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Contexte. La surmédicalisation est un phénomène multifactoriel qui prend de l’ampleur depuis quelques années. La campagne « Choosing Wisely », qui invite à la création de listes de cinq procédures de soins (« top five list ») dont le rapport bénéfices-risques est défavorable, apparaît comme un moyen de lutte contre celle-ci. Objectif. Élaborer une « liste des cinq » française en médecine générale, par un groupe de professionnels de santé pluridisciplinaire et de patients. Méthodes. La méthode de consensus UCLA-RAND avec 10 professionnels de santé et un patient a été utilisée. À partir de 15 résumés de la littérature, sur 15 procédures de soins choisies par des médecins généralistes, les participants ont procédé à deux votes individuels. Le premier à distance et le second en groupe à l’issue d’un débat. Le résultat de ce second vote constituait la « liste des cinq » française en médecine générale. Résultats. Au premier tour, 10 participants sur 11 ont voté. Au second tour, 9 ont pris part au débat et au second vote. La liste obtenue était : I) les antibiotiques dans les bronchites aiguës, grippes non compliquées, otites séromuqueuses et rhinopharyngites aiguës ; II) les inhibiteurs de la pompe à protons au long cours sans révision de l’indication ; III) le scanner du rachis lombaire dans les lombalgies communes ; IV) le tramadol dans la prise en charge de la douleur chez les patients de plus de 65 ans ; V) les anti-inflammatoires non stéroïdiens dans l’angine et la sinusite aiguë. Conclusion. La discussion entre professionnels de santé a permis l’élaboration consensuelle de la « liste des cinq » française en médecine générale. Les effets de cette liste sur la diminution des prescriptions sont à démontrer.

Herein, the first total synthesis of (+)-alterbrassicicene C (

Summary Introduction Treatment of cancer-associated thrombosis (CAT) requires specific approaches, although it is well codified in most cases. Current national and international (International Initiative on Cancer and Thrombosis, ITAC) Clinical Practice Guidelines (CPG) recommend the use of low-molecular-weight heparin (LMWH) over 6 months as first treatment option, and anticoagulation should be maintained thereafter as long as cancer is active. Since compliance improves when patients understand their disease and related treatments, we created a dedicated patient education program (PEP) for CAT, aiming to improve quality of care. Methods Retrospective analysis of all patients who voluntarily joined the PEP for CAT from 2014 to 2020. Results In total, 182 cancer patients (median age, 64.9 years) were included, 53.3% with metastatic disease. A total of 528 PEP sessions (median, 3 per patient) were delivered. After PEP completion, the rate of self-injections or those performed at home by a relative had increased from 49.1% to 59.8% (P = 0.05). Quality of life had improved significantly (P = 0.025) and 90.0% of patients reported adhering to anticoagulant therapy. Conclusion Implementation of a structured and personalized PEP for CAT is feasible, allowing to improve cancer patient empowerment, adherence to CAT treatment and quality of life. The Groupe francophone et cancer (GFTC) members aim at facilitating access to CAT-PEP for both patients and caregivers and use of the multi-language ITAC-CPG mobile app (free access: www.itaccme.com ) to improve the care and quality of life of patients with CAT.

Resumen Dos grandes familias de tratamientos medicos han demostrado un beneficio en la supervivencia en el cancer de prostata en estadio metastasico: la hormonoterapia y la quimioterapia. Los tratamientos hormonales alteran el funcionamiento del receptor de los androgenos mediante inhibicion de la sintesis de sus ligandos (agonistas y antagonista LH-RH [hormona liberadora de la hormona luteinizante], acetato de abiraterona) o mediante interaccion directa en las celulas tumorales prostaticas (inhibidores del receptor de los androgenos). Las dos moleculas de quimioterapia empleadas, el docetaxel y el cabazitaxel, actuan como veneno del huso mitotico. Cuando se observan las metastasis en el momento del diagnostico de la enfermedad, el tratamiento medico se basa en la castracion medica o quirurgica, asociada en ocasiones a la abiraterona o al docetaxel en los pacientes de alto volumen/riesgo metastasico. Se puede asociar al tratamiento medico radioterapia prostatica en los pacientes de bajo volumen metastasico. En fase de resistencia a la castracion, se emplean cuatro moleculas (acetato de abiraterona, enzalutamida, docetaxel y cabazitaxel) de forma secuencial en el tiempo. A pesar de los progresos efectuados en la ultima decada, que han permitido mejorar la supervivencia, la enfermedad, sigue siendo incurable y la actitud terapeutica debe seguir centrada en el respeto al proyecto vital de los pacientes.

Resume Introduction Le depistage precoce du melanome est un defi et un motif de consultation majeurs pour le dermatologue liberal. Il n’existe pas de donnees recentes sur les melanomes depistes en liberal en France, ni sur les circonstances du diagnostic. Patients et methodes Il s’agissait d’une etude observationnelle retrospective sur dossiers, colligeant des informations concernant tous les nouveaux cas consecutifs de melanomes depistes entre janvier 2015 et juin 2018, en secteur liberal uniquement, par les dermatologues volontaires de l’association de formation medicale continue « Dermatologie Paris XV ». Une fiche type recueillait des informations sur le dermatologue, le patient, le motif de la consultation, les caracteristiques du melanome et sa prise en charge initiale, a partir du registre fourni par les cabinets de dermato-pathologie. Resultats L’etude portait sur 383 cas de melanomes, 37 % in situ et 63 % invasifs, majoritairement a extension superficielle, chez des patients d’âge median 61 ans, avec une predominance feminine (58 %). Deux cent deux melanomes (52,7 %) etaient diagnostiques lors du suivi de patients a risque ou d’un examen cutane complet systematique. L’indice de Breslow median de ces melanomes etait moins eleve que dans le reste de la cohorte et globalement de faible epaisseur. Lorsque le patient consultait pour une lesion suspecte (139 cas), c’est lui ou un proche qui avait repere la lesion dans 61 % des cas et l’indice de Breslow etait plus epais. Une premiere consultation pour controle de naevus et depistage permettait de diagnostiquer 42 melanomes, soit seulement 11 % de la cohorte. La dermoscopie etait pratiquee par 92 % des dermatologues participant a l’etude. L’exerese du melanome etait faite au cabinet par le praticien dans 75 % des cas et une RCP demandee dans 65 % des cas. Conclusion Le dermatologue liberal et de premier recours est un acteur majeur pour assurer le depistage precoce du melanome et sa prise en charge initiale.

Uveitis is an inflammation of the uveal tissue: iris, ciliary body and choroid. The annual incidence of uveitis in France is low (17/100,000), but visual and therapeutic consequences may be severe. Etiologic investigation is thus a fundamental step in the management of any uveitis. The history plays an important role in the initial evaluation; it must be methodic. The ophthalmologic examination seeks to classify the uveitis by type (granulomatous or not), location (anterior, intermediate or posterior), severity, duration and recurrence. Systemic signs often orient the diagnosis toward a specific cause. The diagnostic approach to uveitis relies on the history, ophthalmologic examination and evaluation of possible extraocular manifestations. Ancillary testing must be prescribed based on the clinical differential diagnosis, without which their yield is very low.

Multiple human pathogens establish chronic, sometimes life-long infections. Even if they are often latent, these infections can trigger some degree of local or systemic immune response, resulting in chronic low-grade inflammation. There remains an incomplete understanding of the potential contribution of both persistent infections and human genetic variation on chronic low-grade inflammation. We searched for potential associations between seropositivity for 13 persistent pathogens and the plasma levels of the inflammatory biomarker C-reactive protein (CRP), using data collected in the context of the UK Biobank and the CoLaus|PsyCoLaus Study, two large population-based cohorts. We performed backward stepwise regression starting with the following potential predictors: serostatus for each pathogen, polygenic risk score for CRP, and demographic and clinical factors known to be associated with CRP. We found evidence for an association between Chlamydia trachomatis (P-value = 5.04e − 3) and Helicobacter pylori (P-value = 8.63e − 4) seropositivity and higher plasma levels of CRP. We also found an association between pathogen burden and CRP levels (P-value = 4.12e − 4). These results improve our understanding of the relationship between persistent infections and chronic inflammation, an important determinant of long-term morbidity in humans.

3 Pág. Departamento de Reproducción Animal​ (INIA), None.

International audience; The capabilities of the Thermodynamic of Advanced Fuels – International Database (TAF-ID) for reproducing the chemical behaviour of irradiated nuclear fuel in severe accident conditions were studied, by comparing calculation results to experimental observations. SIMFUELs samples containing UO2 + 11 elements (Ba, Ce, La, Mo, Nd, Pd, Rh, Ru, Sr, Y and Zr, in concentration representative of a 76 GWd•tU-1 Burn-up) were submitted to 1327°C in oxidizing conditions, and to 1800, 2000, and 2100°C under reducing ones. Samples were characterized by Electron Probe Micro-Analysis (EPMA), High-Resolution XRD, and X-ray Absorption Spectroscopy (XAS). Thermodynamic calculations reproduced accurately the solubility of fission products in the UO2 matrix, and the type and composition of minor oxide and most metallic phases. Calculations also explain metallic phases microstructure as a result of the progressive solidification of liquids. However, some features such as the U-Pd-Rh association could not be reproduced, due to the lack of a thermodynamic model for this ternary system.

Introduction/Background* Microsatellite instability (MSI) is routinely analyzed in patients with endometrial cancers for selecting patients for immunotherapy. Standard reference methods recommended for MSI/dMMR (deficient MisMatch Repair) are immunohistochemistry and pentaplex PCR assays. Methodology We evaluated here the performance of a custom capture-based NGS method, digital droplet (dd)-PCR and automated-PCR for the determination of MSI status in 30 formalin-fixed paraffin embedded (FFPE) tissue samples from patients with endometrial and colorectal cancers. All samples have been previously characterized using standard reference methods, set as gold standard. Result(s)* Overall agreement, sensitivity and specificity were 93.3%, 93.8% and 92.9% for NGS. Overall agreement, sensitivity and specificity were 100% for dd-PCR and automated-PCR assays. Conclusion* NGS, dd-PCR and automated-PCR can be used routinely used for the analysis of MSI detection and represent complementary options to IHC and pentaplex PCR assays. Dd-PCR and automated-PCR assays allow easy and fast analysis while NGS allows simultaneous analysis of MSI and clinically relevant genomic alterations.

Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma. Firstline immunochemotherapy cures approximatively 60 % of patients. The prognosis of patients with refractory disease or with relapsed disease within the first two years after the end of treatment is highly unfavourable. Since June 2019, a new third-line treatment with CAR T cells (chimeric antigen receptor T cells) seems to completely modify the prognosis of these patients. A significant proportion of long-lasting complete responses is obtained with this revolutionary treatment. Quick specialized intervention is required for the unique side effects of this therapy.Le lymphome B diffus à grandes cellules (LBDGC) est le type histologique de lymphome non Hodgkinien le plus fréquent. Le traitement de première ligne par immunochimiothérapie ne permet de guérir qu’environ 60 % des patients. Les patients présentant une maladie réfractaire à une première ligne de traitement ou en rechute dans les deux premières années suivant le traitement présentent un mauvais pronostic. Disponible depuis juin 2019, un nouveau traitement de 3ème ligne sous forme d’immunothérapie par CAR T cells (acronyme anglais de «chimeric antigen receptor T cells») semble modifier complètement le pronostic de ces patients, avec l’obtention d’une proportion importante de réponses complètes de longue durée. Les effets indésirables spécifiques liés à ce traitement demandent une prise en charge rapide et spécialisée.

Background : The purpose of this study was to assess the perception of patients undergoing cataract surgery under topical anesthesia in an open-space operating hall. The study was set in the Department of Ophthalmology, Cochin Paris Descartes University Hospital, in a newly built open-space operating hall dedicated to ophthalmic surgery. Methods: 250 consecutive patients undergoing cataract surgery by 11 surgeons were included in this prospective study. All the included patients have been operated in an open-space operating hall with 3 surgical areas. Only first-eye standard cataract surgeries performed under topical anesthesia were included. Responses to a face-to-face questionnaire administered by a single interviewer to patients before their discharge on the day of their surgery were analyzed. Results: Fifty-two patients (21%) knew beforehand that their procedure would take place in an open-space operating hall, 118 (47%) realized that they were in such an environment on the occasion of their surgery and 80 (32%) did not notice. Conversations and noises unrelated to their own surgeries were overheard respectively by 15 (6%) and 37 (15%) patients. Of the 250 patients, 237 (95%) did not report any discomfort associated with the fact that their procedure had been performed in an open-space operating hall. Conclusions: Cataract surgery performed in an open-space setting did not seem to affect the patients’ comfort during the procedure. Trial registration : This manuscript has been retrospectively registered and approved in 9 october 2018 by the Ethics Committee of the French Society of Ophthalmology (IRB 00008855 Société Française d’Ophtalmologie IRB#1) because the Committee did not find any challenge against the medical and scientific rules of ethics, as accepted in France.

International audience; Aim : Our qualitative study aims to describe the narrative effects of a psycho-oncology support protocol based on the pictorial productions of one family caregiver (Mrs. Rose, aged 70), who had promulgated care for her husband suffering from an incurable cancer. Material and methods : The protocol around the pictorial figuration consists of four steps (times): a preliminary exploratory interview (T1), a first encounter around pictorial creation (T2), a second encounter more in deep around pictorial creation (T3) and finally, a final interview (T4).We first used the software T-LAB version 9.1.3, a linguistic and statistical tool for text analysis. In this research, we used co-occurrence relationships and word associations recalling moments of narrative structures, according to the humanistic/existential tradition. Findings : We showed the presence of the narrative effects before and after artistic work on the psychological problems inherent in the experience of caregiver and in particular on the anguish of death. The romantic dimension of the story seems to be able to withstand Mrs. Rose’s tragic narrative. Conclusion : “Psychic work with pictorial production” can enable the caregiver to depict love and death through a personal narrative borrowing from the narrative universe of romanticism and its existential issues.; Objectif : Cette étude qualitative vise à décrire les effets narratifs d’un protocole d’accompagnement psychooncologique s’appuyant sur les productions picturales d’une proche aidante (Mme Rose, 70 ans) accompagnant son mari atteint d’un cancer incurable. Matériel et méthode : Il s’agit d’un protocole autour de la figuration picturale de la proche aidante composé de quatre étapes (temps) : l’entretien préliminaire (T1), une première rencontre autour de la création picturale (T2), une seconde rencontre d’approfondissement autour de la création picturale (T3), l’entretien final (T4). Nous avons utilisé le logiciel T-LAB 9.1.3 pour le calcul des associations de mots (cooccurrences) et réalisé une interprétation du récit selon l’approche humaniste/existentielle. Résultats : Ce dispositif de recherche a permis de montrer les effets narratifs avant et après le travail artistique sur les problématiques psychiques inhérentes au vécu du proche aidant et notamment sur l’angoisse de mort. La dimension romantique du récit semble pouvoir supporter la narration tragique de Mme Rose. Conclusion : Le « travail psychique avec la production picturale » peut permettre au proche aidant de mettre en figure l’amour et la mort à travers une narration personnelle empruntant à l’univers narratif du romantisme ses enjeux existentiels.

Protein ubiquitination at sites of DNA double-strand breaks (DSBs) by RNF168 recruits BRCA1 and 53BP1, mediators of the homologous recombination (HR) and non-homologous end joining (NHEJ) DSB repair pathways, respectively. While NHEJ relies on 53BP1 binding to ubiquitinated Lysine 15 on H2A-type histones (H2AK15ub), an RNF168-dependent modification, the mechanism linking RNF168 to BRCA1 recruitment during HR has remained unclear. Here, we identify a tandem BRCT domain ubiquitin-dependent recruitment motif (BUDR) in BARD1 – BRCA1’s obligate partner protein – that binds H2AK15ub directly, thereby recruiting BRCA1 to DSBs. BARD1 BUDR mutations compromise HR, and render cells hypersensitive to PARP inhibition and cisplatin treatment. We find that BARD1-nucleosome interactions require BUDR binding to H2AK15ub and ankyrin repeat domain-mediated binding of the histone H4 tail, specifically when unmethylated on Lysine-20 (H4K20me0), a state limited to post replicative chromatin. Finally, we demonstrate that by integrating DNA damagedependent H2AK15ub and DNA replication-dependent H4K20me0 signals at sites of DNA damage, BARD1 coordinates BRCA1-dependent HR with 53BP1 pathway antagonization, establishing a simple paradigm for the governance of DSB repair pathway choice.

Ocular drug side effects are very varied and can affect all the structures of the eye. The purpose of this review is to help clinicians: (i) to evoke this drug-induced toxicity yearly in the course of an unexplained ocular injury, before its damage become irreversible, (ii) to be able to recognize induced paradoxical ocular inflammation, mimicking an inflammatory pathology flare-up, especially in patient under anti-TNF regimen and (iii) to propose a more in-depth knowledge on recently described ocular toxicities from targeted cancer therapy, mainly the tyrosine kinase inhibitors.

Early detection of melanoma constitutes a major challenge and is a common reason for dermatological consultations. There is no recent data on melanomas diagnosed in the private medical sector in France, nor on the circumstances of diagnosis.This was a retrospective observational study on records collating data on all new consecutive cases of melanoma diagnosed between January 2015 and June 2018, in the private sector only, by volunteer dermatologists belonging to the association for continuing medical education, "Dermatologie Paris XV". A data collection sheet was prepared on which to record information about the dermatologist, the patient, the main complaint, the characteristics of the melanoma, and the initial treatment given, using the computerized list provided by our dermatopathology offices.The study involved 383 cases of melanoma, 37% in situ and 63% invasive, which consisted chiefly of superficial spreading melanoma. The median age of the cohort was 61 years and patients were predominantly female (58%). Follow-up of high-risk patients and complete routine examination (in those consulting for another reason) resulted in direct detection by a dermatologist of 202 of the 383 melanomas (52.7%); these melanomas had a lower median Breslow index than the rest of the cohort and were thin in the main. When patients consulted for a suspect lesion (139 cases), the lesion had been identified mostly by either the patient or by a relative (61% of cases). The decision to consult was made chiefly by the patients themselves, and the Breslow index was thicker. An initial consultation for nevus screening resulted in diagnosis of 42 melanomas, i.e. only 11% of the cohort. Dermoscopy was performed by 92% of the dermatologists participating in the study. Melanoma excision was performed in the office by the practitioner in 75% of cases, and management was validated at multidisciplinary meetings in 65% of cases.In terms of French primary care, dermatologists in private practice play a key role in ensuring early detection and initial management of melanoma.

Cualquier disminucion de la agudeza visual (DAV) obliga a realizar una exploracion por un oftalmologo. Sin embargo, hasta la realizacion de esta exploracion, varios principios generales permiten establecer las principales orientaciones diagnosticas y evaluar el grado de urgencia en relacion con las manifestaciones clinicas. La caracterizacion de la DAV, que puede ser aguda o progresiva, dolorosa o no, con ojo rojo o no, permite completar el marco nosologico. Las DAV acompanadas de eritema y de dolor ocular sugieren una patologia del segmento anterior (queratitis, uveitis o glaucoma agudo), una DAV unilateral de instauracion subita sugiere una patologia vascular (oclusion venosa o arterial retiniana, neuropatia isquemica), mientras que una DAV progresiva bilateral en ancianos obliga a pensar en cataratas. Las neuropatias opticas inflamatorias son unilaterales y afectan sobre todo a los individuos jovenes. Por ultimo, en los ancianos, una DAV acompanada de una vision deformada (metamorfopsias) obliga a buscar una degeneracion macular asociada a la edad (DMAE).

Vogt-Koyanagi-Harada (VKH) disease is defined as a severe bilateral, chronic granulomatous panuveitis associated with serous retinal detachments, disk edema, and vitritis, with central nervous system, auditory, and integumentary manifestations. It is an autoimmune inflammatory condition mediated by T cells that target melanocytes in individuals genetically susceptible to the disease. Vogt-Koyanagi-Harada disease presents clinically in 4 different phases: prodromal, acute inflammatory, chronic, and recurrent, with extraocular manifestations including headache, meningitis, hearing loss, poliosis, and vitiligo. Optical coherence tomography (OCT) allows earlier diagnosis of VKH disease by revealing heterogeneous exudative detachments of the retina in the acute stage and choroidal thickening, and by demonstrating choroidal thinning in the chronic stage. Treatment of this disease is initially with intravenous corticosteroids, with, if needed, a transition to immunosuppressant drugs for long-term control. Patients with VKH disease can have good final visual outcomes if treated promptly and aggressively.

Background Low gestational age (GA) is the principle risk factor for poor long-term neurodevelopment among very preterm (VPT) children. Some of this effect results from a greater vulnerability to severe neonatal morbidities (SNM) which are strongly related to low GA as well as to poor neurodevelopmental outcome. We aimed to investigate how SNM mediates the relationship between GA and VPT adverse neurodevelopmental outcome at 2 years of corrected age. Methods Data come from the area-based Effective Perinatal Intensive Care in Europe (EPICE) cohort of children born below 32 weeks’ GA in 2011/2012 in 11 European countries. Perinatal data were abstracted from medical records and follow-up was conducted using parent questionnaires at 2 years of corrected age. Children unable to walk without assistance or aids, or sit or hold their head up without support were classified with severe gross motor impairment (GMI); Non-verbal cognitive impairment (NVCI) was assessed as a score Results Of 3370 children assessed in the follow-up; 5.3% had GMI, 14.9% had NVCI and 9.4% had LI. A one-week increase in GA was associated with a decreased risk of GMI (OR=0.80; 95 CI%=0.74–0.86]), of NVCI (OR=0.85; 95 CI%=0.81–0.89]) and LI (OR=0.89; 95 CI%=0.83–0.96]). 20.4% of infants had at least one severe morbidity and this was more common among children with GMI (66.0% vs. 18.4%), NVCI (38.8% vs. 17.2%) and LI (38.4% vs. 18.4%). For GMI, almost 100% of the total effect of GA on GMI was mediated by SNM. This proportion was 70% for NVCI and 40% for LI. Conclusion Reducing SNM could lead to substantial improvements in neurodevelopmental outcomes for VPT children, especially those related to motor development.

Uveitis is an inflammation of the uveal tissue: iris, ciliary body and choroid. The annual incidence of uveitis in France is low (17/100,000), but visual and therapeutic consequences may be severe. Etiologic investigation is thus a fundamental step in the management of any uveitis. The history plays an important role in the initial evaluation; it must be methodic. The ophthalmologic examination seeks to classify the uveitis by type (granulomatous or not), location (anterior, intermediate or posterior), severity, duration and recurrence. Systemic signs often orient the diagnosis toward a specific cause. The diagnostic approach to uveitis relies on the history, ophthalmologic examination and evaluation of possible extraocular manifestations. Ancillary testing must be prescribed based on the clinical differential diagnosis, without which their yield is very low.

Inflammation may play a role in the development of epilepsy after brain insults. [11C]-( R)-PK11195 binds to TSPO, expressed by activated microglia. We quantified [11C]-( R)-PK11195 binding during epileptogenesis after pilocarpine-induced status epilepticus (SE), a model of temporal lobe epilepsy. Nine male rats were studied thrice (D0-1, D0 + 6, D0 + 35, D0 = SE induction). In the same session, 7T T2-weighted images and DTI for mean diffusivity (MD) and fractional anisotropy (FA) maps were acquired, followed by dynamic PET/CT. On D0 + 35, femoral arterial blood was sampled for rat-specific metabolite-corrected arterial plasma input functions (AIFs). In multiple MR-derived ROIs, we assessed four kinetic models (two with AIFs; two using a reference region), standard uptake values (SUVs), and a model with a mean AIF. All models showed large (up to two-fold) and significant TSPO binding increases in regions expected to be affected, and comparatively little change in the brainstem, at D0 + 6. Some individuals showed increases at D0 + 35. AIF models yielded more consistent increases at D0 + 6. FA values were decreased at D0 + 6 and had recovered by D0 + 35. MD was increased at D0 + 6 and more so at D0 + 35. [11C]-( R)-PK11195 PET binding and MR biomarker changes could be detected with only nine rats, highlighting the potential of longitudinal imaging studies.

Resume La retinochoroidopathie de Birdshot est une uveite posterieure autoimmune potentiellement cecitante qui touche des patients caucasiens autour de la cinquantaine. Elle se distingue par une forte association a l’antigene HLA A-29 et par des taches caracteristiques au fond d’œil dont l’apparition peut etre retardee. L’interet des examens complementaires prend alors son sens pour permettre le diagnostic et le suivi. Parmi ceux-ci, la tomographie par coherence optique recherche un œdeme maculaire ou une atrophie de mauvais pronostic. L’angiographie a la fluoresceine montre des signes d’activite inflammatoire, tandis que celle au vert d’indocyanine a egalement une valeur diagnostique. L’electroretinogramme global et la perimetrie ont montre leur utilite pour le diagnostic et la surveillance. L’acuite visuelle est un pietre reflet de la fonction visuelle. Une surveillance clinique et paraclinique iterative est necessaire pour assurer le meilleur pronostic. Un traitement corticoide doit etre precocement associe a une immunosuppression pour les formes presentant des facteurs de mauvais pronostic.

Cancer-associated thrombosis (CAT) is the second leading cause of death in cancer patients after tumor progression. The treatment of CAT is challenging because of a high risk of VTE recurrence, a high risk of bleeding, common presence of comorbidities, poly-medication, and potential drug-drug interactions (DDI). Since 2018, direct oral anticoagulants (DOACs) represent a promising therapeutic alternative and have been recently included into the 2019 update of the International Initiative on Thrombosis and Cancer (ITAC-CME) clinical practice guidelines for management of CAT. However, pharmacokinetic studies suggest that concomitant treatment with P-gp or CYP3A4 inhibitors will result in an increased exposure to rivaroxaban and apixaban, but the clinical relevance of these studies is unknown. In addition, there is an important inter-individual variability in drug absorption, distribution, metabolism and elimination, even more in cancer patients. Overall, the risk of pharmacokinetic DDI should be estimated based on several individual (patient age, renal and liver function, number of comedications) and diseases-related factors, including inflammation, sarcopenia, and low body weight. In this context, DDI with clinical implications could be expected with anti-neoplastic agents or supportive care treatments, especially with drugs known to be moderate or strong inhibitors/inducers of CYP3A4 and P-gp. Consequently, in the presence of potential DDIs through CYP3A4, and/or P-gp, LMWHs remain the first-line anticoagulant of choice for the long-term treatment of CAT. Multidisciplinary consultation meetings and therapeutic patient education should be emphasized in the complex management of CAT.

Summary Background. — The management of venous thromboembolism (VTE) is particularly challenging in patients with cancer who undergo complex treatment protocols. Cancer patients often have comorbidities which may affect the efficacy and safety of anticoagulant treatments. Coordinated multidisciplinary management of these complex cases can help optimize delivery of individualized anticoagulant treatment. Aims. — To describe the multidisciplinary team meeting (MDTM) for the management of VTE in cancer patients at our institution and to document outcomes in these patients. Methods. — Bi-monthly MDTMs attended by different physicians and nurses were established at Saint-Louis Hospital in 2008. We performed a retrospective analysis of all cases discussed between September 2008 and January 2018. Results. — Over a 10-year period, 520 patients were discussed a total of 551 times. Their mean age was 63 years with 278 (53%) women. The most frequent primary cancer sites were breast (23%), genitourinary (21 %), hematological (20%), digestive (15%), and lung (9%). Fifty-two percent of patients had metastatic cancer, and 54% of them were receiving chemotherapy. The optimal treatment for pulmonary embolism (17%), deep vein thrombosis (16%), catheter-related thrombosis (20%) or combined events (46%) was discussed. Twenty-three patients (4.4%) were discussed for one VTE recurrence and 4 (0.8%) for 2 recurrences. Conclusions. — A dedicated MDTM for the management of VTE in cancer patients allows to discuss a wide range of clinical scenarios and contributes to optimal adherence to evidence-based clinical practices guidelines. The MDTM evaluation was successfully carried out within a short time-frame of VTE diagnosis and helped optimize individualized treatment plans.

Objectifs L’objectif general de l’etude est de comparer le parcours de soins de cohortes de patients atteints de schizophrenie et traites, soit par APAP, soit par antipsychotique oral. Le critere de jugement principal retenu est la duree de sejours hospitaliers (egalement designee comme le nombre de journees d’hospitalisation complete). Methode Cette etude est realisee a partir des donnees du Systeme national des donnees de sante (SNDS), chez des patients domicilies en Bourgogne-Franche-Comte. Un algorithme a permis de selectionner les personnes âgees de 18 a 64 ans repondant a differents criteres. Tout d’abord, les personnes qui avaient l’une ou l’autre des caracteristiques suivantes ont ete selectionnees : – au moins un sejour hospitalier en MCO ou psychiatrie sur la periode 2011-2014, avec un diagnostic principal, relie ou associe, de schizophrenie (codes CIM-10 F20, F21, F22 ou F25) ; – une ALD pour schizophrenie (codes CIM-10 F20, F21, F22 ou F25) en cours, sur la periode 2013–2014. Dans un second temps, parmi les personnes repondant a l’un des deux criteres ci-dessus, un nouveau critere a ete applique : – au moins un remboursement de medicaments avec codes ATC N05AX08 (risperidone) et/ou N05AX13 (paliperidone) sur la periode 2013–2014 avec suivi d’au moins 12 mois apres le premier remboursement. Les patients traites par APAP (RisperdalConsta® ou Xeplion®) sont ceux ayant beneficie de remboursements relatifs a des dispensations d’APAP pour au moins trois mois (84 jours) de traitement. Les patients traites par antipsychotique oral (Risperidone par voie orale) sont ceux ayant beneficie de remboursements relatifs a des dispensations de Risperidone par voie orale pour au moins trois mois (84 jours) de traitement, sans etre deja inclus dans la cohorte de patients traites par APAP (un patient pouvant beneficier de remboursements pour des dispensations de Risperidone par voie orale et pour des dispensations d’APAP durant la periode d’inclusion). Afin de prendre en compte les caracteristiques non equilibrees entre les cohortes etudiees, un appariement sur scores de propension est realise. Resultats Les resultats en termes de caracteristiques d’âge et de sexe montrent des profils de patients differencies selon le type de traitement suivi. Les patients traites par APAP sont plutot des hommes jeunes tandis que la repartition hommes/femmes est plus equilibree, avec une moyenne d’âge plus elevee chez ceux traites par antipsychotique oral. Sur les cohortes appariees, l’observance est meilleure chez les patients traites par APAP. En termes de nombre ou de duree de sejours hospitaliers, les ecarts entre les cohortes ne different pas significativement. Conclusion L’etude ne montre de difference significative sur le critere de jugement principal, a savoir la duree de sejours hospitaliers. Neanmoins, aux vues des profils de patients identifies dans cette etude, d’autres analyses pourraient etre conduites. Une approche a partir des professionnels de sante prescripteurs serait a explorer via le SNDS. L’autorisation de mise sur le marche des traitements etudies est assez recente. Une actualisation dans un delai de trois a quatre ans pourrait conduire a des analyses plus robustes, en considerant par exemple un suivi sur cinq ans.

International audience; Our work focuses on the development of a test procedure and the creation of a database of current signature in presence of electromagnetic interference (EMI). These signals can affect the reliability of detection algorithms producing false tripping; therefore increasing the number of false detections. An experimental test bench allows generating series arc faults for different load configurations (UL 1699 and IEC 62606 standards). EMI disturbances are produced by the EMTEST UCS500 M4 generator. All tests are performed with conventional household appliances (halogen lamp, vacuum cleaner, drill or computer). We rely on the EN 61000-4-4, EN 61000-4-5 and EN 61000-4-11 standards to emulate the main EMI disturbances presented in a home electrical network (lightning-type overcurrent, voltage variations, motor starts, etc.). Spectral analysis of these signals shows that EMI and the series arc spectra are comparable and can disrupt the operation of conventional detection algorithms generating considerable false detections

Introduction Les recommandations cliniques privilegient le recours aux antipsychotiques injectables a action prolongee (APAP) par rapport aux formes orales (OAP) dans le traitement de maintenance de la schizophrenie, et ce des le premier episode. Les objectifs sont : – principal : analyse cout–efficacite comparant la risperidone et la paliperidone injectables a action prolongee (APAP) a la risperidone orale (OAP) dans le traitement de la schizophrenie ; – secondaires : description et comparaison des profils de patients selon le medicament recu. Methode Les donnees anonymisees des patients pris en charge en Bourgogne Franche-Comte proviennent la base de donnees individuelles des beneficiaires (DCIR). La duree moyenne d’hospitalisation, l’observance medicamenteuse et les couts medicaux directs ont ete compares dans les deux cohortes APAP (n = 722) vs OAP (n = 722), appariees au moyen d’un score de propension. L’observance medicamenteuse a ete estimee par le calcul du medication possession ratio (MPR). Trois niveaux d’observance ont ete consideres : faible (0–50 %), moyenne (50–80 %) et bonne (80–100 %). Resultats Apres deux annees de suivi, le nombre moyen de jours d’hospitalisation n’est pas significativement different entre les deux groupes de traitement (APAP : 70,95 [± 90,12] jours vs OAP : 62,68 [± 86,32] jours, p = 0,061). Le taux de patients dont l’observance au traitement antipsychotique est bonne (MPR ≥ 80 %) est plus important dans le groupe APAP (80,3 % vs 61,9 %, p Les couts medicaux directs sont plus eleves dans le groupe APAP (17 218 € vs 10 885 €). La principale difference entre les deux groupes est liee au cout d’acquisition de l’antipsychotique (APAP : 3150€, OAP : 572€). Les autres couts medicaux sont equilibres dans les deux groupes. Conclusion Dans notre echantillon de patients, le benefice des APAP sur l’observance medicamenteuse et la reduction des coprescriptions ne s’accompagne pas d’une reduction de la duree moyenne d’hospitalisation. La strategie de traitement par APAP, plus onereuse, n’apparait pas cout–efficace a deux ans sur le nombre de jours d’hospitalisation.

Although they represent about a third of all the tumors of the central nervous system, knowledge concerning meningioma epidemiology (including incidence data and exploration of the risk factors) remains scarce compared to that of gliomas. A limited number of cancer registries worldwide only record malignant brain tumors, however their completeness and accuracy have been questioned. Even if comparisons are made difficult due to differences in methodologies, available annual incidence rates (sex- and age-standardized, generally on US or World standard population), provided by population-based registries range from 1.3/100,000 to 7.8/100,000 for cerebral meningiomas. An increase in the incidence of primary brain tumors in general and of meningiomas in particular has been observed during the past decades in several countries. It has been suggested that this trend could be artefactual and could be the resultant of an ageing population, improvement in health access and in diagnostic procedures, changes in coding classification for tumors recorded in registries, and/or an increase in the rate of histological confirmation, even in the elderly. All these factors are likely to play a role but they might not fully explain the increase in incidence, observed in most age groups. In addition to intrinsic risk factors (gender, ethnic groups, allergic conditions, familial and personal history, genetic polymorphisms), some exogenous risk factors have been suspected to play a role in the etiology of meningiomas and their changes with time is likely to impact incidence trends. A causal link has been established only for ionising radiation but the role of many other factors have been hypothesised: electromagnetic fields, nutrition, pesticides, hormonal as well as reproductive factors. Considering the serious or even lethal potentiality of some meningiomas and the apparent rise in their incidence, all practitioners involved in neuro-oncology should feel concerned today of the necessity to better assess their public health burden and to study their epidemiological features.

Introduction Le syndrome catastrophique des antiphospholipides (CAPS) se caracterise par la survenue simultanee de thromboses multiples, typiques par leur predominance microcirculatoire et pouvant conduire a un tableau de defaillance multiviscerale. L’atteinte du segment posterieur de l’œil a ete exceptionnellement rapportee dans la litterature. Patients et methodes Etude retrospective multicentrique des patients ayant presente une atteinte du segment posterieur de l’œil dans un contexte de CAPS (selon les criteres de classification du CAPS revises en 2010) [1] inclus dans la base de donnees francaise « syndrome des antiphospholipides (SAPL)/lupus » au 30/10/2018 (Clinicaltrials NCT 02782039 ). Nous avons egalement inclus les patients de la litterature repondant a ces criteres. Resultats Parmi 61 patients ayant presente un CAPS, nous avons identifie 8 patients avec atteinte du segment posterieur (13 %, cette atteinte n’etant neanmoins pas recherchee systematiquement). Nous avons analyse au total 20 patients (8 cas personnels et 12 cas de la litterature) d’âge median 29,5 ans [extremes 16–79]. Dix-huit etaient des femmes. L’atteinte ophtalmologique etait generalement bilaterale (n = 16). Elle consistait en une retinopathie vasculaire occlusive (n = 15), une vascularite retinienne (n = 1, dans un contexte de lupus associe) et/ou une choroidopathie (n = 9). Tous les patients rapportaient une symptomatologie ophtalmologique (1 donnee manquante) : baisse de l’acuite visuelle (n = 16), scotome (n = 4) et/ou amaurose (n = 1). Un deces etait observe. Parmi les 19 patients suivis pendant une mediane de 13 mois [2 mois–11 ans], 10 patients avaient des sequelles visuelles (53 %, 2 donnees manquantes). Les sequelles faisaient suite a une atteinte vasculaire occlusive retinienne (n = 6), a une atteinte vasculaire occlusive retinienne et choroidienne (n = 3) ou a une atteinte choroidienne seule (n = 1). A la fin du suivi, un patient etait aveugle et trois etaient monophtalmes. Conclusion L’atteinte du segment posterieur de l’œil au cours du CAPS etait volontiers bilaterale. L’atteinte vasculaire occlusive retinienne etait predominante, le plus souvent severe. Les sequelles visuelles etaient frequentes. Nous proposons de faire un fond d’œil chez tous les patients atteints de CAPS afin de ne pas meconnaitre cette atteinte susceptible de passer au second plan du fait de la severite clinique des patients.