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Given the increasing prevalence of pediatric obesity, we evaluated two kindergarten-based strategies for reducing overweight in preschool children in the Haute-Garonne Department in France. Kindergartens (n=79) were randomly assigned to one of the two strategies and followed for 2 years. In the first group (Epidemiologie et prevention de l’obesite infantile, EPIPOI-1), parents and teachers received basic information on overweight and health, and children underwent screening to identify those with overweight (body mass index (BMI) ⩾90th percentile) or at risk for overweight (BMI between 75 and 90th percentile), who were then followed up by their physicians. EPIPOI-2 children, in addition, received kindergarten-based education to promote healthy practices related to nutrition, physical activity and sedentary behaviors. Data on control children from non-intervention kindergartens (n=40) were retrieved from medical records at the Division of School Health. At baseline, groups differed significantly on age and school area (underprivileged/ not). Owing to a significant interaction between school area and group, analyses were stratified by school area. At baseline, groups did not differ on overweight prevalence and BMI z-scores for any school area. After intervention, prevalence of overweight, BMI z-score and change in BMI z-score were significantly lower in intervention groups compared with controls in underprivileged areas. Using multilevel analysis adjusted for potential confounders, a significant effect on overweight prevalence at the end of the study was noted for EPIPOI-1 in underprivileged areas only (odds ratio and 95% confidence interval: 0.18 (0.07–0.51). In non-underprivileged areas, the gain in BMI z-score was lower in EPIPOI-2 group compared with control and EPIPOI-1. Our results suggest that simple measures involving increasing awareness on overweight and health, and periodic monitoring of weight and height with follow-up care when indicated, could be useful to reduce overweight in young children from underprivileged areas. A reinforced strategy with an education component, in addition, may be indicated in children in non-underprivileged areas.

Oxidative stress is commonly observed in chronic renal failure patients resulting from an unbalance between overproduction of reactive oxygen species and impairement of defense mechanisms. Proteins appear as potential targets of uremia-induced oxidative stress and may undergo qualitative modifications. Proteins could be directly modified by reactive oxygen species which leads to amino acid oxydation and cross-linking. Proteins could be indirectly modified by reactive carbonyl compounds produced by glycoxidation and lipo-peroxidation. The resulting post-traductional modifications are known as carbonyl stress. In addition, thiols could be oxidized or could react with homocystein leading to homocysteinylation. Finally, tyrosin could be oxidized by myeloperoxidase leading to advanced oxidative protein products (AOPP). Oxidatively modified proteins are increased in chronic renal failure patients and may contribute to exacerbate the oxidative stress/inflammation syndrome. They have been involved in long term complications of uremia such as amyloidosis and accelerated atherosclerosis.

SummaryIn rheumatoid arthritis (RA) there are currently no good indicators to predict a clinical response to rituximab. The purpose of this study was to monitor and determine the role of peripheral blood cytokine profiling in differentiating between a good versus poor response to rituximab in RA. Blood samples were collected at baseline and at 3 months from 46 RA patients who were treated with rituximab. Responders are defined by the presence of three of four American College of Rheumatology criteria: ≥ 20% decrease in C-reactive protein, visual analogical score of disease activity, erythrocyte sedimentation rate and improvement of the disease activity score (28) (four values) by ≥ 1·2 obtained at 3 months. Twelve cytokines were measured from serum collected on days 0 and 90 by proteomic array, including interleukin-6 (IL-6), tumour necrosis factor-α, IL-1a, IL-1b, IL-2, IL-8, interferon-γ, IL-4, IL-10, monocyte chemoattractant protein-1, epidermal growth factor and vascular growth factor. We showed that C-reactive protein and IL-6 levels decrease significantly at 3 months in the responder group compared with baseline. At day 90 we identified a cytokine profile which differentiates responders and non-responders. High serum levels of two proinflammatory cytokines, monocyte chemoattractant protein-1 and epidermal growth factor, were significantly higher in the responder group at day 90 compared with non-responders. However, we were not able to identify a baseline cytokine profile predictive of a good response at 3 months. These findings suggest that cytokine profiling by proteomic analysis may be a promising tool for monitoring rituximab and may help in the future to identify responder RA patients.

Wegener's granulomatosis (WG) is a granulomatous disease that can affect many organ systems. The most frequently involved organs include the upper and lower respiratory tract as well as the kidney. Cardiac involvement is rare.We report the case of a patient with grade 4 mitral insufficiency associated with severe WG.Surgical analysis of the mitral valve revealed perforation of the anterior leaflet without evidence of endocarditis. Pathological examination of the anterior mitral leaflet revealed myxoid degeneration nodules and bacteriological examination was negative. As the perforated lesion was very close to the free margin of the anterior leaflet, valve replacement appeared a reasonable surgical option in a poor surgical candidate. Six months after the operation, the patient is doing well.Wegener's granulomatosis is an autoimmune necrotizing vasculitis that can affect many organ systems. Cardiac involvement is rare. Heart in his globality can be affected by WG in many different ways. Cardiac valvular involvement in WG is rare. The aortic valve seems to be more frequently affected. Cardiologic investigations should have an important place at diagnosis and supervision.

La recherche de biomarqueurs diagnostiques, pronostiques ou evolutifs est devenue un enjeu crucial pour la prise en charge des patients atteints de pathologies complexes et en particulier de cancers. La proteomique clinique est une approche majeure permettant l’identification de ces biomarqueurs mais elle pose des problemes de reproductibilite, de mise en place de procedures operatoires et de controle qualite en particulier pour les etapes preanalytiques. L’assurance de la qualite et de la reproductibilite de ces analyses passe ainsi par un controle de l’integrite initiale des echantillons avec la standardisation des conditions de prelevement, de conservation et de stockage. Dans cette optique, des actions visant a proposer des recommandations preanalytiques en proteomique clinique ont ete menees au sein de l’Institut national du cancer (INCa) et de la Societe francaise de biologie clinique (SFBC). Des travaux communs ont permis de finaliser des recommandations pour les fluides biologiques suivants : plasma, serum, urine et liquide cephalorachidien. Ces recommandations sont destinees a favoriser une homogeneisation des etapes de recueil, de conditionnement et de stockage des echantillons dans les centres de ressources biologiques et pour les projets de recherche de biomarqueurs utilisant les techniques recemment developpees dans le domaine de l’analyse proteomique. Ces recommandations n’empechent pas la possibilite d’utiliser des protocoles operatoires differents ; cependant, la conservation d’echantillons recueillis et stockes de maniere homogene entre tous les centres permettra a moyen terme de constituer une banque biologique remarquable et indispensable pour des etudes multicentriques et de haut niveau dans le domaine de la proteomique en sante humaine.

Beside the well characterized PRL-secreting adenomas, a wide spectrum of functional hyperprolactinemic states exists. We describe here five women, 21-38 yr old, all suspected of having a PRL-secreting adenoma because of a pseudotumoral appearance of the pituitary on computerized tomographic (CT) scan or magnetic resonance imaging (MRI). Four had oligomenorrhea with or without galactorrhea, one had amenorrhea with galactorrhea, and two complained of infertility. In the same patient, basal plasma PRL levels were variable on different days, sometimes normal (mean +/- SEM, 11.3 +/- 1.5 micrograms/L), sometimes elevated (49 +/- 7 micrograms/L), but in all cases, a PRL response of large amplitude to TRH (6- to 8-fold increase in the basal value) was observed. Basal plasma levels of estradiol were within luteal phase normal values (0.41 +/- 0.13 pmol/L), while progesterone levels were low (1.92 +/- 0.47 nmol/L). CT scan or MRI showed an intrasellar mass with suprasellar extension, suggesting a tumoral process. However, the signal intensity was homogeneous, and on coronal views, the suprasellar extension was pyramidal and symmetrical, and the pituitary stalk was always in the midline. The five patients were operated on by the transsphenoidal route, but no adenoma was found. Surgical biopsies were taken in four cases, and lactotroph hyperplasia, i.e. enlarged cell cords consisting mainly of PRL cells, was found in three of them. One case displayed a continuum between areas of lactotroph hyperplasia and adenomatous PRL cells. We conclude that functional hyperprolactinemia may mimic on CT scan or MRI a PRL-secreting adenoma.

Using H-2 recombinant congenic strains of mice, genetic analysis of resistance to murine hepatitis virus type 3 (MHV3)-induced paralysis was performed. It appeared that both H-2K and H-2D, two class I gene regions of the mouse major histocompatibility complex (MHC), can play independent significant roles in the establishment of such resistance.

Post-operative intracranial aneurysm rests are encountered in 4 to 10% of patients undergoing postoperative angiography. Reoperation of postoperative aneurysm rests can be difficult and lead to significant morbidity and mortality. Endovascular treatment, using controlled detachable coils, was performed in 3 patients with such rests and proved successful as an alternative treatment of post-operative aneurysm rests.

SummaryIn rheumatoid arthritis (RA) there are currently no useful indicators to predict a clinical response to tumour necrosis factor-α (TNF-α) blockade. The purpose of this study was to determine the role of peripheral blood cytokine profiling in differentiating between a good versus poor response to etanercept in RA. Peripheral blood samples were collected at baseline and at 3 months from 33 patients with active disease who were treated twice weekly by etanercept therapy. Responders are defined by the presence of three of four American College of Rheumatology criteria: ≥20% decrease in C-reactive protein (CRP), visual analogue score of disease activity, erythrocyte sedimentation rate and improvement of the disease activity score (28; four values) by ≥1·2 obtained at 3 months. Twelve cytokines were measured from serum collected on days 0 and 90 by proteomic array (protein biochip array, Investigator Evidence, Randox France), including interleukin (IL)-6, TNF-α, IL-1a, IL-1b, IL-2, IL-8, interferon-γ, IL-4, IL-10, monocyte chemoattractant protein (MCP)-1, epidermal growth factor (EGF) and vascular endothelium growth factor. Our results showed that high serum levels of MCP-1 and EGF were associated with a response to etanercept. In addition, the increase of two combined parameters CRP and EGF was predictive of a response to etanercept treatment at 3 months (sensitivity: 87·5% and specificity: 75%, accuracy: 84·4%). These findings suggest that cytokine profiling by proteomic analysis before treatment initiation may help to identify a responder patient to TNF-α blocking agents in RA.

Epitaxial layers of cadmium mercury telluride are simultaneously grown onto several CdTe substrates (total area 20 cm2) by cathodic sputtering in a mercury vapour plasma. The transition region between the CdHgTe layer and the substrate is very narrow (thickness ≈ 80 nm) and the variation of composition across the surface of the layer (4 cm2) is less than ± 0.01 mole fraction CdTe. The Hall coefficient of CdHgTe epitaxial layers have been measured between 4 and 300 K. At 77 K the results concerning layers deposited at 300°C (Cd compontion of 0.20) are about n = 5.1016 cm −3 with a Hall mobility of 12000 cm2V−1sec 1 and p = 1.1017 cm−3 with a Hall mobility of 55 cm2V−1sec−1 for layers deposited at 250°C.

The two compounds were labelled by 14C on the hydroxyimino methyl group substituted on the 2 positions of the pyridinium ring. The convenient pyridinium lithiated intermediates were formylated with N-methyl 14C-formanilide. The hydroxyimino methyl groups were synthezised by reaction of the 14C-formyl compound with hydroxylamine. For the two species alkylation of pyridine was performed with methyliodide. Radiochemical yields were 50% and 20%.

The β‐SiC (or 3C‐SiC) synthesis through high‐dose carbon implantation into a silicon substrate heated at high temperature is studied by means of cross‐sectional transmission electron microscopy, x‐ray diffraction, infrared absorption spectroscopy, Auger electron spectroscopy, Rutherford backscattering spectrometry, channeling, and nuclear reaction analysis. It is shown that a thick buried layer of β‐SiC (about 300 nm) is directly formed after multiple implantations at 860 °C without post‐implantation annealing. This layer is not continuous but consists of small monocrystalline grains (average size ∼7 nm) in a near‐perfect epitaxial relationship with the silicon matrix. These grains are only slightly misorientated (∼3.5°) but are severely twinned on {111} planes.

Administration of two doses of hepatitis A (HA) vaccine to childrenor = 2 years of age has been shown to be protective. The present study assessed whether HA vaccine can be administered as early as 6 months of age and whether it can be administered concomitantly with a hexavalent (HV) vaccine at this age.In an open label, randomized, parallel group study, the liquid HV vaccine (HEXAVAC) (diphtheria, tetanus, 2-component acellular pertussis, inactivated poliomyelitis vaccine, Haemophilus influenzae type b conjugated to tetanus protein and hepatitis B) was administered at 2, 4, 6, and 12 months of age to all children. HA vaccine (VAQTA) was given at 7 and 13 months in the separate administration group (Group 1) and at 6 and 12 months in the concomitant administration group (Group 2). Serum samples were obtained at 2, 7, 12, and 14 months in Group 1 and at 2, 7, 12, and 13 months in Group 2. The primary immunogenicity outcomes were the seroconversion rates for HA 1 month after the second dose of HA vaccine in initially seronegative subjects, and the seroconversion rates for each HV antigen 1 month after the third dose of the HV vaccine (both at 7 months of age).HA seropositivity rates 1 month after the second dose were 100% in both groups, regardless of initial serostatus. The responses to each HV antigen 1 month after the third dose were similar in both groups. The vaccines were generally well tolerated in both groups regardless of vaccine(s) administered.A schedule of two doses of HA vaccine, 6 months apart beginning at 6 months of age is highly immunogenic and well tolerated when administered alone or concomitantly with HV vaccine at 6 and 12 months of age.

International audience; Introduction – Les troubles neuro-psychiatriques constituent une des principales causes de morbidité et d'incapacités liées au vieillissement. Le projet Esprit a pour but d'étudier l'étiologie complexe des troubles psychiatriques chez le sujet âgé pour une meilleure prise en charge. Objectifs – 1) déterminer la prévalence (en actuel et au cours de la vie) et l'incidence des troubles psychiatriques en population générale âgée ; 2) évaluer les facteurs de risque de ces troubles, leur poids relatif et leurs interactions ; 3) étudier l'hétérogénéité clinique ; 4) estimer les probabilités de transition vers un état subsyndromique ou vers la maladie ; 5) construire des modèles étiologiques prédictifs. Méthode - L'étude longitudinale Esprit porte sur 1863 personnes non institutionnalisées de 65 ans et plus, recrutées par tirage au sort sur listes électorales. Depuis l'inclusion en 1999, ces sujets ont déjà été revus deux fois à 2 ans d'intervalle. Ils ont été soumis à différents questionnaires (socio-démographiques, antécédents médicaux, incapacités, expositions, survenue d'événements traumatiques), examens neurologiques ainsi qu'à un enregistrement polysomnographique à domicile. Une DNAthèque et une sérothèque ont été constituées et certains paramètres biochimiques dosés (lipides, cortisol...). La pathologie psychiatrique a été évaluée au cours d'un entretien structuré, le MINI (fondé sur les critères diagnostiques du DSM IV), la symptomatologie dépressive par la CES-D et le niveau d'anxiété via l'échelle de Spielberger. D'autres questionnaires ont été utilisés afin d'évaluer la personnalité colérique (Spielberger-anger), l'impulsivité (Barratt), l'agressivité (Buss-Durkee) et la survenue de traumatismes dans l'enfance. Résultats - Les troubles psychiatriques sont fréquents chez les sujets âgés et au cours de leur vie ils ont touché près d'une personne sur deux. La prévalence des troubles actuels est élevée notamment pour les phobies (10,7%), l'anxiété généralisée (4,6%) et les idéations suicidaires (9,8%). Pour la plupart des troubles psychiatriques, les prévalences sont près de 2 fois plus élevées chez la femme. Nos premières analyses montrent l'importance de certains facteurs de risque jusque-là peu explorés, facteurs environnementaux comme les événements de vie traumatiques ou facteurs biologiques comme le statut hormonal au cours de la vie reproductive ou le rôle des systèmes de régulation du stress (e.g. activité secrétoire de l'axe HPA). L'insomnie est également un facteur de risque de troubles dépressifs ou anxieux. Conclusion - L'étude longitudinale Esprit constitue une base de données relativement exhaustive sur les troubles psychiatriques en population générale française âgée. L'approche multifactorielle (prenant en compte facteurs environnementaux, psychosociaux, biologiques, génétiques, pharmacologiques ou cliniques et leurs interactions) devrait permettre la construction de modèles étiologiques complexes susceptibles d'être validés au sein d'études cliniques et ouvrir de nouvelles perspectives dans le champ de la santé mentale du sujet âgé.

A 22-year-old man presented headache, asthenia, body weight loss and trigeminal hypoesthesia worsening quickly. Radiological analysis showed an enhanced lesion that originated from the cavernous sinus and extended into the Meckel cave, owing to the fifth cranial nerve's course. The lesion was explored by a temporo-pterional approach and was partially removed. On the basis of histological analysis and negativity of tumor marker levels in serum and cerebrospinal fluid (alpha-fetoprotein alpha, human beta-chorionic gonadotropin), a primitive non-secreting intracranial germinoma was diagnosed. Under combined chemotherapy (carboplatine, ifosfamide, etoposide) followed by focal fractionated radiotherapy delivering 40 Gy to the initial tumor volume, the outcome was excellent. Five years later, the patient was in complete clinical and radiological remission. Primitive intracranial germinomas are rare malignant tumors involving mainly pineal and hypothalamic regions. We report a case of intracranial trigeminal nerve germinoma. To the best of our knowledge, no case of primitive germinoma was previously described in this location. Aspects of diagnosis and treatment are discussed in the light of previous publishing data.

Capillary zone electrophoresis of serum proteins is increasingly gaining impact in clinical laboratories. During 2003, we compared the fully automated capillary electrophoresis (CE) system from Beckman (Paragon CZE 2000) with the method agarose gel electrophoresis Sebia (Hydrasis-Hyris, AGE). This new study focused on the evaluation of analytical performance and a comparison including 115 fresh routine samples (group A) and a series of 97 frozen pathologic sera with suspicion of monoclonal protein (group B). Coefficients of variation (CVs %) for the five classical protein fractions have been reported to be consistenly9% in within-run and10% in between-run imprecision studies with the Paragon 2000 system. The results of the comparison study (group A) demonstrated a good correlation between the CE system and AGE, except for beta-globulin (r = 0.65). Among the 97 pathologic serum samples (group B), there were 90 in which we detected a monoclonal protein by immunofixation (IF) (immunosubtraction (IS) was not used). AGE and Paragon 2000 failed to detect 7 and 12 monoclonal proteins, respectively, leading to a concordance to 92% for AGE and 87% for Paragon 2000 for identifying electrophoretic abnormalities in this group. Beta-globulin abnormalities and M paraprotein were well detected with Paragon 2000. Only 81% (21 vs 26) of the gammopathies were immunotyped with IS by two readers blinded to the IF immunotype. The Paragon 2000 is a reliable alternative to conventional agarose gel electrophoresis combining the advantages of full automation (rapidity, ease of use and cost) with high analytical performance. Qualified interpretation of results requires an adaptation period which could further improve concordance between the methods. Recently, this CE system has been improved by the manufacturer (Beckman) concerning the migration buffer and detection of beta-globulin abnormalities.

The effects of two serotonergic agents--fluoxetine, a serotonin (5-HT) reuptake inhibitor, and buspirone, a 5-HT 1a agonist--on rates of self-injurious and stereotypic behavior were examined in 15 adult male Macaca mulatta. All animals received a placebo for 2 weeks followed by either buspirone or fluoxetine for 12 weeks. Behavior was monitored using a focal sampling technique throughout the study and for 2 weeks post-study. Cerebrospinal fluid (CSF) samples and body weights were obtained pre-study, at the ends of placebo and treatment phases, and post-study. Fluoxetine and buspirone were significantly effective in reducing rates of self-biting during treatment weeks 1 to 8 and self-directed stereotypic behavior during weeks 5 to 12 and post-treatment. No significant effect of either treatment on hair-plucking, stereotypic pacing, saluting, or head tossing was identified. The duration of neutral behavior increased, and rates of scratching and yawning decreased in the buspirone-treated condition. In the fluoxetine-treated condition, rates of yawning, scratching, and self-directed grooming were higher overall compared with those of buspirone-treated animals, and rates of scratching increased significantly (P0.05) in weeks 9 to 12; these findings suggest that animals in the fluoxetine-treated condition experienced higher levels of anxiety throughout the study. In both treatment conditions, concentrations of CSF 5-HIAA (5-HT metabolite) were significantly lower (P0.05) than placebo concentrations. Fluoxetine and buspirone may be efficacious for treatment of self-injurious and self-directed stereotypic behavior in macaques. Further studies are required to determine the optimal dosages and treatment length.

Monitoring beta2-microglobulin (beta2M) in biological fluids has gained considerable interest in pathologies such as haematologic malignancies, renal diseases, and chronic inflammatory diseases. Due to limitations of the RIA in the routine laboratory, we measure beta2M with non-isotopic methods. 189 patients suffering from myeloma (n=66), end stage renal failure (n=54) or inflammation (n=69) were included in this study. beta2M was determined in serum, urine and dialysate using an immunoenzymometric assay with chemiluminescence detection [Immulite Diagnostic Products Corporation (DPC), La Garenne Colombes, France] and an immunoturbidimetric assay (Olympus, Rungis, France). The data were compared with a radioimmunoassay (Immunotech, Marseille, France) taken as a reference. Using serum samples, the immunoenzymometric assay with chemiluminescence detection and the immunoturbidimetric assay have reliable analytical performances. Values obtained with serum samples are highly correlated with the radioimmunoassay (DPC/RIA r2=0.84; Olympus/RIA r2=0.94) whatever the type of pathology; however an over-estimation which could be related to cross reactivity with beta2M fragments was observed with the RIA method as suggested by crossover calibration and recovery studies. Values obtained with urinary samples (n=96) are closely related to those obtained with the RIA (DPC/RIA r2 = 0.98; Olympus/RIA: r2=0.99). Despite the low levels observed in dialysate (n=57) good correlations were observed between Olympus vs DPC (r2=0.85). By contrast, the two non-isotope methods are poorly related with the RIA method (DPC vs RIA r2=0.47 and Olympus vs RIA r2=0.54). In conclusion, the immunoenzymometric assay with chemiluminescence detection or the immunoturbidimetric assay could be used in the routine laboratory in order to determine beta2M in plasma, urine and dialysate.

Although not really optimized for thruster use, the laser sustained plasma free jet issued from a sonic nozzle appears as an interesting step in the study of a thruster device. Even without any measurement of the propellant properties, the velocity distributions obtained at the end of the expansion give an estimation of thrust as well as specific impulse, thanks to the isentropic behavior of the free jet, and provided that some assumptions are made on the distributions of density, velocity, and temperature along the nozzle throat radius. It is expected that such assumptions could be got over by a complete calculation of the plasma upstream of the nozzle.

Introduction Chaque annee, 20 000 francais decedent suite a un accident de la vie courante (AcVC). Calyxis, Pole d’expertise du risque et l’equipe « Prevention et prise en charge des traumatismes » de l’Inserm se sont associes pour construire un outil de recherche sur les AcVC : l’Observatoire MAVIE. Ses objectifs sont de determiner l’ampleur et les caracteristiques des AcVC en France ; d’identifier les facteurs associes a la survenue et a la gravite des AcVC, et de proposer des programmes d’intervention prioritaires et innovants. Methodes Le principe est de proposer a 100 000 membres de foyers de decrire leur sante, leur environnement de vie et leurs activites et d’effectuer une collecte prospective des AcVC. Des questionnaires ont ete developpes et integres sur un site Internet specifique. Les participants sont des personnes qui agissent comme referents pour leur foyer ou pour une personne âgee. Lors de l’inscription, ils renseignent les caracteristiques de leur foyer. Les membres du foyer decrivent individuellement les informations qui les concernent. Le referent recoit un e-mail tous les trois mois lui rappelant de declarer les accidents eventuellement survenus au sein du foyer qu’il represente. Resultats Une phase pilote a ete realisee en 2013 afin d’estimer le taux d’inscription et d’ameliorer le site internet. La phase generale sera lancee en juin 2014. Discussion Cet observatoire, concu comme une cohorte prospective, est le premier a avoir comme objectif de decrire et de comprendre les AcVC, cause de mortalite et de morbidite majeure. A terme, il sera egalement un outil qui permettra l’evaluation d’interventions.

Antiphospholipid antibodies (APAs) are circulating immunoglobulins associated with a hypercoagulable state. The antiphospholipid syndrome combines APAs and clinical manifestations, including arterial or venous thromboses and/or recurrent spontaneous fetal loss. The main risk incurred by endovascular treatment of intracranial aneurysms is the occurrence of thromboembolic events. We report two cases of patients with antiphospholipid syndrome who developed thromboembolic complications after the endovascular treatment of unruptured intracranial aneurysms.

To compare the immunogenicity and safety of a trivalent tetanus-diphtheria (low toxoid content)-inactivated poliomyelitis vaccine, Td-IPV (Revaxis; Pasteur Merièux), with a tetanus-diphtheria (low toxoid content) vaccine, Td (Td-Impfstoff Mérieux; Pasteur Merièux), when administered as a booster to children age 6 to 9 years.A group of 301 children were randomized and vaccinated with Td-IPV (n = 150) or Td (n = 151) in this open, controlled, multicenter trial. Serum specimens were obtained before and 28 days after vaccination. Safety was assessed for up to 28 days postvaccination by parental diary cards. Solicited local and systemic reactions were recorded for 7 days after vaccination.Seroprotection (enzyme-linked immunosorbent assay titer,or =0.10 IU/ml) against tetanus and diphtheria was induced by either Td-IPV or Td in all subjects. Tetanus and diphtheria geometric mean titer were higher after Td (34.0 and 5.74 IU/ml) than after Td-IPV (15.9 and 4.38 IU/ml). All subjects boosted with Td-IPV were seroprotected against each type of poliovirus (neutralizing antibody titer,or =5/dilution). The most frequently reported solicited local and systemic symptoms were pain triggered by movement of the arm (54% vs. 39.1%) and headache (17.3% vs. 7.3%), after Td-IPV and Td, respectively. All other events were similar between the two groups. Reactions were generally mild and all were temporary.A booster dose of Td-IPV induced in all children seroprotection against tetanus, diphtheria and poliomyelitis. The overall safety profile of the two vaccines was acceptable.

Objective: To investigate the effects of systemic administration of lidocaine on different components of neuropathic central pains by quantitative sensory testing. Methods: The efficacy of systemic lidocaine (5 mg/kg IV over 30 minutes) was evaluated in a double-blind, placebo-controlled, and cross-over fashion, on both spontaneous ongoing pain and evoked pains (allodynia and hyperalgesia) in 16 patients with chronic poststroke (n = 6) or spinal cord injury (n = 10) related pain. Results: Lidocaine was significantly superior to the placebo (saline) in reducing the intensity of spontaneous ongoing pain for up to 45 minutes after the injection: 10 of 16 patients (62.5%) receiving lidocaine showed a significant reduction in spontaneous pain, whereas only six patients showed this after the placebo. Lidocaine also significantly reduced the intensity of brush-induced allodynia and mechanical hyperalgesia, but was no better than the placebo against thermal allodynia and hyperalgesia. In general, the side effects were moderate and consisted mainly of lightheadedness (44%). Conclusions: Systemic lidocaine can induce a significant and selective reduction of several components of pain caused by CNS injuries. The observed preferential antihyperalgesic and antiallodynic effects of this drug suggest a selective central action on the mechanisms underlying these evoked pains.

We present the first comparative study of nucleation and growth of Si quantum dots on SiO2, SiOxNy and Si3N4 substrates using silane Low Pressure Chemical Vapor Deposition at low temperature (570–610°C). The samples are investigated by Atomic Force Micoscopy, Scanning Electron Microscopy, High Resolution Transmission Electron Microscopy and Spectroscopic Ellipsometry. We confirm that the chemical nature of the surface and precisely the presence of SiO bonds decreases the Si quantum dot density. By optimising the deposition parameters, a Si dot density of 1012 cm−2 can be obtained below 600°C on a pure Si3N4 surface. The influence of hydrogen, provided by silane decomposition, on the Si nucleation mechanism will be discussed.

By using selective epitaxy, submicron‐thick (100) GaAs films can be conformally grown between two sandwiching dielectric layers. The defect structure of such GaAs films is investigated using chemical etching and transmission electron microscopy. The conformally grown films exhibit specular surfaces and appear virtually free from defects. A qualitative model for defect trapping is presented which suggests that the dislocations are blocked on the capping dielectric layer when they should thread laterally.

The purpose of the present study was to investigate substitutions in the D-loop of mitochondrial DNA (mtDNA) in sudden infant death syndrome (SIDS) and controls, since several observations indicate the involvement of mtDNA mutations in SIDS. These include elevated levels of vitreous humour hypoxanthine in SIDS victims, familial clustering without mendelian traits, and observations of increased sleepiness and a lower activity score in infants who later succumbed to SIDS. Eighty-two cases of SIDS and 133 controls were investigated and the D-loop sequences were recorded in the base-pair range 16055-16500 in the mtDNA sequence. The sequencing was carried out using the Applied Biosystems Sequenase dye terminator method and a ABD373A sequencer. The recorded D-loop sequences were compared with the Cambridge sequence and differences were recorded as substitutions. The SIDS cases had a tendency towards a higher substitution rate in the D-loop than the controls (p = 0.088). This observation makes it interesting to search for deleterious mutations in other locations in the mtDNA.

Assessment of clinical health care focuses on 'what is really done' in order to describe day-to-day practice. These data could be compared with standards or guidelines. The method used, the 'clinical audit', aims to improve the quality of care through specific actions. Finally, a second data collection could assess the efficacy of these actions. Many protocol designs could be used; they are illustrated by two examples in this article. The choice of protocols depends on the field and on the objectives of the work. Most of the time, assessment of clinical health care is included in a continuous quality improvement programme.

OBJECTIVE AND IMPORTANCE: Dural arteriovenous fistulas of the superior sagittal sinus (SSS) account for 8% of intracranial dural fistulas. Their association with a thrombosis of the posterior part of the SSS is rare. In such cases, the usual neurosurgical and endovascular approaches cannot provide a good technical solution for treatment of the lesion, and a combined neurosurgical and neuroradiological approach is therefore needed. CLINICAL PRESENTATION: A 68-year-old man presented with rapidly evolving dementia. Cerebral angiography revealed a dural arteriovenous fistula of the SSS associated with thrombosis of the posterior part of the SSS. Various endovascular and neurosurgical approaches failed to cure the fistula. INTERVENTION: A burr hole was drilled in the frontal region, in the neurosurgical room. The patient was then transferred to the angiographic room, and the SSS was occluded using free spirals. CONCLUSION: This procedure led to a complete anatomic cure of the fistula, and a slow clinical improvement was observed.

Abstract This paper presents the results of a numerical study performed in order to confirm the merits of a multilateral well to replace a pattern of parallel horizontal wells to produce an oil reservoir in the presence of a bottom aquifer. The basic assumptions for the study are a same total drilled length from the surface for both production patterns and a homogeneous reservoir. The production of an elementary volume of width a, length L, oil thickness h and depth is simulated considering n parallel horizontal wells of length L or just a single multilateral well composed of a main hole of length L and lateral arms of length a/2 perpendicular to the main hole. Results of the numerical study show that the reduction of coning is very important with the multilateral well. For instance, for a 14 m thick oil reservoir located at a depth of 1000 m, the oil recovery with the multilateral well is 1.7 the recovery of its equivalent pattern of horizontal wells. A three times increase in oil recovery is even obtained within a 4000 m deep reservoir indicating that the oil recovery is significantly improved by increasing the number of lateral arms and reducing the drawdown applied to the reservoir. These results confirm the interest of developing and producing an oil field using multilateral wells rather than conventional horizontal wells. Introduction Many oil (and gas) reserves in the world are found in reservoirs that are underlain by a bottom aquifer. When a well drilled in the pay zone is put on production, it experiences more or less rapidly what is defined as the coning phenomenon. Water rises from the water leg to the perforated interval and breaks through at the well. Once water has entered the well, water production increases with the detrimental consequences of declining oil production and higher operating costs. A factor which contributes to coning is the potential drop or drawdown near the wellbore due to production. Because of its extended exposure with the reservoir, a horizontal well usually has less pressure drawdown for a given production rate than does a vertical well. Moreover, the standoff from the bottom water can be maximized with the horizontal well located high in the oil pay. For 15 years now, these specific advantages of horizontal wells have been at the basis of their successful and intensive use to replace vertical wells to produce oil reservoirs in the presence of a bottom aquifer or a gas cap. Undoubtedly, it can be stated that horizontal wells have become the standard procedure to produce these reservoirs. At the same time, in the last few years new developments in drilling technology have allowed the drilling and completion of multiple lateral wellbores from a single, horizontal or vertical, primary wellbore. In fact, what is achievable with multilateral wells is the capacity to travel within the formation to steer the well in several directions to the oil. Another obvious advantage of using a multilateral well to replace several conventional horizontal wells is that the drilling of the non reservoir sections before the actual entrance into the reservoir is done only once. For the same total drilled length from the surface, the fraction of the wellbore exposed to the reservoir is therefore greater with the multilateral well. In coning situations, such as production of oil reservoirs with a bottom aquifer or a gas cap, a larger exposure to the reservoir implies a reduced drawdown on the formation and a larger drainage area. Thus, reduction in water coning effects is expected with a multilateral well with the benefits of greater oil recovery and substantial reduction both in investment and operating costs and in surface environmental exposure. The objective of this paper, from a numerical study, is to demonstrate the potential of using a multilateral well instead of several parallel horizontal wells to economically increase and accelerate the overall recovery of oil in reservoirs underlain by an active bottom aquifer. The main assumptions considered in this study are: a homogeneous formation, no gas cap, same total drilled length from surface for the pattern of parallel horizontal wells and for the multilateral well.

Two cases of delayed cerebral radionecrosis with cystic presentation are reported. The patients had received radiation therapy for a cutaneous tumor 16 and 12 years before. Surgical extirpation of the cerebral lesion permitted to confirm the diagnosis and to treat the patients with success. A cystic aspect has been reported rarely in the neuroradiologic descriptions of the cerebral radionecrosis in the literature. Its mechanism is discussed. The treatment of the delayed cerebral radionecrosis is not clearly established, but a cystic presentation is an argument for surgery.

Two investigations were undertaken to analyze the 3' region of the apolipoprotein AII (Apo AII) gene in patients with myocardial infarction (MI) and controls. Previous studies have suggested that a MspI polymorphism in this gene may be associated with hypertriglyceridaemia, high levels of HDL cholesterol and Apo AII. To verify this hypothesis, the distribution of MspI genotypes and their possible associations with several plasma lipid variables were studied in 882 subjects (411 cases with MI and 471 controls) from the ECTIM study. There were no differences in genotype and allele frequencies between cases and controls, and no differences in lipid variable levels in controls carrying the less frequent MspI allele vs other controls. Using single-strand conformation polymorphism (SSCP) analysis, we detected a new polymorphism which caused by a C-to-T transition located in the third intron near the splice junction site (acceptor). This polymorphism modifies a Bst N1 restriction site. The ECTIM population was screened for this new marker, and no significant associations with MI and plasma lipid levels were found. Our results suggest that these two variants located in the coding region of the Apo AII gene are unlikely to contribute significantly to the level of plasma lipid variables and the risk of coronary heart disease (CHD) in the European population.

The mitochondrial DNA has several properties useful for the reconstruction of human population history. The origin of the Saami people is still not known, even if much have been done to unravel the secrets of the past. One hypothesis is that Saami are the ancient Nordic people, another that they have a strong Mongolian component among their ancestors, and a third that they are mainly of European descent (for a comprehensive review, see Eriksson 1988). In a recent report, Sajantila et al. (in press 1995) show that Saami are distinct from other Europeans by characteristic patterns in mtDNA D-loop sequence, and they conclude that the Saami seem to have a long history distinct from other European populations.

Objectifs rapporter notre experience concernant 2 cas de tumeur fibreuse solitaire de localisation exceptionnelle. Preciser les difficultes diagnostiques et l’evolution. Materiel et methodes Les dossiers de 2 patients ont ete revus : Une femme de 70 ans presentant une tumeur frontale gauche (patient 1) et d’un patient de 23 ans presentant une tumeur frontocoronale (patient 2). Resultat Dans les deux cas le diagnostic pre operatoire etait celui de meningiome. Les constatations operatoires etaient atypiques en particulier au niveau de l’insertion duremerienne. Le diagnostic a ete porte dans les deux cas par l’histologie avec analyse immunohistochimique. L’index mitotique etait bas chez le patient N° 1, eleve chez le patient Nϒ 2. L’exerese chirurgicale a ete complete dans les deux cas. L’evolution a ete favorable dans le cas nϒ 1, marque par des complications infectieuses et une recidive dans le cas Nϒ 2. La recidive a ete traitee par radiotherapie. Conclusion Les cas rapportes ici completent les donnees de la litterature sur cette rare localisation et documentent les difficultes diagnostiques, et les possibilites therapeutiques en cas d’evolutivite locale.

There is a 25% risk of meningitis in case of cerebrospinal fluid rhinorrhea from the anterior cranial fossa. Treatment usually is based on neurosurgery when medical management is unsuccessful. The risk of morbidity and mortality in such operations is important and recurrence is observed in 25% of the cases. The development of endonasal surgery has increased the incidence of iatrogenic breaches but has also allowed the development of new techniques for closing breaches. Certain authors recently published a recent series of patients treated via the endonasal route. We present here six cases of cerebrospinal fluid rhinorrhoea from the anterior cranial fossa treated at the Foch Hospital. Etiology was iatrogenic in 4 cases, trauma in 1 and spontaneous in 1. The operative technique and mid-term results are presented. Cure was achieved in all cases after a mean follow-up of 2 years. One patient with osteopetrosis of the cranial floor who underwent neurosurgical decompression of the optic nerve complained of recurrent rhinorrhoea which could not be confirmed by endoscopy nor by imaging. Early endoscopic treatment of cerebrospinal fluid rhinorrhoea should be the first intention option as it preserves olfactive function, limits operative morbidity and mortality and leaves open the option of neurosurgery in case of failure.

Understanding how the permeability of a porous medium changes as function of solid fraction and pore geometry is vital in many significant areas. Here, we construct a number of different porous media via computer methods. We then simulate the flow of a viscous liquid through the solid packing using the Smoothed Particle Hydrodynamics (SPH) and Lattice Boltzmann (LB) methods. Qualitative comparisons of flow between the two methods are generally good as are the quantitative permeability comparisons. The relative computational efficiency of both methods is examined with the LB method being superior to SPH for this application.

The exposure of cells to O6-methylguanine or O6-benzylguanine is known to reduce the enzymatic activity of O6-alkylguanine-DNA alkyltransferase, which leads to a sensitivity enhancement to chloroethylnitrosourea cytotoxic effects. The main disadvantage of the guanine derivatives is their low water solubility, which makes their formulation difficult for clinical use in humans. To overcome this problem, water-soluble O6-alkylguanine-DNA alkyltransferase inhibitors have been synthesized and their ability to increase the chloroethylnitrosourea potency in vitro and in vivo was evaluated. Four water-soluble molecules (O6-methyl-N-acetylguanosine; O6-methyl-N-acetyldeoxyguanosine; O6-benzyl-N-acetylguanosine, BNAG; and O6-benzyl-N-acetyldeoxyguanosine, BNADG) were tested for sensitivity of M4Beu cells to N'-(2-chloroethyl]-N[2-(methylsulfonyl)ethyl]-N'-nitrosourea (cystemustine) based on the colony-forming ability of M4Beu melanoma cells. The cell sensitivity to cystemustine was increased by benzylated derivative pretreatment but not with methylated derivative pretreatment. Furthermore, BNAG or BNADG pretreatment followed by cystemustine was less cytotoxic than BNAG or BNADG given simultaneously and followed 24 hr later by BNAG or BNADG. Comparative studies performed with O6-benzylguanine on the same model showed that this inhibitor was effective at lower concentrations than the corresponding guanosine or deoxyguanosine analogs. Preliminary pharmacological assays were carried out in nude mice bearing the M4Beu tumor to determine whether the BNAG-cystemustine combination has greater antitumor activity than cystemustine alone. Simultaneous i.p. injection of 200 mg/kg of BNAG and 15 mg/kg of cystemustine followed by an i.p. injection 4 hr later of 200 mg/kg of BNAG led to a significant enhancement of inhibition of tumor growth.