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Acute zwelling van de tong is een atypisch symptoom dat zelden persisteert na initiële behandeling. Opmerkelijk in de casus is de combinatie van een unilaterale zwelling met ipsilaterale parese van de nervus hypoglossus. Gericht onderzoek kon tot een verrassende diagnose leiden.

A positive power-law trend between the local surface densities of molecular gas, Σgas, and young stellar objects, Σstars, in molecular clouds of the solar neighbourhood has recently been identified. How it relates to the properties of embedded clusters has so far not been investigated. To that purpose, we model the development of the stellar component of molecular clumps as a function of time and local volume density. Specifically, we associate the observed volume density gradient of molecular clumps to the density-dependent free-fall time and we obtain the molecular clump star formation history by applying a constant star formation efficiency per free-fall time, ϵff. The model reproduces naturally the observed (Σgas, Σstars) relation quoted above. The consequences of our model in terms of cluster survivability after residual star-forming gas expulsion and in terms of star age distribution in young gas-free clusters are discussed. (© 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim)

This study quantifies the impact of the oxidation ditch horizontal water velocity on the energy consumption of a full-scale wastewater treatment plant (WWTP). A WWTP was modelled by means of the ASM2d platform, showing very good correlation with reference operational data. As to reduce the energy requirements of the plant while guarantying the same nutrient removal performance, two approaches were used. A classical aeration control optimization, yielding a 4% energy reduction, was compared with an increase of the oxidation ditch propelling power. The horizontal water velocity in the oxidation ditches was estimated at only 0.15 m/s. By increasing the horizontal water velocity to 0.3 m/s, an 8% energy reduction could be achieved. Moreover, a synergistic effect for classic control optimization and oxidation ditch water velocity optimization resulted in a 14% energy reduction. Energy spent in propelling power counteracts the aeration energy gain derived by an increase in the oxidation ditch horizontal velocity. An optimum in the water velocity was quantified at 0.3 m/s, comparably with its design value.

Resume Malgre des avantages reconnus aux antipsychotiques par voie injectable, il existe encore des reticences face a ces traitements, tant de la part de certains patients que de la part des professionnels de sante. Une enquete realisee en 2007 aupres de patients souffrant de trouble schizophrenique avait montre que pres de la moitie de ces patients preferait une forme injectable et se sentaient ainsi mieux accompagnes. Il existe aujourd’hui la possibilite de choisir entre deux sites d’injection : le muscle deltoide ou le muscle gluteal. L’enquete presentee ici (realisee par l’Institut de sondage BVA en 2011) vise a recueillir le point de vue des patients sur ce nouveau choix et les changements qu’il induit. Deux cent quatre-vingts un patients avec une maladie schizophrenique suivis en ambulatoire et sous traitement injectable a action prolongee ont ete interroges. Il ressort de cette enquete que 75 % des patients disent se sentir mieux suite a la prise d’un traitement injectable. Le choix du site d’injection, montrant une preference pour le muscle deltoide, est important pour une majorite (70 %), renforcant leur sentiment d’etre acteur de leur traitement. Ils se sentent ainsi plus impliques dans le suivi de celui-ci, ce qui devrait favoriser une meilleure observance.

Background: We already showed that lymphopenia ( Patients and methods: The ImmunTraCkeR® assay (ImmunID, Grenoble, France), which analyzes through semi quantitative multiplex-PCR the V-D-J combinatorial diversity of TCR-beta chain (TRB), was used to investigate diversity of T cell repertoire on cryopreserved blood samples from a retrospective cohort of MBC patients before chemotherapy administration (n=66). Univariate and multivariate analysis were performed. We then validated our score on a prospective cohort (n=67) using the same eligibility criteria (MBC patients before first line chemotherapy administration). Results: Using a 33% cutoff for divpenia in our retrospective cohort (T cell diversity below 33%) (average diversity for healthy people is 70%), divpenia was associated with a median OS of 10 months vs 22 months for patients with diversity >33% (logrank p value=0.04). The NDL® score (Numeration Diversity Lymphocytes representation) that combines lymphocyte numeration with TRB diversity, demonstrated that lympho-divpenia (T cell diversity below 33% and lymphopenia below lGiga/L) was associated with a poor OS compared to patients with either lymphocyte 33% or lymphocyte >1000/μL & diversity 1000/μL and diversity >33% (p=0.015). In multivariate analysis, including performance status (PS), hemoglobin level, polynuclear neutrophil count (PNN), age, and liver metastasis, NDL® score was identified as an independent prognostic factor for OS. In our prospective validation cohort, NDL® score was also identified as a prognostic factors for OS (p=0,007), as well as lymphopenia ( Conclusion: We showed that Divpenia and NDL® score are prognostic factors for OS in MBC patients. In order to confirm these results, a prospective clinical trial is ongoing on a larger cohort of MBC and lung cancer patients. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-12-10.

In medicine, as in oncological radiotherapy, as elsewhere, the precept of quality has no meaning if it is not defined. In France as everywhere radiotherapy has its forces and its weaknesses. As in every country, its future seems assured by its character cost effective as by its capacity to make progress in the triple point of view of its equipment, its professions and its organization. However, the French radiotherapy is in crisis. The professionals saw clearly. For more than 10 years they had recalled the medical authorities to their responsibilities concerning the demographic trends for the radiotherapists and the physicists, the renovation of the equipment, the modernization of the organizations, the promotion of the evaluation of procedures and outcomes and the development of a greater fairness in the financings. But the delay taken, the setting under pressure of the professionals by the State, its services, its agencies and the media following the recent accidents cause numerous perverse effects and worried the staff. The accident of Epinal was the starting fact of an effort of professionalisation of the risk management, but also of a disturbed period favourable with a certain confusion of minds, discouragement and protective behaviors. The risks felt by the professionals then seem especially to come from the authorities and the media. It appears that the topic of quality is at the center of all these speeches. Under this vocable, it is in fact the respect of the procedures related to the requirement of security which is privileged by the State and its representatives. The apparent security seems to override the real quality of the practices. Thus, time came for a clarification of the quality and security concepts, of organizations which contribute to it and for the development of a clear strategy bringing together the interprofessionnal actors. In this context, the implication of the College and especially of the Societe francaise de radiotherapie oncologique is a requirement.

Evidence favouring a Gaussian initial mass function for systems of old globular clusters has accumulated over recent years. We show that a bell-shaped mass function may be the imprint of expulsion from protoclusters of the leftover star forming gas due to supernova activity. Owing to the corresponding weakening of its gravitational potential, a protocluster retains a fraction only of its newly formed stars. The mass fraction of bound stars extends from zero to unity depending on the star formation efficiency achieved by the protoglobular cloud. We investigate how such wide variations affect the mapping of the protoglobular cloud mass function to the initial globular cluster mass function. We conclusively demonstrate that the universality of the globular cluster mass function originates from a common protoglobular cloud mass-scale of about 106 M⊙ among galaxies. Moreover, gas removal during star formation in massive gas clouds is highlighted as the likely prime cause of the predominance of field stars in the Galactic Halo.

We explore whether we can constrain the shape of the INITIAL mass distribution of the star cluster population in M82's ~1 Gyr-old post-starburst region "B", in which the present-day cluster mass function (CMF) is closely approximated by a log-normal distribution. We conclude that the M82 B initial CMF must have had a mean mass very close to that of the "equilibrium" CMF of Vesperini (1998). Consequently, if the presently observed M82 B CMF has remained approximately constant since its formation, as predicted, then the INITIAL CMF must have been characterized by a mean mass that was only slightly larger than the present mean mass. From our detailed analysis of the expected evolution of CMFs, we conclude that our observations of the M82 B CMF are inconsistent with a scenario in which the 1 Gyr-old cluster population originated from an initial power-law mass distribution. Our conclusion is supported by arguments related to the initial density in M82 B, which would have been unphysically high if the present cluster population were the remains of an initial power-law distribution., Comment: 10 pages, 4 figures, accepted for publication in MNRAS

Accurate relative abundances have been obtained for carbon, oxygen, sodium, aluminium, silicon, and calcium in a sample of mildly metal-poor stars. This analysis complements a previous study carried out by Jehin et al. (1999, A&A, 341, 241), which provided the basis for the EASE scenario. This scenario postulates that field metal-poor stars were born in self- enriched proto-globular cluster clouds. By further investigating the correlations between the different α-element abundances, we propose a modified scenario for the formation of intermediate metallicity stars, in which the stars exhibiting lower than average α/Fe abundance ratios would form in low mass clouds, unable to sustain the formation of very massive stars (M > 30 M� ). Moreover, the carbon-to-iron ratio is found to decrease as one climbs the so-called Population IIb branch, i.e. when the s-element abundance increases. In the framework of the EASE scenario, we interpret this anticorrelation between the carbon and the s-element abundances as a signature of a hot bottom burning process in the metal-poor AGB stars which expelled the matter subsequently accreted by our Population IIb stars.

5-HT2 receptors mediate a large array of physiological and behavioral functions in humans via three distinct subtypes: 5-HT2A, 5-HT2B and 5-HT2C. While selective 5-HT2A antagonists have been known for some time, knowledge of the precise role played by the 5-HT2B receptor was hampered by the existence of solely 5- HT2B / 5-HT2C mixed antagonists. However, selective 5-HT2B antagonists began recently to emerge in the literature. Indeed, four structural classes belonging to the piperazine, indole, naphthylpyrimidine and tetrahydro-β-carboline scaffolds were reported. In this paper, we will briefly review the structural and pharmacological features of selective 5-HT2B antagonists, including patent literature of the last five years.

Les concepts de continuite et de globalite des soins sont reconnus aujourd’hui par tous comme inherents a la medecine moderne. Un groupe de travail s’est reuni pour proposer des modeles de coordination des soins de support pour toutes les maladies graves dans les differents etablissements de soins prives et publics. Les soins de support sont : « l’ensemble des soins et soutiens necessaires aux personnes malades, parallelement aux traitements specifiques, lorsqu’il y en a, tout au long des maladies graves ». Cette definition est inspiree de la definition du supportive care donnee en 1990 par la MASCC (Multinational Association for Supportive Care in Cancer) : » The total medical, nursing and psychosocial help which the patients need besides the specific treatment ». Elle integre autant le champ de la guerison avec eventuelles sequelles que celui des soins palliatifs dont la definition est precisee (phases palliatives initiale et terminale). Une telle coordination est justifiee par la pluridisciplinarite liee a l’hyperspecialisation et a l’hypertechnicite des professionnels, par une insuffisance de communication entre les equipes, par les difficultes administratives des equipes participant aux soins de support. Le groupe de travail insiste sur le fait que les soins de support ne sont pas une nouvelle specialite. Il propose la creation de federations, departements ou poles de responsabilite de soins de support avec une « coordination de base » impliquant les activites de prise en charge de la douleur chronique rebelle, de soins palliatifs, de prise en charge psychologique et d’accompagnement social. Cette coordination peut s’etendre, en fonction de « l’histoire » et des missions des etablissements. Le service rendu par la mise en place « d’un guichet unique » pour les malades et les equipes est un point important. La structure doit repondre a certains cahiers des charges (consultation, unite ou centre de lutte contre la douleur chronique rebelle, structures de soins palliatifs, de psycho‐oncologie, de nutrition, d’accompagnement social, etc.). Une mise en commun du plateau technique est un des interets. La structure doit mettre en place des liens forts avec les professionnels liberaux, les reseaux, l’hospitalisation a domicile (HAD) et les services de soins infirmiers a domicile (SSIAD) quand ils existent pour garantir la continuite des soins de support sous tous ses aspects et pour que les preferences des malades puissent etre prises en compte. Selon les propositions Hopital 2007, le Groupement de cooperation sanitaire (GCS) elargi, souple et polyvalent, repond aux besoins inherents aux structures de soins de support au sein des territoires de sante puisqu’il peut etre constitue entre un ou plusieurs etablissements de sante et des professionnels liberaux de sante favorisant ainsi la cooperation entre etablissements publics de sante, etablissements prives, PSPH et medecine de ville.

Building a European defence will require a parallel adaptation in NATO's structures: to fit them better to the Alliance's new missions; and to make it easier for the Europeans to utilise NATO assets when the US is not part of an operation. The Kosovo War revealed flaws in the current arrangements. Planning was conducted unilaterally at US-Europe Command (EUCOM) rather than multilaterally at the Supreme Headquarters of the Allied Powers in Europe (SHAPE). Dominated therefore by the US in its military command function, NATO is in other ways too micro-managed by its Council. The tensions and confusion that flow from these arrangements act to the detriment of the military operations themselves. Effective multilateral political supervision of the Alliance's military commands should be restored. And commands should be reorganised along functional rather than geographical lines. These changes should bring greater efficiency and flexibility, and also help to give substance to ambitions for making the European cou...

We describe the synthesis of nordolichoic acid and [1-14C]nordolichoic acid starting from polyprenol isolated from the leaves of Ginkgo biloba. Coupling of polyprenol with ethyl acetoacetate, using 1,1′-(azodicarbonyl)dipiperidine/tributylphosphine, followed by hydrolysis, decarboxylation and reduction, yielded the 2-polyprenyl-1-methylethanol. This alcohol was converted into a mesylate, subjected to one-carbon elongation with KCN, and finally converted to the acid by hydrolysis of the nitrile.

We have developed a model of globular cluster self-enrichment, based on the ability of the globular cluster gaseous progenitors to retain the ejecta of a first generation of Type II Supernovae. The key point is that this ability depends on the pressure exerted on the progenitor cloud by the surrounding protogalactic medium and therefore on the location of the cloud in the protogalaxy. The model is able to explain the galactic halo metallicities and the metallicity gradient of the Old Halo which is thought to be the genuine galactic globular cluster system. The possibility that metallicity gradients are a common property of extragalactic globular cluster systems is also presented.

Despite the advantages of antipsychotic treatments via the injectable route of administration, there are still reservations regarding this type of therapy, notably among health professionals. A survey conducted with patients suffering from schizophrenic disorders revealed the positive opinion that they had of their treatment. Another survey showed that nearly half of the patients preferred an injectable form, and two thirds felt they were cared for better, because of the injectable treatment. The slow release form of risperidone allows a choice between two injection sites: the deltoid muscle or the gluteal muscle. A recent study showed the satisfaction of the health professionals towards this novel form. The survey presented here was aimed at collecting the opinion of patients regarding the possibility of choosing the injection site, and the changes it would make.The survey was carried out by the BVA Institute during the first half of 2011. The interviews with the schizophrenic patients, followed-up as out patients and treated with long lasting antipsychotics (n=281), were conducted face to face at the hospital by BVA interviewers specialised in the field of health, without the presence of any health professionals. A total of 32 centres participated in the survey; 38% of the interviews took place in the Paris area and 62% in various regions.Different dimensions were analysed. (1) The perception of injectable treatment was largely positive: among all the patients, 75% claimed they currently felt better once they had started the injectable treatment. (2) The choice of the injection site appeared important to a majority of patients (70% of the total sample; 79% of patients had experienced both sites of injection), 56% claimed that it was legitimate that they be given the choice and they felt that they were thus able to participate in their treatment (58%), their treatment was more acceptable (54%), and they found that their relationship with the doctor or nurse was enhanced (53%). (3) The preference regarding the injection site went to the deltoid muscle, among those who had experienced both sites. (4) The perception of the injection sites confirms this preference, the positive qualifications often being associated with the deltoid site, and the negative qualifications with the gluteal site.The survey presented here could contribute in convincing the health professionals to propose the choice to patients between the two injection sites in order to improve their compliance to treatment. Patients would therefore play a role in the choice of their treatment and hence become more involved in the follow-up.

A number of isoprenoids (e.g. pristanic acid and the side chains of fat soluble-vitamins) is degraded or shortened via beta oxidation. We synthesized 2-methyl-palmitate and 2-methyl[1-14C] palmitate as a model substrate for the study of the beta oxidation of branched (isoprenoid) fatty acids in rat liver. 2-Methylpalmitate was well oxidized by isolated hepatocytes and its oxidation was stimulated after treatment of the animals with a peroxisome proliferator. Subcellular fractionation of rat liver demonstrated that 2-methylpalmitate is activated to its CoA ester in endoplasmic reticulum, mitochondria, and peroxisomes and that mitochondria and peroxisomes are capable of beta-oxidizing 2-methylpalmitate. At low unbound 2-methylpalmitate concentrations and in the presence of competing straight chain fatty acids, a condition encountered in vivo, peroxisomal 2-methyl-palmitate oxidation was 2- to 4-fold more active than mitochondrial oxidation. Treatment of rats with a peroxisome proliferator markedly stimulated mitochondrial but only slightly peroxisomal 2-methylpalmitate oxidation. The same treatment dramatically induced palmitoyl-CoA oxidase but did not change 2-methyl-palmitoyl-CoA oxidase activity. Our results indicate 1) that in untreated rats peroxisomes contribute for an important part to the oxidation of 2-methylpalmitate; 2) that treatment with a peroxisome proliferator stimulates mainly the mitochondrial component of 2-methylpalmitate oxidation; and 3) that palmitoyl-CoA and 2-methylpalmitoyl-CoA are oxidized by different peroxisomal oxidases.

Isoprenoid (branched) fatty acids such as pristanic acid can be degraded via beta-oxidation in peroxisomes. We synthesized 2-methylpalmitoyl-CoA as a model substrate in order to study the first step of the peroxisomal beta-oxidation of branched fatty acids, catalyzed by an acyl-CoA oxidase. 2-Methylpalmitoyl-CoA oxidase activity was found in rat liver homogenates. Subcellular fractionation demonstrated that the oxidase was confined to peroxisomes. 2-Methylpalmitoyl-CoA oxidase was also present in kidney and intestine. It was not induced in liver or in the extrahepatic tissues by treatment of rats with peroxisome proliferators or by feeding diets containing excess isoprenoids. The enzyme was partially purified together with palmitoyl-CoA oxidase and trihydroxycoprostanoyl-CoA oxidase by heat treatment and ammonium sulfate fractionation of liver extracts. The partially purified preparation was chromatographed on various columns. 2-Methylpalmitoyl-CoA oxidase could be separated from the inducible (by peroxisome proliferators) palmitoyl-CoA oxidase and from trihydroxycoprostanoyl-CoA oxidase, but it always coeluted with the noninducible palmitoyl-CoA oxidase, recently described by us (Schepers, L., Van Veldhoven, P. P., Casteels, M., Eyssen, H. J., and Mannaerts, G. P. (1990) J. Biol. Chem. 265, 5242-5246). 2-Methylpalmitoyl-CoA oxidase was purified to near homogeneity in three chromatographic steps (anion exchange, hydroxylapatite, and gel filtration). Its apparent molecular mass is approximately 415 kDa, and it consists of identical subunits of approximately 70 kDa. The enzyme oxidized 2-methylpalmitoyl-CoA twice as rapidly as palmitoyl-CoA and pristanoyl-CoA as rapidly as palmitoyl-CoA, so that it can be considered as a branched fatty acyl-CoA oxidase. Since pristanoyl-CoA is one of its naturally occurring substrates we propose to name this enzyme pristanoyl-CoA oxidase.

The strictly anaerobic intestinal Peptococcus niger H4 synthesizes three different steroidsulfatase enzymes: a constitutive arylsulfatase and two inducible alkylsteroidsulfatases. The arylsulfatase desulfates estrogen-3-sulfates and phenylsulfates. The two alkylsteroidsulfatases desulfate, respectively, 3 alpha-sulfates and 3 beta-sulfates of delta 5, 5 alpha, and 5 beta androstanes, pregnanes, and bile acids. Cholesterol-3 beta-sulfate was not desulfated by the alkylsteroidsulfatases nor were steroids or bile acids that were sulfated in positions other than the 3 position. The alkylsteroidsulfatases were induced by their substrates; bile acid sulfates, however, were poor inducers of the 3 beta-sulfatase and did not induce the 3 alpha-sulfatase activity. In intact bacterial cells, taurine and sulfite suppressed the induction of the alkylsteroidsulfatases and inhibited the activity of the arylsulfatase and alkylsteroidsulfatases. In cell homogenates, the arylsulfatase and alkylsteroidsulfatases activities were inhibited by sulfite and sulfate but not by taurine. Our results support the hypothesis that the main function of the steroidsulfatases in P. niger H4 is to provide the bacteria with sulfur for dissimilatory purposes.

In medicine, as in oncological radiotherapy, as elsewhere, the precept of quality has no meaning if it is not defined. In France as everywhere radiotherapy has its forces and its weaknesses. As in every country, its future seems assured by its character cost effective as by its capacity to make progress in the triple point of view of its equipment, its professions and its organization. However, the French radiotherapy is in crisis. The professionals saw clearly. For more than 10 years they had recalled the medical authorities to their responsibilities concerning the demographic trends for the radiotherapists and the physicists, the renovation of the equipment, the modernization of the organizations, the promotion of the evaluation of procedures and outcomes and the development of a greater fairness in the financings. But the delay taken, the setting under pressure of the professionals by the State, its services, its agencies and the media following the recent accidents cause numerous perverse effects and worried the staff. The accident of Epinal was the starting fact of an effort of professionalisation of the risk management, but also of a disturbed period favourable with a certain confusion of minds, discouragement and protective behaviors. The risks felt by the professionals then seem especially to come from the authorities and the media. It appears that the topic of quality is at the center of all these speeches. Under this vocable, it is in fact the respect of the procedures related to the requirement of security which is privileged by the State and its representatives. The apparent security seems to override the real quality of the practices. Thus, time came for a clarification of the quality and security concepts, of organizations which contribute to it and for the development of a clear strategy bringing together the interprofessionnal actors. In this context, the implication of the College and especially of the Société française de radiothérapie oncologique is a requirement.

Introduction The aim of this article was to evaluate the role of hyperthermic intraperitoneal chemotherapy (HIPEC), associated or not to cytoreductive surgery (CS) in the treatment of different stages of advanced gastric cancer (AGC). Patients and methods Thirty seven patients with AGC who underwent 43 HIPEC from June 1992 to February 2007 were included. HIPEC used Mitomycin-C and Cisplatin for 60–90 min at 41–43 °C intra-abdominal temperature. The main endpoints were long-term survivals, morbidity and mortality rates. Results Eleven patients had no demonstrable sign of PC and constituted the Prophylactic -group, while 26 patients had macroscopic PC ( PC -group). Five patients were Gilly 1 or 2 (nodules PC -group a complete curative CS was achieved before HIPEC in 8 ( PC-curative subgroup) and a palliative HIPEC in 18 patients ( PC-palliative subgroup). The overall 30-days mortality was 5% (2 patients). Two patients in the Prophylactic group died within 6 months after hospital discharge (overall mortality 11%). The estimated risk of death per procedure was 9%. Ten patients (27%) presented one or more complications. The median survival was 23.4 months in the Prophylactic group, and 6.6 months in the PC -group ( p PC-curative subgroup was 15 vs 3.9 months in the PC - palliative subgroup ( p = 0.007). The median survival according to Gilly classification was significantly different (Gilly 1&2 vs Gilly 3&4, 15 vs 4 months respectively, p = 0.014). The global recurrence rates between the Prophylactic group and the PC-curative subgroup at 2 years were 36% vs 50% respectively. The median delay to recurrence was 18.5 vs 9.7 months respectively. Conclusion HIPEC might be useful to improve the survival in selected patients with ACG only when a complete cytoreduction can be achieved. Despite encouraging data, prospective studies, based on larger cohorts of patients are required to assess the role of this procedure as a prophylactic treatment in patients with AGC.

On-line control is able to boost process efficiency and optimise effective capacity of nutrient removal plants. In this paper, costs and benefits of on-line control are presented and economical feasibility is analysed using a simple economical cost-benefit analysis. These concepts are illustrated by a number of full-scale case studies. The on-line control of ferric dosage is illustrated by the case of the Lommel WWTP, and the Harelbeke WWTP and Houthalen WWTP illustrate advanced on-line control of aeration for nitrogen removal.

5-HT(2) receptors mediate a large array of physiological and behavioral functions in humans via three distinct subtypes: 5-HT(2A), 5-HT(2B)and 5-HT(2C). While selective 5-HT(2A)antagonists have been known for some time, knowledge of the precise role played by the 5-HT(2B)receptor was hampered by the existence of solely 5-HT(2B)5-HT(2C) mixed antagonists. However, selective 5-HT(2B)antagonists began recently to emerge in the literature. Indeed, four structural classes belonging to the piperazine, indole, naphthylpyrimidine and tetrahydro-beta-carboline scaffolds were reported. In this paper, we will briefly review the structural and pharmacological features of selective 5-HT(2B) antagonists, including patent literature of the last five years.

Uncertainty is a central concept in the decision-making process, especially when dealing with biological systems subject to large natural variations. In the design of activated sludge systems, a conventional approach in dealing with uncertainty is implicitly translating it into above-normal safety factors, which in some cases may even increase the capital investments by an order of magnitude. To obviate this problem, an alternative design approach explicitly incorporating uncertainty is herein proposed. A probabilistic Monte Carlo engine is coupled to deterministic wastewater treatment plant (WWTP) models. The paper provides a description of the approach and a demonstration of the general adequacy of the method. The procedure is examined in an upgrade of a conventional WWTP towards stricter effluent standards on nutrients. The results suggest that the procedure can support the decision-making process under uncertainty conditions and that it can enhance the likelihood of meeting effluent standards without entailing above-normal capital investments. The analysis led to reducing the capital investment by 43%, producing savings of more than 1.2 million euro.

Ambulatory surgery is a concept of organization, organization centered on the patient. It is an innovation whose development depends on policies of accompaniment that are devoted to it. As for all innovation the patients or the society can't profit of its benefits if its conditions are not respected. Recognized international definitions all insist on its qualified character and on its substitution effect.

We discuss the existence of a mass-metallicity relation among galactic halo globular clusters. The lack of any luminosity-metallicity correlation in globular cluster systems has been used as an argument against self-enrichment models of cluster formation. We show that such a relation is statistically present among the galactic Old Halo globulars. This observational correlation implies that the least massive old clusters are the most metal-rich. This is in contradiction with the idea that, if globular clusters were self-enriched systems, the most metal-rich clusters would also be the most massive ones. We further show that this anti-correlation is as predicted by self-enrichment models., 5 pages, accepted for publication in A&A

Indications for laparoscopic surgery have been extended in the last ten years. Patients with several organ failures may also benefit of such technique. Therefore, it seems interesting to study and analyse the interactions between clinical status and the consequences of intra-abdominal gas insufflation. Because the postoperative benefits of laparoscopic surgery are notable, this technique is more and more proposed to old patients. The only imperative is to anticipate medical problems.

In military life, noise has unusual characteristics and constitutes a serious hazard for hearing. Hearing impairments due to the exposure to weapon noises represent an important prejudice for the health of many soldiers. A special attention is given to (i) the "critical level", (ii) the frequency localization of the threshold shifts, (iii) the actual influence of the protective reflexes of the ear, (iv) the existence of delayed threshold shifts following impulse noise exposures, and (v) the interest of the medical treatment of the acoustic trauma. Damage risk criteria for weapon noises are compared: criteria using the (A-weighted) isoenergy principle represent the best present solution (LAeq = 85 dB). Specific problems related to the use of hearing protection are also discussed.

Accurate relative abundances of light elements (C to Ca) have been obtained in a sample of mildly metal-poor stars (Decauwer et al . 2005). Combined with the results of a previous study (Jehin et al . 1999), we find different slopes in the correlations between the different α-elements. These results can be explained by postulating that the stars exhibiting lower than average α/Fe form in low mass clouds, unable to sustain the formation of very massive stars.

Perforated diverticulitis is an uncommon but severe complication of diverticular disease. Whatever the type of the contamination, whether bacterial or fecal, the peritonitis is responsible for septic shock, which necessitates emergent and aggressive medical and surgical treatment. Intensive intravenous perfusion under monitoring, adapted antibiotherapy should come before surgical decision. The aim of surgery is twofold: to suppress the infectious source and to clean the peritoneum. After all, the peritonitis has a tendency to recur and therefore postoperative abscesses have to be searched systematically and if the case arises, these abscesses have to be reoperated or drained. Best results were obtained with immediate sigmoidectomy and colo-rectal anastomosis associated with loop colostomy; that procedure should be preferred to Hartmann technique. If the morbidity remains high, the mortality should decrease under 10% with intensive therapy.

Blast injuries occur only on gas-containing structures: auditory system, upper respiratory tract, lung and gastro-intestinal tract. The severity of the injuries depends upon the physical characteristics of the shock waves: peak pressure, rise time and A-duration, and upon the number of exposures. We present results obtained on swine and sheep concerning tracheal, pulmonary, gastrointestinal injuries, and a survival estimate for man.

Background Lymphopenia ( 1 Giga/L) before initiation of chemotherapy is a predictive factor for toxicity and death in metastatic phase for cancer patients. Combinatorial diversity of T Cell Receptor -beta chain (TCR-β), as a measure of T cell repertoire diversity, was investigated and tested either alone or in combination with lymphopenia as a prognostic factor for overall survival (OS) in first line treatment of metastatic breast cancer (MBC) patients. Methods Using semi quantitative multiplex PCR, the V-D-J combinatorial diversity of the TCR was measured on cryo-preserved blood samples from 2 cohorts of MBC patients before the initiation of the first line chemotherapy: in an experimental cohort (cohort A, n = 66) and in a validation series (cohort B, n = 67). A prognostic score, defined NDL (Number & Diversity of Lymphocytes) combining lymphocyte count and TCR diversity was delineated. Univariate and multivariate analysis of prognostic factors for OS were performed in both cohorts. Results Lymphopenia ( 1 Giga/L) was associated with shorter OS for cohort B while TCR diversity ≤33% (called divpenia) was associated with a reduced OS in cohort A. The combination of lymphopenia with low TCR diversity (called lympho-divpenia) was associated with poor OS compared to patients with either lymphocyte count ≥1 Giga/L or diversity >33% or both, in cohort A (median OS: 7.6 vs 24.5 months, p.value =0.0006) and cohort B (median OS 10.6 vs 22.9 months, p.value =0.0035). In a multivariate analysis, including all significant clinical factors from the univariate analysis (PS, liver metastasis, hemoglobin) lympho-divpenia was found to be an independent prognostic factor in the pooled cohort (A + B) (p = 0.005) along with triple negative tumors (p = 0.011) and hemoglobin level (11.5 g/dL) (p = 0.009). Conclusion NDL score combining lymphopenia and reduced TCR diversity seems to be a strong prognostic factor for OS and could be use to improve care quality of MBC patients.

A 34-year-old woman with liver cirrhosis and portal hypertension was admitted for gastric bleeding due to congestive gastropathy. Her past medical history included 4 episodes of variceal rupture within the last 5 months. As medical treatment was a failure, an emergency transjugular intrahepatic portosystemic shunt was successfully performed, resulting in a marked drop in portal pressure (from 32 to 15 mm Hg) and a subsequent arrest of acute hemorrhage. Four months later, no recurrent bleeding has been observed and the shunt has remained patent as documented by duplex Doppler sonography.

3-Methyl-substituted fatty acids are first oxidatively decarboxylated (alpha-oxidation) before they are degraded further via beta-oxidation. We synthesized [1-14C]phytanic and 3-[1-14C]methylmargaric acids in order to study their alpha-oxidation in isolated rat hepatocytes, rat liver homogenates and subcellular fractions. alpha-Oxidation was measured as the production of radioactive CO2. In isolated hepatocytes, maximal rates of alpha-oxidation amounted to 7 and 10 nmol/min x 10(8) cells with phytanic acid and 3-methylmargaric acid, respectively. At equimolar substrate concentrations, alpha-oxidation of branched fatty acids was approximately 10- to 15-fold slower than the beta-oxidation of the straight chain palmitate. In whole liver homogenates, rates of alpha-oxidation that equaled 60 to 70% of those observed in the hepatocytes were obtained. Optimum rates required O2, NADPH, Fe3+, and ATP. Fe3+ could be replaced by Fe2+ and ATP could be replaced by a number of other phosphorylated nucleosides and even inorganic phosphate without loss of activity. NADH could substitute for NADPH but not always with full restoration of activity. A variety of other cofactors and metal ions was either inhibitory or without effect. Scavengers of reactive oxygen species, known to be formed during the NADPH-dependent microsomal reduction of ferric-phosphate complexes, were without effect on alpha-oxidation. No evidence was found for the accumulation of NADPH-dependent or Fe(3+)-dependent reaction intermediates. Subcellular fractionation of liver homogenates demonstrated that alpha-oxidation was located predominantly, if not exclusively, in the endoplasmic reticulum. alpha-Oxidation, measured in microsomal fractions, was not inhibited by CO, cytochrome c, or ferricyanide, indicating that NADPH cytochrome P450 reductase and cytochrome P450 are not involved in alpha-oxidation. Our results indicate that, contrary to current belief, alpha-oxidation is catalyzed by the endoplasmic reticulum. The cofactor requirements suggest that alpha-oxidation involves the reduction of Fe3+ by electrons from NADPH and that it is stimulated by phosphate ions and nucleotides.

Acoustic noise propagation in the low atmosphere has been studied experimentally for propagation distances varying between some hundred meters and some kilometers. Experimental signals show that the acoustical propagation is influenced by the meteorological parameters and by their fluctuations. During experiments made with electroacoustic sources and with helicopters, variations of the sound level during the day and as a function of the frequency have been noticed. The fluctuations of the meteorological data are described by a statistical formulation and are included in a ray tracing model. 1 INFLUENCE DES GRADIENTS METEOROLOGIQUES La propagation d'un bruit appartenant a la gamme Alfi(nuatlon (dB) v...... " ........ . . . . . . . . . . . . . . . . . . des frequences audibles est affectee par la topo. . . . . . . . . . . . . . . . . . : : : : : : : : : graphie du terrain, la nature du sol et les conditions atmospheriques. . . . . . . . . . . . . . . . . . . . . . . . . . . . L'ISL, en collaboration avec I'ONERA, a entrepris des experimentations en exterieur, visant a mettre . . , . . en evidence l'effet des conditions atmospheriques . . . . . sur la propagation des ondes acoustiques [ I l . Les parametres meteorologiques ont un poids important : compte tenu des effets conjugues des gradients de vent et de temperature, on peut Observer un renforcement du niveau acoustique ou, au contraire, la creation de d'ombre. Ces phenomenes sont observables soit au cours de journees differentes ayant des situations -60 meteorologiques tres marquees, soit au cours de 1E+O1 2 3 4 5 lE+02 2 3 4 5 1E+03 certaines journees compte tenu de l'evolution des Dlstonce (m) parametres meteorologiques entre le lever et le : Evolution en cours de journee de coucher du soleil (fig. 1). l'attenuation (f = 1000 Hz) 2 INFLUENCE DES FLUCTUATIONS METEOROLOGIQUES La turbulence atmospherique, due a la fois a des phenomenes thermiques et aerodynamiques, cree des fluctuations de l'indice de refraction acoustique le long du chemin de propagation entre la Article published online by EDP Sciences and available at http://dx.doi.org/10.1051/jp4:19921162 Cl-746 JOURNAL DE PHYSIQUE IV source et le recepteur. Ces fluctuations ont pour effet de moduler la phase et l'amplitude de la pression acoustique au niveau du recepteur et de diminuer la coherence entre I'onde directe et I'onde reflechie par le sol. 2-? Mesures acousfiques Lors de I'experience [Il, des trains d'ondes successifs ont ete emis par la source acoustique et recus par des microphones places a differentes distances de la source. A partir de ces mesures, I'ONERA a realise une analyse des fluctuations dues 9 la turbulence du niveau acoustique de chaque train d'ondes [2]. Les histogrammes des niveaux acoustiques des trains d'ondes montrent une dispersion des niveaux acoustiques croissant en fonction de l'eloignement a la source (fig. 2). Nombre d'evenernents 30

Isoprenoid (branched) fatty acids such as pristanic acid can be degraded via beta-oxidation in peroxisomes. We synthesized 2-methylpalmitoyl-CoA as a model substrate in order to study the first step of the peroxisomal beta-oxidation of branched fatty acids, catalyzed by an acyl-CoA oxidase. 2-Methylpalmitoyl-CoA oxidase activity was found in rat liver homogenates. Subcellular fractionation demonstrated that the oxidase was confined to peroxisomes. 2-Methylpalmitoyl-CoA oxidase was also present in kidney and intestine. It was not induced in liver or in the extrahepatic tissues by treatment of rats with peroxisome proliferators or by feeding diets containing excess isoprenoids. The enzyme was partially purified together with palmitoyl-CoA oxidase and trihydroxycoprostanoyl-CoA oxidase by heat treatment and ammonium sulfate fractionation of liver extracts. The partially purified preparation was chromatographed on various columns. 2-Methylpalmitoyl-CoA oxidase could be separated from the inducible (by peroxisome proliferators) palmitoyl-CoA oxidase and from trihydroxycoprostanoyl-CoA oxidase, but it always coeluted with the noninducible palmitoyl-CoA oxidase, recently described by us (Schepers, L., Van Veldhoven, P. P., Casteels, M., Eyssen, H. J., and Mannaerts, G. P. (1990) J. Biol. Chem. 265, 5242-5246). 2-Methylpalmitoyl-CoA oxidase was purified to near homogeneity in three chromatographic steps (anion exchange, hydroxylapatite, and gel filtration). Its apparent molecular mass is approximately 415 kDa, and it consists of identical subunits of approximately 70 kDa. The enzyme oxidized 2-methylpalmitoyl-CoA twice as rapidly as palmitoyl-CoA and pristanoyl-CoA as rapidly as palmitoyl-CoA, so that it can be considered as a branched fatty acyl-CoA oxidase. Since pristanoyl-CoA is one of its naturally occurring substrates we propose to name this enzyme pristanoyl-CoA oxidase.

A number of isoprenoids (e.g. pristanic acid and the side chains of fat soluble-vitamins) is degraded or shortened via beta oxidation. We synthesized 2-methyl-palmitate and 2-methyl[1-14C] palmitate as a model substrate for the study of the beta oxidation of branched (isoprenoid) fatty acids in rat liver. 2-Methylpalmitate was well oxidized by isolated hepatocytes and its oxidation was stimulated after treatment of the animals with a peroxisome proliferator. Subcellular fractionation of rat liver demonstrated that 2-methylpalmitate is activated to its CoA ester in endoplasmic reticulum, mitochondria, and peroxisomes and that mitochondria and peroxisomes are capable of beta-oxidizing 2-methylpalmitate. At low unbound 2-methylpalmitate concentrations and in the presence of competing straight chain fatty acids, a condition encountered in vivo, peroxisomal 2-methyl-palmitate oxidation was 2- to 4-fold more active than mitochondrial oxidation. Treatment of rats with a peroxisome proliferator markedly stimulated mitochondrial but only slightly peroxisomal 2-methylpalmitate oxidation. The same treatment dramatically induced palmitoyl-CoA oxidase but did not change 2-methyl-palmitoyl-CoA oxidase activity. Our results indicate 1) that in untreated rats peroxisomes contribute for an important part to the oxidation of 2-methylpalmitate; 2) that treatment with a peroxisome proliferator stimulates mainly the mitochondrial component of 2-methylpalmitate oxidation; and 3) that palmitoyl-CoA and 2-methylpalmitoyl-CoA are oxidized by different peroxisomal oxidases.