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A low-temperature plasmas jet is generated by a dielectric barrier discharge powered by a pulsed high voltage in helium flow (3 L min−1) at atmospheric pressure in the presence of different targets (a glass slide, ultra-pure water and a grounded metal plate) positioned perpendicular to the plasma propagation axis. Experimental electrical characterizations such as discharge current, voltage and power, and optical characterizations such as intensified camera ICCD, Schlieren imaging and emission spectroscopy to follow specific excited species have been achieved. The transition from laminar to turbulent regime was observed during the discharge ignition with a larger spreading of the plasma on the surface target with lower dielectric permittivity. The generation of two discharges during each voltage pulse is highlighted during the propagation of the ionization wave which has a variable speed along the plasma axis not depending on the target kind. The evolution of some active species (such as OH, O and excited nitrogen and helium) are investigated using time resolved mapping of the emissions of radiative excited species propagating in ambient air between the plasma jet output and the target. For a low relative permittivity target (glass), the volume ionization wave at its arrival on the target spreads on its surface thus behaving as a surface ionization wave. For the highest relative permittivity (metal), a conductive channel appears between the target surface and the plasma jet during the first discharge, followed by a diffuse plasma plume from the target surface towards the plasma jet after the impact of the ionization wave on the target. A hybrid behavior is highlighted for the ultra-pure water which leads to a short spreading of the ionization wave on the target surface, the formation of a conductive channel in ambient air between tube output and target and the formation of a plasma plume on the target surface.

Organized and individual breast screening have been accompanied by an increase in the detection of "atypical breast lesions (ABL)". Recently, the NOMAT multicenter study proposed a predictive model of the risk of developing breast cancer after detection of an ABL in order to avoid surgical removal of "low-risk" lesions. It also aimed to provide information on psychological experience, in particularly anxiety, to assist in the shared medical decision process.Three hundred women undergoing surgery for ABL were included between 2015 and 2018 at 18 French centers. Women completed questionnaires before and after surgery assessing their level of anxiety (STAI-State, STAI-Trait), their level of tolerance to uncertainty, their perceived risk of developing a breast cancer, and their satisfaction with the management care.One hundred nighty nine patients completed the STAI-Status before and after surgery. Overall, a decrease in anxiety level (35.4 vs 42.7, P0.001) was observed. Anxious temperament and greater intolerance to uncertainty were significantly associated swith decreased anxiety (33%), whereas younger age was associated with increased anxiety (8%).Surgery for ABL seems to be associated with only a few cases with an increase in anxiety and seems to increase the perception of the risk of developing breast cancer. Taking into account the psychological dimension remains in all cases essential in the process of shared therapeutic decision.

Background Local excision (LE) after chemoradiotherapy is a new option in low rectal cancer, but morbidity has never been compared prospectively with total mesorectal excision (TME). Early and late morbidity were compared in patients treated either by LE or TME after neoadjuvant chemoradiotherapy for rectal cancer. Method This was a post-hoc analysis from a randomized trial. Patients with clinical T2/T3 low rectal cancer with good response to the chemoradiotherapy and having either LE, LE with eventual completion TME, or TME were considered. Early (1 month) and late (2 years) morbidities were compared between the three groups. Results There were no deaths following surgery in any of the three groups. Early surgical morbidity (20 per cent LE versus 36 per cent TME versus 43 per cent completion TME, P = 0.025) and late surgical morbidity (4 per cent versus 33 per cent versus 57 per cent, P Conclusion The rate of surgical complications after neoadjuvant chemoradiotherapy in the LE group was half that of TME group at 1 month and 10 times lower at 2 years. LE is a safe approach for organ preservation and should be considered as an alternative to watch-and-wait in complete clinical responders and to TME in subcomplete responders.

The French National Cancer Institute recommends the use of survivorship care plans (SCP) for all cancer survivors. Developing useful SCP's requires understanding of what survivors and their providers need and how SCP's can be implemented in practice. We conducted a study to assess the delivery of SCP comprehensive binders for breast cancer women (BCW) and their general practitioners (GP) in a Cancer center from January 2019.SCP binders, containing a full range of information on topics related to post-cancer care to survivor-specific information and referrals, were given to BCW during a post-treatment dedicated consultation. Then a letter, containing the treatment summary and 5-year follow-up schedule, was sent to their GPs. Comprehensive binder delivery assessment was carried out using item checkbox, and anonymous open-answered, self-reported questionnaires were sent by email to BCW and their GPs.The questionnaire response rates were 81.3% for BCW (n = 109/134) and 48.6% for their GPs (n = 52/107). Most BCW (85%) reported that SCP binders provided useful and comprehensive information. However, some of them (18%) felt abandoned and anonymous during the post-treatment follow-up. Most GPs found SCP letters from our anti-cancer center physicians to be useful for their patients, 38% of them had used this information to assure transition of care with other care providers. In addition, GPs were unanimous to express their feeling that this SCP could improve the long-term surveillance of BCW. There was a high concordance between BCW survivors' and PCP' answers, especially regarding SCPs as a communication bridge between GPs and BCW survivors. Response results concerning use of the binders: to talk about them: 59% for BCW vs. 51% for GPs, and to show them: 35% for BCW vs. 31% for GPs.The opinions of BCW survivors' and PCP' opinions about the use of SCP's by our Cancer Center seems to be favourable. It is essential to implement and develop SCP's as a key tool in long-term surveillance and support for cancer patient survivors and they are a useful instrument for care providers in communication and transition.

Resume Introduction Le cancer du sein et sa prise en charge restent un probleme majeur de sante publique chez la femme. L’epidemiologie des complications liee a la radiotherapie apres une reconstruction mammaire immediate prothetique (RMIP) reste insuffisante et ses consequences esthetiques mal definies. L’objectif de ce travail etait de comparer les taux de complications et les resultats esthetiques des reconstructions mammaires immediates (RMI) par prothese avec et sans radiotherapie, afin de determiner les facteurs de risques de complications et de mauvais resultats esthetiques. Materiel et methode Une etude retrospective a ete conduite entre janvier 2014 et decembre 2016 portant sur des patientes atteintes d’un cancer du sein et devant beneficier d’une mastectomie totale sous cutanee (MTSC) avec une RMIP. Le critere d’evaluation etait le taux d’echec de reconstruction et le rendu esthetique global, les criteres secondaires evaluaient le taux de complications precoces et tardives. Il fut realise une analyse multivariee pour deceler des facteurs de risques predictifs de complication. Resultats Trois cent trente-trois patientes ont ete incluses : 157 dans le bras radiotherapie et 176 pour le groupe sans radiotherapie. Les caracteristiques preoperatoires etaient comparables. Le suivi moyen etait de 1 a 3 ans sans perdu de vue. Le resultat sur le critere de jugement principal montrait que les patientes qui avaient beneficie d’une radiotherapie avaient le meme risque d’echec de reconstruction que les patientes non irradiees. L’analyse en sous-groupe ne revelait aucune difference significative : 12,7 % d’echec de reconstruction pour le bras irradie versus 12,5 %. Concernant l’evaluation de l’alteration des resultats esthetiques, il fut constate comme difference un meilleur taux de patientes avec d’« excellents » resultats dans le bras sans radiotherapie (35 % vs 8,2 %). Les resultats sur les criteres secondaires etaient comparables. Conclusion La radiotherapie chez les patientes beneficiant d’une RMIP n’augmente pas le risque d’echec de reconstruction et de mauvais resultats esthetiques comparativement aux patientes non irradiees. Il est donc licite de proposer pour toutes patientes devant beneficier d’une MTSC suivie d’une radiotherapie, une RMIP et ainsi de leur eviter une reconstruction secondaire, plus impactante sur le plan psychologique.

International audience; The plasma is generated by a microwave (MW) source inside a conditioned cell with an axial gas injection working at high pressure argon with a small admixture of air. Several characterization methods based on the analysis of the optical emission spectra are employed to determine rotational Trot, vibrational Tvib, excitation Tex and electron Te temperatures along the plasma flame axis. The densities of electrons and oxygen and nitrogen atoms are also determined from spectra analysis for the same plasma axis positions. The rotational and vibrational temperatures are simultaneously estimated using a new method based on the analysis of 3 consecutive band heads of the second positive system (SPS) of molecular nitrogen spectra. This new method, based on pre-calculated synthetic spectra databases, leads to Trot varying from about 2000 to 2500 K along the plasma axis while Tvib are higher (around 5000 K and more). Both temperatures are coherent when determined from N2SPS in the case of two distinct wavelength ranges (around 313 nm and 376 nm). These temperatures are in agreement with Trot determined from comparison between synthetic and experimental OH(A-X) spectra and Tvib determined from the first negative system N2+FNS spectra. The estimated electron temperatures Te are around 2.0 eV while the electron densities are in the range 1015 to 1016cm−3 using a literature method adapted in the present work to air diluted in argon buffer gas. The densities of atomic oxygen are estimated close to 1015 cm−3 and those of nitrogen close to 1016 cm−3 when using an actinometry method assuming a priori known the density of hot buffer argon gas at Trot temperature and also Tex determined using classical Boltzmann plots based on a chosen series of Ar lines. The significant deviations between the different temperatures Trot, Tvib, Tex and Te clearly underline a pronounced non thermal equilibrium of the present MW argon/air plasma. It is also shown an important chemical non-equilibrium since the measured electron, N and O densities are found much higher than the usual equilibrium densities generated by thermal dissociation and recombination processes. This therefore means that the energetic electron impacts play a significant role on the formation of the present non-equilibrium MW plasma.

Breast cancer and its treatment remains a public health problem. There is still a lack of epidemiological data concerning complications and aesthetic results bound to radiotherapy after an immediate breast reconstruction. The objective of this study was to compare outcomes of immediate breast reconstruction regardless to the use of radiotherapy (history of radiotherapy or adjuvant radiation therapy), in order to determine risk factor of complications and bad aesthetic results.We conducted a retrospective study between January 2014 and December 2016 at the hospital "Gustave Roussy" in Paris, concerning breast cancer patients who needed immediate breast reconstruction after total mastectomy. The primary endpoint was to assess the failure rate of reconstruction and the aesthetic result, the secondary endpoint assessed the early and late rate of complications. We realized a multivariate analysis in order to identify risks factors that may predict complications.Three hundred and thirty three patients have been included: 157 in the "radiotherapy group" compared to 176 in the "no radiotherapy group". Preoperative characteristics were comparable. Average follow-up was between 1 and 3years without missing. Patients who benefited from radiotherapy had an equal risk failure of reconstruction. The subgroup analysis revealed non-significant differences: 12.7% failure rate reconstruction in the "radiotherapy group" vs. 12.5%. We could notify a better rate of "excellent results" in the "no radiotherapy group": 35% vs. 8.2%. Secondary outcomes were comparable.Radiotherapy related to immediate breast reconstruction didn't increase the failure rate of reconstruction or aesthetic results, comparatively to non-irradiated patients. It is therefore permissible to suggest an immediate breast reconstruction to any patients which would benefit from a total mastectomy followed by radiotherapy; in order to prevent them from a secondary breast reconstruction, who could be physically and psychologically more impactful.

BackgroundThe prognostic value of the primary neoplasm responsible for pseudomyxoma peritonei (PMP) remains poorly studied. The aim of this study was to determine the prognosis for patients with extra-appendicular PMP (EA-PMP) treated optimally with complete cytoreductive surgery (CCRS) and hyperthermic intraperitoneal chemotherapy (HIPEC).MethodsAll patients treated for PMP with CCRS and HIPEC between 1994 and 2016 were selected retrospectively from a French multicentre database. Patients with EA-PMP had pathologically confirmed non-neoplastic appendices and were matched in a 1 : 4 ratio with patients treated for appendicular PMP (A-PMP), based on a propensity score.ResultsSome 726 patients were identified, of which 61 (EA-PMP group) were matched with 244 patients (A-PMP group). The origins of primary tumours in the EA-PMP group included the ovary (45 patients), colon (4), urachus (4), small bowel (1), pancreas (1) and unknown (6). The median peritoneal carcinomatosis index was comparable in EA-PMP and A-PMP groups (15·5 versus 18 respectively; P = 0·315). In-hospital mortality (3 versus 2·9 per cent; P = 1·000) and major morbidity 26 versus 25·0 per cent; P = 0·869) were also similar between the two groups. Median follow-up was 66·9 months. The 5-year overall survival rate was 87·8 (95 per cent c.i. 83·2 to 92·5) per cent in the A-PMP group and 87 (77 to 96) per cent in the EA-PMP group. The 5-year disease-free survival rate was 66·0 (58·7 to 73·4) per cent and 70 (53 to 83) per cent respectively.ConclusionOverall and disease-free survival following treatment with CCRS and HIPEC is similar in patients with pseudomyxoma peritonei of appendicular or extra-appendicular origin.

International audience; For the first time, absolute densities of atomic nitrogen in its ground state (N$^4$S) have been measured in hot dry and humid air plasma columns under post-discharge regime. The determination of space-resolved absolute densities leads to obtain the dissociation degrees of molecular nitrogen in the plasma. The hot plasmas are generated inside an upstream gas-conditioning cell at 600 mbar when the air gas flow is directly injected at 10 slm in a microwave resonant cavity (2.45 GHz, 1 kW) placed in the downstream side. Density measurements based on laser induced fluorescence spectroscopy with two-photon excitation (TALIF), are more particularly performed along the radial and axial positions of the plasma column. Calibration of TALIF signals is performed in situ (i.e. in the same gas-conditioning cell but without plasma) using an air gas mixture containing krypton. Optical emission spectroscopy is considered to estimate the rotational gas temperature by adding a small amount of H$_2$ in dry air to better detect OH (A-X) spectra. The rotational temperatures in humid air plasma column (50% of humidity) are larger than those of dry air plasma column by practically 30% near the nozzle of resonant cavity on the axis of the plasma column. This is partly due to attachment heating processes initiated by water vapor. A maximum of the measured absolute nitrogen density is also observed near the nozzle which is also larger for humid air plasma column. The obtained dissociation degrees of molecular nitrogen in both dry and humid air plasma along the air plasma column are lower than the cases where only thermodynamic equilibrium is assumed. This is characteristic of the absence of chemical and energetic equilibria not yet reached in the air plasma column dominated by recombination processes.

International audience; BackgroundNETSARC (netsarc.org) is a network of 26 sarcoma reference centers with specialized multidisciplinary tumor boards (MDTB) aiming to improve the outcome of sarcoma patients. Since 2010, presentation to an MDTB and expert pathological review are mandatory for sarcoma patients nationwide. In the present work, the impact of surgery in a reference center on the survival of sarcoma patients investigated using this national NETSARC registry.Patients and methodsPatients’ characteristics and follow-up are prospectively collected and data monitored. Descriptive, uni- and multivariate analysis of prognostic factors were conducted in the entire series (N = 35 784) and in the subgroup of incident patient population (N = 29 497).ResultsAmong the 35 784 patients, 155 different histological subtypes were reported. 4310 (11.6%) patients were metastatic at diagnosis. Previous cancer, previous radiotherapy, neurofibromatosis type 1 (NF1), and Li–Fraumeni syndrome were reported in 12.5%, 3.6%, 0.7%, and 0.1% of patients respectively. Among the 29 497 incident patients, 25 851 (87.6%) patients had surgical removal of the sarcoma, including 9949 (33.7%) operated in a NETSARC center. Location, grade, age, size, depth, histotypes, gender, NF1, and surgery outside a NETSARC center all correlated to overall survival (OS), local relapse free survival (LRFS), and event-free survival (EFS) in the incident patient population. NF1 history was one of the strongest adverse prognostic factors for LRFS, EFS, and OS. Presentation to an MDTB was associated with an improved LRFS and EFS, but was an adverse prognostic factor for OS if surgery was not carried out in a reference center. In multivariate analysis, surgery in a NETSARC center was positively correlated with LRFS, EFS, and OS [P

Context. The ESA Gaia mission provides a unique time-domain survey for more than 1.6 billion sources with G ≲ 21 mag. Aims. We showcase stellar variability in the Galactic colour-absolute magnitude diagram (CaMD). We focus on pulsating, eruptive, and cataclysmic variables, as well as on stars that exhibit variability that is due to rotation and eclipses. Methods. We describe the locations of variable star classes, variable object fractions, and typical variability amplitudes throughout the CaMD and show how variability-related changes in colour and brightness induce "motions". To do this, we use 22 months of calibrated photometric, spectro-photometric, and astrometric Gaia data of stars with a significant parallax. To ensure that a large variety of variable star classes populate the CaMD, we crossmatched Gaia sources with known variable stars. We also used the statistics and variability detection modules of the Gaia variability pipeline. Corrections for interstellar extinction are not implemented in this article. Results. Gaia enables the first investigation of Galactic variable star populations in the CaMD on a similar, if not larger, scale as was previously done in the Magellanic Clouds. Although the observed colours are not corrected for reddening, distinct regions are visible in which variable stars occur. We determine variable star fractions to within the current detection thresholds of Gaia. Finally, we report the most complete description of variability-induced motion within the CaMD to date. Conclusions. Gaia enables novel insights into variability phenomena for an unprecedented number of stars, which will benefit the understanding of stellar astrophysics. The CaMD of Galactic variable stars provides crucial information on physical origins of variability in a way that has previously only been accessible for Galactic star clusters or external galaxies. Future Gaia data releases will enable significant improvements over this preview by providing longer time series, more accurate astrometry, and additional data types (time series BP and RP spectra, RVS spectra, and radial velocities), all for much larger samples of stars. © 2019 ESO.

Purpose: Diffuse malignant peritoneal mesothelioma (DMPM) is a severe disease with mainly locoregional evolution. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is the reported treatment with the longest survival. The aim of this study was to evaluate the impact of perioperative systemic chemotherapy strategies on survival and postoperative outcomes in patients with DMPM treated with curative intent with CRS-HIPEC, using a multi-institutional database: the French RENAPE network. Patients and methods: From 1991 to 2014, 126 DMPM patients underwent CRS-HIPEC at 20 tertiary centres. The population was divided into four groups according to perioperative treatment: only neoadjuvant chemotherapy (NA), only adjuvant chemotherapy (ADJ), perioperative chemotherapy (PO) and no chemotherapy before or after CRS-HIPEC (NoC). Results: All groups (NA: n Z 42; ADJ: n Z 16; PO: n Z 16; NoC: n Z 48) were comparable regarding clinicopathological data and main DMPM prognostic factors. After a median follow-up of 61 months, the 5-year overall survival (OS) was 40%, 67%, 62% and 56% in NA, ADJ, PO and NoC groups, respectively (P Z 0.049). Major complications occurred for 41%, 45%, 35% and 41% of patients from NA, ADJ, PO and NoC groups, respectively (P Z 0.299). In multivariate analysis, NA was independently associated with worse OS (hazard ratio, 2.30; 95% confidence interval, 1.07e4.94; P Z 0.033). Conclusion: This retrospective study suggests that adjuvant chemotherapy may delay recurrence and improve survival and that NA may impact negatively the survival for patients with DMPM who underwent CRS-HIPEC with curative intent. Upfront CRS and HIPEC should be considered when achievable, waiting for stronger level of scientific evidence.

Background Peritoneal metastasis from biliary carcinoma (PMC) is associated with poor prognosis when treated with chemotherapy. Objective To evaluate the impact on survival of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), and compare with conventional palliative chemotherapy for patients with PMC. Material and methods A prospective multicenter international database was retrospectively searched to identify all patients with PMC treated with a potentially curative CRS/HIPEC (CRS/HIPEC group). The overall survival (OS) was compared to patients with PMC treated with palliative chemotherapy (systemic chemotherapy group). Survival was analyzed using Kaplan-Meier method and compared with Log-Rank test. Results Between 1995 and 2015, 34 patients were included in the surgical group, and compared to 21 in the systemic chemotherapy group. In the surgical group, median peritoneal cancer index was 9 (range 3–26), macroscopically complete resection was obtained for 25 patients (73%). There was more gallbladder localization in the surgical group compared to the chemotherapy group (35% vs. 18%, p = 0.001). Median OS was 21.4 and 9.3 months for surgical and chemotherapy group, respectively (p=0.007). Three-year overall survival was 30% and 10% for surgical and chemotherapy group, respectively. Conclusion Treatment with CRS and HIPEC for biliary carcinoma with peritoneal metastasis is feasible and may provide survival benefit when compared to palliative chemotherapy.

International audience

A new strict gypsophilous species of Chaenorhinum, Ch. gamezii, is described. It is an annual to perennial species found in extremely arid locations upon Triassic gypsic habitats in the south-eastern Iberian Peninsula. This species has an eglandular heterotrichous indumentum, which is related to Ch. segoviense and Ch. flexuosum. However, Ch. gamezii has a characteristic combination of vegetative and micromorphological features (trichomes and ornamentation of the seeds) that are not present in any other taxon of the genus. Herein, the affinities and differences with related species are studied and discussed. For its differentiation, an original key is presented with comparative figures of indumentum and seeds, and a complete iconography. Knowledge of the species ecology, biogeography, demography and threats is also provided, and according to that, Ch. gamezii should be considered as a critically threatened species (critically endangered, according to IUCN criteria). Future conservation proposals are discussed.

Background NETSARC (netsarc.org) is a network of 26 sarcoma reference centers with specialized multidisciplinary tumor boards (MDTB) aiming to improve the outcome of sarcoma patients. Since 2010, presentation to an MDTB and expert pathological review are mandatory for sarcoma patients nationwide. In the present work, the impact of surgery in a reference center on the survival of sarcoma patients investigated using this national NETSARC registry. Patients and methods Patients’ characteristics and follow-up are prospectively collected and data monitored. Descriptive, uni- and multivariate analysis of prognostic factors were conducted in the entire series (N = 35 784) and in the subgroup of incident patient population (N = 29 497). Results Among the 35 784 patients, 155 different histological subtypes were reported. 4310 (11.6%) patients were metastatic at diagnosis. Previous cancer, previous radiotherapy, neurofibromatosis type 1 (NF1), and Li–Fraumeni syndrome were reported in 12.5%, 3.6%, 0.7%, and 0.1% of patients respectively. Among the 29 497 incident patients, 25 851 (87.6%) patients had surgical removal of the sarcoma, including 9949 (33.7%) operated in a NETSARC center. Location, grade, age, size, depth, histotypes, gender, NF1, and surgery outside a NETSARC center all correlated to overall survival (OS), local relapse free survival (LRFS), and event-free survival (EFS) in the incident patient population. NF1 history was one of the strongest adverse prognostic factors for LRFS, EFS, and OS. Presentation to an MDTB was associated with an improved LRFS and EFS, but was an adverse prognostic factor for OS if surgery was not carried out in a reference center. In multivariate analysis, surgery in a NETSARC center was positively correlated with LRFS, EFS, and OS [P

Preoperative radiochemotherapy followed by total mesorectal excision is the standard of care for T3-T4-N0 or TxN1 rectal cancer. Defining target volumes relies on the patterns of nodal and locoregional failures. The lower limit of the clinical target volume depends also on the type of surgery. Conformational radiotherapy with or without intensity-modulated radiotherapy implies an accurate definition of volumes and inherent margins in the context of mobile organs such as the upper rectum. Tumoral staging recently improved with newer imaging techniques such as MRI with or without USPIO and FDG-PET-CT. The role of PET-CT remains unclear despite encouraging results and MRI is a helpful tool for a reliable delineation of the gross tumour volume. Co-registration of such modalities with the planning CT may particularly guide radiation oncologists through the gross tumour volume delineation. Acute digestive toxicity can be reduced with intensity modulation radiation therapy. Different guidelines and CT-based atlas regarding the target volumes in rectal cancer give the radiation oncologist a lot of ground for reproducible contours.

Objective To assess executive function in children with developmental dyspraxia. Patients and method Inclusion criteria: children aged 8 years to 12 years 5 months at the time of the study, diagnosed with developmental dyspraxia between January, 2008 and August, 2009 by a multidisciplinary team in one single center. Assessment tools (1) Paper-and-pencil neuropsychological and ecological tests to assess flexibility, planning, inhibition and prospective memory; (2) two questionnaires answered by parents; (3) the ‘Children's Cooking Task’ (CCT), an ecological task performed in a real environment (Chevignard et al., 2009 [15] ). In this last test, children were compared to matched controls. Non-parametric statistical tests were used. Results Thirteen patients participated in the study (11 boys–2 girls; mean age 10.3 years [SD = 1.3]). Neuropsychological tests highlighted planning and inhibition disorders, but no impaired flexibility. For more than half of the children, the questionnaires indicated impaired executive functions in daily life tasks. Finally, patients showed a significantly increased rate of errors during the CCT, compared with the control group (P Conclusion Overall results suggest that some children diagnosed with developmental dyspraxia also exhibit executive function disorders. Ecological tests seem more sensitive for identifying executive function disorders than conventional tests.

The evolutionary history of modern birth mechanism is now a renewed interest in obstetrical papers. The purpose of this work is to review the literature in paleo-obstetrical field. Our analysis focuses on paleo-obstetrical hypothesis, from 1960 to the present day, based on the reconstruction of fossil pelvis. Indeed, these pelvic reconstructions usually provide an opportunity to make an obstetrical assumption in our ancestors. In this analysis, we show that modern birth mechanism takes place during the emergence of our genus 2 million years ago. References are made to human specificities related to obstetrical mechanism: exclusive bipedalism, increase of brain size at birth, metabolic cost of the pregnancy and deep trophoblastic implantation.

The present work is devoted to the 2D simulation of a point-to-plane Atmospheric Corona Discharge Reactor (ACDR) powered by a DC high voltage supply. The corona reactor is periodically crossed by thin mono filamentary streamers with a natural repetition frequency of some tens of kHz. The study compares the results obtained in dry air and in air mixed with a small amount of water vapour (humid air). The simulation involves the electro-dynamics, chemical kinetics and neutral gas hydrodynamics phenomena that influence the kinetics of the chemical species transformation. Each discharge lasts about one hundred of a nanosecond while the post-discharge occurring between two successive discharges lasts one hundred of a microsecond. The ACDR is crossed by a lateral dry or humid air flow initially polluted with 400 ppm of NO. After 5 ms, the time corresponding to the occurrence of 50 successive discharge/post-discharge phases, a higher NO removal rate and a lower ozone production rate are found in humid air. This change is due to the presence of the HO2 species formed from the H primary radical in the discharge zone.

Two experimental techniques have been used to quantify the atomic oxygen density in the case of hot air plasma generated by a microwave (MW) resonant cavity. The latter operates at a frequency of 2.45 GHz inside a cell of gas conditioning at a pressure of 600 mbar, an injected air flow of 12 L/min and an input MW power of 1 kW. The first technique is based on the standard two photon absorption laser induced fluorescence (TALIF) using xenon for calibration but applied for the first time in the present post discharge hot air plasma column having a temperature of about 4500 K near the axis of the nozzle. The second diagnostic technique is an actinometry method based on optical emission spectroscopy (OES). In this case, we compared the spectra intensities of a specific atomic oxygen line (844 nm) and the closest wavelength xenon line (823 nm). The two lines need to be collected under absolutely the same spectroscopic parameters. The xenon emission is due to the addition of a small proportion of xenon (1% Xe) of this chemically inert gas inside the air while a further small quantity of H2 (2%) is also added in the mixture in order to collect OH(A-X) and NH(A-X) spectra without noise. The latter molecular spectra are required to estimate gas and excitation temperatures. Optical emission spectroscopy measurements, at for instance the position z=12 mm on the axis plasma column that leads to a gas measured temperature equal to 3500 K, an excitation temperature of about 9500 K and an atomic oxygen density 2.09×1017±0.2×1017 cm−3. This is in very good agreement with the TALIF measurement, which is equal to 2.0×1017 cm−3.

Background The benefit of neoadjuvant chemotherapy (NCT) for early-stage oesophageal cancer is unknown. The aim of this study was to assess whether NCT improves the outcome of patients with stage I or II disease. Methods Data were collected from 30 European centres from 2000 to 2010. Patients who received NCT for stage I or II oesophageal cancer were compared with patients who underwent primary surgery with regard to postoperative morbidity, mortality, and overall and disease-free survival. Propensity score matching was used to adjust for differences in baseline characteristics. Results Of 1173 patients recruited (181 NCT, 992 primary surgery), 651 (55·5 per cent) had clinical stage I disease and 522 (44·5 per cent) had stage II disease. Comparisons of the NCT and primary surgery groups in the matched population (181 patients in each group) revealed in-hospital mortality rates of 4·4 and 5·5 per cent respectively (P = 0·660), R0 resection rates of 91·7 and 86·7 per cent (P = 0·338), 5-year overall survival rates of 47·7 and 38·6 per cent (hazard ratio (HR) 0·68, 95 per cent c.i. 0·49 to 0·93; P = 0·016), and 5-year disease-free survival rates of 44·9 and 36·1 per cent (HR 0·68, 0·50 to 0·93; P = 0·017). Conclusion NCT was associated with better overall and disease-free survival in patients with stage I or II oesophageal cancer, without increasing postoperative morbidity.

Resume Objectif de l’etude La prise en charge des sarcomes retroperitoneaux resecables est multidisciplinaire L’objectif de cette etude etait d’analyser retrospectivement les facteurs pronostiques des patients operes d’un sarcome retroperitoneal primitif. Patients et methodes Nous avons analyse les donnees de 50 patients atteints d’un sarcome retroperitoneal primitif opere a visee curative entre 1975 et 2008. Les donnees demographiques, chirurgicales, anatomopathologiques, la chimio/radiotherapie ont ete analysees comme facteurs pronostiques. Resultats Il s’agissait de 22 hommes et 28 femmes d’âge moyen 54 ± 13 ans. Une resection multiviscerale a ete necessaire chez 30 (60 %) patients. Il y avait 16 leiomyosarcomes, 25 liposarcomes et huit autres sous-types de sarcome retroperitoneal. Les tranches de section etaient microscopiquement saines (R0) chez 21 patients (42 %). Vingt-huit patients ont ete irradies apres la chirurgie a une dose mediane de 45 Gy et 15 ont recu une chimiotherapie. Avec un recul median de 55 mois, une recidive locale a ete observee chez 39 % (n = 14) des patients ayant eu une resection R0/R1 (n = 36). La radiotherapie postoperatoire augmentait le delai de survenue de la recidive locale (27 contre 13 mois, p = 0,05). Les probabilites de survie globale a un, trois et cinq ans etaient respectivement de 81 %, 55 % et 46 %. Bien que la resection R0 (p = 0,01), la differenciation tumorale (p = 0,004) et la radiotherapie postoperatoire (p = 0,02) influencaient la survie globale en analyse unifactorielle, seule une resection R0 etait un facteur pronostique independant en analyse multifactorielle. Conclusions Nous confirmons la preeminence de la chirurgie radicale avec des tranches de section saines (R0) en tant que facteur pronostique majeur et le benefice de la radiotherapie postoperatoire.

To determine overall survival of patients treated for a first relapse of FIGO stage III ovarian cancer, outside of randomized trial, with a long term follow-up and to identify prognostic factors.A consecutive series of 108 patients treated for a first relapse of a FIGO stage III ovarian cancer was retrospectively included from December 1999 to November 2004. Each patient was treated with platinum-based chemotherapy in case of late (6 months) relapse and with salvage chemotherapy without platinum in case of6 months relapse. For statistical analysis the studied parameters were age, histological subtype, the completeness of initial surgery, disease-free period, localization of the relapse, clinical response to second-line chemotherapy, the completeness of secondary cytoreductive surgery (SCS) when it was performed.Median follow-up from the first relapse was 40 months. From the 108 patients, 35 underwent SCS. Median overall survival from the first relapse was 13 months in case of no SCS or non-optimal SCS and 35 months for patient with an optimal SCS (p = 0.006). In a multivariate analysis age, disease-free period, the clinical presentation of the relapse, completeness of SCS and response to second line chemotherapy appeared to be independent prognostic factors.Prognostic factors of ovarian cancer relapse are directly or indirectly linked with the feasibility of a complete SCS. Thus in the case of an ovarian cancer relapse, the feasibility of SCS must be considered in order to give the patient the best chance to experience its complete removal.

New grylloblattid insects (Grylloblattida) are described from the Gres a Voltzia of the Vosges (Anisian of Alsace and Lorraine, France): Chauliodites anisicus, sp. nov. (Chaulioditidae), Palaeomesorthopteron pullus gen. et sp. nov. (Mesorthopteridae), Megakhosarodes vosgesicus sp. nov. (Megakhosaridae), Dorniella elcanoides sp. nov., D. apectinata sp. nov., D. diluta sp. nov., D. ovalis sp. nov., Baharellinus umbrosus sp. nov. Embigryllus shcherbakovi gen. et sp. nov., and Vosgesopterum arzvillerensis gen. et sp. nov. (Blattogryllidae).

Pathologies of the salivary glands can be divided into neoplastic, which affect mostly parenchyma, and non neoplastic, which are mainly ductal, cited in Myers and Ferris (2007) [1] . Ductal diseases consist in Sialadenitis that can be acute, due to a stone, or chronic, due to a stricture. One of the factors that contribute to sialadenitis is hyposalivation and altered composition of saliva, given in Triantafyllou (1992) [2] . Xerostomia affects the elderly in 20 to 39% of cases, according to various studies (Astor et al. (1999) [3] , Locker (1993) [4] , Gilbert et al. (1993) [5] ). Main causes in the old patient are medications side effects, cited in Navazesh et al. (1996) [6] , irradiation cited in Dreizen et al. (1976) [7] , Sjogren's syndrome cited in Kaarela et Mutru (1982) [8] , probable atrophy of the gland and ducts due to aging, and salivary stones. Obstructive inflammatory pathologies of salivary glands, caused mainly by sialolithiasis and strictures affect the general population as well as the elderly. However, no specific study has described yet its prevalence in the elderly population. But as xerostomia is probably associated with chronic sialadenitis, and as it is quite frequent in the old population, we can assume that ductal pathologies must be far underestimated in the geriatric population. The classical treatment for obstructive sialadenitis is the removal of the gland which is often difficult to consider in old patients because of the general anesthesia, and morbidity of the surgery (longer hospital stay, risk for facial nerve, complications related to external surgery). Sialendoscopy is one of the new innovations introduced in the last few years in the field of Otolaryngology, head and neck surgery for the diagnosis and treatment of acute and chronic sialadenitis, cited in Marchal et al. (1999) [9] . Its main advantage in the elderly population is that it can be performed in most cases as an ambulatory, outpatient procedure under local anesthesia.

Saliva has numerous oral functions and multiple functions in relation to digestion in the upper gastrointestinal tract. Chronic salivary hypofunction can lead to severe adverse health outcomes. Chronic sialadenitis is one of the major conditions that can cause salivary hypofunction. A correct diagnosis and management of chronic sialadenitis is essential for the recovery of salivary hypofunction. Chronic sialadenitis of the parotid gland is often seen in the clinic, sometimes also referred to as recurrent pyogenic parotitis, recurrent parotitis, non-obstructive parotitis, sialadenitis or obstructive parotitis, among other terms. The literature describes several different classifications and denominations for chronic sialadenitis of the parotid gland. These various classifications and denominations complicate the definition and diagnostic criteria, and if chronic sialadenitis of the parotid gland can develop into Sjogren's syndrome remains unclear. Treatment of this condition is also a challenging problem. Here, we review the presented classification and denomination of chronic sialadenitis of the parotid gland, proposing a classification based on the disease entities identified in a long-term follow-up investigation, and discuss the treatment principles for the condition.

The VUV emissions of gaseous mixtures of krypton and xenon were investigated at room temperature. For this purpose, a pulsed, brief, selective multiphotonic excitation of the two lowest atomic states of the 5p56s configuration of xenon was achieved. A spectroscopic and kinetic study was performed, for the first time, by comparing the radiation characteristics consecutive to initially populating either the metastable Xe[5p56s(3P2)] or the resonant Xe[5p56s(3P1)] states. The formation of the heteronuclear KrXe* excimers was clearly shown. The decay frequency of heteronuclear excimers correlated to the xenon metastable state obeys different scaling laws depending on the xenon pressure. The roles of heteronuclear and homonuclear excimers in the formation of VUV emissions of the gas mixture are discussed. Finally, two kinetic schemes showing the main reaction processes are proposed.

Resume Le calibre des voies aeriennes (VA) varie de facon significative lorsque le systeme thoracopulmonaire est distendu par une inspiration profonde (IP). Une augmentation du calibre des VA a ete mise en evidence chez les enfants presentant une discrete obstruction d'origine asthmatique ainsi qu'apres reponse positive a un test de provocation bronchique par la methacholine ou l'exercice. Cette bronchodilatation n'est, en revanche, observee ni chez le nourrisson, ni en presence d'une obstruction asthmatique severe. L'hyperreactivite bronchique et l'inflammation des VA font partie des facteurs qui determinent les modifications du calibre des VA au decours d'une IP. Les VA et le parenchyme pulmonaire sont des structures elastiques imparfaites interdependantes. L'hysteresis caracterise le caractere imparfait de la relation pression–volume lie a la deformation de ces stuctures. La theorie mecanique de l'hysteresis relative des VA et du parenchyme domine les hypotheses physiopathologiques. Il doit etre tenu compte des variations du tonus bronchomoteur au decours des IP pour l'exploration fonctionnelle de routine. L'effet de l'IP sur le calibre des VA peut contribuer a ameliorer la sensibilite des explorations fonctionnelles des voies aeriennes de l'enfant.

This 2014 version of news in ENT--established by reading more than 10,000 abstracts published in 2014--will focuss this year on two main topics that are trendy: Robotic surgery in ENT, and e-cigarette. Of course, other subjects will be treated as well, in the format of guidelines, like for otitis externa, tinnitus, ear grommets, Bell's palsy, children's sinusitis, topical treatments in sinusitis, or dangers of radiation on kids. Some interesting mobile applications will be as well presented.

The general decline in wild Iberian populations of the red-legged partridge (Alectoris rufa) has been accompanied by an increase in game-farm facilities producing hybrids with chukar partridges (Alectoris chukar). Genetic introgression from chukar partridges is thought to modify male red-legged partridge reproductive indicators. The aim of the present study was to determine the effects of such genetic introgression on seasonal reproductive patterns by comparing the sperm and plasma testosterone concentrations of males from pure red-legged and hybrid red-legged/chukar populations. Semen was collected twice monthly over a 12-mo period using a massage technique. Both types of bird showed a clear seasonal pattern of spermatogenic activity. The proportion of males ejaculating sperm was higher (P < 0.05) among the pure red-legged birds. The greatest sperm production was recorded in March to May among the pure birds and April to May among the hybrids. Reproductive activity in both groups decreased in June, to reach a minimum in August to December among the hybrids and in September to December among the pure birds. Spermatogenic activity resumed in January in both groups. The sperm concentration produced by the pure birds was smaller than that of the hybrids (P < 0.001), but the percentage of motile sperm was higher in the pure birds (P < 0.001). The sperm of the hybrids showed greater straight-line velocity (P < 0.05), linearity (P < 0.001), straightness (P < 0.001), sperm wobble (P < 0.05), and beat-cross frequency values (P < 0.001). The length and area of the sperm head were smaller in the pure birds (P < 0.05). The seasonal plasma testosterone concentration pattern followed a trend roughly parallel to the ejaculatory response. The present results suggest that genetic introgression influences the reproductive variables of the red-legged partridge. © 2015 Poultry Science Association Inc.

We present the results of measurements taken with the newly constructed PASTIS coil set insert, which uses a wide-angle “banana” 3He neutron spin-filter cell to cover a large range of scattering angles. The neutron polarization direction is freely rotatable to allow 3-directional (XYZ) polarization analysis and the coil set is designed to fit within the sample areas of most of the spectrometers at the Institut Laue-Langevin (ILL) in Grenoble. No significant depolarization due to the repeated spin rotations is observed. The PASTIS insert is now available for use on selected instruments at the ILL. This will enable XYZ neutron polarization analysis studies to be implemented on the majority of public ILL instruments.

La sialendoscopie est une nouvelle technique minimale invasive qui permet d’explorer les canaux salivaires des glandes sous-maxillaires et parotides, mais aussi de traiter leurs pathologies, c’est-a-dire extraire les calculs et dilater les stenoses sous controle endoscopique. A titre diagnostique, elle se positionne en concurrente des techniques radiologiques classiques. A titre therapeutique, elle permet de reduire significativement les indications de sous-maxillectomie et de parotidectomie.

Speed and location observations from Global Positioning System (GPS) loggers are quickly becoming an important source of data for travel behavior researchers. Postprocessing these data requires identifying the location of the GPS data points on a coded map of the transportation network. The output of the map-matching process is the identification of the routes that were actually taken. This paper presents an innovative map-matching algorithm that relies only on the GPS coordinates and the network topology. Examples are provided on a large data set for the Zürich area. The paper demonstrates the efficiency of the algorithm in regard to accuracy and computational speed.

Resume Objectif L’objectif de cet article est d’illustrer l’utilisation de la radiofrequence couplee au laser en cancerologie ORL ainsi que la prise en charge d’un chondrosarcome larynge chez un patient de 90 ans. Presentation du cas Il s’agit d’un patient de 90 ans, OMS 3, presentant un chondrosarcome endolarynge de bas grade, vu en consultation fin 2008 pour bilan d’une dysphonie. Une laryngectomie totale jugee trop lourde et par consequent recusee, le patient a ete tout d’abord tracheotomise sous anesthesie locale devant une dyspnee, et pris en charge dans un second temps pour une desobstruction endolaryngee a visee symptomatique associant radiofrequence et laser. Cela a permis au patient une decanulation sous couvert d’une reeducation orthophonique avec realimentation per os. Discussion Dans notre cas, le patient a beneficie d’un traitement palliatif associant de la radiofrequence et du laser dans le cadre d’un traitement a visee symptomatique. Conclusion La radiofrequence peut etre appliquee en cancerologie ORL comme traitement alternatif a la chirurgie permettant une amelioration de la qualite de vie et de la survie.

The experimental work reported here is devoted to the temporal behaviour of a mono-filamentary dielectric barrier discharge in pure argon, from 100 to 700 Torr. A sinusoidal voltage supply is used, its frequency ranging from 10 to 90 kHz. An anode avalanche followed by a cathode streamer as well as the spatial stability of the micro-discharge is clearly seen in successive 3-ns snapshots in the visible range. Near the cathode, its diameter is about 0.2 mm, at 400 Torr. The electrical characteristics of the discharge are also evaluated, in particular the breakdown voltage and the energy deposited in the micro-discharge. The light output in the vacuum ultraviolet range is essentially due to the second continuum of argon, centred at 130 nm. The kinetic study of this continuum shows that primary excitation of the lowest argon atomic 4s and 4s' states is practically achieved after 120 ns since beyond that time the luminescence decay of the second continuum is fairly described by only two exponential terms. So collisions between excited states, electronic collisions, and recombination of ionic species do not contribute significantly to this luminescence, after 120 ns. Surprisingly, we do not observe the contribution of the Ar(3P1) resonant state in the production of the argon excimers. The radiative lifetime of the Ar2[1u(3P2)]low v excimer ((3.18 ± 0.03) µs) and the three-body rate constant relative to the decay of the Ar(3P2) metastable state ((13.2 ± 0.9) Torr−2 s−1) leading to the formation of Ar2[1u(3P2)], are estimated. These results are consistent with those found from the literature. A simple kinetic scheme is proposed for times later than 120 ns.

This work deals with energy transfer from the resonant state Kr(3P1) to xenon. A pulsed, brief and selective excitation of the molecular state Kr2[1u(3P1)] was achieved with a dye laser. An electrometer was used to select the appropriate excitation wavelength in order to prevent ionization. In mixtures, instead of the continuum of krypton, when a small amount of xenon was added, the first and second continua of xenon were observed, even though Kr(3P1) was initially excited, proving the efficiency of the energy transfer. From the temporal analysis in pure krypton, the three-body rate constants for Kr(3P1) and Kr(3P2) and the lifetime of the excimer Kr2[1u(3P1)] have been measured again. In the mixtures, we clearly showed the occurrence of energy transfer from Kr(3P1) to the Xe[5d(7/2)3] level, with a two-body collision rate constant of 6.8 × 105 Torr−1 s−1. A weak coupling could also intervene between these two states. The reverse collision rate constant ki was found to be about 2.9 × 103 Torr−1 s−1. The ternary heteronuclear collision rate constant of the Xe(3P2) state determined at 145 nm and 168 nm is in good agreement (38.7 Torr−2 s−1 and 36.7 Torr−2 s−1, respectively). Finally, a kinetic scheme of the main reaction processes is proposed.

Background: Radiofrequency (RF) is a method of in situ destruction of liver tumor. Biliary complications are bile ducts stenosis or biliary abcess. The aim of this work was to study consequences of liver RF on bile ducts. Methods: A porcine model of biliary lesions was created using radiofrequency ablation liver. Twenty-two pigs were used for the study. The RF RITA 1500 generator (RITA Medical Systems, Mountain View, Calif., USA) was used for all experiments. The needle was positioned under sonographic control in liver parenchyma beside bile ducts. Two lesions were performed in left liver. Four groups of 5 pigs were treated. The pigs were sacrificed 1 or 3 weeks after the procedure. Pringle maneuver was utilized in half of the RF procedures. An ex vivo cholangiogram was obtained by direct injection into the main bile duct. Samples of RF lesions of liver parenchyma near and at a distance from the RF lesions were taken for pathological studies. Results: Radiological lesions were biliary stenosis, with or without upstream bile duct dilatation, or complete interruption of the bile duct, or extravasation of the radiological contrast agent. Histological lesions of bile ducts were observed near RF lesions and at distance of the RF lesions when a Pringle maneuver was used or when the liver was removed after 3 weeks. Conclusions: RF ablation in contact of the intrahepatic bile duct induced biliary lesions. Therefore, it is required to stay away from the bile duct or to protect it when performing RF ablation.

The recovery of several specimens allows to have a good knowledge of australopithecine pelvic bone anatomy. But despite this, differences of opinion still exist regarding locomotory interpretations. The aim of this paper is to present results of a new morphometric analysis of australopithecine pelvic bones to try to understand the reasons of this situation. It appears that australopithecines exhibit the same overall architectural pattern as extant humans, the hominid pattern, just as all African apes also exhibit the same pongid pattern. But, in this pattern, it is possible to clearly depict two subpatterns corresponding to both generaAustralopithecus andHomo. Locomotory interpretations depend on the fact that some studies emphasize traits related to the hominid pattern (concluding then on modern bipedalism) and others focus on trains characterizing australopithecine sub-pattern (concluding then on non-modern bipedalism).

Resume Objectifs : Du point de vue de la psychanalyse, l'acquisition de l’image du corps lors de la phase du miroir joue un role primordial pour inscrire le sujet dans le langage et l'echange. Cette acquisition suppose la neutralisation des extensions corporelles engagees dans l'echange mere-enfant, que designe le terme d'« objet » en psychanalyse. A la condition de cette perte, le sujet humain se trouve dote d'une « image speculaire », c'est-a-dire qu'il se reconnait dans la forme nommee de son corps. Notre hypothese est que l'asomatognosie, pathologie du schema corporel, peut mettre en cause l'image du corps et la neutralisation de l'objet. Dans cet article, les troubles subjectifs de l'asomatognosie sont envisages de ce point de vue. Materiel : Nous presentons deux patients de moins de 50 ans ayant presente un premier accident ischemique constitue dans le territoire de l'artere cerebrale moyenne droite avec une asomatognosie. Methodes : Chez ces patients, le protocole de Bisiach fut utilise pour mesurer le deficit sensitivomoteur, l'hemianopsie, l'heminegligence et l'anosognosie et adapte pour coter l'asomatognosie. Ces donnees furent confrontees avec celles recueillies au cours d'un entretien semi-directif et d'une epreuve d'autoportrait. Resultats : Chez ces deux patients, l'asomatognosie s'accompagnait d'un morcellement de l'image du corps et de manifestations aberrantes de l’oralite mettant en jeu la main paralysee. Discussion – Conclusion : Les phenomenes psychologiques productifs qui accompagnent l’asomatognosie pourraient correspondre a l’intrusion dans la realite psychique des patients, du fait de l’alteration du schema corporel et de l’image du corps, de l’objet normalement neutralise.

Objectives: The lack of agreement regarding assessment methods is responsible for the variability in the reported rate of occurrence of spatial neglect after stroke. The aim of this study was to assess the sensitivity of different tests of neglect after right hemisphere stroke. Methods: Two hundred and six subacute right hemisphere stroke patients were given a test battery including a preliminary assessment of anosognosia and of visual extinction, a clinical assessment of gaze orientation and of personal neglect, and paper and pencil tests of spatial neglect in the peripersonal space. Patients were compared with a previously reported control group. A subgroup of patients (n=69) received a behavioural assessment of neglect in daily life situations. Results: The most sensitive paper and pencil measure was the starting point in the cancellation task. The whole battery was more sensitive than any single test alone. About 85% of patients Presented some degree of neglect on at least one measure. An important finding was that behavioural assessment of neglect in daily life was more sensitive than any other single measure of neglect. Behavioural neglect was considered as moderate to severe in 36% of cases. A factorial analysis revealed that paper and pencil tests were related to two underlying factors. Dissociations were found between extrapersonal neglect, personal neglect, anosognosia, and extinction. Anatomical analyses showed that neglect was more common and severe when the posterior association cortex was damaged. Conclusions: The automatic rightward orientation bias is the most sensitive clinical measure of neglect. Behavioural assessment is more sensitive than any single paper and pencil test. The results also support the assumption that neglect is a heterogeneous disorder.

This paper presents the pros and cons of the so-called “mesoscopic” approach used in dynamic traffic modeling. After a quick overview of methodologies applied in dynamic models, we discuss the critical issues that mostly determined the shape of past and current research: the time modeling scheme, the level of detail of the approach, the computer implementation strategy and the availability of field data. This paper stresses the importance of modeling departure time choice and information processing. Along this discussion, we describe the features of METROPOLIS, a tool-box designed for the simulation of large-scale transportation systems that proved to be tractable on large-scale, real cases. The system features both within-day and day-to-day dynamics. Lastly, this paper presents simulation results on the wide Parisian region (Ile-de-France).

Define the phases composing the learning curve of total hysterectomy (TH) and radical hysterectomy with pelvic lymphadenectomy (RHPL) robot-assisted performed by a single surgeon with no prior experience in laparoscopic surgery.We retrospectively analyzed 72 procedures (TH, n=34 and RHPL, n=38) conducted between 2002 and 2011. The surgeon console time (CT) was used to determine the learning curve of TH and RHPL using CUSUM analysis. Epidemiological data, perioperative and postoperative complications were compared from the different phases of the learning curve.CUSUM analysis of surgeon console time (CUSUMCT) identified two learning phases for the TH group (phase 1: initial learning, phase 2: surgical skill increase). For the RHPL group, three learning phases were identified (phase 1: initial learning, phase 2: extending surgical indications, phase 3: control of surgical skills). Perioperative and postoperative complication rates did not differ significantly between the learning phases. Surgeon CT decreased from the 9th case (P=0.01) for the TH group and from the 13th case (P=0.04) for the RHPL group.CUSUM analysis of the learning curve in robotic-assisted gynecologic oncology surgery identified two phases of learning curve for simple procedures such as total hysterectomy and three phases for more complex procedures as radical hysterectomy with pelvic lymphadenectomy.