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Immune checkpoint blockade (ICB) of PD-1 and CTLA-4 to treat metastatic melanoma (MM) has variable therapeutic benefit. To explore this in peripheral samples, we characterized CD8+ T cell gene expression across a cohort of patients with MM receiving anti-PD-1 alone (sICB) or in combination with anti-CTLA-4 (cICB). Whereas CD8+ transcriptional responses to sICB and cICB involve a shared gene set, the magnitude of cICB response is over fourfold greater, with preferential induction of mitosis- and interferon-related genes. Early samples from patients with durable clinical benefit demonstrated overexpression of T cell receptor–encoding genes. By mapping T cell receptor clonality, we find that responding patients have more large clones (those occupying >0.5% of repertoire) post-treatment than non-responding patients or controls, and this correlates with effector memory T cell percentage. Single-cell RNA-sequencing of eight post-treatment samples demonstrates that large clones overexpress genes implicated in cytotoxicity and characteristic of effector memory T cells, including CCL4, GNLY and NKG7. The 6-month clinical response to ICB in patients with MM is associated with the large CD8+ T cell clone count 21 d after treatment and agnostic to clonal specificity, suggesting that post-ICB peripheral CD8+ clonality can provide information regarding long-term treatment response and, potentially, facilitate treatment stratification. Transcriptomic analysis of peripheral CD8+ T cells in a cohort of patients with metastatic melanoma receiving checkpoint inhibitors shows that the number of large clones early post-treatment is strongly associated with six-month clinical outcome.

IL-7 is a key factor in T cell immunity and common variants at IL7R, encoding its receptor, are associated with autoimmune disease susceptibility. IL7R mRNA is induced in stimulated monocytes, yet a function for IL7R in monocyte biology remains unexplored. Here we characterize genetic regulation of IL7R at the protein level in healthy individuals, and find that monocyte surface and soluble IL7R (sIL7R) are markedly induced by lipopolysaccharide. In monocytes, both surface IL7R and sIL7R expression strongly associate with allelic carriage of rs6897932, a disease-associated IL7R polymorphism. Monocytes produce more sIL7R than CD4 + T cells, and the amount is additionally correlated with the expression of DDX39A, encoding a splicing factor. Synovial fluid-derived monocytes from patients with spondyloarthritis are enriched for IL7R+ cells with a unique transcriptional profile that overlaps with IL-7-induced gene sets. Our data thus suggest a previously unappreciated function for monocytes in IL-7 biology and IL7R-associated diseases., Interleukin-7 (IL-7) is a central cytokine in T cell homeostasis. Here the authors show that allelic variation at rs6897932, an autoimmune GWAS risk allele at IL7R, regulates surface and soluble IL-7R in stimulated monocytes, indicating a function of monocytes in IL-7-related autoimmunity.

Background: Transthyretin Amyloidosis (ATTR) is a common cause of both cardiomyopathy and carpal tunnel syndrome, with many patients needing carpal tunnel release (CTR). Although tafamidis is now an approved treatment of ATTR cardiomyopathy, insurers in most provinces require biopsy confirmation of amyloidosis. Endomyocardial biopsy is often the chosen approach due to optimal sensitivity, albeit with risk of serious adverse events such as stroke, cardiac tamponade, and arrhythmias. CTR may present an ideal opportunity for obtaining amyloidosis biopsy confirmation. Methods: ATTR patients undergoing CTR had biopsy of their transverse carpal ligament (TCL) and/or flexor tenosynovium to assess the sensitivity of both sites for biopsy confirmation of amyloidosis. Results: Twelve patients consecutively underwent biopsies during CTR, with 4 (33%) having bilateral CTR and biopsy. Among 16 TCL biopsies and 14 tenosynovium biopsies, 100% demonstrated amyloid deposition. Another patient had isolated tenosynovium biopsy without CTR and also demonstrated amyloidosis. There were no serious adverse events, and 1/13 (8%) had wound dehiscence requiring repeat suturing. Conclusions: Biopsy of the TCL and/or tenosynovium during CTR is safe, cost-effective, and sensitive, and may represent an alternative to endomyocardial biopsy in patients requiring tissue confirmation for tafamidis approval. ATTR patients eligible for tafamidis may benefit from early neurology assessment.

Drug addiction causes chronic wounds (CW) responsible for severe complications. Very few studies are available on this topic. The aim of our study was to describe the demographic, clinical and etiological characteristics as well as the course of CW in drug addicts.This was a retrospective and prospective multicenter study including all drug addicts with CW.We included 58 patients (17 prospectively), 84.5% of whom were male, of median age 43 years, presenting multiple CW as a result of intravenous (78.2%), inhaled (41.1%) and/or snorted (20%) drug abuse. Addiction to opioids (68.4%), cocaine (47.4%) and/or cannabis (40.4%) was ended and/or treated through substitution in 79.3% of patients. CW were fibrinous and necrotic (42.9 to 53.6%), recurrent (54.2%), and in some cases had been present for more than 1 year (61.5%). Intravenous drug addiction was associated with large, fibrinous, ulcers in a setting of venous and lymphatic insufficiency (74%). Only 23% of these wounds involved the upper limbs. Necrotic ulcers associated with clinical arteriopathy were described mainly with inhaled addiction. Abscesses (50%) and erysipelas (29.3%) were the most common cutaneous complications. After 3 months, 50% of CW were improved and 29.2% of patients were lost to follow-up.Drug abuse-related CW occurred preferentially in young men with history of intravenous abuse. For the most part, CW were seen on the legs and were associated with venous and lymphatic insufficiency, and the resulting major risk for cutaneous infection increased morbidity and mortality in this population in whom medical follow-up is inherently complicated.

Background Interleukin 7 (IL-7) plays a key role in T cell survival and proliferation. Both cell-surface expressed and soluble forms of the IL-7 receptor (sIL7R) are recognised. sIL7R has been shown to prolong IL-7 activity in inflammation(. 1 IL7R polymorphisms are associated with multiple inflammatory diseases including ankylosing spondylitis(AS). Higher levels of circulating sIL7R are present in those carrying the risk variant but the cellular sources of soluble IL7R are unclear. Expression quantitative trait loci (eQTL) studies have shown genetically regulated IL7R gene upregulation in monocytes after innate immune stimuli(. 2 Objectives This study aims to characterise the genotypic effects of IL7R polymorphism on monocyte protein surface expression and sIL7R release. Methods Monocyte cell surface IL7R expression was measured by flow cytometry in the presence or absence of LPS or TNF in a cohort of volunteers recruited from the Oxford biobank. Soluble IL7R was quantified by ELISA in purified monocyte cultures stimulated with LPS. RNA sequencing was performed for 8 paired samples of control and recombinant IL-7 exposed stimulated monocytes. Results Surface IL7R expression was induced after 24 hours of LPS stimulation both in isolated monocytes (n=84, p= ex-vivo staining of monocytes from inflamed synovial fluid of SpA showed significant upregulation of IL7R compared to paired PBMC monocytes (n=4, p= Conclusions Monocytes upregulate IL7R expression and soluble IL7R secretion after LPS treatment in a functional, genotype- and TNFalpha-dependant manner. SpA synovial monocytes express IL7R suggesting preactivation. These data draw attention to an unappreciated key myeloid role for AS risk variants at IL7R. References [1] Lundstrom W, et al. PNAS 2013. [2] Fairfax BP, et al. Science 2014. Acknowledgements BPF and PB contributed equally to this work Disclosure of Interest None declared

Background Immune Checkpoint blockade for the treatment of metastatic melanoma is associated with highly variable clinical outcomes between individuals in terms of both oncological benefit and immune-related adverse events. Early markers of response are urgently sought. Whereas numerous intra-tumoural determinants of sensitivity to immunotherapy are known, the identification of peripheral predictors of response is limited. We aimed to characterize the CD8+ T-cell transcriptomic and clonal changes to treatment across a large cohort of patients in an effort to gain further insight into the peripheral markers of response. Methods We performed paired-end 75bp read RNA-sequencing to assay the peripheral CD8+ response at baseline and across multiple cycles of treatment (n = 105 patients, 69 controls, 315 separate transcriptomes). We validated identified clonal subsets indicative of response using 10X Chromium single cell sequencing (16 samples, 8 patients), flow-cytometry and targeted PCR. Results After adjusting for multiple testing, we identify >5,800 transcripts induced by treatment. These fall into discrete gene modules, with several markedly diverging between combination immunotherapy and anti-PD1 alone. Patients demonstrating a durable radiological response to checkpoint immunotherapy (absence of progression at 6 months) have significantly increased numbers of large peripheral CD8+ circulating clones by day 21 after treatment, compared to non-responders and controls. We replicate this observation in a separately recruited cohort. Large peripheral clones have a distinct gene expression profile, characterized by high expression of CCL5, BCL2L1and NKG7 amongst other genes. Conclusions We identify robust and reproducible predictors of 6 month clinical and radiological responses to immune checkpoint blockade in the transcriptomes of peripheral circulating CD8+ T-cells from metastic melanoma patients after 21 days of treatment. These observations can be used to further our understanding of determinants of patient response, and may provide a mechanism for early treatment stratification of patients with a non-favourable peripheral profile. Legal entity responsible for the study Oxford Radcliffe Biobank. Funding Wellcome Trust, Oxford NIHR Biomedical Research Centre, Cancer Research UK. Disclosure All authors have declared no conflicts of interest.

The race-specific peptide elicitor AVR9 of the fungal pathogen Cladosporium fulvum specifically induces a hypersensitive response in tomato genotypes carrying the complementary resistance gene Cf-9. The total chemical syntheses of this 28-residue AVR9 peptide containing three disulfide bonds, and of three mutant peptides [R8K]AVR9, [F10A]AVR9 and [F21A]AVR9, have been accomplished. The syntheses were carried out using a stepwise solid-phase approach based on tBoc chemistry. The disulfide bridges were formed by air oxidation. The correctness of the chemical structure of all folded synthetic peptides was confirmed by combined NMR and MS analyses. The biological activity and a number of physicochemical properties of folded synthetic AVR9 are identical to those of native fungal 28-residue AVR9. The overall conformations of the folded synthetic mutant peptides were comparable to that of synthetic wild-type AVR9 as demonstrated by NMR spectroscopy. Mutant [R8K]AVR9 showed a threefold higher, and mutant [F10A]AVR9 a threefold lower necrosis-inducing activity when compared to synthetic wild-type AVR9. However, mutant [F21A]AVR9 showed hardly any necrosis-inducing activity. Affinity for polyclonal antibodies raised against native fungal AVR9 is positively correlated with the necrosis-inducing activity of the synthetic AVR9 peptides ([R8K]AVR9 > wild-type AVR9 > [F10A]AVR9 > [F21A]AVR9).

The CIS by electrodeposition (CISEL) project between Electricite de France (EDF), Centre National de la Recherche Scientifique (CNRS)/Ecole Nationale Superieure de Chimie de Paris (ENSCP) and Saint-Gobain Recherche (SGR) aims at developing a low-cost electrodeposition process for Cu(In,Ga)(S,Se) 2 (CIGS) solar cells. The process is characterized by two main steps: (i) deposition of the precursor film and (ii) thermal annealing. This process enables the preparation of a large range of sulfur containing absorbers, with S/(S+Se) atomic ratio from 0% to more than 90%. The films are single phase over the whole composition range. The influence of Sulfur content on the microstructure has been shown with grain sizes decreasing with increasing sulfur content. Efficient solar cells can be obtained from all the different precursor compositions, with efficiencies of over 10% on lab cells on sulfur-rich absorbers, and 6–7% on 30×30 cm 2 devices. The homogeneity of 15×15 cm 2 substrates is also discussed.

The restrictions inherent in the use of the conventional reference in capillary viscometry, the viscosity of water at 20 °C, have led to increased interest in absolute viscometers. The viscosity laboratory of the Bureau National de Metrologie, Laboratoire National d'Essais (BNM-LNE) has begun the study of an absolute falling-ball viscometer. The principal difficulties with this system are the measurement of the velocity of the ball and the corrections to compensate for the effects exercised on the ball. Results from a preliminary experiment indicate that uncertainties better than those of capillary viscometers can be obtained. The use of a velocity measurement video system should further reduce the uncertainties.

The race-specific peptide elicitor AVR9 of the fungus Cladosporium fulvum induces a hypersensitive response only in tomato (Lycopersicon esculentum) plants carrying the complementary resistance gene Cf-9 (MoneyMaker-Cf9). A binding site for AVR9 is present on the plasma membranes of both resistant and susceptible tomato genotypes. We used mutant AVR9 peptides to determine the relationship between elicitor activity of these peptides and their affinity to the binding site in the membranes of tomato. Mutant AVR9 peptides were purified from tobacco (Nicotiana clevelandii) inoculated with recombinant potato virus X expressing the corresponding avirulence geneAvr9. In addition, several AVR9 peptides were synthesized chemically. Physicochemical techniques revealed that the peptides were correctly folded. Most mutant AVR9 peptides purified from potato virus X::Avr9-infected tobacco contain a single N-acetylglucosamine. These glycosylated AVR9 peptides showed a lower affinity to the binding site than the nonglycosylated AVR9 peptides, whereas their necrosis-inducing activity was hardly changed. For both the nonglycosylated and the glycosylated mutant AVR9 peptides, a positive correlation between their affinity to the membrane-localized binding site and their necrosis-inducing activity in MoneyMaker-Cf9 tomato was found. The perception of AVR9 in resistant and susceptible plants is discussed.

Micropapillary breast carcinoma has been recognized as a morphologically and biologically distinct form of breast carcinoma. Although data suggest that patient outcomes in cases of micropapillary breast carcinoma do not differ significantly from other breast carcinomas, the impact that a micropapillary component might have on the pathological work-up of a case of breast carcinoma remains an important point of discussion (especially as pertaining to the risk of lymphovascular disease). In this study, we perform an extensive retrospective study of the pathological parameters of seven years of breast surgical pathology cases to explore the relationship that micropapillary morphology might have with other important pathological parameters of a breast cancer case work-up (e.g. tumour size, lymphovascular invasion, lymph node status). We also analyze our data set to see if a micropapillary component would influence hierarchical classification by pathological parameters. Micropapillary features correlated with a higher frequency of ER positivity and lymphovascular invasion; there was no statistical difference between those cases with and without a micropapillary component from the perspective of other clinicopathological parameters, however. The presence of micropapillary features did influence classification, however, and produced a distinct cluster amidst comparison of other pathological variables.

A 26-year-old nurse presented with a three-day history of sudden onset of pyrexia of 39 °C, malaise, and a patchy maculopapular rash, after returning from a monthlong work in Senegal. A tourniquet was applied to help locate the vein for diagnostic blood sampling. After the procedure, a petechial rash erupted with a demarcation line below the level of the tourniquet. A diagnostic test for dengue fever was performed and confirmed by the polymerase chain reaction (PCR) to be positive for serotype DEN-1. The tourniquet test is performed by inflating a blood pressure cuff tied on the upper arm to a point midway between systolic and diastolic blood pressure for five minutes. The test is considered positive when there are 20 or more petechiae per square inch (6.25 cm(2)) on the forearm, and is one of several clinical parameters considered by the World Health Organization to be important in the diagnosis of dengue fever.

We report the isolation, characterization, and total synthesis of a small peptide ligand for nicotinic acetylcholine receptors (nAChRs). It is highly active against the neuromuscular receptor in frog but not in mice. In contrast, it induces seizures when injected centrally in mice and rats, suggesting that it may target neuronal nAChRs in mammals. Although such receptors may be important in both normal cognition and the pathophysiology of several neuropsychiatric disorders, there are few ligands to discriminate between the multiple receptor subtypes. The new peptide is a highly divergent alpha-conotoxin from the snail Conus imperialis, which preys on polychaete worms. In this article, the purification, structural analysis, synthesis, and preliminary physiological characterization of alpha-conotoxin ImI (alpha-CTx-ImI) are reported. The sequence of the peptide is: Gly-Cys-Cys-Ser-Asp-Pro-Arg-Cys-Ala-Trp-Arg-Cys-NH2. The peptide shows striking sequence differences from all alpha-conotoxins of fish-hunting Conus, but its disulfide-bridging is similar: [2-8; 3-12]. We suggest that cone venoms may provide an array of ligands with selectivity for various neuronal nAChR subtypes.

Objective: To evaluate the prevalence, clinical aspects and management of wounds in a hospital. Method: A one-day survey was undertaken in our university hospital. All hospitalised patients (n=624) were examined. The clinical aspects, aetiology and management (pain, cleansing and primary dressing) of wounds were systematically evaluated. Results: A total of 327 patients (52%) had 933 wounds (mean 2.8 per patient). The prevalence was higher in surgical departments (82%) than medical departments (37%), although wounds in the latter departments were larger, deeper, more painful and less numerous per patient. Pain at wound dressing changes was treated in 89% of cases; antiseptics were used for wound cleansing in 14% of cases; the primary dressing used was appropriate in fewer than 50% of cases in the medical departments. Conclusion: This study highlights the high prevalence of wounds in this hospital setting. Many problems with their management have been identified and measures will be taken to optimise care. Declaration of interest: None.

Cost-efficient anti-reflection coatings on solar modules can help reduce the cost of photovoltaics. The efficiency increase that can be expected from such coatings is in the range of 2 - 3%. While this effect is noticeable and important, it is still small; and precise measurements as well as suitable experimental procedures are required if anti-reflection coatings are to be evaluated using only a small number of modules. This paper highlights optical effects related to the interface between the solar cell and the glass/EVA (lamination foil). We show by means of optical simulation that neglecting these effects can easily obscure the benefit of an anti-reflection coating.

Summary Background Psoriasis is a T-cell-mediated immunological disease characterized by epidermal proliferation. The nature of the antigen(s) responsible for T-cell activation is still unknown. It has been suggested that the human papillomaviruses (HPVs) associated with epidermodysplasia verruciformis (EV), including the oncogenic HPV5, may contribute to the pathogenesis of psoriasis. Objectives To determine whether EV-HPVs may play a role early in the disease, we searched for these viruses in children with psoriasis. The influence of clinical data on EV-HPV infection was investigated. Methods We studied scrapings of involved skin from 26 children aged 1·5–13 years with psoriasis. As controls, we analysed scrapings from 28 adults with psoriasis and 15 children with atopic dermatitis, as well as scrapings from normal skin of 28 adults with no known history of HPV infection. We searched for EV-HPV DNA sequences with a nested polymerase chain reaction method using degenerate primers specific for EV-HPVs and primers specific for HPV5 and HPV36, two EV-HPVs frequently detected in adults with psoriasis. Results Similar high prevalences were observed in children and adults with psoriasis for EV-HPVs (38·5% vs. 35·7%), HPV5 (46·2% vs. 46·4%) and HPV36 (15·4% vs. 25·0%). As in adults, we found several EV-HPV genotypes and HPV5 and HPV36 variants. A novel HPV36 subtype, HPV36b, was identified. Lower prevalences were observed in children with atopic dermatitis and in adults from the general population (6·7–10·1%). No correlation was observed between frequency of detection of HPVs and clinical data. It is noteworthy that HPV5 was identified in an 18-month-old girl and in a boy with psoriasis developing for only 1 week. Conclusions The early detection of several EV-HPV genotypes in children further supports the link between psoriasis and EV-HPVs and suggests a putative role for these viruses in the pathogenesis of psoriasis.

Association of drug-induced hypersensitivity syndrome with viral infection is debated. Human herpesvirus 6 (HHV-6) reactivation has been the most frequently reported infection associated with this syndrome. However, a case of cytomegalovirus (CMV) infection was recently described associated with anticonvulsant-induced hypersensitivity syndrome. We report a case of severe allopurinol-induced hypersensitivity syndrome with pancreatitis associated with Epstein-Barr virus (EBV) infection. Active EBV infection was demonstrated in two consecutive serum samples by the presence of anti-EBV early antigen (EA) IgM antibodies and an increase in anti-EBV EA IgG antibodies, whereas no anti-EBV nuclear antigen IgG antibodies were detected. EBV DNA was detected by polymerase chain reaction (PCR) in peripheral blood mononuclear cells. Reactivation of HHV-6 was suggested only by the presence of anti-HHV-6 IgM antibodies, but HHV-6 DNA was not detected by PCR in the serum. Other viral investigations showed previous infection (CMV, rubella, measles, parvovirus B19), immunization after vaccination (hepatitis B virus), or absence of previous infection (hepatitis C virus, human immunodeficiency virus). We suggest that EBV infection may participate in some cases, as do the other herpesviruses HHV-6 or CMV, in the development of drug-induced hypersensitivity syndrome.

The discovery of the major role of TNF alpha in the physiopathology of certain inflammatory diseases and notably in rheumatoid arthritis and Crohn's disease has led to the development of anti-TNF alpha drugs. These new therapeutic arms issued from bio-technology have rapidly demonstrated their efficacy in the treatment of these two diseases. The anti-TNF alpha arsenal is currently dominated by etanercept, a fusion protein composed of a soluble TNF alpha receptor, and infliximab, a chimeric monoclonal antibody. However, new molecules will soon enrich this arsenal. TNF alpha is a major cytokine of inflammatory diseases of the skin. Many dermatological diseases will probably benefit from these new treatments. Two studies have already demonstrated their interest in cutaneous and articular psoriasis. Encouraging sporadic results suggest other potential indications (Behcet's disease, bullous dermatitis, neutrophilic dermatitis, toxic epidermal necrolysis, systemic vascularitis,.). These promising new treatments, although expensive, and with yet unknown long term side effects, justify rigorous assessment of their efficacy and tolerance in each indication. Here again the dermatologist has a major role to play in post-marketing pharmacovigilance.

An SOA, designed and fabricated with a thin wide active layer, has given a low noise ( 16.5 dBm) across the C-band. The device is proven to be a successful system booster.

We report the isolation, characterization, and total synthesis of a small peptide ligand for nicotinic acetylcholine receptors (nAChRs). It is highly active against the neuromuscular receptor in frog but not in mice. In contrast, it induces seizures when injected centrally in mice and rats, suggesting that it may target neuronal nAChRs in mammals. Although such receptors may be important in both normal cognition and the pathophysiology of several neuropsychiatric disorders, there are few ligands to discriminate between the multiple receptor subtypes. The new peptide is a highly divergent alpha-conotoxin from the snail Conus imperialis, which preys on polychaete worms. In this article, the purification, structural analysis, synthesis, and preliminary physiological characterization of alpha-conotoxin ImI (alpha-CTx-ImI) are reported. The sequence of the peptide is: Gly-Cys-Cys-Ser-Asp-Pro-Arg-Cys-Ala-Trp-Arg-Cys-NH2. The peptide shows striking sequence differences from all alpha-conotoxins of fish-hunting Conus, but its disulfide-bridging is similar: [2-8; 3-12]. We suggest that cone venoms may provide an array of ligands with selectivity for various neuronal nAChR subtypes.

Few agents (agonists) bind at [3H]nicotine-labeled nicotine receptors with an affinity comparable to that of nicotine. We initially approached this problem by undertaking a systematic structure-affinity study to determine the contribution to binding of various aspects of the nicotine molecule and of nicotine-related derivatives. For example a series of aryl-substituted and unsubstituted, primary, secondary, and tertiary amine derivatives of 3-(aminomethyl)pyridine (1) were prepared and examined. The finding that 1 (R = Me, R’ = Et, X = H) binds with good affinity (Ki = 28 nM) led to the synthesis of several conformationally-restricted analogs, such as 2 and 3 (Ki = 85 and 12 nM, respectively). With the availability of such structure-affinity and conformational data, it should now be possible to optimize affintiy by design and synthesis of new compounds. (Supported in part by funding from TDC/CIT.)

Objectif Evaluer de facon exhaustive la frequence et les caracteristiques des maladies dermatologiques aux urgences pediatriques d’un CHU de la region parisienne. Sujets et Methodes Etude monocentrique retrospective sur fichier informatique prospectif sur 20652 dossiers d’enfants ayant consulte aux urgences pediatriques pendant l’annee 2006. La recherche de dossiers a ete realisee en deux etapes : etude des codes CIM (CIM10), puis analyse des dossiers restants a partir de mots cles dermatologiques (n = 67). Tous les dossiers « d’allure » dermatologique ont ensuite ete etudies afin de confirmer les diagnostics et de les classer par groupes de pathologies. Les lesions traumatiques, morsures d’animaux (hors insectes), lesions des annexes oculaires et complications non infectieuses de plaies operatoires etaient exclues de l’etude. Les caracteristiques des enfants avec ou sans pathologies dermatologiques ont ensuite ete comparees. Resultats Parmi les 20652 dossiers etudies, 1897 (9.2 %) correspondaient a une pathologie dermatologique. Les enfants ayant une maladie dermatologique etaient significativement plus jeunes (4,1 ans vs 4,65 ans, p - maladies inflammatoires et immunologiques (26,2 %), principalement urticaire (13 %) et angio-œdeme (2,9 %), dermatite atopique (3,5 %) et purpura rhumatoide (2,1 %) - dermatoses par agents externes (14,8 %), principalement brulures (6,1 %) et piqures d’insectes (7,4 %) - dermatoses focales non specifiques (9,2 %), incluant balanites (4,7 %), vulvites (2,6 %) et aphtes (0,7 %) – pathologies transitoires du nourrisson (3,7 %), maladies post-vaccinales (0,9 %), lesions tumorales (0,6 %) et etat carentiels (0,1 %) etaient plus rares. - dermatose non specifique (3 %). Le taux d’hospitalisation dans le groupe dermatologique etait de 8,2 % versus 13,7 % dans le groupe non dermatologique. Conclusion Cette etude confirme la frequence elevee des pathologies dermatologiques dans les services d’urgences pediatriques ainsi que leur potentielle severite. Ces donnees incitent a accroitre les collaborations entre les deux specialites afin d’optimiser la prise en charge de ces enfants.

The authors, reviewing their own experience of Blepharoplasty (92 cases) since ten years, discuss the principal approaches used depending on the age of the patient, the amount of adipose tissue, the lower lid tarsal and muscular laxity and the quality of the skin excess. On the lower eye lid they emphasize the interest of the transconjunctival approach in young an or coloured people and they undermine a cutaneo-muscular flap in the classical technique. On the upper eye lid, they combine the skin excision with an orbicular muscle strip and in old people with a suspension of the lateral canthus. A good choice between these different approaches avoid the rare complications (ectropion and scleral show) because blepharoplasty must be considered like a "variable geometry" operation.

The authors study some cases of surgical revision in post traumatic or secondary rhinoplasty. Cartilaginous grafts with temporal superficialis fascia are recommended. The removal of ear cartilage is used by a posterior approach for the concha cartilage associated with a septum or an alar cartilage removal. They describe the Delta graft associating a concha cartilage supported by a prop (auricular or septal) to repair a loss of substance from the middle or lower third of the nasal pyramid.

The authors have reviewed their clinical experiences with 92 cases of blepharoplasties treated during the past 10 years and discuss the principal approaches used, depending on the age of the patient, the amount of adipose tissue present, the degree of lower lid tarsal and muscle laxity present, and the quality of the skin excess encountered. On the upper eyelid, skin excision is combined with an orbicular muscle strip and in older patients a suspension of the lateral canthus. On the lower eyelid the transconjunctival approach is emphasized in young and or colored patients, using an undermined musculocutaneous flap in the classical technique. A good choice between these different approaches avoids the rare complications of ectropion and scleral show because the procedure used is considered to be a variable "geometric" operation.

The authors start by recalling the principal histomorphological and physiological characteristics of skin tissues subjected to expansion, in particular their hyper-vascularisation which allows the raising of vast flaps of excellent quality. After presenting the major principles, they then present their clinical experience in the context of reconstructive surgery of the scalp, particularly in the correction of Juri flap scars used in the treatment of baldness. Finally, they emphasise the great potential of this technique in the whole field of reconstructive surgery.

Fourteen cases of Ewing's inversed papilloma of the nose and sinuses were treated as primary lesions or after recurrence. Clinical and paraclinical, mainly radiologic, endoscopic, and biologic investigations are of fundamental importance and should be as extensive for primary as for recurrent lesions. Treatment is largely dependent on the results of these examinations, is essentially surgical, and should respond to two imperatives. First, it should lead to total excision under the best possible conditions, and second, it should involve a minimum of sequelae, particular esthetic complications. Techniques for excision through the natural pathways are described, followed by those using an external approach (canine fossa or para-lateronasal approaches), as well as their advantages and inconveniences. The preferred procedure is through an open, wide, para-lateronasal approach, enabling the most effective excision to be performed, this technique appearing to be essential for recurrent lesions.