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Objective: We report the results of a prospective study of the efficacy and tolerability of levetiracetam, a new antiepileptic drug with a unique mechanism of action, in comparison with controlled-release carbamazepine as first treatment in newly diagnosed epilepsy. Methods: Adults with ≥2 partial or generalized tonic–clonic seizures in the previous year were randomly assigned to levetiracetam (500 mg twice daily, n = 288) or controlled-release carbamazepine (200 mg twice daily, n = 291) in a multicenter, double-blind, noninferiority, parallel-group trial. If a seizure occurred within 26 weeks of stabilization, dosage was increased incrementally to a maximum of levetiracetam 1,500 mg twice daily or carbamazepine 600 mg twice daily. Patients achieving the primary endpoint (6-month seizure freedom) continued on treatment for a further 6-month maintenance period. Results: At per-protocol analysis, 73.0% (56.6%) of patients randomized to levetiracetam and 72.8% (58.5%) receiving controlled-release carbamazepine were seizure free at the last evaluated dose (adjusted absolute difference 0.2%, 95% CI −7.8% to 8.2%) for ≥6 months (1 year). Of all patients achieving 6-month (1-year) remission, 80.1% (86.0%) in the levetiracetam group and 85.4% (89.3%) in the carbamazepine group did so at the lowest dose level. Withdrawal rates for adverse events were 14.4% with levetiracetam and 19.2% with carbamazepine. Conclusions: Levetiracetam and controlled-release carbamazepine produced equivalent seizure freedom rates in newly diagnosed epilepsy at optimal dosing in a setting mimicking clinical practice. This trial has confirmed in a randomized, double-blind setting previously uncontrolled observations that most people with epilepsy will respond to their first-ever antiepileptic drug at low dosage.

Preserving the environmental functions of agriculture in a grassland area needs an original approach on the farm users and uses. Because the environmental functions depend on characteristics at a larger scale than field or whole farm, they must be studied on a continuous farming area often run by several and different farms. The approach of such farmland area users and functions is rare and complex : preliminary methodological setting up is compulsory to tackle the farming activity at this scale and as regards these functions. Our aim is to apply this double approach - definition of a methodological frame, then analysis of the farms and functions - on a continuous farming area of 350 ha run by 36 land-users in a grassland region.It emerges a variety of contribution to environmental functions within one farm, as well as among various farms. These varieties come from the heterogeneous quality of the used environments and of the various adaptations of the practices to these environments. This study provides tracks in order to define and to target means of action for grassland areas with strong environmental stakes.; L`étude des fonctions environnementales de l`agriculture dans une zone herbagère nécessite une approche originale des usages et usagers agricoles de l`espace, les fonctions environnementales dépendant souvent de caractéristiques d`entités plus larges que les parcelles ; de ce fait, il est important d`étudier de larges entités d`espace agricole continu mise en valeur par plusieurs usagers. De telles approches sont rares et complexes et nécessitent la mise au point de méthode adaptée. L`objectif du travail présenté est double : définir un cadre méthodologique pour aborder les fonctions d`un espace continu, analyser les liens entre usages, usagers et fonctions sur cet espace agricole dans une petite zone herbagère de 350 ha tenue par 36 usagers agricoles. Il ressort une variété de contributions de ces usagers aux fonctions environnementales dans et entre exploitations. Cette diversité provient souvent de l`heterogeneité des terrains mis en valeur et de la diversité d`adaptation des pratiques à ces milieux selon les exploitations. Cette étude donne des perspectives d`actions pour les zones herbagères présentant des enjeux environnementaux.

Introduction of preanalytical automation in our laboratory required the use of plastic blood collection tubes. Because of possible interference caused by adsorption of components to the plastic wall and because there is virtually no literature on this subject, we investigated the influence of collection of serum in plastic tubes on the results of nearly all our immunoassays for hormones and tumour markers. Blood from healthy volunteers was collected simultaneously in glass and plastic tubes, or sera prepared from blood collected in glass tubes were brought into the plastic tubes under investigation. Hormone and tumour marker levels were measured in the pairs thus obtained. Results were analysed using paired t-tests or Wilcoxon signed rank tests. We found small but statistically significant differences (p

National audience; Pour une meilleure prise en compte de la multifonctionnalité de l'agriculture par les acteurs concernés, sa diversité et sa variabilité spatiale et temporelle au sein de l'espace agricole doivent être mieux comprises et analysées. Dans cette perspective, une méthode est proposée et confrontée au terrain. Une diversité de contributions des exploitations à la multifonctionnalité est dégagée et reliée à des caractéristiques d'exploitation et de localisation sur l'espace étudié. L'ensemble du travail permet des recommandations méthodologiques et de gestion visant la multifonctionnalité de l'agriculture

This paper sets out the approach and results obtained from a survey on farmers owning floodable land in central France, carried out in the framework of the European project EUROTAS. After a presentation of the methodology used, we characterise the damage caused by floods, on the one hand, on the scale of a flooded field and, on the other hand, taking into account other elements of the system, on the scale of the whole farm. Since the damage liable to occur depends in part on how farmers decide to use the floodable fields and on the farm's internal organisation, we present the different ways in which farmers take into account possible flooding in the management of their farms, and the reasons linked to these decisions. Lastly, regarding the above elements, we discuss the incidence of increased floods on farms and their acceptability by the farmers., La présente communication expose la démarche et les résultats obtenus par enquête auprès d'agriculteurs disposant de terres inondables dans le Centre de la France dans le cadre du projet européen EUROTAS. Après une présentation de la méthodologie utilisée, les dommages causés par les inondations sont caractérisés d'une part à l'échelle de la parcelle inondée, et d'autre part, compte tenu d'éventuels effets induits sur d'autres éléments du système d'exploitation, à l'échelle de l'exploitation agricole. Comme l'ampleur des dommages encourus dépend pour partie de décisions prises par l'agriculteur concernant l'utilisation des parcelles inondables et l'organisation interne de l'exploitation, les différentes façons dont les agriculteurs traduisent l'existence de possibles inondations dans la gestion de leur exploitation sont présentées, ainsi que les raisons associées à ces choix. Enfin, au regard de ces éléments, l'incidence de l'accroissement des inondations sur les exploitations et de leur acceptabilité par les agriculteurs est discutée.

ICI 89,406, a new cardioselective beta-adrenoceptor antagonist possessing marked intrinsic sympathomimetic activity, was administered (0.04 mg/kg, i.v.) to 10 patients with stable, uncomplicated, exercise-induced angina pectoris and angiographically proven coronary artery disease. The drug resulted in a significant reduction in heart rate (from 125 +/- 5 to 110 +/- 4/min, p less than 0.001), mean systemic arterial pressure (from 147 +/- 4 to 137 +/- 3 mm Hg, p less than 0.01), and electrocardiographic ST-segment depression (from 1.9 +/- 0.5 to 0.8 +/- 0.3 mm, p less than 0.01) without any change in pulmonary arterial or wedge pressure during submaximal supine leg exercise on a bicycle ergometer. These changes were accompanied by a reduction of cardiac output in 6/10 patients and of the duration of pain in 8/10 patients. At rest, all the hemodynamic parameters remained essentially unchanged in comparison with the control study. These studies indicate that ICI 89,406 produces effective beta-adrenoceptor blockade during exercise in patients with angina pectoris. The partial agonist activity of the drug may be responsible for the minimal circulatory response at rest.

Topiramate was assessed in an open-label trial as broad-spectrum antiepileptic monotherapy, independently from the epilepsy type or syndrome. Adults and children aged 2 years and older, who were diagnosed with epilepsy within the last 5 years, treatment-naive or failing prior treatment with one antiepileptic drug (AED), received individually adjusted doses of topiramate, after escalation to 100mg/day over 4 weeks (maximum 400mg/day) or 3mg/kg/day over 6 weeks (maximum 9 mg/kg/day), respectively. Patients were followed foror=7 months and optionally up to a maximum of 13 months. Data were analysed for all patients (n=692), as well as for focal (n=421) and generalized epilepsies (n=148). The median topiramate dose used was 125 mg/day in adults and 3.3mg/kg/day in children (or=12 years). Overall, 80% of patients completed the 7-month study. During this period, 44.3% were seizure-free, while 76.3% achievedor=50% reduction in mean monthly seizure frequency. Patients with focal and generalized epilepsies alike responded to treatment (73.9 and 83.8% with at least 50% seizure reduction): 39.4% of patients with focal epilepsy and 61.5% of those with generalized epilepsy were seizure-free. The mean monthly seizure frequency was significantly reduced versus baseline at all visits (p0.001). Similar response rates were obtained from the 237 patients completing the 1-year observation period. During the mandatory 7-month period of study, 8.8% of patients reported insufficient tolerability as a reason for dropout. The most frequent adverse event was paraesthesia. Our results support findings that emerge from controlled studies that topiramate is effective and well tolerated when used as initial or second monotherapy. They also suggest that in a naturalistic setting, overall good retention on treatment and seizure freedom are observed at low doses in a broad spectrum of epilepsies.