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For vessels which operate offshore for extended periods, there has been industry interest in providing means to recharge the battery systems without repeated return to port. Solutions would ideally use renewably sourced power as opposed to onboard charging from diesel engines. The electric charging buoy is a concept that has arisen based on existing technologies from the single point mooring (SPM) buoy. To support this innovation, we can draw from experience with offshore vessels, SPMs, and electrical transmission and storage systems as they relate to safety of personnel and assets at sea. The result has been the development of Classification requirements for charging buoys which address issues such as system design, operating philosophy, operations, testing and verification. Electrical safety and establishing connections in a marine environment are fundamental to deploying this technology. Key factors include the buoy structure, power sources (e.g. onshore grid connection, offshore substation, offshore wind turbines), voltage ranges, power quality, maximum allowable current, and on-buoy systems such as transformers, converters, and cables. It is also important to address risks related to vessel profiles for connection time to the buoy and the environmental conditions which may be experienced. This paper outlines the considerations for SPM-based charging and the process by which existing standards have been combined with established practice to develop criteria, including input from interested stakeholder organizations that are engaged in battery powered operations. The new Rules are presented along with their underlying goals. Readers will gain an understanding of the process and the importance of supporting innovation in the energy transition, from the design stage through construction and in-service surveys.

Clinic-ambulatory blood pressure (BP) difference is influenced by patients- and device-related factors and inadequate clinic-BP measurement. We investigated whether nonadherence to antihypertensive medications may also influence this difference in a post hoc analysis of the DENERHTN trial (Renal Denervation for Hypertension). We pooled the data of 77 out of 106 evaluable patients with apparent resistant hypertension who received a standardized antihypertensive treatment and had both ambulatory BP and drug-screening results available at baseline after 1 month of standardized triple therapy and at 6 months on a median of 5 antihypertensive drugs. After drug assay samplings on study visits, patients took their antihypertensive treatment under supervision immediately after the start of the ambulatory BP recording, and supine clinic BP was measured 24 hours post-dosing; both allowed to calculate the clinic minus daytime ambulatory systolic BP (SBP) difference (clinic-SBP–day-SBP). A total of 29 (37.7%) were found nonadherent to medications at baseline and 38 (49.4%) at 6 months. At baseline, the mean clinic-SBP–day-SBP difference in the nonadherent group was 12.7 mm Hg (95% CI, 7.8–17.7 mm Hg, P P =0.947). Similar observations were made at 6 months. Using receiver operating characteristics curves, we found that a 6 mm Hg cutoff of clinic-SBP–day-SBP difference had 67% sensitivity and 69% specificity to predict nonadherence to the triple therapy at baseline. In conclusion, a large clinic-SBP–day-SBP difference may help discriminating between adherence and nonadherence to treatment in patients with resistant hypertension. Clinical Trial Registration— URL: https://www.clinicaltrials.gov . Unique identifier: NCT01570777.

Resume Les hemoptysies abondantes necessitent frequemment une prise en charge endovasculaire en urgence. Parmi ses etiologies, on retrouve les pseudoanevrismes arteriels pulmonaires, notamment dans un contexte de neoplasie pulmonaire. Nous rapportons le cas d’un homme de 62 ans suivi pour un carcinome epidermoide pulmonaire multi-traite, se presentant pour des episodes d’hemoptysie recidivants et abondants. La bronchoscopie souple et la tomodensitometrie orientaient vers un pseudoanevrisme arteriel pulmonaire qui se fistulisait de facon intermittente dans une bronche necrotique. Il a ete traite en urgence par mise en place d’une branche iliaque d’une prothese couverte manuellement redimensionnee. Aucune recidive n’a ete observee en post-therapeutique. Nous presentons le traitement endovasculaire par stent couvert et en urgence d’un rare cas de pseudoanevrisme arteriel pulmonaire dans un contexte de neoplasie pulmonaire multi-traitee.

The young (50-400 Myr) A3V star $\beta$ Leo is a primary target to study the formation history and evolution of extrasolar planetary systems as one of the few stars with known hot ($\sim$1600$^\circ$K), warm ($\sim$600$^\circ$K), and cold ($\sim$120$^\circ$K) dust belt components. In this paper, we present deep mid-infrared measurements of the warm dust brightness obtained with the Large Binocular Telescope Interferometer (LBTI) as part of its exozodiacal dust survey (HOSTS). The measured excess is 0.47\%$\pm$0.050\% within the central 1.5 au, rising to 0.81\%$\pm$0.026\% within 4.5 au, outside the habitable zone of $\beta$~Leo. This dust level is 50 $\pm$ 10 times greater than in the solar system's zodiacal cloud. Poynting-Robertson drag on the cold dust detected by Spitzer and Herschel under-predicts the dust present in the habitable zone of $\beta$~Leo, suggesting an additional delivery mechanism (e.g.,~comets) or an additional belt at $\sim$5.5 au. A model of these dust components is provided which implies the absence of planets more than a few Saturn masses between $\sim$5 au and the outer belt at $\sim$40 au. We also observationally constrain giant planets with the LBTI imaging channel at 3.8~$\mu$m wavelength. Assuming an age of 50 Myr, any planet in the system between approximately 5 au to 50 au must be less than a few Jupiter masses, consistent with our dust model. Taken together, these observations showcase the deep contrasts and detection capabilities attainable by the LBTI for both warm exozodiacal dust and giant exoplanets in or near the habitable zone of nearby stars., Comment: 11 pages, 9 figures, accepted for publication in Astronomical Journal

Telemedicine has been developing in France since 2018. The objective of this survey was to assess the knowledge, attitudes, practices and training of internal physicians regarding telemedicine.A national descriptive observational study carried out between July and October 2019, via an online self-questionnaire with members of the National Society of Internal Medicine and the Association of Young Internists, included a descriptive and comparative analysis by subgroups of age.Analysis of 309 responses from physicians qualified in internal medicine or practicing in an internal medicine service (61,8%) and residents in internal medicine (38%) showed that 34.6% had notions or a good knowledge of regulation of telemedicine. For 62,1%, 72.5% and 74.1% respectively, it could improve patient care, access to care and exchanges between internists and other doctors. The main obstacles to this practice were the absence of face-to-face with the patient (57.3%) and computer dysfunctions (55%). Only 23.3% practiced it, including 88.9% tele-expertise. Telemedicine was performed informally (telephone and email) in 70.8% of the cases. Doctors over the age of 50 were better acquainted with the regulations and more practiced official telemedicine. In total, 54% wanted to practice telemedicine and 72.8% wanted to train there.Attitudes towards telemedicine were positive, but few internists knew about it and practiced it formally, warranting appropriate training.

Resume Un homme de 71 ans, aux antecedents de retrecissement aortique lâche et de cardiopathie ischemique, ancien eleveur bovin, consulte pour alteration de l’etat general et douleurs abdominales peri-ombilicales. La palpation d’une masse abdominale battante et expansive conduit a la realisation d’une echographie qui confirme la presence d’un anevrisme de l’aorte abdominale (AAA) mesurant 43 mm de diametre maximal. L’echographie de controle a 6 mois montre une evolution rapide avec un diametre maximal de 50 mm. Un scanner abdominal realise a visee pre-therapeutique confirme le diametre maximal mesure a l’echographie et revele une importante infiltration de la graisse retroperitoneale peri-aortique, presentant un rehaussement apres injection de produit de contraste. Un TEP-scanner complementaire montre un hypermetabolisme intense de la paroi anevrismale et de la graisse retroperitoneale adjacente. Le bilan serologique est en faveur d’une fievre Q chronique, confirmee par PCR sur prelevement aortique apres traitement chirurgical de l’anevrisme. Nous presentons les caracteristiques d’imagerie qui orientent vers un anevrisme infectieux.

The aim of the present study was to estimate the incidence of very early hepatic metastases (HMs) (6 months) and their imaging patterns after cephalic duodenopancreatectomy (CDP) for periampullary carcinoma (excluding duodenal carcinoma) and to identify their associated risk factors.From January 2003 to June 2016, all patients who underwent surgical treatment for periampullary carcinoma by CDP at our institution and with adequate pre- and postoperative CT scans were included. Univariate and multivariate logistic regressions were performed to determine factors associated with very early HM and recurrence.Of the 132 patients included retrospectively, 27 (20.5%) patients developed HMs. The mean time to diagnosis of HM was 103.9±55.2days. HMs were multiple in 81.4% of cases and bilobar in 59.3% of cases; their mean maximum size was 16.7±12.7mm. In univariate logistic analysis, lymphovascular emboli were significantly associated with HM (p=0.02). No independent risk factors for HM were found in multivariate analysis. In multivariate logistic analysis, two independent risk factors were identified for the occurrence of early recurrence: tumor size23mm on preoperative CT scan (OR: 3.3; 95% CI: [1.2-9.3]; p=0.02) and tumor differentiation (poor vs. good: OR 15.5; 95 CI [1.5-158.3]; moderate vs. good: OR: 17.1; 95% CI: [1.9-154.4]; p=0.04).Nearly one in five patients developed HM after CDP within 6 months with a highly consistent pattern. A thorough preoperative assessment, combining CT scan and MRI with a delay of less than three weeks before surgery, appears essential. A routine systematic postoperative CT scan at 8 weeks is also required prior to initiating adjuvant chemotherapy. The type of surgical intervention does not seem to be a risk factor, although the risk of HM occurrence appears to be related to the lymphovascular invasion of the tumor and maybe its degree of differentiation, elements not assessable by imaging.

Introduction Le psoriasis touche 1 a 5 % de la population generale. La corticotherapie locale a longtemps ete le seul traitement disponible. Il est toujours le traitement local de reference. La corticophobie est l’un des facteurs de la mauvaise observance du traitement et du mauvais controle de la maladie. En 2013, Moret et al. ont developpe le questionnaire TOPICOP pour evaluer la corticophobie. Ce dernier est compose de 12 items, 6 items relatifs aux croyances et 6 items relatifs aux peurs des patients. Plusieurs etudes ont porte sur la corticophobie chez les patients atteints de dermatite atopique, une seule a compare ce phenomene chez des enfants atteints de DA ou de psoriasis, mais aucune etude n’a concerne les adultes atteints de psoriasis. Materiel et methodes L’objectif de cette etude etait d’evaluer le niveau de corticophobie a l’aide de plusieurs outils, dont le score TOPICOP qui etait le critere de jugement principal, chez les patients atteints de psoriasis en fonction de la severite et de differentes donnees sociodemographiques. Nous avons pour cela realise une etude observationnelle transversale monocentrique dans le service de dermatologie du CHRU de Nancy de janvier 2019 a mars 2020. Les donnees etaient collectees grâce a un questionnaire standardise. La severite du psoriasis etait evaluee grâce au score PASI et au PGA. Une evaluation du retentissement sur la qualite de vie etait egalement realisee a l’aide du questionnaire DLQI. Resultats Au total, 109 patients ont repondu au questionnaire, dont 60,6 % d’hommes ; l’âge moyen etait de 48,4 ans. L’âge au diagnostic etait de 29,1 ans. Deux tiers des patients utilisaient des dermocorticoides de classe forte et un tiers de classe tres forte. Seul un patient n’avait jamais utilise de dermocorticoides. Trente-six patients rapportaient la survenue d’au moins un effet secondaire en lien avec l’utilisation des dermocorticoides. Les effets secondaires les plus frequemment rapportes etaient l’amincissement cutane et l’hypopigmentation, dans 20,2 % et 5,5 % des cas, respectivement. Le score PGA moyen etait de 1,9 et le score PASI moyen de 5,5. Le score DLQI moyen etait de 8,7. Le score TOPICOP moyen etait de 39,3 %. Les scores TOPICOP croyances et peurs moyens etaient respectivement de 41,3 % et 36,9 %. Seul le DLQI etait significativement lie au score TOPICOP (p = 0,0065). Aucune autre caracteristique sociodemographique n’etait significativement liee a une augmentation du score TOPICOP. Discussion La corticophobie est un sujet peu etudie chez les patients atteints de psoriasis. Elle existe pourtant et semble surtout influencee par l’alteration de la qualite de vie mais ne semble pas influencee par les caracteristiques sociodemographiques des patients. La prise en compte de cette donnee parait importante a evaluer, notamment en cas d’echec de la corticotherapie locale et avant d’avoir recours a un traitement systemique.

Resume Introduction L’objectif de cette etude etait de decrire les caracteristiques epidemiologiques des uveites de l’adulte pour lesquelles un bilan a ete realise dans le centre de competences regional dedie aux maladies systemiques et auto-immunes du centre hospitalier universitaire (CHRU) de Nancy. Les objectifs secondaires etaient de decrire l’evolution de la repartition etiologique au cours du temps et d’identifier des specificites locales. Patients et methodes Nous avons realise une etude epidemiologique retrospective au CHRU de Nancy sur les patients vus en consultation ophtalmologique pour une uveite et adresses dans le Centre de competences regional dedie aux maladies systemiques et auto-immunes entre le 1er janvier 2005 et le 31 decembre 2016. Les patients de moins de 18 ans, ceux presentant un premier episode d’uveite anterieure aigue, ainsi que ceux pour lesquels le diagnostic etiologique etait fait par l’ophtalmologiste seul, etaient exclus. L’âge, le genre, la lateralite, le siege de l’inflammation, les signes cliniques et l’etiologie (infectieuse, non infectieuse ou idiopathique, et diagnostic) ont ete recueillis. Resultats Nous avons inclus 690 patients dont 59 % de femmes, avec un âge moyen de 49 ans. L’uveite etait unilaterale dans 53 % des cas. La panuveite etait la forme la plus frequente (52 %, n = 358), suivie par l’uveite anterieure recidivante (30 %, n = 205), l’uveite posterieure (16 %, n = 107) et l’uveite intermediaire (3 %, n = 20). Les etiologies non infectieuses representaient 35 % de l’ensemble des uveites, les plus frequentes etant les uveites liees au HLA-B27, la sarcoidose, la spondylarthrite ankylosante et la maladie de Behcet. Treize pourcent de l’ensemble des uveites etaient d’origine infectieuse avec en premier lieu la tuberculose, la toxoplasmose, et la maladie de Lyme. La proportion d’uveites idiopathiques etait de 52 %. Une tendance a l’amelioration du rendement diagnostique a ete observee : 53 % des uveites ont ete considerees comme idiopathiques avant 2011 contre 50 % apres 2011 (p Conclusion Nous avons identifie une majorite de panuveites, ce qui s’explique par notre mode d’inclusion. Notre serie comptait 52 % d’uveites idiopathiques, avec une tendance a l’amelioration du rendement diagnostique au cours du temps. Cette etude nous a permis de mieux connaitre les caracteristiques des uveites dans notre centre.

Resume Objectif Cette etude avait pour objectif d’evaluer le rendement diagnostique et fonctionnel des vitrectomies realisees dans le cadre du bilan etiologique d’uveites. Materiels et methodes Nous avons realise une etude retrospective monocentrique portant sur les patients ayant beneficie d’une vitrectomie dans le cadre du bilan etiologique d’une uveite entre janvier 2011 et decembre 2016 au CHRU de Nancy. Les prelevements vitreens ont ete analyses en cytopathologie avec etudes morphologiques et immunohistochimiques et/ou microbiologiques avec culture et PCR bacteriennes fongiques et virales, selon la suspicion clinique. L’acuite visuelle postoperatoire a ete recueillie a 1 et 6 mois et comparee a l’acuite preoperatoire. Resultats Nous avons analyse les resultats de 39 vitrectomies diagnostiques realisees chez 34 patients. La vitrectomie a ete contributive dans 36 % des cas. Les diagnostics retrouves etaient un lymphome (10 patients), une amylose (2 patients), une retinite a CMV (un patient) et une metastase choroidienne de melanome cutane avec envahissement vitreen (un patient). L’acuite visuelle moyenne s’est amelioree de 1,2 ± 0,7 logMAR en preoperatoire a 0,8 logMAR ± 0,7 a un mois (p Conclusion Dans notre serie, la vitrectomie et l’analyse du vitre ont permis de mettre en evidence un diagnostic dans un certain nombre de cas d’uveites avec une majorite de lymphomes oculo-cerebraux. L’acuite visuelle a ete amelioree chez la plupart des patients. Dans un contexte d’uveite inexpliquee, le recours a la vitrectomie doit etre envisage en ciblant precisement les recherches en fonction des hypotheses etiologiques apportees par l’examen clinique.

International audience; OBJECTIVES: Kidney transplant recipients are at high-risk for donor-derived infections in the early post-transplant period. Transplant preservation fluid (PF) samples are collected for microbiological analysis. In case of positive PF cultures, the risk for the recipient is unknown and there is no consensus for prescribing prophylactic antibiotics. This nationwide observational study aimed to determine the epidemiology of bacterial and fungal agents in kidney transplant PF cultures and identify risk factors associated with positive PF cultures.METHODS: We performed a retrospective observational study on the following data collected from a national database between October 2015 and December 2016: characteristics of donor, recipient, transplantation, infection in donor and PF microbiological data.RESULTS: Of 4487 kidney transplant procedures, including 725 (16.2%, 725/4487) from living donors, 20.5% had positive PF cultures (living donors: 1.8%, 13/725; deceased donors: 24.1%, 907/3762). Polymicrobial contamination was found in 59.9% (485/810) of positive PF cultures. Coagulase-negative staphylococci (65.8%, 533/810) and Enterobacteriaceae (28.0%, 227/810) were the most common microorganisms. Factors associated with an increased risk of positive PF cultures in multivariable analysis were (for deceased-donor kidney transplants): intestinal perforation during procurement (OR 4.4, 95% CI 2.1-9.1), multiorgan procurement (OR 1.4, 95% CI 1.1-1.7) and en bloc transplantation (OR 2.5, 95% CI 1.3-4.9). Use of perfusion pump and donor antibiotic therapy were associated with a lower risk of positive PF cultures (OR 0.4, 95% CI 0.3-0.5 and OR 0.6, 95% CI 0.5-0.7, respectively).CONCLUSION: In conclusion, 24% of deceased-donor PF cultures were positive, and PF contamination during procurement seemed to be the major cause.

Editor's Choice - Management of Descending Thoracic Aorta Diseases : Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS).

The purpose of this study was to describe the epidemiologic characteristics of adult uveitis evaluated at the regional center of excellence specializing in systemic and autoimmune disease in the Nancy university medical center. The secondary objectives were to describe the progression over time of the various etiologies and to identify local specificities.We performed a retrospective epidemiological study of patients diagnosed with uveitis. All patients were referred to the regional center of excellence of the Nancy university medical center between January 1, 2005 and December 31, 2016. Patients under 18 years of age, patients with a first episode of acute anterior uveitis, as well as patients for whom the etiological diagnosis was made by the ophthalmologist with no need of internal medicine referral, were excluded. Age, gender, laterality, site of inflammation, clinical signs, etiology (infectious, non-infectious or idiopathic, as well as diagnosis), and date of first consultation were recorded.Six hundred and ninetypatients were included, with 59 % women and a mean age of 49 years. The uveitis was unilateral in 53 % of cases. Panuveitis was the most common form (52 %, N=358), followed by recurrent anterior uveitis (30 %, N=205), posterior uveitis (16 %, N=107), and intermediate uveitis (3 %, N=20). Non-infectious etiologies accounted for 35 % of all uveitis (the most common being HLA-B27 uveitis, sarcoidosis, ankylosing spondylitis and Behçet's disease) and infectious etiologies for 13 % (tuberculosis, toxoplasmosis and Lyme disease were the most frequent). The uveitis was idiopathic in 52 %. A trend toward improvement in diagnostic yield was observed : 53 % of uveitides were considered idiopathic prior to 2011 compared to 50 % after 2011 (P0,01).We identified a majority of panuveitis, which is explained by our inclusion criteria. Fifty-two percent of our series remained idiopathic, with an improvement in the diagnostic yield over time. This could be related to both repeated etiological assessments and better diagnostic performance. The study of this large cohort of patients improved our knowledge of the characteristics of uveitis in our center.

To determine the diagnostic and functional yield of vitrectomy in patients with uveitis of unknown origin.A single-centered retrospective study was performed on patients who underwent a diagnostic vitrectomy for uveitis in the Department of Ophthalmology of the Nancy University Hospital from January 2011 to December 2016. Vitreous samples were analyzed in the cytology laboratory by cytological and immunohistochemical techniques, and in the microbiological laboratory by culture and bacterial, fungal and viral PCR, depending on clinical findings. Preoperative and one- and six-month postoperative visual acuity were collected and compared.Thirty-four patients (39 vitrectomies) were included. Vitreous testing led to a diagnosis in 14 out of 39 cases (36 %): 10 intraocular lymphoma, 2 amyloidosis, 1 CMV retinitis, and 1 choroidal metastasis of cutaneous melanoma with vitreous dissemination. Vitrectomy was negative in 20 patients. Visual acuity improved from 1.2±0.7 logMAR preoperatively to 0.8±0.7 logMAR at 1 month (p0.001) and 0.9±0.8 logMAR at 6 months (p=0.054).In our study, diagnostic vitrectomy and vitreous fluid analysis were useful to diagnose uveitis of unknown origin, most of which were found to be intraocular lymphomas. Visual acuity improved for the majority of patients. Diagnostic vitrectomy with appropriate vitreous analysis related to clinical examination must be considered in the evaluation of uveitis of unknown origin.

We investigated the predictive factors for extended-spectrum beta-lactamase producing Enterobacteriaceae (ESBL-PE) causing infections among intensive care unit patients with prior documented ESBL-PE colonization. Using multivariate analysis, referral from medical ward, nursing home or rehabilitation center [Odds ratio (OR), 2.5; 95 % confidence interval (CI), [1.3–5.0]; p = 0.007], previous fluoroquinolone treatment (OR, 3.4; CI, [1.1–10.5]; p = 0.003), extracorporeal membrane oxygenation (OR, 4.6; CI, [1.3–15.9]; p = 0.02), and absence of prior positive ESBL-PE rectal swab culture (OR, 5.0; CI, [1.6–10.0]; p = 0.0009) were risk factors for ESBL-PE infection. Easily identifiable factors may help with targeting carbapenem prescriptions.

Adrenal venous sampling (AVS) is a challenging technical procedure and few patients had AVS procedure twice.To evaluate the reproducibility of the AVS, why AVS were repeated and the conclusions drawn from them.From 1997-2012, 12 patients underwent two AVS. A cortisol level in the adrenal vein greater than or equal to 1.1 to inferior vena cava defined a successful catheterization and a lateralization of secretion corresponded to an aldosterone-to-cortisol vein ratio greater than or equal to 2 between the one side to another.The same side of lateralization of secretion was found in 75% of them. The second AVS were due to technical failure (n=4), unproven lateralization (n=2), a lateralization opposite to the main nodule and ipsilateral to hyperplasia (n=4) on first AVS. For two patients, as the CT was normal, AVS was required again. The second AVS was successful in all patients, including those with an initial technical failure but only patient with technical failure underwent surgery, as BP and kaliemia were controlled. Lateralization on the side of hyperplasia or opposite to the biggest nodule was confirmed in two of four cases.When AVS is unsuccessful for technical reasons, it is worth doing it again but after being sure that surgery is still possibly indicated.

Background: The DENERHTN trial (Renal Denervation for Hypertension) confirmed the blood pressure–lowering efficacy of renal denervation added to a standardized stepped-care antihypertensive treatment for resistant hypertension at 6 months. We report the influence of adherence to antihypertensive treatment on blood pressure control. Methods: One hundred six patients with hypertension resistant to 4 weeks of treatment with indapamide 1.5 mg/d, ramipril 10 mg/d (or irbesartan 300 mg/d), and amlodipine 10 mg/d were randomly assigned to renal denervation plus standardized stepped-care antihypertensive treatment, or the same antihypertensive treatment alone. For standardized stepped-care antihypertensive treatment, spironolactone 25 mg/d, bisoprolol 10 mg/d, prazosin 5 mg/d, and rilmenidine 1 mg/d were sequentially added at monthly visits if home blood pressure was ≥135/85 mm Hg after randomization. We assessed adherence to antihypertensive treatment at 6 months by drug screening in urine/plasma samples from 85 patients. Results: The numbers of fully adherent (20/40 versus 21/45), partially nonadherent (13/40 versus 20/45), or completely nonadherent patients (7/40 versus 4/45) to antihypertensive treatment were not different in the renal denervation and the control groups, respectively ( P =0.3605). The difference in the change in daytime ambulatory systolic blood pressure from baseline to 6 months between the 2 groups was –6.7 mm Hg ( P =0.0461) in fully adherent and –7.8 mm Hg ( P =0.0996) in nonadherent (partially nonadherent plus completely nonadherent) patients. The between-patient variability of daytime ambulatory systolic blood pressure was greater for nonadherent than for fully adherent patients. Conclusions: In the DENERHTN trial, the prevalence of nonadherence to antihypertensive drugs at 6 months was high (≈50%) but not different in the renal denervation and control groups. Regardless of adherence to treatment, renal denervation plus standardized stepped-care antihypertensive treatment resulted in a greater decrease in blood pressure than standardized stepped-care antihypertensive treatment alone. Clinical Trial Registration: URL: http://www.clinicaltrials.gov . Unique identifier: NCT01570777.

Resume Introduction La thermo-ablation (ou radiofrequence) est une nouvelle technique de radiologie interventionnelle utilisee pour le traitement des tumeurs primitives bronchiques ou secondaires de petite taille (inferieures a 3 cm) chez des patients inoperables ou ne pouvant beneficier de radiotherapie externe. Elle est deja utilisee pour le traitement de certains cancers (foie, rein) de facon courante mais est une technique plus recente s’appliquant aux tumeurs pulmonaires primitives et secondaires. Methodes Nous avons suivi, par tomodensitometrie, 12 patients porteurs de primitifs bronchiques traites par cette technique de 2004 a 2008. Resultats Notre etude a montre une bonne tolerance immediate du geste avec des effets iatrogenes mineurs (75% de pneumothorax) et aucun effet iatrogene majeur. De plus, cette technique est associee a un bon controle local (8,3% de recidive locale). Conclusions La radiofrequence apparait comme une alternative interessante chez les patients porteurs d’un cancer bronchique non operable, du fait de sa bonne tolerance et d’un controle local satisfaisant.

OBJECTIVES: To assess the relationship between self-reported omega-3 fatty acid (O3FA) intake and bone mineral density (BMD) and lower extremity function in older adults. DESIGN: Cross-sectional analysis of baseline information from three separate ongoing studies of older adults, pooled for this analysis. SETTING: Academic health center. PARTICIPANTS: Two hundred forty-seven men (n=118) and women (n=129) residing in the community or an assisted living facility. MEASUREMENTS: Self-reported dietary intake (O3FA, omega-6 fatty acids (O6FA), protein, and total calorie); BMD of the hip or heel; and lower extremity function including leg strength, chair rise time, walking speed, Timed Up and Go, and frailty. RESULTS: The mean reported intake of O3FA was 1.27 g/day. Correlation coefficients (r) between O3FA and T-scores from total femur (n=167) were 0.210 and 0.147 for combined femur and heel T scores. Similar correlations were found for leg strength (r=0.205) and chair rise time (r=−0.178), but the significance was lost when corrected for protein intake. Subjects with lower reported O3FA intake (

Cardiac CT: Technical considerations The possibility to perform cardiac and coronary imaging was a major driving force behind an ongoing, rapid evolution of scanner technology, accompanied by improvements of software and post-processing tools. The most recent generations of MDCT with the ability to acquire at least 64 slices simultaneously allow relatively robust morphological and functional imaging of the heart. By nature of its target, the continuously moving heart, cardiac CT is technically more challenging than other CT applications. Also, rapid technical development requires constant adaptation of acquisition protocols. The present manuscript summarizes the current state of technology of cardiac CT. Included are considerations regarding appropriate patient selection, patient medication, contrast enhancement, acquisition and reconstruction parameters, image display and analysis techniques with a special emphasis on radiation dose and all possible measures to keep the dose. It does not constitute a meta-analysis of published literature, but merely reflects an expert consensus on the current technical aspects of cardiac CT imaging.

Introduction Le syndrome cave est une urgence oncologique pour laquelle la mise en place d’une prothese cave superieure doit etre discutee. Materiel et methode Afin d’apprecier l’efficacite et les complications de cette methode, nous avons etudie de maniere retrospective 41 patients porteurs de cancers bronchiques et ayant beneficie de la mise en place de protheses en nitinol auto expansibles durant les 5 dernieres annees. Le geste etait associe a une anticoagulation, une corticotherapie par voie generale et un traitement etiologique. Resultats Quarante et un patients ont beneficie de ce traitement (30 hommes et 11 femmes) avec un âge moyen de 59 ans. Les etiologies tumorales du syndrome cave superieur etaient : adenocarcinomes (8), cancers a petites cellules (11), carcinomes epidermoides (9), cancers a grandes cellules (9) ou autres types (4). Tous les patients etaient symptomatiques. Le delai moyen entre l’apparition des symptomes et la realisation du geste etait de 14 jours. Le traitement etait associe a un traitement etiologique de type chimiotherapie seule pour 18 patients, radiotherapie seule pour 1 patient, radio-chimiotherapie pour 14 patients et aucun traitement pour 6 patients. Le geste consistait en la mise en place de 1 (73 %) ou 2 (27 %) protheses, d’une longueur totale moyenne de 7,5 cm et d’un calibre moyen de 14 mm. Aucune complication n’etait rapportee. Une amelioration des symptomes dans les 48 heures etait obtenue chez tous les patients. La survie moyenne apres mise en place de la prothese etait de 6,7 mois. Conclusion La mise en place d’une prothese cave superieure permet une amelioration rapide des symptomes, avec un tres faible taux de complication. Sous reserve d’une technique adequate, ce traitement doit etre envisage en premiere intention chez les patients presentant un cancer bronchique peu radio- ou chimiosensible complique d’un syndrome cave symptomatique.

Nosocomial infections result in severe health and financial difficulties for patients and healthcare facilities. The objective of the study was to determine the presence of Staphylococcus aureus on computer mice and keyboards in the intensive care units (ICUs) of Universitas Academic Hospital, Bloemfontein, and ICU staff's knowledge regarding cleaning of computer mice and keyboards and their potential hazard as reservoirs for pathogens. Swab specimens from computer mice and keyboards (14 each) were investigated for S. aureus. Swabbing was repeated six months later. Standard microbiology laboratory methods were used to culture and identify organisms. An anonymous questionnaire completed by the ICU staff determined their awareness of computer mice and keyboards as potential sources of nosocomial infections. In addition to various environmental microorganisms and normal human flora, S. aureus was initially isolated from one computer mouse, and from two keyboards and five mice six months later. The questionnaire response rate was 85.6%. Seventy-one percent of respondents stated that they regarded keyboards and mice as an important source of nosocomial infections. Nevertheless, 62% of doctors and 40.3% of nurses indicated that they never washed their hands before or after using the computer. Ninety-seven percent of respondents were not aware of an official cleaning policy for computer equipment. In order to prevent nosocomial infections resulting from microbial transmission between equipment, staff and patients, proper cleaning policies should be implemented.

RADIOLOGIE ET IMAGERIE MEDICALE : Genito-urinaire - Gyneco-obstetricale - Mammaire - 34-305-A-10

Type A aortic dissection remains fatal if untreated. Although classical medical therapy for type B dissection is considered the therapy of choice in uncomplicated cases, the paradigm is changing as greater experience is accrued with endovascular treatments and technical advances improve the long-term outlook. Diagnosis is also becoming more sophisticated, allowing greater appreciation of the anatomy of dissections and improving the knowledge base as their natural history is assessed.

Resume Objectifs Mieux connaitre les modalites d’organisation en France de la prise en charge des hemorragies du post partum. Patients et Methodes Une enquete nationale aupres des membres de la Societe Francaise de Radiologie Cardio-Vasculaire (SFICV) et des centres de catheterisme a ete conduite au printemps 2004. Resultats 465 embolisations en 2002 et 497 en 2003 ont ete recensees dans 64 centres : 13 en Ile de France (8 CHU) (respectivement 45 % en 2002 puis 42,5 % en 2003 du total), 51 en province, (24 CHU) (soit respectivement 55 puis 57,5 % du total), avec en 2002 en moyenne 7,265 actes par centre (0-36) et en 2003 7,77 (0-43). La continuite des soins etait assuree dans 77,6 %, avec de 1 a 8 radiologues (moyenne : 3,5) participant a l’astreinte. Les gestes etaient realises dans un service de radiologie dans 98 % des cas, situe dans le meme bâtiment que la maternite pour 53,4 %, ou a une distance moyenne de 1 100 m (100 m a 7 km), soit un delai de transport moyen de 18 mn (5 mn a 1 h). Conclusion Fiable et sure, l’embolisation quand elle est disponible doit pouvoir etre proposee en premiere intention dans ses indications validees. Prenant place dans le cadre d’une collaboration multidisciplinaire, elle suppose des protocoles de mise en œuvre reflechis, et la continuite des soins assuree par des equipes de gynecologues, reanimateurs et radiologues entraines.

Resume Les anomalies veineuses des membres inferieurs regroupent un ensemble d'alterations morphologiques ou fonctionnelles des veines superficielles et/ou profondes dont l'origine est en rapport avec un arret, a un stade plus ou moins tardif, de leur morphogenese. Elles s'integrent dans le vaste registre des malformations veineuses. Ces lesions, sporadiques et rares, peut-etre liees a une alteration genetique a expression variable, sont tantot latentes et de decouverte fortuite, ou symptomatiques entrainant alors un tableau d'insuffisance veineuse chronique severe. Elles peuvent etre isolees, ou s'inscrire dans un tableau de malformation complexe. Leur evaluation a largement beneficie de l'utilisation des methodes echographiques et de l'angiographie par resonance magnetique nucleaire, permettant de distinguer les formes ou l'abstention therapeutique est de mise, et celles ou un geste, medical, interventionnel ou chirurgical s'impose.

Pseudoaneurysm of the hepatic artery is a rare complication of blunt abdominal trauma. We report a case of post-traumatic pseudoaneurysm diagnosed several months after the initial traumatism in a 18-year-old man who presented recurrent abdominal pain. This pseudoaneurysm was successfully treated by association of both classical endovascular treatment and transhepatic percutaneous embolization.

Throughout the province of Quebec, Canada, there are more than 40 native plant species producing edible fruits. From these species, it appears that some have the potential to be grown on a commercial basis. In 1996, many cultivators specialized in different horticultural crops, expressed their interest in diversifying their enterprises. To fulfill the needs of these cultivators, the Research and Development Institute for the Agri-Environment (IRDA), along with Ministere de l'Agriculture, des Pecheries et de l'Alimentation du Quebec, began to work on a native fruit development program. Since then, the plants that are being studied include the native species of the genus Rubus, Amelanchier, Viburnum and Aronia, respectively called blackberry, juneberry, cranberrybush and black chokeberry. The objectives of the program are to select individual clones in the wild that display interesting agronomic characteristics and to evaluate their performance as fruit crops; to develop plant production schemes; to determine cultural requirements; to identify major pests and diseases and develop integrated pest management programs; to transform these fruits into different high-value products and to carry out market research. The touristic aspect also represents an important part of the project. Six plantings, each designed by a landscape specialist, have been carried out on six farms in the Quebec city area. Twelve different clones of blackberry and seven different clones of juneberry were evaluated on these private farms and at the IRDA's Research Farm. The work accomplished to date is, of course, a first step in developing native fruit crops. Valuable cultivars of blackberry and juneberry will be released on a small scale. However, research will continue to improve the quality of these cultivars. Extensive pests and diseases surveys have also been conducted. Plant production schemes are available and high-value products have been developed. A production guide will soon be available.

The Canadian Council of Forest Ministers (CCFM), established in 1985, is composed of the federal, provincial and territorial Ministers responsible for forests. Its role has evolved into one that stimulates the development of policies and initiatives for strengthening the forest sector, including the forest resource and its use. One of the most important functions of the CCFM is that it sets the overall direction for the stewardship and sustainable management of Canada's forests by addressing issues and stimulating joint initiatives. Under its guidance, four successive National Forest Strategies and three Forest Accords have been developed. Another major achievement has been the development of the CCFM Criteria and Indicators Framework: Defining Sustainable Forest Management - A Canadian Approach to Criteria and Indicators. Today, the CCFM works under five strategic themes: sustainable forestry; international issues; forest communities; science and technology; and information and knowledge. The ongoing, positive cooperation between the two levels of government helps maintain healthy and productive forests and their sustained contribution to Canadians' economic, environmental and social well-being over the long term. Key words: stewardship, governments, collaboration, national framework, for action, criteria and indicators, integrated information

The Canadian Council of Forest Ministers (CCFM), established in 1985, is composed of the federal, provincial and territorial Ministers responsible for forests. Its role has evolved into one that stimulates the development of policies and initiatives for strengthening the forest sector, including the forest resource and its use. One of the most important functions of the CCFM is that it sets the overall direction for the stewardship and sustainable management of Canada's forests by addressing issues and stimulating joint initiatives. Under its guidance, four successive National Forest Strategies and three Forest Accords have been developed. Another major achievement has been the development of the CCFM Criteria and Indicators Framework: Defining Sustainable Forest Management – A Canadian Approach to Criteria and Indicators. Today, the CCFM works under five strategic themes: sustainable forestry; international issues; forest communities; science and technology; and information and knowledge. The ongoing, positive cooperation between the two levels of government helps maintain healthy and productive forests and their sustained contribution to Canadians' economic, environmental and social well-being over the long term. Key words: stewardship, governments, collaboration, national framework for action, criteria and indicators, integrated information

Nous focaliserons cette presentation sur la maladie renovasculaire, definie par une relation de cause a effet entre une stenose de l’artere renale et une hypertension arterielle et/ou une insuffisance renale. Deux grandes causes sont retrouvees en pratique : – l’atherome, principale cause des stenoses de l’artere renale (ARAS), mais dont la prevalence au sein de la population des patients hypertendus reste faible (5 %). Dans ce contexte, une selection rigoureuse des patients est essentielle avant de debuter une investigation par imagerie. Par ailleurs, plusieurs essais cliniques, n’ont pas demontre un avantage certain pour la revascularisation renale par rapport au traitement medical, en dehors de certains criteres. Par consequent, il est imperatif d’identifier les patients qui doivent beneficier d’une revascularisation ; – la dysplasie fibromusculaire, maladie non atherosclereuse, non inflammatoire des arteres de moyen calibre, entraine des stenoses segmentaires et parfois des anevrismes ou dissections. Quelle que soit l’etiologie, l’echographie Doppler des arteres renales est un examen incontournable car il permet a la fois un bilan anatomique et fonctionnel. L’angioscanner et l’angiographie par resonance magnetique presentent une excellente performance diagnostique pour le depistage de la stenose renale. Ils sont souvent utilises si l’examen par echographie Doppler est douteux, incomplet ou negatif dans un contexte de forte suspicion clinique. Ils peuvent etre couples a une imagerie de perfusion dynamique. La scintigraphie renale avec test au captopril est moins utilisee en raison de sa faible sensibilite. L’angiographie par catheter est devenue presque exclusivement therapeutique. Elle peut avoir un interet diagnostique, dans le cadre de la dysplasie fibromusculaire et egalement dans la pathologie renovasculaire de l’enfant car ces lesions sont parfois difficiles a quantifier en imagerie par coupes. Ces techniques invasives peuvent etre eventuellement couplees a une echographie endovasculaire et une fractional flow reserve (FFR), basees sur une mesure de pression « trans-stenotique » pendant une hyperhemie, permettant ainsi de quantifier l’impact d’une lesion arterielle specifique sur la perfusion distale.