Search

Background Eosinophilic annular erythema (EAE) is a rare eosinophil-related skin disease which typically manifests with annular erythematous plaques and severe pruritus. Besides the diagnosis, the treatment of EAE is challenging since relevant published data are sparse. Methods The aim of this study was to assess the underlying diseases, treatments and outcomes of patients with EAE. To this end, we conducted a retrospective multicenter study and a systematic review of the MEDLINE database. Results We included 18 patients with EAE followed in 8 centers. The MEDLINE database search yielded 37 relevant publications reporting 55 cases of EAE with 106 treatment sequences. The most common and efficient treatments included topical or systemic corticosteroids, hydroxychloroquine and dapsone. In refractory patients, a combination of systemic corticosteroids with hydroxychloroquine was associated with 88% of complete clinical response. Discussion To improve the management of EAE patients, we discuss the following treatment strategy: in topical steroid-resistant patients, hydroxychloroquine can be given as first-line systemic treatment. Dapsone, hydroxychloroquine or systemic corticosteroids are second-line options to consider. Last, monoclonal antibodies or JAK inhibitors targeting type 2 inflammation could represent promising last-resort options in refractory patients.

International audience; Here we highlight the career contributions of Chantal Gascuel-Odoux in hydrology, soil science and agronomy. These contributions are divided into four main categories: i) Influence of soil and subsoil properties on hydrological processes; ii) Water, solute and particulate transfer at the catchment scale; iii) Design of integrated approaches to landscapes and territorial management; iv) Contributions to public policies and public debates. We conclude by emphasising Chantal’s human qualities, which we particularly appreciate as former mentees.

International audience; IntroductionLes traitements combinés sont l’association de médicaments utilisés principalement pour augmenter l’efficacité et réduire la toxicité de chaque médicament pris isolément. Dans le psoriasis sévère cutané ou articulaire chez l’adulte, la combinaison de traitements systémiques habituels avec des biothérapies est fréquente (12 % dans le registre PsoBioTeq), et chez l’enfant dans l’arthrite juvénile idiopathique et les maladies inflammatoires de l’intestin. De rares données (cas cliniques) sont disponibles chez l’enfant souffrant de psoriasis sévère.L’objectif de cette étude était d’évaluer en pratique quotidienne l’utilisation des combinaisons de traitements systémiques habituels et de biothérapies chez les enfants souffrant de psoriasis sévère : schémas d’utilisation, efficacité, sécurité.Matériel et méthodesÉtude en deux étapes : évaluation des thérapies combinées chez les 170 enfants inclus dans les cohortes franco-italiennes BiPe. Les enfants devaient avoir reçu pendant au moins 1 mois acitrétine, méthotrexate, ou cyclosporine avec une biothérapie ; et une enquête menée en avril 2022 auprès des dermatologues français et italiens (SFDP, GrPso, SIDerP) pour mieux comprendre les motivations à utiliser ou non ces combinaisons.RésultatsAu total, 33 enfants (19,4 %) inclus dans 13 centres ont cumulé 48 associations thérapeutiques (durée cumulée totale : 43,6 ans), dont trois cas de trithérapies (acitrétine-méthotrexate et inhibiteur du TNF-alpha). Les formes sévères de psoriasis étaient surreprésentées : psoriasis arthropathique (27,3 %), palmoplantaire (21,1 %), érythrodermique (6,1 %) ou pustuleux (6,1 %). Quatorze associations différentes ont été utilisées incluant les trois systémiques conventionnels et étanercept, adalimumab, infliximab, ustékinumab et sécukinumab. Les quatre associations les plus fréquentes étaient étanercept-acitrétine (n = 10), adalimumab-acitrétine (n = 7), adalimumab-méthotrexate (n = 5), et ustékinumab-méthotrexate (n = 5). Les combinaisons ont été utilisées à l’initiation du traitement biologique dans 41 cas (85,4 %), et les 7 autres cas après une période de monothérapie du biologique. Les scores PGA et PASI moyens entre le début du traitement et M3 ont diminué pour toutes les associations. Quatre événements indésirables graves ont été rapportés (3 infections et 1 urticaire) toujours avec une évolution favorable.Soixante et un dermatologues ont répondu à l’enquête, 39 (63,9 %) avaient déjà utilisé ou prévu d’utiliser des associations, principalement des inhibiteurs du TNF-alpha avec de l’acitrétine ou du méthotrexate. La principale motivation était d’optimiser le traitement biologique en cas d’efficacité partielle ou de perte d’efficacité.DiscussionLes combinaisons de traitements sont finalement fréquemment utilisées dans le psoriasis de l’enfant, avec une grande variabilité des situations cliniques et des associations, sans toxicité significative. Leur place éventuelle dans la prise en charge du psoriasis de l’enfant reste à préciser : switchs progressifs en initiation de traitement (éviter une poussée, ou optimisation du systémique), de psoriasis difficiles à traiter, les psoriasis cutanés avec rhumatisme psoriasique associé, optimisation d’une biothérapie…

Earth and water monitoring and observation systems provide open geo data to scientists and professionals supporting distributed knowledge of major hydromet dynamics and extremes. Mobile technologies, at the same time, are empowering citizens who are nowadays informed and involved in volunteering actions designed and implemented to make our communities more safe and sustainable. Citizen science, as a consequence, is gaining momentum empowering the general public, from the “pleasure of doing science” to complementing observations, increasing scientific literacy, and supporting collaborative behaviour to solve specific water-related challenges. This work illustrates a conceptual transdisciplinary assessment model that was designed with the goal of standardizing the use of citizen science for advancing hydrology. This work was promoted by the Citizens AND HYdrology (CANDHY) Working Group established by the International Association of Hydrological Sciences (IAHS), and that is composed by a diverse group of hydrological, computer and social science experts. A community paper (Nardi et al., in press) presented the conceptualization of this transdisciplinary framework by identifying the shared constituents, interfaces and interlinkages between hydrological sciences and other academic and non-academic disciplines. Particular emphasis was given to the integration of human sensing and behavioural mechanisms into citizen science programs addressing hydrological problems. The proposed CANDHY transdisciplinary framework is here further tested and applied to assess some selected citizen science programs to understand the knowledge gaps and opportunities arising from ongoing citizen science programs. This comparative assessment shows some interesting preliminary results demonstrating the capacity of the proposed framework in homogenizing and accumulating knowledge from the collaboration of diverse participatory programs addressing similar or complementary hydrological challenges. Nardi F. et al., in press. Citizens AND HYdrology (CANDHY): conceptualizing a transdisciplinary framework for citizen science addressing hydrological challenges. Hydrological Sciences Journal, https://doi.org/10.1080/02626667.2020.1849707

Background Tattooing is a widespread phenomenon, with an estimated prevalence of 10-30% in Western populations. For psoriasis patients, current recommendations are to avoid having a tattoo if the disease is active and they are receiving immunosuppressive treatments. Although scientific data supporting these recommendations are lacking, dermatologists are often reluctant to advocate tattooing in psoriasis patients. Objective We aimed to evaluate the frequency of tattoo complications in patients with psoriasis and determine whether the occurrence of complications was associated with psoriasis status and treatments received at the time of tattooing. Methods We performed a multicentre cross-sectional study. Adults with psoriasis were consecutively included and classified as tattooed or non-tattooed. Prevalence of complications associated with tattoos was then evaluated according to psoriasis onset and treatments. The study was divided into three parts, in which data were collected through a series of questionnaires filled in by the dermatologist. Complications included pruritus, oedema, allergic reaction/eczema, infection/superinfection, granuloma, lichenification, photosensitivity, Koebner phenomenon and psoriasis flare after tattooing. Diagnosis of complications was made retrospectively. Results We included 2053 psoriatic patients, 20.2% had 894 tattoos. Amongst non-tattooed patients, 15.4% had wished to be tattooed, with psoriasis being stated as a reason for not having a tattoo by 44.0% and 5.7% indicating that they planned to have a tattoo in the future. Local complications, such as oedema, pruritus, allergy and Koebner phenomenon, were reported in tattoos in 6.6%, most frequently in patients with psoriasis requiring treatment at the time of tattooing (P

Widely available digital technologies are empowering citizens who are increasingly well informed and involved in numerous water, climate, and environmental challenges. Citizen science can serve many different purposes, from the "pleasure of doing science" to complementing observations, increasing scientific literacy, and supporting collaborative behaviour to solve specific water management problems. Still, procedures on how to incorporate citizens' knowledge effectively to inform policy and decision-making are lagging behind. Moreover, general conceptual frameworks are unavailable, preventing the widespread uptake of citizen science approaches for more participatory cross-sectorial water governance. In this work, we identify the shared constituents, interfaces, and interlinkages between hydrological sciences and other academic and non-academic disciplines in addressing water issues. Our goal is to conceptualize a transdisciplinary framework for valuing citizen science and advancing the hydrological sciences. Joint efforts between hydrological, computer, and social sciences are envisaged for integrating human sensing and behavioural mechanisms into the framework. Expanding opportunities of online communities complement the fundamental value of on-site surveying and indigenous knowledge. This work is promoted by the Citizens AND HYdrology (CANDHY) Working Group established by the International Association of Hydrological Sciences (IAHS).

Multi-Criteria Decision Analysis (MCDA) requires a critical step, namely to elicit individual preferences. On the basis of learning theories, we formalize preference construction as learning about facts and values, and as a process; we also conceptualize an online preference elicitation survey that offers learning loops to increase factual learning and support preference construction. Another originality is gamification. Game elements (a narrative and non-player characters as motivational affordance) keep respondents engaged in the demanding task of weight elicitation. Our tool enables broad public participation in MCDA, allowing reliable online preference elicitation. The survey concept was tested with 107 students and a control treatment. Quantitative and qualitative data indicate that the concept works. Participants’ factual knowledge increased. The survey helped students to learn about their own preferences concerning the importance of objectives. The practical implication is that weighting can be reliably elicited by online surveys. Participants reported a positive experience; further ways to improve it are thoroughly discussed.

Serious games, gamification, or game-based interventions are increasingly used as tools to aid participatory decision-making processes, but their evaluation is often not very rigorous. Therefore, it is still unclear whether game-based interventions are really beneficial. We focused on the following overarching question: how effective are game-based interventions specifically designed to support decision-making processes. We used an illustrative case to reflect on this question. Using a published framework proposing that design processes of game-based interventions and their evaluation are intertwined, we designed simultaneously (1) a game-based intervention, specifically a card game and a workshop structure in which this card game is to be used, and (2) its evaluation procedure, formulating evaluation questions and proposing measure instruments based on the literature. We pre-tested the evaluation procedure in a small pilot study with 10 students. We illustrate the use of the design framework for an intervention to generate objectives in a decision-making process about sustainable wastewater management. Through our illustrative case, we identify future research opportunities about designing game-based interventions and evaluating their effectiveness. We found that it is possible to address the dual challenge of game-based interventions for participatory decision-making processes: (1) designing an informative and engaging game-based intervention without telling participants what to think and (2) designing a tailored evaluation procedure. Designing the game-based intervention and its evaluation simultaneously is valuable, because both are strongly intertwined. However, conducting the evaluation is demanding and requires the collaborative efforts of scientists, including across disciplinary boundaries. For instance, the data collection effort could be distributed among different research groups to increase sample size. This would allow including control treatment(s) and covering the variation span of the confounding factors more broadly. All material is made openly available to foster collaborative future research.

Serious games and gamification are nowadays pervasive. They are used to communicate about science and sometimes to involve citizens in science (e.g. citizen science). Concurrently, environmental decision analysis is challenged by the high cognitive load of the decision-making process and the possible biases threatening the rationality assumptions. Difficult decision-making processes can result in incomplete preference construction, and are generally limited to few participants. We reviewed 43 serious games and gamified applications related to water. We covered the broad diversity of serious games, which could be explained by the still unsettled terminology in the research area of gamification and serious gaming. We discuss how existing games could benefit early steps of Multi-Criteria Decision Analysis (MCDA), including problem structuring, stakeholder analysis, defining objectives, and exploring alternatives. We argue that no existing game allows for preference elicitation; one of the most challenging steps of MCDA. We propose many research opportunities for behavioral operational research.

Resume L’evaluation de la severite du psoriasis est une problematique complexe qui doit evaluer plusieurs dimensions : la severite clinique et le retentissement de la maladie (qualite de vie). Le plus souvent cette evaluation est realisee dans les essais cliniques. Le score de severite le plus utilise est le score PASI (Psoriasis Area Severity Index). Les scores utilises dans les essais ne sont pas les plus faciles a utiliser en pratique clinique quotidienne. En effet, le score PASI par exemple n’est pas tres adapte pour l’evaluation de faibles surfaces cutanees. Cependant les scores ont egalement un interet en pratique clinique. Des scores plus adaptes a la pratique clinique quotidienne ont ete developpes, comme le score SPI (Simplified Psoriasis Index) qui evalue la severite clinique, le retentissement et l’histoire du psoriasis. Les auto-scores destines aux patients sont de plus en plus souvent realises car ils permettent une evaluation plus precise de l’evolution de la maladie lorsqu’ils sont bien correles aux scores objectifs. Les scores et les auto-scores peuvent nous aider a mieux evaluer la severite clinique au cours du temps et ses variations, ainsi que la severite ressentie, afin de prendre la bonne decision therapeutique. © 2021 Elsevier Masson SAS. Tous droits reserves.

Atopic dermatitis is a multifactorial disease due to a combination of genetic and environmental factors. The pathophysiological mechanisms involved in AD are multiple: innate functional abnormality in the skin barrier partly linked to mutations of the filaggrin, a major structural protein of the skin; and genes involved in innate and adaptive immunity; Finally, the model of the hygiene theory has been clarified in recent years: environmental factors alter the diversity of skin and digestive microbiomes, and this diversity seems to play a major role in the development of atopy.

Most of the literature on serious games and gamification calls for a shift from evaluating practices to using theories to assess them. While the former is necessary to justify using game-based approaches, the latter enables understanding “why” game-based approaches are beneficial (or not). Based on earlier review papers and the papers in this special issue of Water entitled “Understanding game-based approaches for improving sustainable water governance: the potential of serious games to solve water problems”, we show that game-based approaches in a water governance context are relatively diverse. In particular, the expected aims, targeted audience, and spatial and temporal scales are factors that differentiate game-based approaches. These factors also strongly influence the design of game-based approaches and the research developed to assess them. We developed a framework to guide and reflect on the design and assessment of game-based approaches, and we suggest opportunities for future research. In particular, we highlight the lack of game-based approaches that can support “society-driven” sustainable water governance.

Le present article est une synthese de doctorat, portant sur l'analyse de donnees issues du bassin versant agricole Kervidy-Naizin, appartenant a l'Observatoire de Recherche en Environnement (ORE) AgrHys. Des 2000, face aux enjeux de la qualite de l'eau et du changement climatique, le site a beneficie d'un suivi hydrologique et chimique particulierement fin. Les travaux presentes ci-apres sont la premiere exploration de l'ensemble des chroniques longues de 12 ans du site de Kervidy-Naizin. Ces chroniques remarquables ont permis de repondre aux questions suivantes : quels sont les processus hydrologiques qui controlent les exportations de solutes dans le bassin versant ? Comment la dynamique temporelle d'humectation du bassin influence ces processus dominants ?Quatre methodes originales d'analyse fonctionnelle du bassin versant ont permis de repondre, en etudiant les trois niveaux de variabilite temporelle : la crue, la saisonnalite et les variations interannuelles. Ainsi, un modele conceptuel d'exportation des solutes a quatre compartiments est propose pour expliquer la diversite des dynamiques d'exportation dans ce bassin. Ces resultats montrent une structuration temporelle du signal de qualite de l'eau. Le signal, marque pour certains solutes par l'activite agricole intensive, est domine par la saisonnalite et varie sensiblement selon les conditions hydrometeorologiques de l'annee, et notamment le changement d'etat d'humidite du bassin.

Introduction Les syndromes hypereosinophiliques (SHE) sont une entite rare, potentiellement grave, au cours de laquelle il existe peu d’options therapeutiques. Les traitements habituellement recommandes dans les formes non liees a la deletion FIP1L1/PDGFRA sont les corticoides et en cas d’echec l’interferon-alpha (IFN-α), l’hydroxyuree ou le mepolizumab (dans un cadre protocolaire). Les donnees de la litterature sous-tendant l’utilisation de l’IFN-α au cours des SHE sont limitees a de petites series avec un suivi a court terme. Patients et methodes Nous avons realise une etude multicentrique, retrospective, descriptive, visant a evaluer l’efficacite et la tolerance de l’IFN-α au cours des SHE non lies a FIP1L1/PDGFRA. Les reponses hematologiques complete (RHC : eosinophiles Resultats Vingt-neuf patients (dont 9 femmes) d’âge moyen au diagnostic 38 ± 13 ans ont ete inclus. Quinze patients (52 %) avaient un SHE idiopathique, 10 (34 %) un SHE lymphoide, et 4 (14 %) un SHE clonal. Les manifestations cliniques les plus frequentes etaient l’atteinte cutanee (69 %) et l’atteinte digestive (31 %). L’IFN-α etait utilise sous forme pegylee chez 16 patients a une dose moyenne de 113 ± 45 μg/semaine et sous forme non pegylee chez 13 patients a une dose moyenne de 12 ± 9 MUI/semaine. Un mois apres le debut de l’IFN-α, 24 patients (83 %) etaient repondeurs dont 16 en RHC. A 1 an, 16 patients etaient toujours sous IFN-α dont 9 etaient en RHC et 7 en RHP. Le traitement par IFN-a etait associe a une baisse notable de la dose journaliere moyenne de prednisone de 20 ± 16 mg/j avant traitement, a 11 ± 6 mg/j a 6 mois et a 9 ± 9 mg/j a 1 an. Apres une duree mediane de 15 mois (1 a 161 mois), 21 patients (72 %) ont interrompu l’IFN-α suite aux effets indesirables (27 %) ou a une perte d’efficacite (31 %). Au terme du recueil, 8 patients etaient encore sous IFN-α avec une duree mediane de traitement de 21,5 mois (3 a 161 mois) dont 6 en RHC et 2 en RHP. Chez 7 d’entre eux, l’IFN-α pegyle etait utilise a la dose d’entretien mediane de 50 μg/semaine avec maintien d’une epargne cortisonique (dose journaliere mediane de prednisone a 5,5 mg/j). Conclusion L’IFN-α apparait comme etant un traitement efficace des SHE corticoresistants ou corticodependants non lies a la deletion FIP1L1/PDGFRA. Son efficacite peut se maintenir au long cours et a faible dose chez pres d’un quart des patients avec une bonne tolerance. Neanmoins une perte d’efficacite ou des effets indesirables justifient l’arret de l’IFN-α dans la majorite des cas, rendant necessaire le developpement de therapeutiques alternatives ciblant specifiquement l’eosinophile.

Introduction La maladie du greffon contre l’hote (GVH) apres greffe hematopoietique apparait chez 35 a 50 % des patients. Nous rapportons ici le cas d’un garcon de 4 ans avec une reaction cutanee severe simulant une necrolyse epidermique toxique (NET) ( Fig. 1 ). Resultats Allogreffe pour une leucemie aigue lymphoblastique, il a en traitements preventifs : aciclovir, fluconazole et ciclosporine. Puis en aplasie febrile : il recoit tazocilline, vancomycine et cefazoline. A J12 de la greffe, il a une eruption maculeuse qui s’etend ensuite avec un signe de Nikolsky, une atteinte genitale, des ulcerations endobuccales sans cheilite ni conjonctivite. Les diagnostics evoques sont une NET, une dermatose a IgA lineaire a la vancomycine ou une GVH aigue cutanee. Les medicaments suspects sont arretes. La biopsie cutanee retrouve un decollement epidermique complet, des lesions lichenoides et des corps de necrose posant le diagnostic de GVH aigue bulleuse de grade IV. Celle-ci est traitee par une corticotherapie IV forte dose, de la ciclosporine puis du mycophenolate mofetil associe a un inhibiteur de Jak (ruxolitinib). A J37, le tableau se complete par une GVH digestive de grade IV confortant le diagnostic de GVH cutanee. Discussion La GVH aigue apparait dans les 100 premiers jours. Les signes cutanes sont polymorphes (de l’exantheme a la NET). La GVH mimant une NET est rare (2 %) et grave (50 % de mortalite). Dans la litterature, ces pathologies ont des similitudes histologiques (infiltration de CD8 + , necrose keratinocytaire, decollement epidermique). Pourtant des differences existent : dans la GVH, moins de spongiose et d’eosinophiles et cliniquement, des lesions muqueuses moins severes. Conclusion Ce cas illustre une GVH aigue grave dont l’aspect clinique doit etre connu et differencie d’une NET afin d’adapter rapidement le traitement.

Introduction Les phytodermatoses sont des entites connues pour lesquelles on ne retrouve pas toujours l’agent causal. Il s’agit d’une phytophotodermatose lorsque l’exposition solaire est indispensable au developpement des lesions cutanees. Nous rapportons 2 cas pediatriques de phytodermatose. Methodes Le premier cas est celui d’un nourrisson de 6 mois, presentant un erytheme peribuccal associe a des phlyctenes et des erosions post bulleuses. L’interrogatoire retrouvait l’ingestion d’une puree de panais cuit lors d’un pique-nique ensoleille 24 h auparavant. Le deuxieme cas est celui d’une enfant de 5 ans consultant pour une eruption diffuse erythemateuse et pustulobulleuse du visage. L’interrogatoire retrouvait l’application directement sur le visage d’eau de pluie stagnant sur les feuilles d’une euphorbe maritime, la veille. Dans les 2 cas, l’evolution etait favorable sous dermocorticoides et soins locaux ( Fig. 1 ). Discussion Nous rapportons un cas de phytophotodermatose au panais chez un enfant avec un type de contact remarquable : l’application du panais cuit sur la peau. Le panais contient de la furocoumarine, agent photosensibilisant qui, associe a une exposition solaire prolongee est a l’origine de lesions phototoxiques potentiellement severes. L’euphorbe, espece vivace de la famille des euphorbiaces, est ici toxique via l’eau stagnante appliquee directement sur la peau. Toute la plante renferme un latex blanc et caustique contenant une resine et des ester diterpeniques. Conclusion Une eruption erythemato bulleuse, localisee sur les zones photo-exposees chez l’enfant, doit faire rechercher un contact avec un agent photosensibilisant vegetal (celeris, citron, figue, panais) mais egalement avec certaines plantes possedant des proprietes irritantes, independamment de l’exposition solaire, comme les euphorbes.

To improve hydro-chemical modeling and forecasting, there is a need to better understand flood-induced variability in water chemistry and the processes controlling it in watersheds. In the literature, assumptions are often made, for instance, that stream chemistry reacts differently to rainfall events depending on the season; however, methods to verify such assumptions are not well developed. Often, few floods are studied at a time and chemicals are used as tracers. Grouping similar events from large multivariate datasets using principal component analysis and clustering methods helps to explain hydrological processes; however, these methods currently have some limits (definition of flood descriptors, linear assumption, for instance). Most clustering methods have been used in the context of regionalization, focusing more on mapping results than on understanding processes. In this study, we extracted flood patterns using the probabilistic Latent Dirichlet Allocation (LDA) model, its first use in hydrology, to our knowledge. The LDA method allows multivariate temporal datasets to be considered without having to define explanatory factors beforehand or select representative floods. We analyzed a multivariate dataset from a long-term observatory (Kervidy-Naizin, western France) containing data for four solutes monitored daily for 12 years: nitrate, chloride, dissolved organic carbon, and sulfate. The LDA method extracted four different patterns that were distributed by season. Each pattern can be explained by seasonal hydrological processes. Hydro-meteorological parameters help explain the processes leading to these patterns, which increases understanding of flood-induced variability in water quality. Thus, the LDA method appears useful for analyzing long-term datasets.

New scientific understanding is catalyzed by novel technologies that enhance measurement precision, resolution or type, and that provide new tools to test and develop theory. Over the last 50, years, technology has transformed the hydrologic sciences by enabling direct measurements of watershed fluxes (evapotranspiration, stream flow) at time scales and spatial extents aligned with variation in physical drivers. High frequency water quality measurements, increasingly obtained by in situ water quality sensors, are extending that transformation. Widely available sensors for some physical (temperature) and chemical (conductivity, dissolved oxygen) attributes have become integral to aquatic science, and emerging sensors for nutrients, dissolved CO, turbidity, algal pigments, and dissolved organic matter are now enabling observations of watersheds and streams at time scales, commensurate with their fundamental hydrological, energetic, elemental, and biological drivers. Here we synthesize insights from emerging technologies across a suite of applications, and envision future advances, enabled by sensors, in our ability to understand, predict, and restore watershed and stream systems.