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International audience; In-person sessions of participative design are commonly used in the field of Learning Analytics, but to reach students not always available on-site (e.g. during a pandemic), they have to be adapted to online-only context. Cardbased tools are a common co-design method to collect users' needs, but this tangible format limits data collection and usage. We propose here two steps: first to adapt an existing co-design card deck-based method for an online use, then to leverage the benefits of the digital format to trace data with a research focus to study the dynamics of collaboration. We also assess whether the previously adapted digital tool has the same impacts as the face-to-face original method. Beyond the case described here, this chapter aims at identifying key factors and points of attention identified in adapting a cardbased co-design method into a digital version for designing learning dashboards, and which elements can be traced in order to study collaboration and propose future improvement to the method. This digital adaptation was tested by university students in different contexts (n=177). All groups have successfully designed a dashboard, and using the original evaluation scales, users have evaluated our digital tool as almost as suitable as the original method. Then, we compared the use of the digital adaptation online with this use in face-to-face sessions which were less successful. We conclude by showing how the added traces open new perspectives to understand collaboration through links between speech acts and collaboration profiles or defining adapted dashboard for students.

Objective The aim of this study was to provide a reliable instrument to assess evidence-based practice (EBP) dimensions in French-speaking dental students. To do so, a transcultural adaptation into French of the self-administered KACE questionnaire (Knowledge, Attitude, Access and Confidence Evaluation) and the evaluation of its psychometric properties in a sample of French dental students and teachers were performed. The effects of individual and academic factors on student performance in the KACE were also investigated. Method Teachers and fourth-year students completed once the translated KACE and fifth-year students completed twice the questionnaire before and after an epidemiology course. Cronbach's alpha coefficient analysis, Kruskal-Wallis and post hoc Dunn's tests, paired samples Wilcoxon tests and a generalised linear mixed model were performed to assess the psychometric properties (reliability, internal consistency, discriminant validity and responsiveness) of the questionnaire and to identify the factors associated with KACE scores, respectively. Results 186 participants completed the survey. Cronbach's alpha ranged from 0.06 to 0.48 for Knowledge, 0.21 to 0.59 for Attitude, 0.42 to 0.76 for Access and 0.82 to 0.93 for Confidence. The discriminant value and sensitivity of the French KACE revealed significant differences amongst students and teachers and accurately identified the effect the training course had on the students who had completed it. Preparing for a residency programme or having received add-on modules in science improved the students' performance in the test. Being female negatively impacted the KACE Confidence score. Conclusion This version of the KACE is appropriate to assess EBP dimensions in French dental students. Academic background and gender may affect test performance.

Many older adults take benzodiazepines and sedative-hypnotics for the treatment of sleep disorders. With a view to considering the possible discontinuation of hypnotics, the objectives of the present study were to describe bedtime habits and sleep patterns in older adults and to identify the sleep medications taken. An expert group developed a structured interview guide for assessing the patients’ bedtime habits, sleep patterns, and medications. During an internship in a community pharmacy, 103 sixth-year pharmacy students conducted around 10 interviews each with older adults (aged 65 or over) complaining of sleep disorders and taking at least one of the following medications: benzodiazepines, benzodiazepine derivatives (“Z-drugs”), antihistamines, and melatonin. A prospective, observational study was carried out from 4 January to 30 June 2016. The pharmacy students performed 960 interviews (with 330 men and 630 women; mean ± standard deviation age: 75.1 ± 8.8). The most commonly taken hypnotics were the Z-drugs zolpidem (n = 465, 48%) and zopiclone (n = 259, 27%). The vast majority of patients (n = 768, 80%) had only ever taken a single hypnotic medication. The median [interquartile range] prescription duration was 120 (48–180) months. About 75% (n = 696) of the patients had at least 1 poor sleep habit, and over 41% (n = 374) had 2 or more poor sleep habits. A total of 742 of the patients (77%) reported getting up at night—mainly due to nycturia (n = 481, 51%). Further, 330 of the patients (35%) stated that they were keen to discontinue their medication, of which 96 (29%) authorized the pharmacist to contact their family physician and discuss discontinuation. In France, pharmacy students and supervising community pharmacists can identify problems related to sleep disorders by asking simple questions about the patient’s sleep patterns. Together with family physicians, community pharmacists can encourage patients to discuss their hypnotic medications.

Valve-sparing aortic root replacement with the David procedure is an alternative to the Bentall procedure in patients with aortic root aneurysm. The aim of this study was to describe our long-term experience with this technique and the predictive factors of late failure.Between January 1998 and August 2019, 300 consecutive patients underwent a David procedure. Clinical and echocardiographic early- and long-term outcomes were analyzed. Median follow-up was 7.0 years (range, 4.1-11.5), with 98.3% complete.Early mortality was 1%. No early valve-related reoperations occurred. There were 9 cardiac-related deaths and 22 reinterventions (19 valve-related). All patients survived reoperation. In 3 patients reintervention consisted of transcatheter aortic valve implantation. Overall survival rates were 95.3% (95% confidence interval [CI], 92.0-97.2), 91.1% (95% CI, 86.5-94.2), and 82.9% (95% CI, 75.3-88.4) at 5, 10, and 15 years, respectively. Freedom from postoperative aortic insufficiency (AI) grade ≥ 2 was 84.8% (95% CI, 79.9-88.6) and 74.3% (95% CI, 67.4-79.9) at 5 and 10 years, respectively. Freedom from reintervention for aortic valve disease was 97.1% (95% CI, 94.2-98.5), 92.9% (95% CI, 88.2-95.7), and 92.5% (95% CI, 87.1-95.7) at 5, 10, and 15 years, respectively. Preoperative AI ≥ 2 (hazard ratio, 1.782; 95% CI, 1.352-2.350) and a ventriculoaortic junction ≥ 29 mm (hazard ratio, 3.379; 95% CI, 1.726-6.616) were predictive factors for postoperative AI ≥ 2 in a multivariate analysis (P.001).Preoperative AI ≥ 2 and a ventriculoaortic junction ≥ 29 mm were identified as risk factors for late postoperative AI ≥ 2.

Summary Background Global roll-out of rapid molecular assays is revolutionising the diagnosis of rifampicin resistance, predictive of multidrug-resistance, in tuberculosis. However, 30% of the multidrug-resistant (MDR) strains in an eSwatini study harboured the Ile491Phe mutation in the rpoB gene, which is associated with poor rifampicin-based treatment outcomes but is missed by commercial molecular assays or scored as susceptible by phenotypic drug-susceptibility testing deployed in South Africa. We evaluated the presence of Ile491Phe among South African tuberculosis isolates reported as isoniazid-monoresistant according to current national testing algorithms. Methods We screened records of 37 644 Mycobacterium tuberculosis positive cultures from four South African provinces, diagnosed at the National Health Laboratory Service–Dr George Mukhari Tertiary Laboratory, to identify isolates with rifampicin sensitivity and isoniazid resistance according to Xpert MTB/RIF, GenoType MTBDRplus, and BACTEC MGIT 960. Of 1823 isolates that met these criteria, 277 were randomly selected and screened for Ile491Phe with multiplex allele-specific PCR and Sanger sequencing of rpoB. Ile491Phe-positive strains (as well as 17 Ile491Phe-bearing isolates from the eSwatini study) were then tested by Deeplex-MycTB deep sequencing and whole-genome sequencing to evaluate their patterns of extensive resistance, transmission, and evolution. Findings Ile491Phe was identified in 37 (15%) of 249 samples with valid multiplex allele-specific PCR and sequencing results, thus reclassifying them as MDR. All 37 isolates were additionally identified as genotypically resistant to all first-line drugs by Deeplex-MycTB. Six of the South African isolates harboured four distinct mutations potentially associated with decreased bedaquiline sensitivity. Consistent with Deeplex-MycTB genotypic profiles, whole-genome sequencing revealed concurrent silent spread in South Africa of a MDR tuberculosis strain lineage extending from the eSwatini outbreak and at least another independently emerged Ile491Phe-bearing lineage. Whole-genome sequencing further suggested acquisition of mechanisms compensating for the Ile491Phe fitness cost, and of additional bedaquiline resistance following the introduction of this drug in South Africa. Interpretation A substantial number of MDR tuberculosis cases harbouring the Ile491Phe mutation in the rpoB gene in South Africa are missed by current diagnostic strategies, resulting in ineffective first-line treatment, continued amplification of drug resistance, and concurrent silent spread in the community. Funding VLIR-UOS, National Research Foundation (South Africa), and INNOVIRIS.

Background The best valvular substitute remains controversial in young adults with active aortic valve endocarditis. The Ross procedure has gained interest because of its theoretical resistance to infection. We aimed to report our long-term outcomes of the Ross procedure in this indication. Methods Between March 1992 and January 2019, 511 patients underwent a Ross procedure in our institution. Among them, we included 38 patients who suffered from an active aortic valve infective endocarditis. The mean age was 33.9 ± 8.1 years. Six patients had emergent procedures and 17 patients had perivalvular involvement. A pulmonary autograft was implanted using the full root technique in 78.9% of patients. Median follow-up was 12 (interquartile range, 1.75-16.25) years. Results The hospital mortality rate was 5.3%. Estimated overall survival was 84.2% ± 6.6% at 10 years. There were 2 cases of recurrent endocarditis, both requiring reoperation. Six other patients required reoperation on an autograft or homograft. Estimated freedom from recurrent endocarditis or reoperation was 89.4% ± 5.9% at 10 years. Conclusions In experienced centers, the Ross procedure is a reliable alternative to prosthetic or homograft valve replacement in young adults experiencing active aortic valve endocarditis, with a low operative risk and good long-term results.

The rate of head louse infestations is increasing. Most of the neurotoxic treatments are not reliably ovicidal and are faced with genetic resistance. The treatments based on a mechanical mode of action show no sufficient efficacy, transferring the chances of a cure on a tedious combing or leaving the hair fatty. This double-blinded, randomized, controlled, superiority trial evaluates the efficacy and safety of a novel mixture made of semi-crystalline polymers and plant extracts. Forty-five participants received a single application of either 1% Permethrin lotion or the novel lotion, applied for 15 minutes. Untreated and treated nits were collected and placed in an incubator during 10 days. The worst case intent-to-treat analysis found the novel lotion significantly more effective than 1% Permethrin, with 21/22 (95.5%) participants cured and 9/23 (39.1%), respectively (p &lt, 0.0001). Rate of viable nymphs was 0.5 (2.1) for the new lotion and 40.8 (20.4) for the 1% Permethrin. The new lotion cures head louse infestations, offering an effective alternative treatment, with a high efficacy for inhibiting the hatching of eggs. Its physical actions on lice and their eggs should not be affected by resistance to neurotoxic insecticides.

PURPOSE To quantify and compare the histological components and architectural patterns of Gleason grades in cancerous areas with restriction on apparent diffusion coefficient (ADC) maps. MATERIALS AND METHODS Twelve consecutive cases with 14 separate ADC restriction areas, positive for cancer in the peripheral zone (PZ) and transition zone (TZ) were included. All had 3 Tesla MRI and radical prostatectomy. Ten regions of interest (ROIs) within and outside the 14 ADC restriction areas positive for cancer were selected. For each ROI, we performed quantitative analysis of (a) prostate benign and malignant histological component surface ratios, including stroma, glands, epithelium, lumen, cellular nuclei; (b) percent of Gleason grades and measures of ADC values. Means of histological components according to ADC restriction for cancerous area were compared with analyses of variance with repeated measures. RESULTS Independent predictors of the probability of cancer were median epithelium/ROI ratio (P = 0.001) and nuclei/ROI ratio (P = 0.03). Independent predictors of the probability of ADC restriction were malignant glands/ROI and luminal space/ROI (P

International audience; The World Health Organization (WHO) and other international organisations, including the Food and Agriculture Organization of the United Nations, the World Organisation for Animal Health and the International Union Against Tuberculosis and Lung Disease recently called for formally assessing and (re)prioritising the burden of zoonotic tuberculosis (TB) in people, due to Mycobacterium bovis [1, 2]. Its global contribution to human TB, otherwise principally caused by Mycobacterium tuberculosis, might be underestimated [2]. Nationally representative prevalence data are virtually non-existent on continents with the highest presumed burdens, i.e. in Africa and Asia [3]. In addition to causing hard-to-diagnose extrapulmonary TB more frequently, M. bovis is naturally resistant to pyrazinamide [4], a crucial drug for the standard short-course anti-TB therapy. Due to reliability issues, phenotypic susceptibility to pyrazinamide is often not tested [5]. The most commonly used phenotypic and molecular diagnostics, including the WHO-endorsed GeneXpert MTB/RIF test (Cepheid, Sunnyvale, CA, USA), do not differentiate M. bovis from M. tuberculosis [1]. Thus, M. bovis-infected patients may receive inadequate treatment, risking poorer outcomes [6]. Underdiagnosis in people also implies the existence of undetected animal and food sources and zoonotic risks escaping common TB control measures [1, 2]. In Europe, patients with M. bovis infection are often African-or southern Mediterranean-born, suggesting regional endemicity [6, 7]. We determined the prevalence of M. bovis-caused TB in a survey including all TB patients reported to the national TB programme over an 18-month period in Lebanon. In addition to its national population and >1.5 million Syrian and Palestinian refugees, this Mediterranean country hosts large numbers of migrant workers from Africa and Asia [8]. Many are from Ethiopia [8], where proportions of extrapulmonary TB and M. bovis-caused disease among TB patients apparently culminate, reaching ∼30% [9] and 15-30% (in focal studies; [10]), respectively. We used a novel targeted next-generation sequencing-based assay for extensive drug resistance detection, including resistance to pyrazinamide, and genotypic differentiation between M. bovis and M. tuberculosis [11]. This survey was approved by the Azm Center/Lebanese University ethical committee (document CE-EDST-3-2016). Clinical samples were collected from all 1104 different TB patients with presumption of pulmonary or extrapulmonary TB, based on the presence of symptoms and prior tuberculin skin testing or radiological examination in local hospitals for a number of patients, and reported to all national anti-TB centres between June 1, 2016 and November 31, 2017. All of these 1104 patients were tested by at least one of the following assays: solid (Lowenstein-Jensen) and/or liquid (BBL MGIT; Beckton Dickinson, Franklin Lakes, NJ, USA) culturing, GeneXpert MTB/RIF on sputum, and Anyplex MTB/NTM Real-time (Seegene, Seoul, Republic of Korea) on sputum or culture on solid or liquid medium. Out of these 1104, 417 were confirmed as TB positive by GeneXpert and/or Anyplex. Among these 417 patients, 354 were culture positive. Among the 354 corresponding patients, 325 were new TB patients, 22 had a previous TB history, while TB history information was unavailable for seven patients. Available DNA extracts, obtained from 348 out of 354 primary cultures by using MasterPure™ DNA Purification Kit (Epicentre, Illumina, Madison, WI, USA), were subjected to targeted sequencing, more @ERSpublications In response to recent international calls, this study reveals the nationally representative prevalence of zoonotic tuberculosis in people in a non-high income country, highlighting the need for appropriate diagnostics and treatment of these patients http://bit.ly/2l3ydDh

Ethnopharmacological relevance The plant species reported here are used in contemporary phytotherapies by native and neo-urban societies from the Iquitenian surroundings (district of Loreto, Peruvian Amazon) for ailments related to microbial infections. Inhabitants of various ethnic origins were interviewed and 81 selected extracts were evaluated for their antimicrobial properties against a panel of 36 sensitive and multi-resistant bacteria or yeast. Medicinal plant researches in the Peruvian Amazon are now significant, but none of them has focused on an exhaustive listing of identified species tested on so many microbes with standardized experiments (to obtain MIC value). Aim of the study The aim of the study was to inventory the plants used against infections in the Loreto, an Amazonian region of Peru. It led to the new identification of secondary metabolites in two plant species. Materials and methods Ethnographic survey was carried out using “participant-observation” methodology and focus on bioprospecting of antimicrobial remedies. Selected plant extracts and antimicrobial drugs were tested in vitro with agar dilution method on 35 bacteria strains and 1 yeast to evaluate their Minimal Inhibitory Concentration (MIC). Microdilution methods using 96-well microtiter plates were used for the determination of MIC from isolated compounds, and cytotoxicity in HepG2 cells from some selected extracts were also evaluated. Activity-guided isolation and identification of compounds were performed by various chromatographic methods and structural elucidations were established using HRMS and NMR spectroscopy. Results This study outlined antimicrobial activities of 59 plant species from 33 families (72 single plant extracts and 2 fermented preparations), 7 mixtures, and one insect nest extract against 36 microorganisms. Of the 59 species analysed, 12 plants showed relevant antibacterial activity with MIC ≤0.15 mg/mL for one or several of the 36 micro-organisms (Aspidosperma excelsum, Brosimum acutifolium, Copaifera paupera, Erythrina amazonica, Hura crepitans, Myrciaria dubia, Ocotea aciphylla, Persea americana, Spondias mombin, Swartzia polyphylla, Virola pavonis, Vismia macrophylla). Examination by bioautography of E. amazonica, M. dubia and O. aciphylla extracts allowed the phytochemical characterization of antimicrobial fractions and compounds. Conclusion This study suggested an a posteriori correlation of the plant extract antimicrobial activity with the chemosensory cues of the drugs and attested that those chemosensory cues may be correlated with the presence of antimicrobial compounds (alkaloids, tannins, saponosids, essential oil, oleoresin …). It also led to the first isolation and identification of three secondary metabolites from E. amazonica and M. dubia

International audience; In a 12-month nationwide study on the prevalence of drug-resistant tuberculosis (TB) in Lebanon, we identified 3 multidrug-resistant cases and 3 extensively drug-resistant TB cases in refugees, migrants, and 1 Lebanon resident. Enhanced diagnostics, particularly in major destinations for refugees, asylum seekers, and migrant workers, can inform treatment decisions and may help prevent the spread of drug-resistant TB.

To quantitatively assess the risk of contamination by Pneumocystis depending on the degree of immunosuppression (ID) of the exposed rat hosts, we developed an animal model, where rats went through different doses of dexamethasone. Then, natural and aerial transmission of Pneumocystis carinii occurred during cohousing of the rats undergoing gradual ID levels (receivers) with nude rats developing pneumocystosis (seeders). Following contact between receiver and seeder rats, the P. carinii burden of receiver rats was determined by toluidine blue ortho staining and by qPCR targeting the dhfr monocopy gene of this fungus. In this rat model, the level of circulating CD4(+) and CD8(+) T lymphocytes remained significantly stable and different for each dose of dexamethasone tested, thus reaching the goal of a new stable and gradual ID rat model. In addition, an inverse relationship between the P. carinii burden and the level of circulating CD4(+) or CD8(+) T lymphocytes was evidenced. This rat model may be used to study other opportunistic pathogens or even co-infections in a context of gradual ID.

BACKGROUND During their studies, pharmacy students must acquire the specific skills in clinical virology required for their subsequent professional practice. Recent experiments on teaching and learning in higher education have shown that hybrid courses strengthen the students’ commitment to learning and enable high-quality knowledge acquisition. OBJECTIVE This study concerned the design and deployment of a hybrid course that combines face-to-face and Web-based instruction in clinical virology for fourth-year pharmacy students. The study’s objectives were to (1) measure the students’ level of involvement in the course, (2) gauge their interest in this type of learning, and (3) highlight any associated difficulties. METHODS The study included 194 fourth-year pharmacy students from the Lille Faculty of Pharmacy (University of Lille, Lille, France) between January and June 2017. The students followed a hybrid course comprising an online learning module and 5 tutorial sessions in which professional situations were simulated. The learning module and 3 online evaluation sessions were delivered via the Moodle learning management system. Each tutorial session ended with an evaluation. The number of Moodle log-ins, the number of views of learning resources, and the evaluation marks were recorded. The coefficient for the correlation between the marks in the online evaluation and those in the tutorials was calculated. The students’ opinions and level of satisfaction were evaluated via a course questionnaire. RESULTS The course’s learning resources and Web pages were viewed 21,446 and 3413 times, respectively. Of the 194 students, 188 (96.9%) passed the course (ie, marks of at least 10 out of 20). There was a satisfactory correlation between the marks obtained in the online evaluations and those obtained after the tutorials. The course met the students’ expectations in 53.2% of cases, and 57.4% of the students stated that they were able to work at their own pace. Finally, 26.6% of the students stated that they had difficulty organizing their work around this hybrid course. CONCLUSIONS Our results showed that pharmacy students were strongly in favor of a hybrid course. The levels of attendance and participation were high. However, teachers must be aware that some students will encounter organizational difficulties.

International audience; Three molecular assays (FTD® Viral GE from Fast-track diagnostics, RIDA®GENE VSP1 from R-Biopharm, and Xpert Norovirus from Cepheid) were compared for virus detection in acute diarrhea samples. RIDA®GENE and FTD® Viral GE showed perfect/almost perfect agreement for Rotavirus, Sapovirus and Norovirus, substantial agreement for Adenovirus, and moderate agreement for Astrovirus.

Pneumocystis pneumonia is a serious complication that may affect immunosuppressed patients. The absence of reliable and safe therapeutic alternatives to trimethoprim–sulfamethoxazole (TMP/SMX) justifies the search for more effective and less toxic agents. In this study, the in vitro and in vivo anti-Pneumocystis jirovecii activity of iclaprim, a diaminopyrimidine compound that exerts its antimicrobial activity through the inhibition of dihydrofolate reductase (DHFR), as does TMP, was evaluated alone or in combination with SMX. The antimicrobial activity of iclaprim was tested in vitro using an efficient axenic culture system, and in vivo using P. carinii endotracheally inoculated corticosteroid-treated rats. Animals were orally administered iclaprim (5, 25, 50 mg/kg/day), iclaprim/SMX (5/25, 25/125, 50/250 mg/kg/day), TMP (50 mg/kg/day), or TMP/SMX (50/250 mg/kg/day) once a day for ten consecutive days. The in vitro maximum effect (Emax) and the drug concentrations needed to reach 50% of Emax (EC50) were determined, and the slope of the dose–response curve was estimated by the Hill equation (Emax sigmoid model). The iclaprim EC50 value was 20.3 μg/mL. This effect was enhanced when iclaprim was combined with SMX (EC50: 13.2/66 μg/mL) (p = 0.002). The TMP/SMX EC50 value was 51.4/257 μg/mL. In vivo, the iclaprim/SMX combination resulted in 98.1% of inhibition compared to TMP/SMX, which resulted in 86.6% of inhibition (p = 0.048). Thus, overall, the iclaprim/SMX combination was more effective than TMP/SMX both in vitro and in vivo, suggesting that it could be an alternative therapy to the TMP/SMX combination for the treatment of Pneumocystis pneumonia.

Ensuring the correct administration of antineoplastic drugs is a constantly challenging task. Nowadays, several specific infusion devices have been marketed to decrease occupational exposure to these drugs through a post-administration rinsing step. As their impact on drug pharmacokinetics has never been evaluated, the objective of this study was to assess how the infusion process may alter the pharmacokinetics of antineoplastic drugs.We developed a prospective randomized multicenter pharmacokinetic study (ONCOPERF01) to compare the influence of three infusion techniques (gravity-fed infusion-GFI, infusion pump-IP, and gravity-fed infusion with post-administration rinsing-PAR) to assess the impact of both flow rate and post-administration rinsing on gemcitabine pharmacokinetics during three consecutive administrations. Gemcitabine pharmacokinetics was determined with a two-compartment model after plasma dosing with an HPLC-UV method. Statistical comparisons of the three groups were made using repeated-measure analysis of variance (PROC MIXED).Patients received gemcitabine by gravity-fed infusion (GFI, n = 9; IP, n = 9; PAR, n = 7). Significant differences were noted between infusion duration (GFI = 30.0 ± 2.6 min, IP = 29.1 ± 1.2 min, PAR = 33.7 ± 3.5 min; p = 0.003) and AUCt (GFI = 23.5 ± 8.2 µM h, IP = 25.4 ± 9.1 µM h, PAR = 28.5 ± 6.3 µM h; p = 0.0009), which was significantly higher in the infusion group with post-administration rinsing than in the other groups.The ONCOPERF01 study indicates that post-administration rinsing leads to a significant increase in patient exposure to gemcitabine, whereas controlling flow rate has no significance. Further surveys are required to assess the impact of such infusion techniques on other antineoplastic drugs.

Background Stentless porcine roots (SPV) have been proposed for right ventricular outflow tract reconstruction in the Ross procedure due to the relative availability of pulmonary homografts in large diameters. We report here our experience with SPV used in the Ross procedure. Methods Between March 1992 and February 2011, 360 patients had a Ross procedure; 61 patients received a SPV in pulmonary position and they represent the study population. Mean age was 38 ± 7.6 years. Indication for surgery was an infective endocarditis in 15 cases, there were 3 redo operations. Median SPV diameter was 29 mm (range, 25 to 29 mm). Pulmonary stenosis was defined as a peak transvalvular gradient of more than 50 mm Hg. Results Perioperative mortality was 4.9% (3 patients) and late mortality was 3.3% (2 patients). Median follow-up was 4 years (range, 7 days to 14.9 years). There was no reoperation on the right ventricle outflow tract, and freedom from pulmonary stenosis was 100% at 5 years. Mean transpulmonary gradients were 7.1 ± 3.1 mm Hg and 13.5 ± 6.8 mm Hg postoperatively and at 5 years, respectively. Mean transpulmonary gradient increased faster over time when the SPV diameter was less than 29 mm ( p = 0.03). Conclusions The SPV could represent an alternative to cryopreserved pulmonary homografts during the Ross procedure in adult patients. Hemodynamic results were improved by using large diameter SPV, but longer follow-up is mandatory to confirm those results.

International audience; Etoposide phosphate (EP; single injection, 60 mg/kg) followed by total body irradiation (TBI) at 12 Gy has been used as an allogeneic stem cell transplantation (allo-SCT) conditioning regimen for children since 2010. In our institution, EP has been suspected of leading to acute nephrotoxicity. The aim of this study was to assess the potential renal toxicity of EP in this context.A retrospective study was carried out on children hospitalized between 2007 and 2015 for allo-SCT with TBI-based myeloablative conditioning associated with cyclophosphamide (CY, 60 mg/kg/day × 2 days) or EP. The primary endpoint of the study was the occurrence of acute kidney injury (AKI). Additional endpoints were time to recovery for children with AKI, survival, and treatment-related mortality.Thirty-five patients were analyzed (CY: 22 vs. EP: 13). AKI occurred more frequently in the EP group than in the CY one (69% vs. 27%, adjusted odds ratio 6.0, 95% confidence interval [CI] [1.145; 31.445], P = 0.03). The median time to recovery was estimated at 3 days, 95% CI (2; 17), with CY and 11 days 95% CI (5; 18) with EP (adjusted hazard ratio of recovery for EP vs. CY 0.262, 95% CI [0.071; 0.969], P = 0.04). No significant difference was highlighted between the two treatments for survival or for treatment-related mortality.This study shows that EP at high dosage or one of its excipients is probably responsible for AKI, as compared to CY. Further studies are required to explore the origin of this adverse effect.

Introduction Breast cancer remains the leading cause of cancer death in French women in spite of continuously improving management. The objectives of this study were to analyse trends in the metastasis-free interval over the past 30 years and to identify the prognostic factors of survival, while accounting for time dependency. Methods A total of 1613 patients diagnosed with invasive non-metastatic breast cancer at Saint Vincent de Paul Hospital, Lille, France between 1977 and 2013, were followed for outcome (metastasis-free interval). Cohort entry time delay, a continuous temporal covariate, was defined to assess improvement of outcome. Data were analysed using the Cox proportional hazards model and presented as hazard ratio (HR). Results Metastatic disease developed during follow-up in 446 (27.6%) patients. Cohort entry time delay exhibited strong independent prognostic value while accounting for multiple prognostic factors including: tumour size (HR = 1.62, 95 %CI 1.37–1.91); rapid tumour growth (HR = 1.59, 95%CI 1.17–2.16); lymph node ratio (HR = 2.29, 95%CI 1.97–2.66); histological grade (grade 2 was significant only during the first 10 years after diagnosis, grade 3 and progesterone receptor status only during the first 5 years after diagnosis); and oestrogen receptor status (significant only during the first 8 years (HR = 0.75, 95%CI 0.58–0.96)). Conclusion The current study showed an improvement in the prognosis of breast cancer patients over the past 30 years and pointed to the importance of evaluating covariates with time-varying effects.

Background Closed system drug transfer devices (CSTD) may significantly reduce the contamination of isolators to antineoplastic drugs, 1 but persisting contamination remains. To date, no data are available to determine which of the CSTD or the cleaning process is mostly involved in contamination reduction. Purpose To describe the relative contribution of CSTD and the cleaning process in the control of occupational exposure inside isolators. Material and methods A comparative and prospective study was performed over 6 months in a new compounding unit equipped with two new isolators. Spikes and needles were used in one isolator and a CSTD (BD-Phaseal, Becton-Dickinson) was used in the other one. A standard biocide (Surfa’safe, Anios, Lezennes, France) was used daily in both isolators. 10 drugs (cyclophosphamide, cytarabine, dacarbazine, doxorubicin, fluorouracil, ganciclovir, gemcitabine, ifosfamide, irinotecan and methotrexate) were monitored on three locations inside each isolator: gloves, workbench and window. Drugs were alternatively compounded in one or the other isolator between even and odd days. Sampling was performed before and after the daily cleaning on 24 sampling days progressively spaced over 6 months during the study. Monitoring was performed by a validated LC-MS/MS method. Probability of contamination for each drug was analysed using logistic models with repeated measures (PROC GLIMMIX, SAS version 9.4, SAS Institute Inc., Cary, NC, USA). Results Since dacarbazine, doxorubicin, irinotecan and methotrexate were never or very rarely retrieved, our analysis included 6 drugs. For cyclophosphamide, cytarabine, ganciclovir and ifosfamide, the use of a CSTD was significantly associated with a risk reduction of contamination, either independently of other predictors or in interaction with time, leading to a risk reduction from about 70% for cytarabine to 98% for ganciclovir. For all drugs, except cyclophosphamide, the cleaning process alone or in interaction with time and/or localisation was significantly associated with a reduction in contamination by about 30% for gemcitabine to 80% for ifosfamide. Conclusion This study shows that the CSTD plays a major role for most drugs in controlling the occupational exposure inside isolators. Combining a CSTD and an improved decontamination process is required to remove the residual contamination by antineoplastic drugs. References and/or acknowledgements Simon, et al. PLOS One2016. Conflict of interest: Corporate sponsored research or other substantive relationships: The study was funded by Becton-Dickinson laboratories. Data analysis and interpretation, and the writing of all scientific communications, were performed independent of the funder.

SummaryBackgroundThe increasing number of obese patients eligible for cardiac surgery requires risks and benefits to be balanced in this population.AimsTo study the results of cardiac surgery in severely obese patients (body mass index [BMI]≥35kg/m2).MethodsIn this retrospective study of 3564 patients undergoing elective cardiac surgery between 2004 and 2012, the population was divided into two groups: BMI 20–34.9kg/m2 (n=3282) and BMI≥35kg/m2 (n=282). Patients with BMI

SummaryBackgroundOwing to the heterogeneous population of patients with acute coronary syndromes (ACS), risk stratification with tools such as the GRACE risk score is recommended to guide therapeutic management and improve outcome.AimTo evaluate whether anaemia refines the value of the GRACE risk model to predict midterm outcome after an ACS.MethodsA prospective registry of 1064 ACS patients (63±14years; 73% men; 57% ST-segment elevation myocardial infarction [MI]) was studied. Anaemia was defined as haemoglobin less than 13mg/dL in men or less than 12mg/dL in women. The primary endpoint was 6-month death or rehospitalization for MI.ResultsThe primary endpoint was reached in 132 patients, including 68 deaths. Anaemia was associated with adverse clinical outcomes (hazard ratio 3.008, 95% confidence interval 2.137–4.234; P5–10%) or high risk (>10%); 79.5% patients at intermediate risk were reclassified as low (55%) or high risk (24%); and 45.5% patients at high risk were downgraded to intermediate risk. Overall, 174 patients were reclassified into a higher risk category (17.3%) and 421 into a lower risk category (41.9%).ConclusionAnaemia provides independent additional prognostic information to the GRACE score. Combining anaemia with the GRACE score refines its predictive value, which often overestimates the risk.

BACKGROUND Management of acute coronary syndromes in elderly patients is poorly defined. OBJECTIVE To assess the impact of functional decline on all-cause mortality in elderly patients with acute coronary syndromes. METHOD Clinical data, including the Global Registry of Acute Coronary Events score and assessment of functional status obtained by using the Katz scale, were prospectively collected on 272 patients 70 years or older hospitalized for acute coronary syndromes. All-cause mortality was assessed at 6 months, and longer term outcome data were obtained. RESULTS Mean age of the patients was 78 years (SD, 6), and 58% were men. A total of 28% had functional decline. Six months after the index hospitalization, 38 patients had died. Another 29 patients died during a median follow-up of 611 days after the initial 6 months. Functional decline was associated with both 6-month (hazards ratio, 3.63; 95% CI, 1.91-6.88; P < .001) and long-term (hazards ratio, 2.69; 95% CI, 1.28-5.64; P = .009) outcomes. Functional decline remained associated with both 6-month and long-term outcomes in multivariate analysis and was systematically selected in the most predictive multivariate models for 6-month and long-term mortality. The multivariate model including the Global Registry of Acute Coronary Events score and functional decline was predictive of 6-month mortality, but the combination of functional decline and biological data was more predictive of long-term mortality than was a model combining functional decline and the Global Registry score. CONCLUSIONS Functional decline in elderly patients with acute coronary syndromes is predictive of poor outcomes.

To quantify and compare the histological components and architectural patterns of Gleason grades in cancerous areas with restriction on apparent diffusion coefficient (ADC) maps.Twelve consecutive cases with 14 separate ADC restriction areas, positive for cancer in the peripheral zone (PZ) and transition zone (TZ) were included. All had 3 Tesla MRI and radical prostatectomy. Ten regions of interest (ROIs) within and outside the 14 ADC restriction areas positive for cancer were selected. For each ROI, we performed quantitative analysis of (a) prostate benign and malignant histological component surface ratios, including stroma, glands, epithelium, lumen, cellular nuclei; (b) percent of Gleason grades and measures of ADC values. Means of histological components according to ADC restriction for cancerous area were compared with analyses of variance with repeated measures.Independent predictors of the probability of cancer were median epithelium/ROI ratio (P = 0.001) and nuclei/ROI ratio (P = 0.03). Independent predictors of the probability of ADC restriction were malignant glands/ROI and luminal space/ROI (P 0.0001). Effect of malignant glands/ROI area was different according to the localization of the ROI (P = 0.03). We observed an overall difference between the means for all of the histological components for the comparison of true positive and false negative (P 0.0001), except for the percent of Gleason grade 4 (P = 0.18). In TZ cancers, a predominant grade 3 pattern was associated with low ADC values. In PZ cancers, a predominant grade 4 pattern was associated with low ADC values.Determinants of low ADC were high ratio of malignant glands/ROI area which may be seen in Gleason grades 3 or 4 cancers.3 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2017;46:1786-1796.

Resume Introduction Les deformations les plus frequentes de la paroi thoracique affectent le plastron sternocostal. Leur origine est une hypertrophie en longueur de certains cartilages costaux. Nous avons evalue les resultats anatomiques, esthetiques et fonctionnels cardiopulmonaires d’une technique de sternochondroplastie, basee sur la resection sous-perichondrale des cartilages hypertrophies en longueur. Hypothese Cette technique de sternochondroplastie est une reponse adaptee a toutes les variantes anatomiques de deformations de la paroi thoracique anterieure. Patients et methode D’octobre 2001 a septembre 2009, 205 adultes (171 hommes et 34 femmes) ont ete operes de pectus excavatum (181), pectus carinatum (19) et pectus arcuatum (5) et l’ensemble des donnees pre-, per- et postoperatoires de ces patients a ete analyse, apres avoir ete recueilli dans une base de donnees informatisee. Les resultats ont ete apprecies avec un recul minimum de deux ans. Resultats L’intervention etait peu invasive, la morbidite faible et il n’y avait pas de mortalite. Les resultats esthetiques etaient classes excellents (72,5 %), bons (25 %) et moyens (2,5 %). Les patients avaient une appreciation encore plus positive de leur resultat. Dans le pectus excavatum, nous avons observe une plus grande frequence de permeabilite echographique du foramen ovale (17,5 %), qui s’obturait dans 61 % des cas apres intervention, ainsi qu’une amelioration statistiquement significative de la fonction cardiovasculaire a l’exercice apres chirurgie. Discussion La sternochondroplastie basee sur la resection sous-perichondrale des cartilages hypertrophies en longueur, procure des resultats esthetiques satisfaisants dans les differents types de deformation de la paroi thoracique anterieure. De plus, elle corrige les desordres fonctionnels frequemment associes au pectus excavatum. Elle devrait contribuer a une prise en charge effective de ces deformations, actuellement faible au regard de leur prevalence. Niveau de preuve Etude de cohorte descriptive IV.

Background The risk of reoperation on the autograft and homograft is the major long-term drawback of the Ross procedure. The incidence and clinical implications of reoperations after the Ross procedure are reported. Methods Between March 1992 and February 2010, 336 consecutive patients had a Ross procedure (mean follow-up, 6.2 ± 4.9 years). Autograft implant technique was freestanding root replacement in 269 patients, subcoronary implantation in 52 patients and a modified root replacement with the autograft included in a Valsalva tube graft in 15. Results Subsequently, 38 patients (11.3%) underwent reoperations, for autograft dilatation in 23 and a significant autograft insufficiency in 9, at 9.6 ± 3.7 years and 2.6 ± 3.9 years, respectively. Aortic and pulmonary infective endocarditis occurred in 3 patients. Three patients underwent a non valve-related cardiac reoperation. Three patients received a transcatheter pulmonary valve implantation after 12.2 ± 1.7 years. At 15 years, freedoms for autograft and homograft explantation (with 95% confidence interval) were 83.3% (77.4%- to 9.2%) and 92.8% (87.6% to 97.9%), respectively. Native aortic valve regurgitation, indexed aortic annulus diameter exceeding 1.35 cm/m 2 and autograft diameter were risk factors for dilated autograft reoperation (hazard ratio, 3.23 [95% confidence interval, 1.19 to 8.81], p = 0.02; 3.83 [0.9 to 16.33], p = 0.07 and 1.2 per mm [1.01 to 1.41], p = 0.03), respectively. Conclusions Autograft dilatation was the leading cause of reoperation in patients who underwent root replacement. Long-term follow-up is mandatory to determine whether modifications of the operative technique could limit autograft dilatation.

In this work, we analyzed the prognostic significance of changes in hemoglobin during intensive care unit (ICU) stay in patients with acute coronary syndromes (ACS). We prospectively enrolled 591 patients (62 ± 14 years old, 73% male, 48% ST elevated myocardial infarction) free of blood cell transfusion or bleeding events. Changes in hemoglobin between admission and ICU discharge were obtained. The primary endpoint was death or hospitalization for MI within 6 months. Hemoglobin decreased from 13.65 ± 1.77 to 13.17 ± 1.74 g/dl, p 0.0001 in the whole population. The end point was reached in 43 patients at a mean follow-up of 180 (range 2-180 days). A decrease in hemoglobin ≥0.9 g/dl (32% of the population) was associated with adverse clinical outcomes (HR 2.37, 95% CI (1.30-4.35), p = 0.005, respectively). In multivariate analysis, age77 year-old (p = 0.0016), Killip class ≥2 (p = 0.009), anemia (p = 0.0064), decreased estimated glomerular filtration rate (p = 0.003), and hemoglobin decline ≥0.9 g/dl (p 0.0001) were independently associated with outcome. Hemoglobin decline and anemia both provided additional prognostic information on top of the GRACE score, as demonstrated by a systematic improvement in model global fit, discrimination, and calibration. Hemoglobin decline is frequent during ICU stay in non-bleeding ACS patients. A decline in hemoglobin ≥0.9 g/dl identifies high-risk patients. Identification of these patients refines the prognostic value of the GRACE score.

The present study was designed to build and validate a composite score based on the Global Registry of Acute Coronary Events (GRACE) score and B-type natriuretic peptide (BNP) concentrations to predict outcome in patients with acute coronary syndromes (ACS).The GRACE risk score and BNP concentrations were obtained in a retrospective and a prospective cohort. A composite score including the GRACE score and BNP concentrations was first developed in a retrospective cohort of 248 patients with ACS and then validated in a prospective cohort of 575 patients. The primary outcome was 6-month death or myocardial infarction.End points were reached in 34 patients in the retrospective cohort and in 68 patients in the prospective cohort. Both higher BNP concentration and GRACE score were independently associated with outcome in the retrospective cohort (p=0.003 and p0.0001). The composite score could be obtained as follows: GRACE+BNP/60. The use of the composite score increased the accuracy of the GRACE score, with an increase in the C statistic from 0.810 (0.727 to 0.892) to 0.822 (0.745 to 0.902) in the retrospective cohort and from 0.724 (0.657 to 0.791) to 0.750 (0.686 to 0.813) in the prospective cohort. Finally, 7% of patients in the prospective study population were reclassified from low to high risk or from high to low risk using this composite score.Plasma BNP levels refine the accuracy of the GRACE score. A comprehensive risk score, which includes BNP concentration and the GRACE risk score, might improve ACS risk stratification in clinical practice.

Background. Functional renal impairment is a common feature of heart failure with preserved ejection fraction (HFpEF). The link between functional renal impairment and HFpEF remains incompletely understood. With hypertension and diabetes as frequent co-morbidities, patients with HFpEF are at risk of developing intra-renal vascular hemodynamic alterations that may lead to functional renal impairment and impact on prognosis. Methods. Renal resistive index (RRI) was non-invasively determined by Doppler ultrasonic examination in 90 HFpEF patients and 90 age- and sex-matched hypertensive patients without evidence of heart failure (HF) who served as controls. Clinical, laboratory and cardiac echocardiography data were obtained in HFpEF patients and controls. To investigate its possible clinical relevance, RRI was evaluated as a prognostic index of all-cause mortality and hospitalization for HF. Results. Mean RRI was substantially greater in HFpEF patients than in controls (P < 0.0001), while mean blood pressure, glomerular filtration rate, hemoglobin and serum protein levels were significantly lower in HFpEF patients than in controls. On multivariable analysis, mean RRI was independently associated with HFpEF. In addition, increased mean RRI was an independent predictor of poor outcome [hazard ratio ¼ 1.06 95% confidence interval (1.01–1.10), P ¼ 0.007] and remained significantly associated with the outcome after adjustment for univariate predictors that included low mean blood pressure, low hemoglobin concentration and low glomerular filtration rate. Conclusion. Patients with HFpEF exhibit intra-renal vascular hemodynamic alterations. The severity of intra-renal vascular hemodynamic alterations correlates with a poor outcome.

Background This study was designed to assess the early and long-term results, and determine suitable indications of anterior mediastinal tracheostomy, after radical resection for cervicothoracic malignancies. Methods From 1985 to 2009, 13 patients ranging in age from 40 to 75 years underwent an anterior mediastinal tracheostomy for malignancy, 2 as an isolated procedure, 5 with concomitant laryngectomy, and 6 with concomitant laryngopharyngoesophagectomy. The patients had subglottic carcinoma, proximal tracheal carcinoma invading the subglottic larynx (n = 6), stomal recurrence following laryngectomy (n = 4), esophageal carcinoma invading the proximal trachea (n = 2), or tracheal recurrence after conventional resection (n = 1). The postoperative course and outcome were assessed in all patients. Results In 5 patients, the postoperative course was uneventful. There were 2 in-hospital deaths, and 6 patients experienced nonfatal complications including three pharyngocutaneous fistulas, two pharyngogastric or pharyngocolic anastomotic leaks, and one pulmonary embolism. Satisfactory airway was achieved in 7 patients presenting with proximal obstruction, and ability to tolerate oral feeding, in 2 patients with esophageal carcinoma. The mean follow-up time for survivors was 89 months (range, 9 to 201 months). Patients with esophageal carcinoma or recurrence of tracheal carcinoma showed a poor outcome. In contrast, in the subgroup of patients with head and neck malignancy, 3-year and 5-year survival rates were 57% and 43%, respectively. Conclusions Our results and survival analysis from the literature suggest that suitable indications for anterior mediastinal tracheostomy are (1) carcinoma of the subglottic region or proximal trachea invading the subglottic larynx, (2) stomal recurrence after laryngectomy, and (3) well-differentiated thyroid carcinoma invading the trachea or recurrence.

Objectifs L’imagerie IRM a recemment ameliore le diagnostic des cancers prostatiques. Il y a peu de donnees publiees concernant les resultats anatomopathologiques des cas de prostatectomies totales (PT) pour cancer anterieur detectes par IRM. L’objectif de notre etude est de faire un recueil et une analyse comparative des cancers anterieurs et posterieurs a l’aide des donnees des resultats anatomopathologiques des PT, incluant la localisation et l’etendue des foyers tumoraux et des marges d’exerese chirurgicales (MCP). Methodes Etude de cohorte incluant tous les patients operes d’une PT de janvier 2009 a juin 2016, pour cancer, et ayant beneficie d’une IRM prostatique systematique et de biopsies dirigees en cas de presence d’une lesion non echantillonnee par les biopsies systematisees (notamment en cas de lesion anterieure). Recueil effectue dans une base de donnees des resultats anatomopathologiques des PT : localisation, taille (grand axe), grade tumoral du foyer principal (FP) et secondaire (FS) eventuel, localisation des marges chirurgicales positives et taille des MCP (focales ou etendues, si > 3 mm). Un cancer anterieur etait defini par la presence d’un FP anterieur. Analyse par test du Chi2 et de test de Student. Resultats Au total, 1002 patients ont ete inclus. L’âge median etait de 63 ans (59–8), le PSA median de 6,8 ng/mL (5,2–9,5). Le FP etait anterieur dans 13 % des cas (n = 129). Dans 75 % (745) des cas, il existait un FS. Le FS etait anterieur dans 13 % des cas (n = 92), posterieur dans 85 % des cas (638) et non precise dans 2 % des cas. Le grand axe tumoral etait de 16 mm (12–22) pour les FP posterieurs et 20 mm (15–24) pour les FP anterieurs (p = 0,0006). On retrouvait plus de MCP etendues lorsque le FP etait anterieur (19,1 % vs 12,1 %, p = 0,04). Il n’existait pas de difference entre le grade (p = 0,46) et le stade (p = 0,71) tumoral des FP anterieurs vs posterieurs ( Fig. 1 ). Conclusion L’analyse de cohorte de prostatectomies totales pour cancer diagnostique par IRM et biopsies a permis de mettre en evidence que les cancers anterieurs etaient de meme grade que ceux de localisation posterieure, mais avaient un plus grand axe tumoral et un taux de MCP etendues plus important. L’impact de ces donnees sur la survie sans recidive biologique doit etre etudie apres un delai de suivi d’au moins 5 ans.

The separation of Pneumocystis carinii life-cycle stages while preserving infectivity is a hitherto unresolved challenge. We describe an original, reproducible, and efficient method for separating trophic from cystic forms of P. carinii using a high-speed cell sorter. The large amounts of highly purified (99.6+/-0.3%) infectious trophic and cystic forms can now be used to elucidate the poorly understood P. carinii life cycle.

Background: Patients with chronic heart failure (CHF) due to left ventricular systolic dysfunction (LVSD) may develop pulmonary hypertension at rest and during exercise. The cardiac correlates of pulmonary hypertension have been ascertained in the resting state, but seldom during exercise in these patients. Aims: We sought to determine the cardiac correlates of exercise induced pulmonary hypertension in patients with LVSD by monitoring the estimated pulmonary artery systolic pressure (PASP) by continuous Doppler echocardiography during semirecumbent bicycle exercise. Methods: Eighty-five patients (mean age 57 ± 13 years, 75% male) with CHF due to LVSD (LV ejection fraction [EF]

Resume Dans un modele de regression non parametrique avec fonction de regression monotone et erreur, la probabilite de franchissement d'un seuil pour la variable reponse est definie en fonction d'un seuil sur la variable explicative. Des estimateurs de cette fonction de probabilite et de ses quantiles sont definis et leurs proprietes asymptotiques sont etablies pour des observations dependantes. Pour citer cet article : C. Pincon, O. Pons, C. R. Acad. Sci. Paris, Ser. I 344 (2007).

Objective The purpose of this study was to compare renal outcomes (glomerular filtration rate [GFR] and renal volume) after endovascular aneurysm repair (EVAR) and open repair (OR) of abdominal aortic aneurysm (AAA). Methods All AAA repairs performed between November 2009 and July 2011 were included in this retrospective study. Patients requiring suprarenal clamping and renal bypass or reimplantation and patients requiring fenestrated endografting were excluded from the OR and EVAR groups, respectively. All EVARs were performed with transrenal proximal fixation. Renal volume (calculated with a three-dimensional workstation) and GFR (estimated with the Modification of Diet in Renal Disease formula) were evaluated before the procedure, at 12 months after the procedure, and yearly thereafter. Results The study included 90 patients (41 ORs and 49 EVARs). Both groups were comparable except for age at intervention, body mass index, smoking, peripheral arterial disease, arrhythmia, and vitamin K antagonist treatment. Median follow-up was 2.8 years for OR (2.5-2.9 years) and 3.2 years for EVAR (3.0-3.4 years). In both groups, we found a significant decrease when comparing postoperative estimated GFR with 1-year (14.4% decrease [3.8%-23.8%]; P = .002) and 3-year (12.8% decrease [3.8%-20.9%]; P = .0007) levels. In both groups, total renal volumes significantly diminished. Median preoperative total renal volume (372 cm 3 [311-349]) significantly decreased (6.7% [2.8%-10.5%]; P = .008) between 1 year and 2 years of follow-up. Conclusions Renal function impairment is similar after open and endovascular AAA repair. It is associated with a decrease in total renal volume, which seems to be an early and constant marker of postoperative renal impairment.

International audience; BACKGROUND: Identification of the culprit genes underlying multifactorial diseases is one of the most important current challenges of molecular genetics. While recent advances in genomics research have accelerated the discovery of susceptibility genes, much remains to be learned about the functions of disease-associated genetic variants. Recently, Moore and co-workers identified, in the donor genome, an association between a common genetic variant (rs4730751) in the gene encoding caveolin-1 (CAV1), a major structural component of caveolae, and long-term allograft survival.METHODS: Four hundred seventy-five renal recipients consecutively transplanted were included in this study. Donor genomic DNA was extracted and used to genotype CAV1 rs4730751 Single Nucleotide Polymorphism.RESULTS: Patients receiving a graft carrying CAV1 rs4730751 AA genotype displayed a significant decrease in estimated glomerular filtration rate and a significant increase in serum creatinine in both univariate and multivariate analyzes. Moreover, patients receiving a graft with CAV1 AA genotype significantly developed more interstitial fibrosis lesions on systematic biopsies performed 3 months post-transplantation.CONCLUSIONS: Genotyping of CAV1 may be relevant to identify patients at risk of adverse renal transplant outcome.

Cet article se propose d'examiner les benefices du traitement beta-bloquant dans le syndrome coronaire aigu a travers les principaux essais cliniques ayant evalue cette therapeutique. Le benefice de l'utilisation precoce du traitement beta-bloquant intra-veineux a la phase aigue de l'infarctus du myocarde (IDM) apparait desormais mince. Le benefice substantiel du traitement beta-bloquant prescrit a long-terme dans le post-infarctus du myocarde a ete demontre essentiellement par des essais cliniques menes avant l'ere de la reperfusion et dans tous les cas avant l'introduction de l'angioplastie primaire associee aux puissants traitements antiagregants plaquettaires. Son benefice et par consequent sa prescription a long-terme peuvent etre raisonnablement remis en question chez les patients revascularises et ayant une fonction ventriculaire gauche conservee, d'autant plus si des effets secondaires apparaissent.

We developped a multivariate version of weighted logrank tests to compare two multivariate time-to-event distributions; our method is based on the marginal approach, and uses martingale properties. Our results can be extended to the study of several risk factors in a multivariate proportional hazard model. To cite this article: C. Pincon, C. R. Acad. Sci. Paris, Ser. I 338 (2004).