery of the limbs. The causes of failure were analyzed, and possible therapeutic strategies defined (i.e., a second free flap procedure, a pedicle flap, coverage with artificial dermis, or amputation). In our opinion, careful analysis of the causes of flap failure is essential to an appropriate choice of subsequent therapeutic strategy.

Thermoplastics are commonly used in thermal nanoimprint lithography (NIL) but their high viscosity leads to inhomogeneities of residual thickness in patterns with various densities. Monomers exhibit low viscosity and are imprinted easily and polymerized with UV-NIL processes. These monomers can be also used for thermal NIL. We have imprinted A-POSS material which is spontaneously polymerized at 170^oC. The inorganic part of this monomer is interesting for pattern transfer and for permanent applications. Thermal properties of this molecule are presented in this paper. It is shown that polymerization occurs at 170^oC, and that the viscosity is 1330mPas at ambient temperature. Imprint experiments have demonstrated that A-POSS flows over larger surfaces during imprint step, compared to thermoplastics. Patterns with different densities have been studied and different filling regimes have been observed depending on material viscosity. They are induced by a competition between material flow and mold deformation. Finally, we imprinted some nanoelectrodes simultaneously with millimetric large connection pads, and it was demonstrated that complete filling was obtained with monomers whereas this was not possible with thermoplastics.

International audience; Consumption of sheep meat presents a risk of human contamination by Toxoplasma gondii. A nationwide study was conducted in France to evaluate the prevalence of Toxoplasma in fresh ovine meat. A sampling procedure was established to guarantee the representativity of consumption. As is the case for meat consumed, half of the samples were from France and half were imported from other countries. Animals were selected according to their age, as lamb (

Resume Le traitement des thromboses du syndrome des anticorps antiphospholipides (SAPL) a longtemps ete empirique, base sur les donnees de cohortes retrospectives. Nous disposons maintenant des resultats d’essais therapeutiques randomises qui permettent d’optimiser les recommandations de prise en charge. Cette revue indique les progres realises mais egalement les incertitudes persistantes. Prevention secondaire des thromboses Alors que la poursuite du traitement par les antivitamines K (AVK) au long cours apres une premiere thrombose est consensuelle, deux essais randomises ont compare des intensites differentes de traitement. De maniere concordante, ces deux etudes ont montre qu’une anticoagulation avec un INR cible compris entre 3 et 4 n’etait pas plus efficace qu’une cible therapeutique entre 2 et 3. Ces etudes concernaient des patients ayant presente de facon preferentielle des thromboses veineuses. Aucun essai therapeutique n’a compare differentes strategies antithrombotiques pour la prophylaxie secondaire des accidents arteriels du syndrome des antiphospholipides. En particulier, l’etude WARSS/APASS ne concerne pas des patients avec syndrome des antiphospholipides defini et n’est donc pas applicable a cette population, comme cela a pu etre propose de facon erronee. Dans l’attente d’autres etudes, le traitement AVK reste le traitement de prophylaxie secondaire chez ces patients. Prevention primaire des thromboses Le risque eleve de thrombose chez des patients asymptomatiques presentant des anticorps antiphospholipides, en particulier dans le lupus systemique, a motive la realisation d’une etude randomisee aspirine versus placebo dans cette situation clinique. Cette etude n’a pas pu demontrer de benefice de l’aspirine en prophylaxie primaire. En conclusion, les resultats des essais therapeutiques recents ont permis d’optimiser la strategie antithrombotique du SAPL, notamment des formes avec maladie thromboembolique veineuse. Des questions non resolues restent posees sur les strategies optimales dans les formes arterielles et en prophylaxie primaire.

La gestion des ressources en eau a l’echelle d’un grand bassin-versant est particulierement complexe. Ces bassins sont generalement caracterises par de fortes pressions sur les ressources en eau pendant les etiages. Ces ressources sont necessaires a la vie aquatique, la production d’eau potable, la production industrielle, la production d’electricite, l’agriculture… Les besoins des nombreux acteurs agissant sur ces bassins n’etant pas toujours concordants, une gestion optimale des ressources en eau s’impose. L’utilisation de la modelisation hydrologique permet d’anticiper de quelques jours a quelques mois les ressources en eau disponibles et d’ameliorer ainsi leur gestion et la concertation entre les differents acteurs de l’eau sur ces bassins-versants.Nous prendrons l’exemple du bassin-versant de la Loire, qui est caracterise par une variabilite climatique et hydrologique tres forte, des barrages destines au soutien d’etiage, a l’ecretement des crues, ainsi qu’a la production d’electricite, avec des prelevements eleves pour l’irrigation et l’AEP et la presence de quatre centrales nucleaires. Dans ce cadre, EDF developpe en concertation avec la DIREN de bassin un systeme de modelisation hydrologique lui permettant le suivi et la prevision des ressources en eau sur ce bassin. Cet outil, base sur l’utilisation conjointe de modeles hydrologiques et d’un reseau de mesure en temps reel, permet de suivre au fil des evenements meteorologiques l’etat hydrologique du bassin-versant et d’anticiper de quelques semaines a quelques mois les besoins ou les ressources en eau disponibles en plusieurs points du bassin. Dans cet article, nous donnons un apercu sur le developpement, l’utilisation de ce systeme de modelisation hydrologique et la performance des previsions d’ensemble de debit. Ensuite, nous realisons des previsions dans un contexte de variabilite climatique, afin d’etudier si ces methodes de previsions classiquement utilisees restent encore robustes et pertinentes, face a cette variabilite climatique.

Importance Congenital hemangiomas (CHs) are rare benign vascular tumors that differ from common infantile hemangiomas in that they grow in utero and are fully developed at birth. While ulceration is a common, predominantly benign complication in infantile hemangioma, little is known about the prognosis of ulcerated CH. However, it has been observed that ulcerated CH may be complicated by life-threatening bleeding episodes. Observations We report 2 cases of ulcerated rapidly involuting congenital hemangiomas (RICH) that were complicated by life-threatening bleeding episodes in the neonatal period. In both cases, the CHs were fed by high-flow vessels and the ensuing massive bleeding was due to superficial vessel wall erosion induced by the ulceration. Both patients were successfully treated with intravascular embolization; one patient underwent additional hemostatic surgery. Conclusions and Relevance These 2 cases highlight the importance of closely monitoring children with ulcerated CH because of the risk of severe bleeding. Embolization is the treatment of choice in the case of severe bleeding, as the natural history of RICH is to spontaneously regress.

Arterial stiffness assessed by the pulse wave velocity (PWV), a non-invasive and reproducible method, predicts cardiovascular morbidity and mortality. The main determinants of arterial stiffness are well established in younger and middle-aged populations, but much less in the elderly. The aim of this study was to describe the determinants of arterial stiffness in elderly apparently healthy subjects. The study included 221 voluntary subjects born before 1944 (mean age 67.4+/-5.0 years), who had a standard health check-up at the 'Centre de Medecine Preventive' of Nancy. Arterial stiffness was evaluated by measuring the carotid-femoral PWV with the PulsePen automatic device. Clinical and biological parameters were evaluated at the same day. Measurements were valid and analysed in 207 subjects (94 women). Mean PWV was 9.39+/-2.64 m/s. Men showed higher PWV values than women (9.99+/-2.56 vs 8.66+/-2.56, P

The purpose of this study was to test the accuracy of a new portable spirometric-telemetric device (Oxycon Mobile) over a wide range of exercise intensities against an accurate stationary apparatus (Oxycon Pro). Therefore, fifteen endurance-trained subjects (VO2peak: 58.8 +/- 5.2 ml x min(-1) x kg(-1)) performed an incremental as well as an endurance exercise test on two different occasions. Gas exchange variables were measured by the two ergospirometric devices simultaneously. For this purpose, a special face mask was designed which allowed respiratory gas sampling with both devices at exactly the same time. Compared to the Oxycon Pro as an accurate reference system, the Oxycon Mobile showed significantly lower values for VO2 at 200 and 250 W during the incremental exercise test. For VCO2 no significant differences were found although the Oxycon Mobile seemed to systematically measure higher values. With regard to RER the Oxycon Mobile showed significantly higher values at all workloads tested. We therefore dissuade from comparing gas exchange variables collected by the Oxycon Mobile with data measured under laboratory conditions by an accurate reference system like the Oxycon Pro. Furthermore, the extrapolation of information about substrate utilization during different exercise durations and intensities from data measured by the Oxycon Mobile seems inappropriate.

Resume Il y a un peu plus de 20 ans, nous avions propose l'hypoventilation controlee comme approche de l'assistance respiratoire mecanique chez les asthmatiques intubes. Dans le present article sont evoques les circonstances qui ont preside a la naissance de l'idee initiale, ainsi que les developpements survenus dans ce domaine dans les deux decennies qui ont suivi.

We present the replication of sub-40nm nanoelectrodes over an 8-in. silicon wafer using nanoimprint lithography (NIL). Three different NIL polymers (NEB22A2, PMMA and Polycarbonate) are investigated as potential replication candidates. For each polymer resist, we study the single step imprint of both micrometric contact pads and nanoelectrodes. Flow capability of the polymers over large area, imprinting small scale features to obtain nanogaps, and reproducibility over an 8-in. silicon wafer are investigated to define the most suitable resist.

Tracheotomy is a surgical procedure for various indications, such as ventilator dependence and airway obstruction. Reported rates in the literature of complications of tracheostomy vary widely. We report an unusual presentation of serious complication after surgical tracheostomy. The correct timing of tracheostomy is still controversial in the literature. A 74-year-old male had emergency surgical tracheostomy under general anesthesia. At the end of the procedure, in recovery room, he developed subcutaneous emphysema of the eyes. There was no pneumothorax seen on chest X-ray. Bronchoscopic examination through the tracheostomy tube showed no evidence of damage to the posterior tracheal wall. Three hours later patient had difficulty breathing requiring sedation with respiratory assistance. X-ray of the chest at this stage showed a right pneumothorax and extensive subcutaneous emphysema of the chest wall. Pneumothorax was managed using a chest tube. Two days after, a control CT scan of the chest showed a left pneumothorax and pneumomediastinum. The pneumothorax was managed using a chest tube. Bronchoscopic examination showed no obvious lesion in the tracheobronchial tree. The patient was treated successfully with supportive care and large doses of antibiotic to prevent mediastinitis. Seven days later, recovery was rapid and complete and CT scan of the chest was completely normal. The patient was discharged from the hospital on the 13th postoperative day. This case illustrates that complications occurring after surgical tracheostomy could be dramatic. Management of tracheotomy is important to prevent complications. There is still debate on optimal timing of tracheotomy. The last three trials have shown no interest to perform an early tracheotomy, neither in terms of vital prognosis nor in terms of the duration of mechanical ventilation.

Uniformity of the printing process is one of the key parameters of nanoimprint lithography. This technique has to be extended to large size wafers to be useful for several industrial applications, and the uniformity of micro and nanostructures has to be guaranteed on large surfaces. This paper presents results of printing on 200 mm diameter wafers. The residual thickness uniformity after printing is demonstrated at the wafer scale in large patterns (100 µm), in smaller lines of 250 nm and in sub-100 nm features. We show that a mould deformation occurs during the printing process, and that this deformation is needed to guarantee printing uniformity. However, the mould deformation is also responsible for the potential degradation of the patterns.

Resume Introduction. – Les criteres cliniques de Cochin sont valides pour selectionner les patients lombalgiques chroniques repondant positivement a un test anesthesique articulaire posterieure. Objectif. – Determiner si les criteres de Cochin permettent de selectionner au sein d’une population de lombalgiques chroniques, les patients susceptibles d’etre soulages par des infiltrations articulaires posterieures de corticoides. Materiels et methodes. – Quatre-vingt-onze patients adresses pour beneficier d’infiltrations articulaires posterieures ont ete inclus et repartis en deux groupes en fonction du nombre de criteres de Cochin positifs presentes a l’admission. Les patients presentant au moins cinq criteres etaient classes dans le groupe positif (GP), ceux en presentant moins de cinq integraient le groupe negatif (GN). Les parametres d’evaluation, releves le jour de l’inclusion puis deux, huit et 30 jours apres, associaient l’appreciation globale du patient sur l’efficacite du geste, les intensites des douleurs lombaires et projetees et l’incapacite liee a la lombalgie mesurees par un auto-questionnaire. Resultats. – La comparaison intragroupe par rapport a J0 objectivait une diminution significative de la douleur lombaire a J2, J8 et J30 dans les deux groupes, une augmentation significative de la douleur des membres inferieurs a J30 dans le GN et une amelioration significative du score de Quebec a J8 et J30 dans le GP. La comparaison intergroupe revelait, par rapport au GN, une appreciation globale de l’efficacite des infiltrations significativement meilleure dans le GP a J2, J8 et J30 (p 0,05). Conclusion. – Les criteres de Cochin semblent utiles pour selectionner les lombalgiques chroniques susceptibles de beneficier d’infiltrations articulaires posterieures de corticoides.

Latency and development of Botrytis cinerea were assessed under field conditions and after artificial inoculation of two grape varieties, Gamay (susceptible) and Gamaret (resistant). When the percentage of latent Botrytis was the same for both varieties, severity of visible grey mould remained very low in Gamaret berries, while Gamay clusters were destroyed by the disease to a high percentage. Some biochemical parameters were measured in berries, such as constitutive and induced anti-fungal compounds, polymeric proanthocyanidins and lipid peroxidation products as markers of senescence. Differences were observed in polymeric proanthocyanidins (PPRA) of Gamaret compared with those of Gamay. Concentration and mean degree of polymerization (mDP) of PPRA were always higher in the berries of the resistant variety. The inhibitory effect of Gamaret PPRA on enzyme activity remained until harvest whereas Gamay PPRA lost their inhibitory activity at the beginning of veraison. Based on these results, resistance to B. cinerea seems to be linked to the maintainance of the fungus in its latent form in berries, mainly due to the ability of Gamaret PPRA to inhibit macerating fungal enzyme activities.

Polymer selection and critical dimension (CD) pattern uniformity across the wafer are key parameters for the nanoimprint lithography technique. This nanotechnology requires polymers having a low glass transition temperature (Tg) combined with a good etch resistance. The printing of a commercial E-beam photoresist is studied as a function of the pressing conditions and the pattern density on the wafer. The influence of the printing temperature is analyzed in order to understand the polymer behaviour during the printing process. The residual thickness uniformity across the wafer after pressing has been carefully studied and correlated to the thermal properties of the polymer. Our results show that high resolution resists are well adapted to obtain dense nanostructures with a good CD control.

Nanoimprint lithography (NIL) is a promising technique to obtain nanometer scale features on large size wafers. The patterns defined in a silicon mold are replicated by pressing a polymer film at high temperature. Previous studies have been mostly devoted to PMMA imprinting. Due to the low etch resistance of this polymer, a lift off step is needed to be able to transfer the patterns by plasma etching,. In this paper, we present results obtained with different polymers presenting a good etching resistance. They will be compared in terms of printed resolution and thermal properties.

Silicon technology has become a good alternative to copper for the elaboration of efficient cooling devices required in power electronics domain. Owing to its high degree of miniaturization, it is expected to provide suitable microchannels and other inlets holes that were not achievable by copper micromachining. Besides, the use of silicon technology provides a variety of bare materials (silicon dioxide, silicon nitride, silicide, etc.) which may be either insulator or conductive, with a good or bad thermal conductivity. This large choice makes it possible to built up rather complex multilayer devices with mechanical properties good enough in comparison with hybrid copper technology heat sinks. Nevertheless, the use of silicon technology, where the microchannel width may reach few tens of microns, raises fundamental features concerning the fluid displacement within such small sections. More precisely, fundamental fluid mechanics studies have to be conducted out in order to get an accurate description of the fluid boundary layers and to provide basic data on the exchange mechanisms occurring at these surfaces. In this paper, we review the operation principles of both single- and double-phase heat exchange devices elaborated in silicon technology. Forced-convection heat sinks as well as integrated micro heat pipes are analyzed. An analytical approach is adopted to evaluate their total thermal resistances as a function of several geometrical parameters. Numerical simulations are then used in order to assess the accuracy of the analytical approach and to evaluate the impact of the fluidic aspects on the whole performance. The optimum devices are then conceived thanks to an appropriate optimization procedure taken into account the several experimental constraints. Reference values of similar copper devices are reminded and the advantages of the silicon integrated approach are highlighted.

Background: This two-way, randomized, single-dose, crossover study determined the pharmacokinetics and absolute oral bioavailability of telithromycin in young and elderly healthy subjects. Methods: Twelve young (18–40 years) and 12 elderly (>65 years and ≤85 years) subjects received a single 800-mg oral dose of telithromycin or an intravenous infusion of 400 mg (young subjects) or 480 mg (elderly subjects) of telithromycin over 2.5 h in two treatment periods, separated by a 1-week washout period. The plasma concentrations and pharmacokinetic parameters of telithromycin and its major metabolite, RU 76363, were determined. Absolute oral bioavailability was calculated using the area under the plasma concentration-time curve (AUC) from zero hours to infinity. Results: The absolute oral bioavailability of telithromycin was 57% in both young and elderly subjects. The AUC for the metabolite was lower after intravenous infusion of telithromycin, indicating first-pass loss following oral administration. Telithromycin was well tolerated in both groups of subjects. Conclusions: Telithromycin has an absolute oral bioavailability of 57% in young and elderly subjects and is well tolerated.

Introduction L’enjeu majeur de l’hyperaldosteronisme primaire est de differencier adenome de Conn et hyperplasie bilaterale des surrenales pour proposer une prise en charge adaptee : surrenalectomie unilaterale versus traitement medical. Pour affirmer la lateralisation de la secretion d’aldosterone, il est recommande de completer le TDM surrenalien par un catheterisme des veines surrenaliennes (KTVS). Notre etude evalue l’apport des KTVS par rapport au TDM sur le type de prise en charge. Methodes Recueil des donnees clinico-biologiques, hormonologiques, radiologiques et chirurgicales des patients ayant eu un KTVS entre mai 2015 et mai 2017 au CHU de Nantes. Resultats Vingt-trois patients ont beneficie d’un KTVS. Ils presentaient tous une kaliemie spontanee Les resultats anatomo-pathologiques, l’evolution de la kaliemie et du controle tensionnel (nombre de traitements anti-hypertenseurs) en postoperatoire sont en cours d’evaluation. Discussion Vingt et un sur 23 KTVS realises ont ete selectifs et ont permis de recommander 15 surrenalectomies. La realisation du KTVS a permis de modifier la prise en charge par rapport a ce qu’elle aurait ete avec un TDM isole pour 8 patients sur 23.

BACKGROUND: The annual number of surgical fractures among elderly people is growing in context of an average age that is increasing. Because of comorbidities, management of geriatric patients usually requires a multidisciplinary management.In Nancy University Hospital elderly inpatients can benefit of a geriatric assessment by the Geriatric Mobile Team (EMLG).Since April, 2015, a geriatric assessment is systematically proposed for elderly people, over 75 years-old, admitted in the Traumatology Department by the Emergency Department.PURPOSE: Purpose of the study is to analyze the impact of the systematic assessment of the EMLG in the Traumatology Department by a comparative retrospective study of type before/after during 7 consecutive months (June to December) on 2014 (without systematic assessment by EMLG) and on 2015 (with systematic assessment by EMLG).The main results concern: future of the patients (home, nursing home, rehabilitation department), rate of death and rate of rehospitalisation at a month, and follow-up of recommendations of EMLG.PRELIMINARY RESULTS: During the seven consecutive months on 2015, 196 inpatients received geriatric assessment by EMLG. The main recommandations were therapeutic adjustements for 92 patients and advices for pain management for 65 patients. Recommandations were partly or completely followed for 109 patients.122 inpatients were transferred by Nancy University Hospital to rehabilitation departments. During the first month of follow-up, 9 patients died and 19 patients were readmitted in Nancy University Hospital. Intervention of the Geriatric Mobile Team trend to reduce hospital readmissions.The definitive results of two periods will be presented during the congress.

Etat de la question Les maladies chroniques sont habituellement considerees individuellement. Nous avons cherche a decrire des modeles de multimorbidite chez les adultes afin d’evaluer leur effet sur la qualite de vie (QdV). Materiel et methodes Nous avons utilise les donnees de 5647 participants inclus dans l’etude SU.VI.MAX2. La QdV etait evaluee par les versions francaises du « Medical Outcome Study Short Form 36 » et du « Duke Health Profil ». Une analyse factorielle exploratoire determinait nos modeles de multimorbidite. Un score etait calcule pour chaque modele. L’association entre les scores de multimorbidite et les scores de QdV etait examinee par regression lineaire multiple par sexe et pour chaque groupe d’âge (55–59, 60–64, 65–69, ≥ 70 ans). Resultats Plus de 63 % de l’echantillon declarait au moins deux maladies chroniques. La multimorbidite etait plus frequente chez les femmes (67,3 % versus 60 %). Deux modeles de multimorbidite differents ont ete identifies. Le modele A etait represente principalement par des maladies osseuses et des troubles mentaux, et le modele B par des troubles cardiovasculaires et metaboliques. Apres ajustement, un score de multimorbidite eleve pour le modele A etait associe a une reduction de QdV pour les composantes physique et mentale de chaque questionnaire. Un score eleve du modele B etait associe a une QdV reduite uniquement pour la composante physique de chaque questionnaire. Ces scores de multimorbidite affectaient la QdV differemment selon l’âge. Conclusion Nous avons utilise une nouvelle approche methodologique pour tenir compte de la multimorbidite par rapport a la QdV. Nos resultats contribuent a accroitre la comprehension du lien entre multimorbidite et QdV.

Oral and maxillofacial surgeons must be aware of the potentially life-threatening complications of dental extractions in patients with hereditary haemorrhagic telangiectasia because of their high prevalence of pulmonary arteriovenous fistulas. Despite the lack of evidence-based guidelines, antibiotic cover should be given to patients with HHT who require oral surgery according to the same rules as those used for patients at high risk of bacterial endocarditis.

Introduction Cutaneous arterio-venous malformations (AVM) are high-flow vascular malformations made up of a direct link between arteries and veins without intermediary capillary space. ‘Distal limb's AVM’, which mean involving hands or feet, are rare and their functional prognosis is often poor. Little is known about their early clinical symptoms. The objectives of this study were to identify early clinical symptoms of distal limb's cutaneous AVMs and to determine their long-term clinical outcome. Methods A retrospective study was carried out including adult patients who had distal limb's AVM, who were followed up between January 2000 and November 2013 in two regional tertiary care centres. The information was collected from patients' clinical records and completed by a structured telephone questionnaire. Results Nineteen patients were included in the study: four (21%) with foot AVM and 15 (79%) with hand AVM. The first clinical symptoms were as follows: swelling (47%), pain (47%), one or several venous dilatations (37%) and rarely abnormal skin colour, hyperthermia and pulsating sensation. The median diagnosis delay was 9 years after the onset of first manifestations. Amongst the 17 patients who underwent a treatment, 53% had embolotherapy session(s), 12% surgery and 35% had both. After an average follow-up of 57.6 months, 31% of the 13 patients contacted who were receiving treatment were in complete remission; 31% had partial remission; 15% had relapse after initial improvement and 23% had treatment failure. Overall, 74% of patients had a serious development of the AVM: 37% had digital or hand amputation, and 42% remained symptomatic and/or unstable. Conclusion This study suggests that initial manifestations of distal limb's AVMs are discreet and non-specific, leading to a diagnosis delay of about 10 years, with poor prognosis. Doctors should evoke the diagnosis earlier, when these symptoms are shown: pain and/or swelling, sometimes with a large vein.

Toxoplasma gondii is an obligate, intracellular, parasitic protozoan within the phylum Apicomplexa that causes toxoplasmosis in mammalian hosts (including humans) and birds. We used modified direct agglutination test for the screening of the animals' sera collected in Senegal. In total, 419 animals' sera have been studied: 103 bovines, 43 sheep, 52 goats, 63 horses, 13 donkeys and 145 dogs. The collection of sera was performed in four different regions of Senegal: Dakar, Sine Saloum, Kedougou and Basse Casamance from 2011 to 2013. We have revealed antibodies in 13% of bovines, 16% of sheep, 15% of goats, 30% of horses, 23% of donkeys and 67% of dogs. Private dogs from villages were more often to have the anti-Toxoplasma antibodies compared to security society-owned dogs from Dakar. It may be explained by different meal consumed by dogs (factory-produced meal for dogs from Dakar vs. irregular sources for village dogs). Intense circulation of T. gondii in the studied zone may explain the unusually high seroprevalence among horses and donkeys. Tropical climate with high temperature and humidity is favorable for the conservation of oocysts of T. gondii. Results presented here may contribute to the evaluation of the risks of toxoplasmosis in humans in Senegal.

CLOVES syndrome (Congenital Lipomatous asymmetric Overgrowth of the trunk with lymphatic, capillary, venous, and combined-type Vascular malformations, Epidermal nevi, Skeletal anomalies) is a sporadic malformational syndrome that has recently been described (mutation of PIK3CA), with asymmetric body hypertrophy, lipomatous hamartoma of the trunk and numerous malformations.We report a case of CLOVES syndrome initially diagnosed as Proteus syndrome, revealed by infection of a dorsal lipomatous hamartoma. The patient presented with both right lower limb hypertrophy and capillary and venous-lymphatic malformations, associated with dorsal capillary malformations, left cervico-facial hypertrophy, and cervical epidermal hamartoma, all of which are consistent with Proteus syndrome. Imaging of the dorsal lipomatous hamartoma associated with capillary as well as underlying venous-lymphatic malformations and syringomyelia resulted in subsequent correction of the earlier diagnosis of Proteus syndrome to that of CLOVES syndrome.Several malformational syndromes are associated with tissue hypertrophy, hamartoma and vascular malformations. Diagnosis of CLOVES syndrome may be delayed due to its fairly close phenotypic similarity to Proteus syndrome. Nevertheless, the prognosis and complications differ. Our case underlines the importance of considering a diagnosis of CLOVES syndrome in the presence of lipomatous hamartoma with hemi-hypertrophy and epidermal hamartoma, in order to enable adequate follow-up with specific monitoring for the possible complications associated with this disease.