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Introducción: La Educación Basada en la Comunidad (EBC) representa una estrategia educativa que acerca la formación médica a la práctica real, y promueve una atención médica de mayor aceptabilidad que contempla la esfera social de los procesos de salud/enfermedad y aborda de forma adecuada las necesidades reales de la población. Existen, a la fecha, escasas publicaciones a nivel regional en las cuales los propios estudiantes reflexionen sobre este tipo de experiencias formativas. Objetivos: Identificar y comunicar los principales aprendizajes obtenidos de una experiencia de EBC por parte de estudiantes de grado de Medicina. Metodología: Se revisaron las sistematizaciones de experiencias confeccionadas por la primera cohorte que completó esta experiencia en el Instituto Universitario del Hospital Italiano de Buenos Aires. Se reflexionó sobre las principales dificultades observadas y los aprendizajes más significativos obtenidos a partir de dicha experiencia. Se establecieron dominios y codificaron los textos de las sistematizaciones generadas durante la cursada. Finalmente, se generó un mapa de conceptos a partir del cual se escribió este artículo. Resultados: Esta experiencia tuvo para los estudiantes tres momentos bien definidos: una etapa inicial, caracterizada por incertidumbre y malestar; una intermedia, con aprendizaje estratégico y algo de transformación; y una avanzada, con aprendizaje profundo y situado. Conclusión: Es recomendable que a las experiencias de EBC se les asigne el tiempo suficiente en las planificaciones y que finalicen con un proceso de reflexión promovido por el equipo docente.

The practice of maternal-fetal surgery (MFS) has expanded from lethal fetal conditions to conditions which are significantly disabling but not a lethal fetal abnormality. The inclusion of myelomeningocele within the scope of MFS in the 1990s sparked a renewed debate over the ethics of MFS. While demonstrating increasing efficacy and range of application, MFS continues to be ethically fraught due to the inherent tension between maternal and fetal interests. Ethical issues central to MFS include the patienthood of the fetus; the balance of risks and benefits between the woman and fetus; informed consent for experimental procedures; and determination of conditions that meet ethical qualifications for MFS intervention. These concerns are likely to persist and evolve as perinatal medicine continues to advance. Here we summarize the current state of MFS ethics, highlighting the major positions in the literature thus far as well as examine future directions. It is essential robust discussions of these important issues continue both to ensure ethical medical practice and to provide support to clinicians, pregnant women, and their families.

Background The incidence of inflammatory bowel disease (IBD) has been steadily increasing worldwide and its etiology remains poorly understood. This study aims to estimate the associations between exposure to psychosocial factors in childhood or adolescence and the development of IBD in adulthood, separately for Crohn's disease and ulcerative colitis. Methods A case-control study nested in a population-based birth cohort was carried out. A total of 993 cases of Crohn's disease, 489 cases of ulcerative colitis and 914 controls born between 1970 and 1974 in Quebec, Canada, were analyzed. Sociodemographic and medical information were extracted from administrative databases. Participants filled out a questionnaire including a section on selected psychosocial factors experienced over their life course. Odds ratios (OR) and confidence intervals (95% CI) for the associations between psychosocial factors in childhood (0-9 years), adolescence (10-17 years) or over the full pediatric period (0-17 years), and IBD in adulthood were estimated by unconditional logistic regression models adjusted for potential confounding factors. For each association, a model including tailored covariates selected with a directed acyclic graph was estimated. The number of psychosocial factors experienced over the pediatric period was also analyzed in relation to the risk of IBD in adulthood. Results Some factors were associated with the risk of Crohn’s disease, such as sexual abuse in childhood (OR=1.58; 95% CI: 1.08-2.30) or over the full pediatric period (OR=1.39; 95% CI: 1.04-1.84). Likewise, the following factors occurring during adolescence were associated with increased odds of Crohn’s disease: parental neglect (OR=1.64; 95% CI: 1.01-2.66), the death of a loved one (OR=1.37; 95% CI: 1.02-1.85), and anxiety disorders (OR=1.66; 95% CI: 1.02-2.70). An association was identified between the experience of anxiety disorders from 0 to 17 years and ulcerative colitis in adulthood (OR=1.67; 95% CI: 1.05-2.67). Finally, exposure to three or more (vs. none) psychosocial factors from 0 to 17 years old was associated with the occurrence of Crohn's disease (OR=1.63; 95% CI: 1.13-2.36), but not ulcerative colitis (OR=0.98; 95% CI: 0.60-1.60) in adulthood. Conclusion In this study, the occurrence of sexual violence, parental neglect, the death of a loved one or anxiety disorders during childhood and/or adolescence was associated with the development of IBD in adulthood. Our results bring new light to the etiological puzzle of IBD by focusing on psychosocial factors and their accumulation during periods of vulnerability. Further studies taking into account resilience and assessing microbiota changes will be needed to confirm these results.

Resume Objectifs Les violences politiques peuvent pousser sur les routes de l’exil la ou les soutiens amicaux, familiaux et culturels sont moins presents et les adversites se vivent par consequent souvent seules. Ces bouleversements existentiels affectent les sexualites des personnes survivant ces violences. Pourtant, celles-ci sont rarement au cœur des parcours de soin posttraumatique. Methode Nous proposons d’etudier les enjeux clinique et politique des sexualites dans l’apres trauma pour des populations migrantes et racisees. A partir d’illustrations tirees de nos experiences cliniques, nous proposons de presenter nos approches psychotherapeutiques ecosociale et transculturelle afin de discuter les sexualites au regard de la notion de relationnalite et de la facon dont celle-ci se traduit en termes de parentalite et de conjugalite. Resultats Nous presentons une pratique psychotherapeutique narrative et relationnelle prenant en consideration les aspects psychologiques, sociaux et politiques du trauma. Nous proposons trois vignettes de personnes exilees qui se questionnent dans l’apres trauma autour de leur sexualite, identite et capacite a faire famille. Ce travail autour de la relation est un travail intersubjectif informe par le contexte en proposant des interventions culturellement sensibles. Conclusion Pour les populations ayant eu l’experience de violences sociales et politiques, le trauma se manifeste dans leurs vies dans leurs aspects sociaux et intimes. Ce qui vient faire le lien entre l’intime et le politique est la relationnalite. Celle-ci peut faire echo aux difficultes a creer des relations de confiance et peut se manifester dans les difficultes d’adaptation, mais aussi dans des enjeux familiaux, conjugaux et sexuels.

Resume La Pharmacie clinique s’inscrit progressivement en officine depuis 2009 par le biais du developpement des services pharmaceutiques afin de repondre a un souci d’efficience des soins, de vieillissement de la population, d’augmentation de la prevalence des pathologies chroniques et de polymedication. Alors que la Societe Francaise de Pharmacie Clinique a recemment revisite la definition de la Pharmacie Clinique, quelles sont les perceptions des pharmaciens d’officine ? Onze entretiens semi-diriges ont ete conduits aupres de pharmaciens d’officine. Les entretiens ont ete entierement enregistres, puis retranscrits. L’analyse thematique des verbatims a degage 3 axes : l’identite professionnelle, la posture de travail et l’evolution de l’organisation de l’officine et des institutions l’impactant. Outre une resistance au changement de la part des officinaux et une etonnante dissociation de la dispensation et de la Pharmacie Clinique, cette derniere est definie par les participants par une posture associee a l’ecoute des patients ainsi que par des actes. Les representations des pharmaciens d’officine, differant des definitions etablies par des institutions, nous amenent a penser que celles-ci doivent etre reexpliquees selon leur propre perspective.

International audience; Delayed defecation is common in patients on intensive care. We aimed to determine factors associated with time to defecation after admission to intensive care and in turn its association with length of stay and mortality. We studied 396 adults admitted to one of five intensive care units in whom at least 2 days' invasive ventilation was anticipated during an expected stay of at least 3 days. The median (IQR [range]) time to defecate by the 336 out of 396 (84%) patients who did so before intensive care discharge was 6 (4-8 [1-18]) days. Defecation was independently associated with five factors, hazard ratio (95%CI), higher values indicating more rapid defecation: alcoholism, 1.32 (1.05-1.66), p = 0.02; laxatives before admission, 2.35 (1.79-3.07), p < 0.001; non-invasive ventilation, 0.54 (0.36-0.82), p = 0.004; duration of ventilation, 0.78 (0.74-0.82), p < 0.001; laxatives after admission, 1.67 (1.23-2.26), p < 0.001; and enteral nutrition within 48 h of admission, 1.43 (1.07-1.90), p = 0.01. Delayed defecation was associated with prolonged intensive care stay but not mortality.

International audience; Objective: The innate immune system plays a central role in osteoarthritis (OA). We identified 14-3-3ε as a novel mediator that guides chondrocytes toward an inflammatory phenotype. 14-3-3ε shares common characteristics with alarmins. These endogenous molecules, released into extracellular media, are increasingly incriminated in sustaining OA inflammation. Alarmins bind mainly to toll-like receptor 2 (TLR2) and TLR4 receptors and polarize macrophages in the synovium. We investigated the effects of 14-3-3ε in joint cells and tissues and its interactions with TLRs to define it as a new alarmin involved in OA.Design: Chondrocyte, synoviocyte and macrophage cultures from murine or OA human samples were treated with 14-3-3ε. To inhibit TLR2/4 in chondrocytes, blocking antibodies were used. Moreover, chondrocytes and bone marrow macrophage (BMM) cultures from knockout (KO) TLRs mice were stimulated with 14-3-3ε. Gene expression and release of inflammatory mediators [interleukin 6 (IL-6), monocyte chemoattractant protein-1 (MCP-1), tumor necrosis factor alpha (TNFα)] were evaluated via reverse transcription quantitative polymerase chain reaction (RT-qPCR) and ELISA.Results: In vitro, 14-3-3ε induced gene expression and release of IL6 and MCP1 in the treated cells. The inflammatory effects of 14-3-3ε were significantly reduced following TLRs inhibition or in TLRs KO chondrocytes and BMM.Conclusions: 14-3-3ε is able to induce an inflammatory phenotype in synoviocytes, macrophages and chondrocytes in addition to polarizing macrophages. These effects seem to involve TLR2 or TLR4 to trigger innate immunity. Our results designate 14-3-3ε as a novel alarmin in OA and as a new target either for therapeutic and/or prognostic purposes.

Background Early childhood is an important period for the establishment of gut microbiota. Most early life risks or protective factors for inflammatory bowel disease are likely to act through an effect on the gut microbiota. The aim of this study was to estimate the associations between exposures in infancy (birth until 3 years of age) such as breastfeeding, antibiotic treatment, presence of domestic pets, and passive smoking, and the occurrence of inflammatory bowel diseases. Methods This case-control study was nested within the Quebec Birth Cohort on Immunity and Health. Cases and controls were identified among persons born in Quebec in 1970-1974 based on their health services from 1983 to 2014 using validated algorithms. All cases and randomly selected controls were invited to participate in a web or telephone questionnaire. Participation rates were 47% among controls (n=946), and respectively 52% (n=1212) and 55% (n=570) among cases of Crohn’s disease and ulcerative colitis. Logistic regression models were used to estimate adjusted odds ratios (OR) and 95% confidence intervals (CI), separately for Crohn's disease and ulcerative colitis. Each exposure was analyzed in a multiple regression model adjusted for relevant covariates identified with a directed acyclic graph. Results Adjusting for perinatal and sociodemographic characteristics, the risk for Crohn's disease or ulcerative colitis did not differ in subjects who were exclusively breastfed compared to non-breastfed subjects. Partial breastfeeding (breastfeeding combined with infant formula) was not associated with Crohn’s disease (OR=1.03, 95% CI: 0.76-1.40), but an increase in the odds of ulcerative colitis (OR=1.40, 95% CI: 0.99-1.99) was observed as compared with no breastfeeding. Early introduction of solid foods was associated with higher odds of Crohn's disease (introduction at 3-6 months compared with >6 months: OR=1.35; 95% CI: 1.05-1.78), but not of ulcerative colitis (OR=1.06; 95% CI: 0.77-1.46). Antibiotic use and the presence of domestic pets were not associated with either Crohn's disease or ulcerative colitis. Passive smoking was associated with increased odds of Crohn’s disease (OR=1.23; 95% CI: 1.00-1.51), but not ulcerative colitis (OR=0.96; 95% CI: 0.75-1.22). Conclusion Differences were noticed in early childhood risk factors for Crohn’s disease and ulcerative colitis. Early introduction of solid foods and passive smoking increased the risk of Crohn's disease, whereas there was a trend of increased risk of ulcerative colitis with partial as compared with no breastfeeding. The results for partial breastfeeding and early introduction of solid foods are novel and will require further investigation.

In the management of prostate cancer in recent years, innovative therapies have appeared requiring precise and reliable disease detection. In 2021, new generation imaging (PET/CT, multiparametric MRI, PET/MRI) have their place at all stages of the prostate cancer natural history to help target the lesion(s) and guide therapy and improve the results obtained. PSMA PET/CT is currently the leader in this type of imaging with a complete offer during the disease: both from diagnosis, to recurrence or in the oligo-metastatic and metastatic stage resistant to castration with a pivotal role in the PSMA theranostic approach. However, multiparametric MRI also has many detection advantages when the prostate is left in place, which suggests the potential major benefit of hybrid PSMA PET/MRI imaging.

International audience; The objective of this cross-sectional survey was to assess the prevalence of psychoactive substance use (PSU) in people attending 11 French Sexual Transmitted Infection Centers, and to specify their profiles (PSU and link with risky sexual behaviors) using the ascending hierarchical clustering method. Among the 5220 individuals who completed the survey, 55.6% were men and the median age was 24 years [IQR: 20-31]. Among the participants, 2751 (52.7%) reported PSU at least once in their life. Ascending hierarchical clustering identified seven distinct profiles of participants based on their PSU. This study shows a high prevalence of PSU and alcohol consumption in this young population. Moreover, subgroup analysis allowed identifying groups of psychoactive substance users who presented specific risks or vulnerabilities and who should be priority targets for interventions, particularly sexual minority groups.

National audience; Objective: Diagnosis and therapeutics are challenging in pregnancy-related breast cancer and a multidisciplinary approach is therefore essential. A nomogram predictive of recurrence at 36 months of PABC has recently been developed, the aim was to evaluate it on an independent cohort. Patients and methods: This was a monocentric retrospective study including all patients with PABC between January 2004 and March 2018. A Kaplan–Meier method was used for the analysis of recurrence-free survival. Nomogram performance was analysed on 3 indicators: discrimination by a receiver operator characteristic curve (ROC), calibration and net clinical benefit by a decision curve analysis. Results: Forty-one patients have been included. The survival rate was 83 % at 3 years. The nomogram showed acceptable discrimination capacities on receiver-operator characteristic analysis (c-index: 0.78). Decision-curve analysis showed a positive net-benefit for relapse probability ranges between 5 % and 35 %. Conclusion: The performance of this prediction model is acceptable but the net clinical benefit low. In conclusion, prediction of recurrence remains challenging with a continued need for more precise tools. © 2021 Elsevier Masson SAS

BackgroundRheumatoid arthritis (RA) is characterized by synovial tissue (ST) inflammation leading to pain, joint destruction, impaired mobility and ultimately increased morbidity and mortality. These various components of disease etiology can be monitored by pain scores and imaging technologies. Noninvasive assessment of joint tissues metabolism can be performed by measuring serum metabolites of tissue matrix turnover. Specific biochemical markers (BM) of bone and cartilage have been developed, but there is still a lack of a sensitive index of ST metabolism abnormalities, although there are early and key drivers of joint destruction.ObjectivesTo develop a sensitive ELISA-based serum BM of ST turnover (SynHelix) and evaluate its performance in patients with RA.MethodsWe identified a 11 amino-acid sequence (HELIX-III) within the triple helical portion of type III collagen, a main component of ST matrix which is released during ST turnover and can be measured in the serum. A highly specific rabbit polyclonal antibody raised against the synthetic HELIX-III peptide was produced to develop a competitive ELISA. Specificity of the antibody was evaluated by competitive inhibitions with homologous sequences of type I, IV and XI collagens which are also present in ST, but in minor quantities for the two later. Immunohistochemistry analysis of human ST obtained during hip surgery was performed to investigate in situ localisation of the HELIX-III peptide. ELISA was then used to quantify serum HELIX-III fragments in two samples of patients with low (n= 40, median DAS 28: 2.1) and moderate (n=11, median DAS28: 3.5) RA activity participating in clinical trials. Levels in RA subjects were compared to sex and age-matched healthy controls randomly selected from epidemiological cohorts (n=70).ResultsThe ELISA for SynHelix demonstrated adequate analytical performances with intra and interassay variations below 10 and 15%, respectively; analytical and functional limits of quantification of 0.21 and 2.5 ng/ml, respectively and dilution recovery of human serum ranging from 80 to 108%. Competitive inhibition experiments demonstrated that the antibody does not recognize HELIX-III peptide shortened or elongated by one amino-acid, indicating that immunogenicity is dependent on the presence of a neopitope resulting from the cleavage of the collagen molecule. The antibody does not recognize the homologous sequence of type I collagen, but shows significant immunoreactivity with the homologous sequences of type IV (alpha 5) and type XI (alpha 2) collagens with however a lower affinity than for type III collagen (a 2.2 and 4-fold higher concentration, respectively, is needed to displace 50% of the immune signal). Immunohistochemistry of ST tissue from RA subjects showed increased staining in the interstitial tissue and around vessels which are rich in type IV collagen. Median serum levels of SynHelix were significantly higher in patients with low (p=0027, +17%) and moderate RA activity (+220%, p=00004 vs healthy controls; +164% p=0.16 vs low RA) compared with those in age-matched controls, although CRP did not discriminate RA patients with low and moderate activity (2.2 mg/L for both groups, p=0.90). In RA subjects, serum SynHelix correlates modestly with CRP (r=0.59, p ConclusionThe new SynHelix ELISA measures precisely circulating degradation fragments of Helix-III peptide-containing collagens. Serum SynHelix levels are already increased in patients with low activity RA, values correlating modestly the degree of systemic inflammation. Larger longitudinal studies are needed to further evaluate the value of SynHelix to predict disease outcome in RA.Disclosure of InterestsPatrick Garnero: None declared, Evelyne Gineyts: None declared, Jean-Charles Rousseau: None declared, Hubert MAROTTE: None declared, Roland Chapurlat Consultant of: BMS, abbvie, Lilly, Galapagos, fresenius-Kiabi, novartis.

International audience; Multicenter studies are needed to demonstrate the clinical potential value of radiomics as a prognostic tool. However, variability in scanner models, acquisition protocols and reconstruction settings are unavoidable and radiomic features are notoriously sensitive to these factors, which hinders pooling them in a statistical analysis. A statistical harmonization method called ComBat was developed to deal with the "batch effect" in gene expression microarray data and was used in radiomics studies to deal with the "center-effect". Our goal was to evaluate modifications in ComBat allowing for more flexibility in choosing a reference and improving robustness of the estimation. Two modified ComBat versions were evaluated M-ComBat allows to transform all features distributions to a chosen reference, instead of the overall mean, providing more flexibility. B-ComBat adds bootstrap and Monte Carlo for improved robustness in the estimation. BM-ComBat combines both modifications. The four versions were compared regarding their ability to harmonize features in a multicenter context in two different clinical datasets. The first contains 119 locally advanced cervical cancer patients from 3 centers, with magnetic resonance imaging and positron emission tomography imaging. In that case ComBat was applied with 3 labels corresponding to each center. The second one contains 98 locally advanced laryngeal cancer patients from 5 centers with contrast-enhanced computed tomography. In that specific case, because imaging settings were highly heterogeneous even within each of the five centers, unsupervised clustering was used to determine two labels for applying ComBat. The impact of each harmonization was evaluated through three different machine learning pipelines for the modelling step in predicting the clinical outcomes, across two performance metrics (balanced accuracy and Matthews correlation coefficient). Before harmonization, almost all radiomic features had significantly different distributions between labels. These differences were successfully removed with all ComBat versions. The predictive ability of the radiomic models was always improved with harmonization and the improved ComBat provided the best results. This was observed consistently in both datasets, through all machine learning pipelines and performance metrics. The proposed modifications allow for more flexibility and robustness in the estimation. They also slightly but consistently improve the predictive power of resulting radiomic models.

International audience; BACKGROUND AND PURPOSE The reasons for poor clinical outcome after thrombectomy for acute stroke, concerning around half of all patients, are misunderstood. We developed a hierarchic algorithm based on DWI to better identify patients at high risk of disability. MATERIALS AND METHODS Our single-center, retrospective study included consecutive patients with acute ischemic stroke who underwent thrombectomy for large anterior artery occlusion and underwent pretreatment DWI. The primary outcome was the mRS at 3 months after stroke onset. Multivariable regression was used to identify independent clinical and imaging predictors of poor prognosis (mRS > 2) at 3 months, and a hierarchic algorithm predictive of disability was developed. RESULTS A total of 149 patients were analyzed. In decreasing importance, DWI lesion volume of >80 mL, baseline NIHSS score of >14, age older than 75 years, and time from stroke onset to groin puncture of >4 hours were independent predictors of poor prognosis. The predictive hierarchic algorithm developed from the multivariate analysis predicted the risk of disability at 3 months for up to 100% of patients with a high predictive value. The area under the receiver operating characteristic curve was 0.87. CONCLUSIONS The DWI-based hierarchic algorithm we developed is highly predictive of disability at 3 months after thrombectomy and is easy to use in routine practice. © 2020 by American Journal of Neuroradiology.

Resume Introduction L’objectif de notre etude etait d’evaluer la diversite, ou l’homogeneite, des recommandations des RCP (Reunions de Concertation Pluridisciplinaire) dans la prise en charge des cancers cutanes de la face en France, et d’en analyser les determinants. Methodes Nous avons sollicite un panel de RCP d’onco-dermatologie et d’ORL et recueilli leurs recommandations pour trois cas cliniques : un carcinome epidermoide avec marge d’exerese incomplete chez un patient transplante renal (cas no 1), un carcinome basocellulaire localement avance (cas no 2) et un melanome de Dubreuilh in situ (cas no 3). Les reponses ont ete analysees de facon globale, puis selon deux sous-groupes definis par la presence ou non d’un dermatologue au sein de la RCP. L’impact de la composition de la RCP (selon la presence d’un dermatologue, d’un plasticien, d’un oncologue et d’un ORL) a ete evalue pour les principales propositions therapeutiques. Resultats Les avis des 45 RCP ayant repondu a l’enquete etaient contrastes pour les trois cas, sur des elements importants tels que l’indication de la reprise chirurgicale pour le cas no 1, la realisation d’un traitement alternatif a la chirurgie pour le cas no 2 ou les modalites de surveillance pour le cas no 3. Certaines propositions etaient associees a la presence d’un dermatologue au sein de la RCP, telles que la discussion de l’adaptation du traitement immunosuppresseur et le detail des marges chirurgicales a realiser pour le cas no 1, ou la surveillance simple et le detail des modalites de surveillance dans le cas no 3. Conclusion L’implication des dermatologues dans les RCP est importante a maintenir, de par leur expertise dans l’ensemble des domaines therapeutiques des cancers cutanes.

In this paper we give the bifurcation diagram of the family of cubic vector fields z=, depending on the values of . The bifurcation diagram is in ℝ 4, but its conic structure allows describing it for parameter values in . There are two open simply connected regions of structurally stable vector fields separated by surfaces corresponding to bifurcations of homoclinic connections between two separatrices of the pole at infinity. These branch from the codimension 2 curve of double singular points. We also explain the bifurcation of homoclinic connection in terms of the description of Douady and Sentenac of polynomial vector fields.

The aim of this paper is to validate a French version of the Pediatric Migraine Disability Assessment (Ped- MIDAS). The PedMIDAS is a six-question tool that assesses the disability caused by headaches in school-age children and adolescents. A total of 73 participants completed the questionnaire. Overall, the questionnaire has a good internal consistency (α = 0.76), test–retest reliability (0.85), and several correlations with headache characteristics, emotional disorders, and quality of life.

Resume L’imagerie joue un role preoperatoire important pour la planification de la chirurgie du cancer de l’endometre. Elle repose essentiellement sur l’IRM qui est l’examen de reference pour evaluer l’extension locoregionale de la tumeur. Les sequences T2 et T1, sans et avec injection de produit de contraste, ont de bonnes performances pour l’evaluation de l’envahissement du myometre et de l’extension au stroma cervical, les sequences de fusion diffusion/T2 pouvant etre une alternative en cas de contre-indication a l’injection. L’interpretation peut etre difficile dans certains cas et une bonne communication entre chirurgien et radiologue est primordiale pour un apport optimal de l’IRM.

Introduction et but de l’etude Les micro-ARNs (miRs) sont des ARNs non-codants de petite taille qui regulent l’expression genique en se liant a une sequence complementaire sur l’ARN messager cible aboutissant a la repression de sa traduction ou a sa degradation. Ils sont impliques dans la reponse du muscle squelettique a l’entrainement chez l’animal et chez l’homme [1] . Le but de notre etude etait de mesurer les effets d’un entrainement de type HIIT (High Intensity Interval Training ou Entrainement a haute intensite par intervalles) associe ou non a la prise de L-Citrulline (CIT) sur l’expression du miRome serique et musculaire chez l’homme age. Materiel et methodes Neuf hommes (âge moyen: 66,6 ± 2,9 ans ; 6 hommes du groupe placebo et 3 du groupe CIT, 10 g/jour) soumis a un entrainement HIIT pendant 12 semaines, appartenant a une cohorte de 56 hommes et femmes [2] ont subi un prelevement serique et une biopsie musculaire une semaine avant et une semaine apres la periode d’entrainement afin d’analyser l’expression des miRomes seriques et musculaires. La quantification de l’expression des miRs a ete realisee par la technique NGS (Next Generation Sequencing) selon la methode preconisee par EXIQON (Danemark). L’extraction des miRs a ete realisee a partir de 400 μl de serum ou 5 mg de muscle (Biofluids extraction kit, Exiqon®, Danemark), suivie par la preparation de la bibliotheque, l’amplification et le sequencage (plate-forme Illumina). Pour l’analyse statistique, les mesures ont ete normalisees avec la methode TMM (Trimmed Mean of M-values). Resultats et analyse statistique Un total de 225 miRs seriques et 379 miRs musculaires ont ete detectes avec un niveau d’expression ≥ 1 TPM, limite de detection fiable (Tags Per Million, le nombre de lectures pour un miR particulier etait divise par le nombre total de lectures et multiplie par 1 million). Apres avoir utilise une correction de type Benjamini-Hochberg pour eliminer les faux positifs, 5 miRs seriques du groupe CIT avaient un niveau d’expression significativement different avant et apres entrainement: hsa-miR-744-5p, hsa-miR-106b-5p, hsa-miR-484, hsa-miR-151a-3p et hsa-miR-6511a-3p (p Conclusion Avec une approche de type NGS, l’expression des miRs circulants semble influencee par la CIT avant et apres entrainement HIIT. Afin de determiner l’utilite clinique de ces marqueurs, la prochaine etape de validation consistera a mesurer ces miRs specifiques dans l’ensemble de la cohorte.

Background Mitral valve resistance (MVR) is a hemodynamic consequence of mitral stenosis but it has no clear threshold and it has a shortage of data to be reliable. Purpose is to investigate match and mismatch between opening area and resistance especially in patients with moderate and mild mitral stenosis. Materials This cross section case control study comprised 88 patients with moderate and mild rheumatic mitral stenosis. Transthorathic echocardiographic study estimated: mitral valve area (MVA) both by planimerty (2D) and pressure half time (PHT), mitral valve score (MVS), mean transmitral pressure gradient (MPG), diastolic filling time(DFT), left ventricular out flow tract diameter (LVOTd) and velocity time integral (LVOT vti) , the MVR was calculated as: MPG/aortic flow ratio [(LVOTd) (LVOTvti)/ DFT] in dynes.sec.cm5, NYHA function class of all patients was estimated. We classified our patients into 2 groups, group 1 (51 patients) with matched MVR and group 2 (37 patients) with unmatched MVR (unexpected high MVR in relation to valve area). Methods Patients with moderate mitral stenosis have MVR less than 105 dynes.sec/cm5, while patient with mild mitral stenosis have MVR less than 76 dynes.sec/cm5 this is in the matched group, but there are patients with unmatched higher MVR. Group 2 compared to group 1; had higher NYHA function class (1.4±0.6 vs. 1.2±0.4, P < 0.05), MVS (8.1±1.8 vs 7±0.9, P < 0.05), MPG (11,3±3.7 vs.7.8±2.5 mmHg, P < 0.01) and higher MVR (122.37±29.87 vs. 67.18±20.12 dynes.sec/cm5 , P < 0.01), MVR showed positive correlation with MVS (r=0.5, P < 0.05), Step wise logistic regression analysis showed that MVS is the only independent predictor of the MVR severity in the mismatched (unexpected high) group , so the higher the MVS the higher the expected MVR whatever the MVA is ; (B±SE=6.997±2.826, t=2.476, 95% CI 1.241±12.752 with an odds ratio=0.412, P < 0.05). Conclusion It would make much more sense to investigate match and mismatch between opening area and resistance in rheumatic mitral stenosis, the only independent predictor of mismatch is the mitral valve score.

International audience; The natural river water reference material SLRS‐6 (NRC‐CNRC) is the newest batch of a quality control material routinely used in many international environmental laboratories. This work presents a nine‐laboratory compilation of measurements of major and trace element mass fractions and their related uncertainties, unavailable in the NRC‐CNRC certificate (B, Cs, Li, Ga, Ge, Hf, Nb, P, Rb, Rh, Re, S, Sc, Se, Si, Sn, Th, Ti, Tl, W, Y, Y, Zr and REEs). Measurements were mostly made using inductively coupled plasma‐mass spectrometry. The results are compared with equivalent data for the last batch of the material, SLRS‐5, measured simultaneously with SLRS‐6 in this study. In general, very low mass fractions, close to the quantification limits, were found in the new batch. The Sr isotopic ratio is also reported.