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BACKGROUND Levodopa-carbidopa intestinal gel (LCIG) is an advanced therapy for patients with Parkinson Disease (PD). Weight loss has been pointed out as an adverse event of LCIG infusion. AIMS OF THE STUDY To compare weight changes between three groups of PD patients: patients treated with LCIG, patients within the first year of subthalamic deep brain stimulation (STN-DBS) and patients treated exclusively with oral treatment during 1 year of follow up. METHODS Patients treated with LCIG were retrospectively matched by age, gender, disease duration and Hoehn and Yahr to patients undergoing STN-DBS and to patients both receiving the standard of care treatment and unwilling advanced therapies (SOC). Clinical features and weight were collected at baseline, and 12 months after introducing the treatment (LCIG and STN-DBS groups) or for one year of treatment (SOC). RESULTS Eighteen patients were included in each group. They had no differences in clinical and demographic features, except for cognitive impairment. There was a mean weight (-5.8kg ±6.8) and BMI (-2.1kg/m2±2.6) reduction in the LCIG group after 12 months, while there was a slight weight loss in the SOC (-1.4kg ±3.1) and a weight increase in the STN-DBS group (5.4kg ±4.7). Differences of weight were statistically different between, LCIG and STN-DBS (P

BACKGROUND Reflectance confocal microscopy (RCM) is particularly suitable for the study of skin ageing because it provides nearly histological information in vivo and non-invasively. However, there are no studies that evaluated RCM skin features of a large population older than 70 years. OBJECTIVES The aim of our investigation was to study age-related skin changes in an elderly population by RCM and to evaluate their topographical and gender differences. METHODS We obtained RCM images of photoprotected (volar arm) and chronic (face) and intermittently photoexposed (dorsal forearm) body sites of 209 volunteers (105 women and 104 men, mean age: 77.5, range 74-81 years). 15 previously reported and new RCM parameters related to skin ageing were assessed. RESULTS Photoexposed sites had thicker suprapapillary epidermis, more linear, distant and thin furrows, higher presence of mottled pigmentation, polycyclic papillae and coarse and huddled collagen and lower presence of dermal papillae than the photoprotected site. Irregular honeycomb pattern was not higher in photoexposed sites, indicating that it is probably more dependent on intrinsic ageing. Two ageing scores defined for facial skin ageing (epidermal disarray score and epidermal hyperplasia score) were found useful for the identification of photoageing. Gender differences only concerned some RCM parameters (i.e. thickness of different layers of the epidermis, furrows and collagen score) and some body sites, in line with the fact that women and men of our cohort had no major differences in clinically visible skin ageing. CONCLUSIONS Our study confirmed that RCM is a powerful non-invasive technique to microscopically quantify ageing signs and our observations contribute to highlight the differences between intrinsic and extrinsic ageing.

The behavioral summarized evaluation scales, the BSE and its revised version the BSE-R, were developed and validated in the 1980-1990s. The BSE-R is still used daily by clinical teams in France and foreign countries, and it is recommended by the French Health Authority (2018). Having taken into account knowledge improvement in neurodevelopment and autism spectrum disorder (ASD) and the importance of observation by relatives in ecological context, the second version of the BSE was developed. This paper presents the construction and the validation study of the second version of the behavioral summarized evaluation scale, the BSE2 and the BSE2-P rated by parents.Construct validity of the BSE2 scale has been studied in a population of 244 children and adolescents with ASD according to DSM-5 criteria, aged from 30 months to 18 years. Discriminant validity has been analyzed using a population of 86 patients of the same age, with neurodevelopmental disorder (NDD) without comorbidity of ASD.BSE2 comprises 30 items and is a two-dimensional scale as was BSE-R. Both dimensions, labelled "Interaction" (11 items) and "Modulation" (11 items), accounted for 41.7 % of the total variance. They describe autism severity and are in accordance with the two DSM-5 dimensions. Internal consistency (0.927 and 0.850 respectively) and inter-rater reliability (0.932 and 0.897 respectively) are good or excellent for both dimensions. Sensibility and specificity (0.758 and 0.767 respectively) range BSE2 among the tools with good psychometric properties. The parent version, BSE2-P, dedicated to ecological context is easily rated by parents.BSE2 scale for children and adolescents is a clinical tool with good psychometric properties. Its two-dimensional structure is in accordance with DSM-5 criteria. This scale covers all spectrum of ASD clinical forms in both children and adolescents. It can be used to identify ASD in complex neurodevelopmental disorders with several comorbidities and can help to distinguish autism symptomatology from other neurodevelopmental diagnoses. Furthermore, this scale allows to expand the rating context, involving parents to define and adjust the individualized therapeutic project. Thus the BSE2 is a valuable clinical tool for practitioners for both diagnosis and follow-up.

Few studies have evaluated the prevalence of skin tumours in the geriatric population and none have analysed different skin aging parameters for whole-body skin in this population. To evaluate the prevalence of skin tumours and global skin aging in a French cohort of elderly people. In total, 209 subjects, 105 women and 104 men (mean age: 77.5; range: 74-81 years), were enrolled from the PROOF (PROgnostic indicator OF cardiovascular and cerebrovascular events) cohort. SCINEXA (SCore for INtrinsic and EXtrinsic skin Aging) was used to assess the degree of skin aging and the prevalence of skin tumours. Some additional cutaneous parameters were also studied. Skin aging in women and men was compared. Mean global SCINEXA was 24.3 (SD: 4.7; range: 8.2-35.3). Solar elastosis and lax appearance were more severe in women (t test; p

International audience; The Rhône Valley Human-Environment Observatory (OHM) studies hydrosystem dynamics and riverine societies along the French Rhône river course. Since 2010, data centralization and diffusion have been structured within a SDI (Spatial Data Infrastructure) which has strengthened the interactions between scientists and practitioners. In 2018, the CHRONO-RHÔNE project is conducted in this context of knowledge sharing. The objective is to develop a chronosystemic timeline describing the significant events in the Rhône geo-historical trajectory in regard to the OHM research results. This timeline is aimed to be a communication tool for river managers and a working tool for researchers in order to cross disciplines and to raise new scientific issues. This communication presents the steps of timeline construction, from the conception of a trial version to the organization of a researchers-managers workshop. The challenge lies in developing a dynamic, ergonomic and evolving web tool. We believe that the SAGEO'2018 workshop will provide us some technical solutions.; L’Observatoire Hommes-Milieux (OHM) Vallée du Rhône appréhende les dynamiques de l’hydrosystème et des sociétés riveraines sur l’ensemble du Rhône français. Depuis sa création en 2010, la mutualisation et la valorisation des données produites ont été structurées dans une Infrastructure de Données Spatio-temporelles (IDS), ce qui a renforcé les interactions avec les acteurs territoriaux. En 2018, le projet CHRONO-RHÔNE s’inscrit dans cette volonté de partage de connaissances. L’objectif est d’élaborer une frise chrono-systémique qui détaille les évènements marquants dans la trajectoire géo-historique du Rhône, auxquels sont superposés les résultats de recherche de l’observatoire. La frise est conçue comme un outil de communication auprès des gestionnaires, et un outil de travail à disposition des chercheurs pour croiser les disciplines et faire émerger de nouveaux questionnements scientifiques. Cette communication présente les étapes d’élaboration de la frise, depuis la création d’une maquette à l’organisation d’un atelier chercheurs-gestionnaires. L’enjeu réside dans le développement d’un outil web dynamique, ergonomique et évolutif. L’atelier SAGEO’2018 devrait nous aider à lever certains verrous technologiques.

Although it has been suspected that there is a decrease in semen quality over time, the results reported to date remain debatable because of methodological issues. The aim of the study reported here was to investigate the evolution of semen quality over time in a population of 1114 fertile candidates for sperm donation at CECOS, Tours, between 1976 and 2009. We investigated semen volume, sperm concentration, progressive motility, vitality, percentage of normal forms and multiple abnormalities index of the first ejaculate in this population. We did not find a decline in semen volume, whereas we observed a significant decrease in total sperm count (from 443.2 million in 1976 to 300.2 million in 2009), motility (from 64% in 1976 to 49% in 2009) and vitality (from 88% to 80%). Moreover, a significant decline in the percentage of normal forms was noted between 1976 and 1997 (from 67% to 26%) with a steady rise in the multiple abnormalities index between 1998 and 2009 (from 1.19 to 1.65). This study involving a population of fertile men from a restricted area revealed various degrees of decline in semen parameters over a period of 34 years. These findings will have to be compared with findings in other geographical areas.

The aim of this study was to compare assessment of sperm morphology by using David's classification (DC), a method of manual analysis most common in France, with a computer-assisted method (Integrated Visual Optical System) based on the strict criteria (CASA SC) for their ability to predict fertilization in a selected in vitro fertilization (IVF) population. A total of 120 couples engaged in IVF protocols were prospectively included in the study. To focus mainly on sperm morphology, couples were excluded in cases of abnormalities of sperm concentration and/or motility and immunological factors and when a low number of oocytes were collected. Sperm morphology analysis was performed on the day of oocyte retrieval by the same trained biologist. Our results showed a moderate correlation between the two techniques (r = 0.49). The DC sperm morphology analysis was less indicative of fertilization than CASA SC (r = 0.07, p = 0.47 vs. r = 0.22, p = 0.014). Using receiver-operating characteristics analysis, we showed that DC was not discriminating in the prediction of fertilization (AUC = 0.572). DC seemed less appropriate for the prediction of fertilization success or failure. In contrast, with CASA SC, the previously determined cut-off value of around 14% was confirmed (AUC = 0.735, cut-off = 6%). Our results argue in favour of the replacement of DC by SC to tend towards worldwide standardization.

BACKGROUND AND STUDY AIM: Polyp miss rates during colonoscopy have been calculated in a few tandem or back-to-back colonoscopy studies. Our objective was to assess the adenoma miss rate while limiting technique or operator expertise biases, i. e. by performing a large multicenter study, with same-day back-to-back video colonoscopy, done by two different operators in randomized order and blinded to the other examination. PATIENTS AND METHODS: 294 patients at 11 centers were included. Among the 286 analyzable tandem colonoscopies, miss rates were calculated in both a lesion- and patient-based analysis. Each of these rates was determined for polyps overall, for adenomas, and then for lesions larger than 5 mm, and for advanced adenomas. Univariate and logistic regression analysis were performed to define independent variables associated with missed polyps or adenomas. RESULTS: The miss rates for polyps, adenomas, polyps ≥ 5 mm, adenomas ≥ 5 mm, and advanced adenomas were, respectively, 28, 20, 1, 9 and 11 %. None of the masses with a carcinomatous (n = 3) or carcinoid component (n = 1) was missed. The specific lesion miss rates for patients with polyps and adenomas were respectively 36 and 26 % but the corresponding rates were 23 and 9.4 % when calculated for all 286 patients. The diameter (1-mm increments) and number of polyps (≥ 3) were independently associated with a lower polyp miss rate, whereas sessile or flat shape and left location were significantly associated with a higher miss rate. Adequacy of cleansing, presence of diverticula, and duration of withdrawal for the first procedure were not associated with adenoma miss rate. CONCLUSIONS: We confirm a significant miss rate for polyps or adenoma during colonoscopy. Detection of flat polyps is an issue that must be focused on to improve the quality of colonoscopy.

The Behavioral Summarized Evaluation is a rating scale specifically related to the assessment of autistic behaviors in children and young teenagers with Autism Spectrum Disorder, such as communication, social interaction and interests. It also facilitates progressive recording of the evolution of children with ASD involved in short-term therapeutical studies. In the absence of standardized tools to assess autistic behaviors and effects of therapeutics in Lebanon, the BSE-R validation is an urgent need. The purpose of this study is to validate the BSE-R to the Lebanese population.Specialized translators and clinicians ensured forward and backward translation of the scale into Arabic. The participants consisted of 100 children with ASD, diagnosed upon DSMIV-TR criterion (age range: 35 to 153 months, DS: 28.0). Fifty-eight had intellectual disability (ID). Scores of autism severity as measured by CARS1 (Schopler et al., 1980) varied from 20-58.5. Trained raters on recorded individual and group situations performed BSE-R ratings.BSE-R for Lebanese was found to have excellent inter-rater reliability. The internal validity highlighted a main factor which describes the severity of core autistic behaviors related to social interactions and communication, and behavioral specificities and particular interests with an internal consistency of 0.91 in a one-to-one setting and 0.92 in group settings. External validity of the scale as measured by correlations with CARS and the age of the children showed that this main factor is essentially determined by ASD severity, not by the severity of ID. It was named "relational deficiency" according to the initial paper of Barthélémy et al. (1997).BSE-R in Arabic is a practical tool, useful to all team members working with ASD children in Lebanon and the Arab countries. It will also allow future research based on reliable tools at an international level.

Both molecular profiling of tumors and longitudinal tumor size data modeling are relevant strategies to predict cancer patients' response to treatment. Herein we propose a model of tumor growth inhibition integrating a tumor's genetic characteristics (p53 mutation and 1p/19q codeletion) that successfully describes the time course of tumor size in patients with low‐grade gliomas treated with first‐line temozolomide chemotherapy. The model captures potential tumor progression under chemotherapy by accounting for the emergence of tissue resistance to treatment following prolonged exposure to temozolomide. Using information on individual tumors' genetic characteristics, in addition to early tumor size measurements, the model was able to predict the duration and magnitude of response, especially in those patients in whom repeated assessment of tumor response was obtained during the first 3 months of treatment. Combining longitudinal tumor size quantitative modeling with a tumor''s genetic characterization appears as a promising strategy to personalize treatments in patients with low‐grade gliomas.

The aim of this study was to determine the incidence of sex chromosome aneuploidy in spermatozoa of two males with a 47,XYY karyotype and one male with a 46,XY/47,XYY constitution. Spermatozoa obtained from two oligospermic patients and one volunteer semen donor were studied by multicolour fluorescence in situ hybridization. In the XY/XYY male, the frequencies of X-bearing to Y-bearing sperm were significantly different from the 1 : 1 expected ratio. Significantly increased frequencies were found in the mosaic and non-mosaic males for 24,XX and 24,YY sperm when compared with control donors. The number of 24,XY sperm was significantly different from the controls in the XYY males, but not in the mosaic male. The incidence of disomy 18 and the rate of diploidy also increased in the three patients. However, the mosaic male had the lowest cumulative rate of disomic and diploid spermatozoa when compared with the two XYY patients. Our data suggest that: (i) chromosome abnormalities observed in spermatozoa of the two XYY oligoasthenoteratospermic (OAT) males arise through segregation errors in XY germ cells rather than normal meiosis of XYY germ cells, (ii) mosaic XYY males with normal semen parameters have a lower risk of producing offspring with a sex chromosomal abnormality than OAT males with XYY karyotype.

International guidelines recommend noradrenaline (NA) as the vasopressor of choice to treat septic shock. The aim of this study was to determine the best way to infuse patients with NA.The in vitro study was designed to measure NA concentration at the end of each studied assembly line. Three infusion systems used the double pump method and three single pumps, which differed as regards NA concentrations (0,2 - 0,5 - 1 mg/h), dead space volume of the devices and the use of saline. Infusion systems were compared according to the time necessary to reach an NA mass flow rate steady-state plateau after the onset of infusion or after a flow change.Times were significantly different between the six methods for infusing NA. The system using the double syringe method with a standard extension set was the longest to reach the steady state after the onset of infusion [40.00 min (19.57 - 49.22)]. The steady-state plateau was obtained most rapidly with the double-syringe pump systems using very low dead-space volume extension sets and single-syringe pump systems containing diluted noradrenaline at the beginning of NA infusion.A combination of a low dead-space volume extension set and a double pump method with a constant saline flow rate at 5 ml/h might be the solution to provide the most reliable NA infusion delivery.

Resume Introduction L'impact interstitiel musculaire d'un exercice en resistance du vaste externe sur l'Insulin-like Growth Factor-I libre a ete evalue par microdialyse musculaire a +3 h30, +4 h50 et +6 h chez quatre sujets volontaires sains. Synthese des faits On observe une augmentation interstitielle chez trois des quatre sujets 3 h30 apres l'exercice, puis une diminution progressive. En revanche, il n'existe pas de modification des concentrations libres ou totales plasmatiques. Conclusion L'exercice en resistance semble provoquer une augmentation precoce de l'Insulin-like Growth Factor-I libre interstitielle musculaire afin d'initier de maniere autocrine–paracrine la croissance musculaire.

Introduction L’evaluation de la douleur est generalement realisee au moyen d’une echelle visuelle analogique (EVA). Toutefois la barriere de la langue, l’angoisse, les troubles de comprehension lies a la demence, au grand âge ou a l’enfance notamment rendent inoperante l’utilisation de l’EVA. Le diametre pupillaire, sous la dependance du systeme para sympathique (myotique) et orthosympatique (mydriatique), varie de maniere quasiment instantanee lors de la douleur ou de stress physiologiques. Nous avons procede a l’analyse de cette variation pour quantifier de maniere objective la douleur induite par des gestes realises frequemment en dermatologie. Patients et methodes Nous avons procede a la cryotherapie (CTP) par cryo-vaporisation de 49 keratoses actiniques (KA) et 29 keratoses seborrheiques (KS), ainsi qu’a la phototherapie dynamique (PDT) de 12 maladies de Bowen (MB) ou KA multiples. Une mesure basale a ete effectuee chez 43 de ces patients (T0). Les mesures etaient effectuees avec le videopupillometre AlgiScan, chez des malades de consultation ou hospitalises, en filmant la variation instantanee du diametre pupillaire en appliquant l’AlgiScan en avant d’un œil du malade. Une mesure de la douleur par EVA etait realisee dans le meme temps. Resultats Les variations du diametre pupillaire (moyenne ; mediane et ecart-type) etaient en % respectivement a T0 : (27 ; 2 et 3,6) ; lors de la CTP des KS : (13,6 ; 11 et 10,8) ; lors de la CTP des KA : (12,5 ; 10,5 et 8,9) et lors de la PDT : (26,2 ; 20,5 et 18,4). Les variations de l’EVA (moyenne ; mediane et ecart-type) etaient en % respectivement a T0 : (0 ; 0 et 0) ; lors de la CTP des KS : (26,6 ; 26 et 19,2) ; lors de la CTP des KA : (32,6 ; 39 et 20,5) et lors de la PDT : (17,7 ; 13 et 18). Discussion La douleur induite par la cryotherapie des KS et KA a induit des variations similaires du diametre pupillaire. La PDT occasionnait quant a elle des variations majeures. Les anesthesistes estiment que la douleur peroperatoire necessite une readaptation de l’analgesie pour une variation de plus de 14 %. Conclusion La mesure de la variation du diametre pupillaire est une methode simple, objective et bien acceptee par les patients pour evaluer l’intensite douloureuse. Les traitements evalues sont des gestes dermatologiques usuels mais responsables de douleurs qui ne doivent pas etre negligees et restent objectivement mal prises en charge. Il faut noter que plus de 10 % des patients n’ont pu etre etudies, l’intensite douloureuse occasionnant une fermeture palpebrale prolongee, ce qui sous-evalue nos constatations. L’utilisation de traitements antalgiques adaptes lors de la cryotherapie et/ou une autre prise en charge therapeutique des KA, KS, et MB doit etre evaluee en fonction des patients pour tenir compte de la douleur.

Introduction et objectifs Le tocilizumab (TCZ) est un anticorps monoclonal utilise dans des pathologies auto-immunes telles que la polyarthrite rhumatoide ou dans l’arthrite juvenile idiopathique. La posologie est de 8 mg/kg par cure, administree toutes les 4 semaines. L’objectif de notre etude a ete d’evaluer l’interet pharmaco-economique de la reconstitution des preparations du TCZ en unite de preparation centralisee (UPC) par rapport a une reconstitution par les infirmieres dans les services de soins. Methodes Nous avons realise une etude prospective sur un an de novembre 2013 a octobre 2014 durant laquelle nous avons releve le nombre de flacons par jour qui auraient ete consomme sans la gestion des reliquats en unites de soins (methode 1) et le nombre de flacons reellement consomme par jour en UPC avec gestion des reliquats d’un patient a l’autre (methode 2). Nous avons mesure les reliquats jetes chaque jour afin d’evaluer l’interet d’une etude de stabilite du TCZ permettant une gestion des reliquats d’un jour sur l’autre. L’ensemble des resultats a ete rapporte dans un tableur Excel pour analyse. Resultats Trois cent dix-sept cures de TCZ ont ete realisees durant la periode de l’etude. Au total, 360 flacons de 400 mg, 92 de 200 mg et 401 de 80 mg auraient ete consommes en unites de soins sans gestion des reliquats tandis que 385 flacons de 400 mg, 77 de 200 mg et 248 de 80 mg ont ete reellement consommes par l’UPC. L’economie annuelle generee s’eleve a 8900 €. Un test de Student sur echantillons apparies a montre une difference significative de consommation mensuelle entre les deux methodes ( p La gestion des reliquats d’un jour sur l’autre permettrait une economie supplementaire de 4300 €. Discussion et conclusions Cette etude montre, au-dela de l’aspect securitaire, l’interet pharmaco-economique de la preparation centralisee en UPC du TCZ malgre un faible nombre de cures realisees (entre 1 et 2 par jour en moyenne). Ces resultats montrent que la preparation centralisee en UPC doit s’etendre aux molecules en dehors des seuls produits cytotoxiques. A l’heure actuelle, en l’absence de donnees de stabilite consolidees de la part des Laboratoires pharmaceutiques, la preparation centralisee genere encore des pertes qui pourrait etre minimisees en regroupant, par exemple, tous les patients sous TCZ un jour donne de la semaine.

La gastrostomia percutanea endoscopica es el metodo terapeutico de eleccion para permitir el suministro de una alimentacion enteral a los pacientes con disfagias graves o trastornos de la deglucion. Se utiliza cuando la alimentacion enteral debe durar mas de un mes. La tecnica es simple y rapida, con un bajo indice de complicaciones significativas. Esta contraindicada en los trastornos graves de la hemostasia, la ascitis y la insuficiencia respiratoria. Los fracasos, poco numerosos, se observan en casos de estenosis esofagica marcada, gastrectomias y la ausencia de transiluminacion. El seguimiento debe quedar a cargo de un equipo de especialistas.

Resume Introduction – L'impact interstitiel musculaire d'une electromyostimulation de surface du vaste externe de basse frequence et de faible intensite (14 Hz, 30 mA) sur l' insulin-like growth factor-I libre, le glucose et le lactate a ete evalue par microdialyse musculaire pendant (45 minutes) et apres (40 minutes) la stimulation chez trois sujets sains. Synthese des faits – Pendant l'electrostimulation, on observe une captation immediate de glucose et une baisse de production retardee de lactate. L' insulin-like growth factor-I libre est diminue pendant la periode de recuperation. Conclusion. – L'electrostimulation de faible intensite determine une activation metabolique de la cellule musculaire. La sequence des evenements observee se prolonge jusqu'a la periode de recuperation.

The synthesis of anionic, cationic, and non-ionic water-soluble naphthalene derivative are described. Their water solubility at 37°C is always greater than 10−2 M. The corresponding endoperoxides are prepared by chemical oxidation (H2O2/Na2MoO4) or by photo-oxidation (O2/hν/photosensitizer). The overall rate constants, kr + kq of 1O2 quenching by naphthalene derivatives are measured using flash photolysis. Determination of the half-times of the decomposition and the yield of 1O2 generated from all the endoperoxides on thermolysis at 37°C showed that within 2 h almost all of the trapped oxygen is released, half of which is in the excited singlet state. Diffusion rates of these carriers through an artificial lipidic membrane are about ten times lower for the ionic molecules than for the non-ionic compounds. Therefore, according to their physico-chemical properties, these naphthalene derivatives should be suitable as chemical sources of pure 1O2 in biological media.

Introduction Le systeme nerveux autonome (SNA) est le marqueur le plus puissant du vieillissement global de l’organisme. La relation entre activite du SNA et vieillissement de particuliers organes a ete exploree, mais pas la relation entre activite du SNA et vieillissement cutane. Materiel et methodes Deux cent neuf sujets (105 femmes et 104 hommes, 74–81 ans, âge moyen 77,5 ans) appartenant a la cohorte stephanoise prognostic indicator of cardiovascular and cerebrovascular events (PROOF) ont ete etudies. Le vieillissement cutane a ete evalue par le score clinique score for intrinsic and extrinsic skin aging (Scinexa), par VISIA et videodermatoscopie. L’activite du SNA a ete mesuree par la variabilite de la frequence cardiaque sur enregistrement de l’electrocardiogramme de 24 heures. Resultats Une relation entre SNA et vieillissement cutane global mesure par score Scinexa n’a pas pu etre demontree. Cependant, une relation entre baisse de l’activite sympathique du SNA qui est responsable de la vasoconstriction et porphyrines elevees dans la peau du visage (p = 0,02) etait trouvee par analyse Anova. Conclusion Quoique nous n’ayons pas trouve de relation entre le vieillissement cutane global et la fonction du SNA, il est possible que le SNA joue un role sur le vieillissement intrinseque de la peau, mais d’une maniere negligeable en comparaison a des facteurs externes tels que l’exposition solaire, et que cette partie du vieillissement soit difficile a mettre en evidence. Cependant, ayant trouve une relation entre porphyrines elevees et le SNA, notre etude encourage les futures recherches sur l’influence du SNA sur les differents composants du vieillissement cutane.

Resume • Objectif : Rechercher la presence d'un foramen ovale permeable (FOP) lors d'une echographie de contraste realisee par voie transœsophagienne et en apprecier l'evolution et le retentissement gazometrique, chez des patients sous ventilation mecanique controlee sans et avec PEP. • Type d'etude : Etude prospective ouverte avant-apres. • Patients : Quarante neuf patients sous ventilation mecanique pour insuffisance respiratoire aigue avec un rapport PaO 2 /FiO 2 inferieure a 250 ont ete etudies. • Methodes : Epreuve de PEP a PEP = 0 cmH 2 O et a PEP = 10 cmH 2 O. A chaque niveau de PEP, une epreuve de contraste aux colloides et une gazometrie arterielle a FiO 2 = 1 ont ete pratiquees apres 15 min d'etat stable a chaque niveau. Semi-quantification du shunt selon la quantite de microbulles presentes dans l'oreillette gauche sur une vue biauriculaire par echographie transœsophagienne. • Resultats : Onze patients sur 49 (22%) avaient un FOP a l'un des deux niveaux de PEP. Un shunt intracardiaque droit-gauche est apparu chez un patient et s'est aggrave chez trois autres a PEP = 10 cmH 2 O. En l'absence de FOP, la PaO 2 augmentait de 119 ± 10 mmHg a 145 ± 10 mmHg (P • Conclusion : La ventilation mecanique avec PEP favorise l'apparition d'un shunt intracardiaque droit-gauche par le foramen ovale, responsable d'une absence d'amelioration de l'hematose en pression positive permanente. En presence d'un FOP permanent pendant le cycle respiratoire ou d'une aggravation gazometrique, la PEP doit etre evitee et les effets deleteres de la ventilation mecanique sur le retour veineux minimises par une ventilation partielle et le sevrage respiratoire.

Although it has been suspected that there is a decrease in semen quality over time, the results reported to date remain debatable because of methodological issues. The aim of the study reported here was to investigate the evolution of semen quality over time in a population of 1114 fertile candidates for sperm donation at CECOS, Tours, between 1976 and 2009. We investigated semen volume, sperm concentration, progressive motility, vitality, percentage of normal forms and multiple abnormalities index of the first ejaculate in this population. We did not find a decline in semen volume, whereas we observed a significant decrease in total sperm count (from 443.2 million in 1976 to 300.2 million in 2009), motility (from 64% in 1976 to 49% in 2009) and vitality (from 88% to 80%). Moreover, a significant decline in the percentage of normal forms was noted between 1976 and 1997 (from 67% to 26%) with a steady rise in the multiple abnormalities index between 1998 and 2009 (from 1.19 to 1.65). This study involving a population of fertile men from a restricted area revealed various degrees of decline in semen parameters over a period of 34 years. These findings will have to be compared with findings in other geographical areas.

As chronic respiratory symptoms and the presence of expiratory flow limitation (EFL) are commonly reported in the elderly, we investigated whether they were associated in a population of 75 years old volunteers. We analyzed the results of a prevalence survey of chronic respiratory symptoms and respiratory infections, and performed spirometry and measured EFL after application of a negative expiratory pressure at the mouth (NEP). EFL was present in 170 (46%) subjects, a chronic cough in 49 (13%), chronic sputum in 58 (29%) and a history of respiratory infection in 62 (17%). Chronic cough and the composite outcome "chronic cough or sputum" were significantly associated with the presence of EFL (respectively 60% vs. 43%, OR=2.04 [1.09 to 3.78], P=0.023, and 56% vs. 43%, OR=1.74 [1.05 to 2.87], P=0.04), after controlling for smoking or airway obstruction. History of respiratory infections were not associated with an increased prevalence of EFL. We concluded that the presence of a LED could be an interesting indicator of respiratory aging. Its detection could be advocated in elderly subjects presenting with respiratory symptoms.

Endoscopic ultrasonography was performed in 80 cirrhotic patients and 50 control subjects. The aim of the study was to describe and classify the vascular abnormalities of the gastric wall as observed on echoendoscopy in cirrhotic patients and to compare the data with endoscopy. The size of gastric varices was classified into 3 grades: grade 0 (none), grade 1 (small or non-confluent varices5 mm), grade 2 (large or confluent varicesor = 5 mm). The abnormalities of the gastric wall were classified into 3 grades: 0 (none), grade 1 (thickening and brilliance of the third hyperechogenic layer with or without fine internal anechogenic structures), grade 2 (visible vessels in the third layer which deform the entire wall, with penetrating varices). Endoscopy provides better visualization of esophageal varices than echoendoscopy but does not detect gastric varices and the first signs of portal hypertension as well. In conclusion echoendoscopy should be a routine examination for screening portal hypertension in cirrhotic patients and could be used in therapeutic follow-up.

The potentialities of ceramic coatings as a protective layer have been discussed by the comparison of the oxidation kinetics between coated and uncoated SiC-based materials. It was observed that a thermally sprayed coating of titanium dioxide (TiO2), in the same conditions of oxidation, decreases the kinetics constants and acts as a diffusion barrier. The evolution of the (micro-)structural features of oxidized materials were followed by XRD and SEM.

Autistic syndrome is defined by several abnormalities, mainly affecting social interaction skills. Disorders of the processes of processing facial and emotional stimuli, and particularly avoidance of gaze, have also been reported in this disorder. Some authors have suggested that these abnormalities may be explained, or at least contributed to, by the social disorder observed in this syndrome. The aim of this study was therefore to improve the understanding of the processes involved in perception AND the representation of faces expressing emotion in subjects with autism spectrum disorders (ASDs).Eleven children with ASDs (mean developmental age 7 years 11 months) and eleven normally developing children (mean age 7 years 9 months) took part in three experiments. The first involved overall discrimination of emotions using photographs of faces expressing six basic emotions, the second required local emotional discrimination on the basis of isolated elements of the face (photographs of eyes and mouths isolated from the rest of the face), and for the third the children were asked to create faces expressing emotions by means of a jig-saw puzzle format, using photographs of isolated elements of the face (overall representation necessitating local discrimination).Our findings revealed that the normally developing children had difficulties with the process of local discrimination of emotions: their performance improved when overall perception was possible. In contrast, and astonishingly, the children with ASD were more able to discriminate isolated eyes expressing emotion than the controls, but their performance declined when overall processing was required.Our results suggested that the emotional disorders observed in ASDs might be explained by greater skills in the processing of local information. This might explain the inability of children with ASDs to achieve coherent perception of their social environment and might also lead to the withdrawal that is characteristic of this disorder. These results also suggest that the gaze avoidance that is characteristic of individuals with ASDs is eliminated when eyes are presented alone. This gaze avoidance therefore seems to be related to the complexity and variability of this type of stimulus and not to the social nature of the stimulus.

ERMA; International audience; BACKGROUND AND STUDY AIM: Polyp miss rates during colonoscopy have been calculated in a few tandem or back-to-back colonoscopy studies. Our objective was to assess the adenoma miss rate while limiting technique or operator expertise biases, i. e. by performing a large multicenter study, with same-day back-to-back video colonoscopy, done by two different operators in randomized order and blinded to the other examination. PATIENTS AND METHODS: 294 patients at 11 centers were included. Among the 286 analyzable tandem colonoscopies, miss rates were calculated in both a lesion- and patient-based analysis. Each of these rates was determined for polyps overall, for adenomas, and then for lesions larger than 5 mm, and for advanced adenomas. Univariate and logistic regression analysis were performed to define independent variables associated with missed polyps or adenomas. RESULTS: The miss rates for polyps, adenomas, polyps > or = 5 mm, adenomas > or = 5 mm, and advanced adenomas were, respectively, 28 %, 20 %, 12 %, 9 % and 11 %. None of the masses with a carcinomatous (n = 3) or carcinoid component (n = 1) was missed. The specific lesion miss rates for patients with polyps and adenomas were respectively 36 % and 26 % but the corresponding rates were 23 % and 9.4 % when calculated for all 286 patients. The diameter (1-mm increments) and number of polyps (> or = 3) were independently associated with a lower polyp miss rate, whereas sessile or flat shape and left location were significantly associated with a higher miss rate. Adequacy of cleansing, presence of diverticula, and duration of withdrawal for the first procedure were not associated with adenoma miss rate. CONCLUSIONS: We confirm a significant miss rate for polyps or adenoma during colonoscopy. Detection of flat polyps is an issue that must be focused on to improve the quality of colonoscopy.

Restricted and repetitive behaviours (RRB) represent a common problem throughout the autistic spectrum. They comprise a wide range of behavioural manifestations that persist over time and resist therapeutics. Furthermore, degrees of heterogeneity have been reported in the clinical expression of autistic syndrome, particularly in the restricted and repetitive aspects. Advances are needed in the understanding of this complex and heterogeneous clinical dimension of autism to improve efficacy of therapeutics.Most clinical studies have subdivided RRB into "lower-level" sensory-motor behaviours and "higher-level" behaviours, which are more complex and characteristic features of autism. However, none of these studies have taken into account all the forms of RRB. To date, there is no specific and thorough tool to evaluate this dimension of autism. From the analysis of the literature, we proposed a list of 43 behaviours covering the full range of repetitive, restricted and stereotyped activities observed in autism.The aim of the present study was to test the relevance of these 43 RRB in a family context.The participants were 14 children with an autism spectrum disorder, aged from six to 16 years. Circumscribed interests were the most commonly reported RRB, and motor stereotypies, aggressive and body-focused behaviours were the least expressed behaviours.Multivariate statistical analysis identified three groups of children with different behavioural profiles and three clusters of RRB, i.e. repetitive motor behaviours, repetitive sensory-vocal behaviours and restricted ideational behaviours.Although these preliminary results need to be validated in a wider population, the list of 43 RRB allowed us to describe accurately this symptomatology of autism and to confirm the heterogeneity of this dimension of autistic disorders. The identification of clinical subgroups, possibly underlain by different psychopathological or physiopathological factors would help research and contribute to the development of specific new therapeutic strategies which are still needed to improve quality of life of patients with autistic disorder and their families.

Summary Objective: To develop a model based on mean residence time for better understanding the effect of grapefruit juice on the metabolism of nifedipine (NIF). Material and methods: Sixteen healthy volunteers from an urban population were included. For each trial, the subjects drank water, fresh grapefruit juice or bottled grapefruit juice. Thirty minutes later, the subjects took a 10 mg capsule of NIF, orally. Plasma concentration of NIF was measured and the kinetic parameters were calculated with a non-compartmental model. Results: Grapefruit juice increased the bioavailability of NIF, but did not significantly reduce the drug's metabolism as shown by the approximately constant metabolite to parent drug AUC ratio (P = 0·948). There was no significant increase in the amount of non-metabolized drug absorbed during first-pass: 0·12 and 0·16 (P = 0·470) without and with grapefruit juices respectively. There was an increase in the relative bioavailability (P = 0·039) and the apparent volume of distribution (Vdm) (P =0·025) of dehydronifedipine with grapefruit co-administration. A second peak was also observed in the NIF plasma-concentration profile when the drug is co-administered with grapefruit juice. Therefore, the most likely explanation for the double peak phenomenon is a delay in gastric emptying (+32 min with grapefruit juice) caused by the pH of grapefruit juice. Conclusion: This study shows that grapefruit juice interferes with the metabolism of NIF by inhibiting NIF metabolism and slowing down the rate of gastric emptying. This study also confirms that the metabolic inhibition is not a first pass effect, but is a secondary oxidative step.

The aim of this study was to determine the incidence of sex chromosome aneuploidy in spermatozoa of two males with a 47,XYY karyotype and one male with a 46,XY/47,XYY constitution. Spermatozoa obtained from two oligospermic patients and one volunteer semen donor were studied by multicolour fluorescence in situ hybridization. In the XY/XYY male, the frequencies of X-bearing to Y-bearing sperm were significantly different from the 1 : 1 expected ratio. Significantly increased frequencies were found in the mosaic and non-mosaic males for 24,XX and 24,YY sperm when compared with control donors. The number of 24,XY sperm was significantly different from the controls in the XYY males, but not in the mosaic male. The incidence of disomy 18 and the rate of diploidy also increased in the three patients. However, the mosaic male had the lowest cumulative rate of disomic and diploid spermatozoa when compared with the two XYY patients. Our data suggest that: (i) chromosome abnormalities observed in spermatozoa of the two XYY oligoasthenoteratospermic (OAT) males arise through segregation errors in XY germ cells rather than normal meiosis of XYY germ cells, (ii) mosaic XYY males with normal semen parameters have a lower risk of producing offspring with a sex chromosomal abnormality than OAT males with XYY karyotype.

Highly active antiretroviral therapy includes antiretroviral drugs chosen in 3 families of agents: nucleosidic (NRTI) and non nucleosidic (NNRTI) reverse transcriptase inhibitors and protease inhibitors (PI) (1). These treatments have totally transformed the prognosis of HIV infection. They are however associated with many adverse symptoms, the mitochondrial origin of which is often proposed (2). One of the most severe clinical presentations is acute lactic acidosis, which has been reported in patients exposed to various treatments but always including a NRTI (3). Mitochondrial DNA (mtDNA) depletion was shown with zidovudine treatment (4–6). More recently, defects of the respiratory chain activities and multiple mtDNA deletions have been reported in a few patients (7, 8). In parallel mitochondrial toxicity has been proposed in infants exposed to zidovudine during pregnancy (9). Potential mitochondrial toxicity of antiretroviral therapy has therefore been convincingly shown in patients but its real incidence remains to be established. Molecular mechanism(s) of this toxicity are still debated (2, 10). They include incorporation of the NRTI in DNA (11), efficient inhibition of the gamma polymerase (12, 13), but also possibly mitochondrial toxicity independent from the mtDNA (14, 12).

Introduction L’evaluation de la douleur est generalement realisee au moyen d’une echelle visuelle analogique (EVA). Toutefois la barriere de la langue, l’angoisse, les troubles de comprehension lie a la demence au grand âge ou l’enfance notamment rendent inoperant l’utilisation de l’EVA Le diametre pupillaire (DP) varie sous la double influence des systemes sympathique (Σ), dilatateur de la pupille, et parasympathique (pΣ), irido-constricteur. Le DP augmente en reponse a une stimulation douloureuse, de facon proportionnelle a l’intensite de la stimulation nociceptive. Cette variation du DP a ainsi ete proposee initialement comme un moyen d’evaluation de la douleur chez des patients sous anesthesie generale puis chez le sujet conscient. Nous avons procede a l’analyse de cette variation pour quantifier de maniere objective une anesthesie locale par lidocaine. En effet certains patients signalent une douleur notable lors de ce geste banal en dermatologie. Materiel et methodes A ete procede a 138 anesthesies locales au moyen de lidocaine 2 % non adrenaline, 46 a la face externe l’avant-bras et 92 a la face interne du bras de 46 hommes de 77 ans vus dans le cadre d’une etude portant sur le vieillissement physiologique. Cent trente-deux mesures ont ete realisees avec l’Algiscan lors des anesthesies locales ainsi qu’une EVA de la douleur. Resultats Les variations du diametre pupillaire : moyenne, mediane et ecart type etaient respectivement en % : 10,5, 9, 8,2. La variation de l’EVA moyenne, mediane et l’ecart type etaient respectivement en % : 14, 20, 11. Discussion L’anesthesie locale, geste banal en dermatologie occasionne une douleur non negligeable confirme par une variation mediane du diametre pupillaire de 13,5 % et une augmentation mediane de l’EVA a 20 sur une echelle de 0 a 100. Conclusion Une premedication par une creme anesthesiante de la zone qui sera anesthesiee peut etre proposee si la biopsie peut etre programmee, dans le cas contraire peut etre utilise l’adjonction de bicarbonate 14 pour mille a volume egal avec la lidocaine 2 %. L’evaluation de la douleur en dermatologie reste necessaire.

The diffuse biliary or pancreatic papillomatosis is a rare pathology. Reported cases in the literature underscore the difficulties of preoperative diagnosis of these lesions, their extensive nature, their tendency to relapse, and their malignant potential. The case that we report differs by the isolated involvement of the biliary tract and by the increasing role of imaging (MRCP) for diagnosis and follow-up.

Objective Aspirin administered orally is one of most widely self-prescribed drugs to treat headaches or other pains. The aim of this study was to evaluate whether the influence of different beverages may be used to help in the ingestion of an aspirin tablet on the pharmacokinetic parameters of this drug. Method This study was undertaken in five healthy volunteers. Seven beverages were tested: water, tea, coffee, orange juice, milk, beer and 40 degrees distilled alcohol. After plasma extraction, aspirin and salicylic acid were measured by HPLC with UV detection. The main pharmacokinetic parameters were determined by the compartimental method and drug disposition profiles by the Wagner-Nelson modified method. Results Elimination was not modified by any of the beverages but absorption was affected. Two opposing effects were observed: 40 degrees alcohol seemed to increase AUC and Cmax. Milk and beer seemed to decrease these parameters. With 40 degrees alcohol and tea, the amount absorbed and the disposition rate were higher. For milk and orange juice, the amount absorbed was lower and the disposition rate was unaffected. For beer, both the amount absorbed and the disposition rate increased. For coffee, both the amount absorbed and disposition rate were not significantly modified. Conclusion The bioavailability of salicylates on the healthy volunteers in this study was significantly affected by concomitant administration of 40 degrees alcohol (spirit), beer and milk. The beverages seem to interfere with aspirin absorption and the drug disposition profile was modified.

In chronic congestive heart failure (CHF), attenuated heart rate response to exercise, a manifestation of chronotropic incompetence (CI), contributes to limiting exercise capacity. The present study was thus conducted to evaluate the respective role of chronic attenuation of cardiac vagal tone associated with depressed baroreflex sensitivity or affected cardiac sympathetic responsiveness in CHF patients with CI. Spontaneous cardiac baroreflex sensitivity (BRS) assessed by sequence method and spectral- and time-domain analysis of heart rate variability (HRV) were analysed in 21 chronic CHF patients. All patients performed a symptom-limited exercise test with measurement of gas exchange. Chronic incompetence which was defined as failure to achieveor =80% of the heart rate reserve (%HRR) given by (HRpeak - HRrest)/(predictive maximal heart rate - HRrest) was observed in 14 (66%) patients. There was no significant difference in age, heart rate, peak oxygen uptake or left ventricular ejection fraction between the patients with and without CI. Although there was no significant difference in BRS, low frequency power of HRV in normalized units (LFnu) and SDNN were significantly lower in CI patients. Percentage of HRR correlated significantly with LFnu on 15 min (r=0.64, P0.005) and, with LFnu on 24 h (r=0.52, P0.01), SDNN (r=0.48, P=0.03) and SDANN (r=0.48, P=0.03), but not BRS (r=0.04, P=NS). Autonomic nervous system derangement is a complex process in CHF. The role of basal depressed cardiac sympathetic tone seems to contribute more closely than depressed baroreflex sensitivity to the impaired heart rate response to exercise frequently observed in CHF patients.

Through a report of 4 late-onset cases with mitochondrial DNA (mtDNA) depletion, we address the specificity of the clinical entities associated with a very low residual amount of mtDNA. Three of the patients met the diagnostic criteria of Kearns Sayre syndrome, which has never been associated with mtDNA depletion. The fourth patient had an isolated skeletal myopathy. Deleted mtDNA molecules were found by long-range polymerase chain reaction (PCR) only in the Kearns Sayre syndromes, which strengthens the clinical differences between the two types of patients. All patients had extremely low residual amounts of mtDNA as shown by Southern blot analysis. Using an original method based on competitive PCR, we were able to measure the number of mtDNA copies per diploid genome. These results demonstrated the severity of the depletion in the patients by comparison not only to normal controls but also to patients with mtDNA disorders. Despite the severity of the depletion, in situ hybridization using two mtDNA transcripts revealed a normal steady-state level of transcription. Such compensation provides clues to the striking contrast between the severity of mtDNA depletion and the late onset and slowly progressive disease.

Mathematical methods to statistically compare the relative accuracy of physiological monitoring devices to reference measurements are scarce. We developed such a method to compare any number of devices to each other as well as to reference values. This new statistical comparative procedure uses a combination of different known mathematical processes. The method allows the separation of the error of the devices into two components, the first, being systematic, can be easily amended, while the second, inherent to the technical limitations of the measuring device as well as to the physical properties of the explored phenomenon, cannot be corrected and will thus be used as the comparative criterion for statistics. That method, which is easy to implement should ease comparisons of the accuracy of any number of devices as well as comparison of other sets of physiological values, by giving an easy access to statistical results.

Difficulty in filtering relevant auditory information in background noise is one of the features of autism. Auditory filtering processes can be investigated at the peripheral level as they are hypothesized to involve active cochlear mechanisms which are regulated by the efferent activity of the medial olivocochlear (MOC) system. The aim of the present work was therefore to assess these peripheral auditory processes in 22 children and adolescents with autism compared with age- and gender-matched normal controls. Active cochlear mechanisms were evaluated with transiently evoked otoacoustic emissions (TEOAEs) and MOC system efficiency was assessed via TEOAEs which are decreased when stimulating the contralateral ear with noise. The MOC system evaluation was performed on 18 of the 22 children. In both studies, results were analysed according to age (from 4 to 10 years and from 11 to 20 years). The main result concerns the asymmetry of the efferent system which differs in individuals with autism. Several neural processes might be hypothesized as involved in the results obtained as the MOC system which originates in the brainstem received regulating controls from upper brain structures including auditory cortex. Lateralization abnormalities at the auditory periphery may reflect indirectly a problem at a higher level of auditory processing. A second important result shows a decrease in TEOAE amplitude with age, in patients, that may correspond to a decrease in hearing sensitivity.