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International audience; The replication crisis in psychology has led to question popular phenomena such as ego depletion, which has been criticized after studies failed to replicate. Here, we describe limitations in the literature that contributed to these failures and suggest how they may be addressed. At the theoretical level, the literature focuses on two out of at least eight identified auxiliary hypotheses. Thus, the majority of the hypotheses related to the three core assumptions of the ego-depletion theory have been overlooked, thereby preventing the rejection of the theory as a whole. At the experimental level, we argue that the low replicability of ego-depletion studies could be explained by the absence of a comprehensive, integrative, and falsifiable definition of self-control, which is central to the concept of ego depletion; by an unclear or absent distinction between ego depletion and mental fatigue, two phenomena that rely on different processes; and by the low validity of the tasks used to induce ego depletion. Finally, we make conceptual and methodological suggestions for a more rigorous investigation of ego depletion, discuss the necessity to take into account its dynamic and multicomponent nature, and suggest using the term self-control fatigue instead.

The aims of the present study were to characterize the mechanical output of final road sprints of an elite sprinter during international competitions in relation to his power-velocity-endurance characteristics, and to investigate the relationship between this sprint performance and the power produced during preceding phases of the race. The sprinter performed a set of short and long sprints (5 to 15 s) on a cycle ergometer to determine his maximal power-velocity-endurance profile. Based on eleven races, the distribution of power throughout each race, peak and mean power (Ppeak and Pmean ) and associated pedalling rates (vPpeak and vPmean ) during the final sprint were analyzed. The power-velocity-endurance profile of the sprinter indicated that his mean maximal power and corresponding optimal pedalling rate ranged from 20.1 W.kg-1 (124 rpm) for a 1-s sprint to 15.2 W.kg-1 (112 rpm) for 20 s. Race data showed that final road sprints were mainly performed on the ascending limb of the power-velocity relationship (vPpeak , 104±8 and vPmean , 101±8 rpm). Additionally, Ppeak and Pmean were lower than the theoretical maximal power determined from the power-velocity-endurance profile (10.4±7.0% and 11.2±9.2%, respectively), which highlighted a significant state of fatigue induced by the race. Finally, sprint power exhibited a high variability between races and was strongly related to the level of power produced during the last minute before the sprint. These findings show the importance of considering both the power-velocity-endurance qualities and the power demand of the last lead-up phase before the sprint in order to optimize final sprint performance.

International audience; Introduction: The search for the 'perfect' renal replacement therapy has been paralleled by the search for the perfect biomarkers for assessing dialysis adequacy. Three main families of markers have been assessed: small molecules (prototype: urea); middle molecules (prototype β2-microglobulin); comprehensive and nutritional markers (prototype of the simplified assessment, albumin levels; composite indexes as malnutrition-inflammation score). After an era of standardization of dialysis treatment, personalized dialysis schedules are increasingly proposed, challenging the dogma of thrice-weekly hemodialysis.Areas covered: In this review, we describe the advantages and limitations of the approaches mentioned above, focusing on the open questions regarding personalized schedules and incremental hemodialysis.Expert opinion: In the era of personalized dialysis, the assessment of dialysis adequacy should be likewise personalized, due to the limits of 'one size fits all' approaches. We have tried to summarize some of the relevant issues regarding the determination of dialysis adequacy, attempting to adapt them to an elderly, highly comorbidity population, which would probably benefit from tailor-made dialysis prescriptions. While no single biomarker allows precisely tailoring the dialysis dose, we suggest using a combination of clinical and biological markers to prescribe dialysis according to comorbidity, life expectancy, residual kidney function, and small and medium-size molecule depuration.

Recent evidence suggests that during volitional stepping older adults control whole-body angular momentum (H) less effectively than younger adults, which may impose a greater challenge for balance control during this task in the elderly. This study investigated the influence of aging on the segment angular momenta and their contributions to H during stepping. Eighteen old and 15 young healthy adults were instructed to perform a series of stepping at two speed conditions: preferred and as fast as possible. Full-body kinematics were recorded to compute angular momenta of the trunk, arms and legs and their contributions to total absolute H on the entire stepping movement. Results indicated that older adults exhibited larger angular momenta of the trunk and legs in the sagittal plane, which contributed to a higher sagittal plane H range during stepping compared to young adults. Results also revealed that older adults had a greater trunk contribution and lower leg contribution to total absolute H in the sagittal plane compared to young adults, even though there was no difference in the other two planes. These results stress that age-related changes in H control during stepping arise as a result of changes in trunk and leg rotational dynamics.

BACKGROUND We seek to evaluate whether ischemia extent (unilateral or bilateral) impacts spatiotemporal and neuromuscular gait parameters differently in patients with peripheral arterial disease and presenting intermittent claudication (PAD-IC). METHODS Two groups of PAD-IC patients: unilateral (Unilat-IC; n = 15), bilateral (Bilat-IC; n = 15) and a group of control subjects with similar risk factors (n = 15) were evaluated during a constant load treadmill walking test. Spatiotemporal parameters and neuromuscular activation in tibialis anterior and gastrocnemius medialis were recorded. Patients were instructed to describe their pain during walking test, and three phases were analysed: pain-free, onset of pain and maximum pain in PAD-IC patients. FINDINGS Single leg stance in the asymptomatic leg of Unilat-IC increases and becomes higher than the symptomatic leg and the Bilat-IC legs at maximum pain. Step time is higher and cadence is lower in PAC-IC than in controls. Tibialis anterior activation peak in Unilat-IC continuously decreases between phases and becomes lower than in Bilat-IC during maximum pain. Tibialis anterior activation time is higher in Bilat-IC and in the asymptomatic leg than in the symptomatic of Unilat-IC during all the phases. Gastrocnemius medialis activation peak in Bilat-IC decreases with pain. Gastrocnemius medialis activation time in the symptomatic leg of Unilat-IC presents a significant decrease between pain-free and maximum pain phases. INTERPRETATION Ischemia impacts gait in PAD-IC patients differently according to its extent between legs compared to controls. Imbalance between legs in Unilat-IC induces compensatory mechanism and an asymmetrical pattern. Bilat-IC should not be simply considered as a 'double' Unilat-IC when evaluating gait.

Cancer-related fatigue can continue long after curative cancer treatment. The aim of this study was to investigate sleep and rest–activity cycles in fatigued and non-fatigued cancer survivors. We hypothesized that sleep and rest–activity cycles would be more disturbed in people experiencing clinically-relevant fatigue, and that objective measures of sleep would be associated with the severity of fatigue in cancer survivors. Cancer survivors (n = 87) completed a 14-day wrist actigraphy measurement to estimate their sleep and rest–activity cycles. Fatigue was measured using the Functional Assessment of Chronic Illness Therapy Fatigue Scale (FACIT-F). Participants were dichotomised into two groups using a previously validated score (fatigued n = 51 and non-fatigued n = 36). The participant’s perception of sleep was measured using the Insomnia Severity Index (ISI). FACIT-F score was correlated with wake after sleep onset (r = −0.28, p = 0.010), sleep efficiency (r = 0.26, p = 0.016), sleep onset latency (r = −0.31, p = 0.044) and Insomnia Severity Index (ISI) score (r = −0.56, p &lt, 0.001). The relative amplitude of the rest–activity cycles was lower in the fatigued vs. the non-fatigued group (p = 0.017, d = 0.58). After treatment for cancer, the severity of cancer-related fatigue is correlated with specific objective measures of sleep, and there is evidence of rest–activity cycle disruption in people experiencing clinically-relevant fatigue.

Background We aimed at developing a core outcome and variables of interest set to investigate the effects of mediolateral episiotomy on Obstetric Anal Sphincter Injury (OASI) during and after operative delivery in nulliparous women in a large-scale one-year observational French study including 15,000 women (INSTRUMODA). Methods A list of outcomes and variables of interest was suggested to obstetricians participating in the INSTRUMODA study using online questionnaires divided into 7 categories: the woman’s history and course of pregnancy, course of labor, modalities of operative delivery, episiotomy characteristics, immediate maternal morbidity, one-year maternal morbidity, immediate neonatal morbidity. We used a three-round DELPHI method to reach a consensus. In the first round, outcomes and variables considered as essential by 70% or more of obstetricians were included in the corpus whereas they were excluded when 70% rated them as “not important”. In the second round, non-consensual outcomes and variables were reassessed and excluded or definitively included if considered as “not important” or essential by 50% or more of the obstetricians. During the first round, obstetricians were invited to suggest new outcomes and/or variables that were then assessed in the second and third round. We used the same method to develop a core outcome and variables of interest set in a population of women in the community recruited via an association of patients. At the end of the procedure the core outcome and variables of interest sets were merged to provide the final core outcome set for the INSTRUMODA study. Results Fifty-three obstetricians and 16 women filled out questionnaires. After the 3 rounds of Delphi procedure in each population, 74 outcomes and variables were consensually reported by obstetricians and 92 by women in the community. By mixing these two consensual corpora we reported a final consensual list of 114 variables of interest and outcomes for both obstetricians and women. Conclusion We established a core outcome and variables of interest set among obstetricians and women in the community to investigate the association between mediolateral episiotomy and OASI during operative delivery. Trial registration The INSTRUMODA study was registered on https://clinicaltrials.gov on June 25, 2020 (NCT04446780).

The public health policies and sanitary measures taken by governments in various countries to stem the spread of the COVID-19 pandemic (e.g. lockdown, social distancing) have major implications for athletes. The radical changes are challenging and risk causing significant career disruption to athletes, with subsequent negative psychological effects. Thus, the ways athletes cope with such adversity is of critical importance. The present study aimed to identify athletes' coping profiles using a person-centred approach, based on their reported use of multiple coping strategies in response to the impact of the COVID-19 outbreak, and to compare levels of anxiety, stress appraisals, interpersonal coping strategies, and availability and appreciation of the major sources of support across profiles. A total of 526 French athletes competing at national to elite levels answered an online questionnaire during the lockdown. Latent profile analysis results yielded four distinct coping profiles (i.e. self-reliant, engaged, avoidant, active and social). The MANOVA showed that athletes belonging to the four profiles differed on anxiety, stress appraisals, social support, and interpersonal coping. In particular, avoidant copers reported high levels of anxiety, threat, and uncontrollability, and appeared less able to regulate responses to the impact of the COVID-19 outbreak. Using a person-centred approach, the findings could inform the development of more adequate care, support, and intervention for athletes, especially avoidant copers, who were characterized by the least effective coping skills and resources. Accordingly, stress reappraisal and stress mindset interventions could be promising approaches to effectively manage pandemic-related impact during and after the COVID-19 crisis.Highlights The COVID-19 outbreak has major implications for athletes and is causing significant disruption to their careers. Using a person-centred approach, four coping profiles emerge showing athletes' preferred use of several coping strategies in response.The four coping profiles (i.e. self-reliant, engaged, avoidant, active and social) differentiate distinct groups of athletes in relation to anxiety, stress appraisals, social support, and interpersonal coping.Avoidant copers were characterized by the least effective coping skills and social context of coping. Management of the COVID-19 situation may be more problematic for them than other in mitigating its negative psychological effects.Using a person-centred approach, the findings could inform the development of more adequate care, support, and intervention for athletes, especially avoidant copers, who were characterized by the least effective coping skills and resources.

Some studies have suggested that postural balance improved after a single session of transcranial direct current stimulation (tDCS), whereas others have found minimal, if any, effects on postural performance. To address the issue of replication in tDCS studies, we re-tested the anodal tDCS effects of left dorsolateral prefrontal cortex while performing a dual-task by increasing the attentional demands associated with more challenging proprioceptive conditions. Twenty-four young adults (mean age: 21.3 ± 1.2 years) were randomly divided into two groups (a “real tDCS” vs. a “sham tDCS” group) were asked to maintain a quiet stance on a force platform. Eight trials were conducted, with eyes open and eyes closed, standing on a firm and foam surface and performing a simple and dual-task (backward counting). The postural performance was assessed by various centre-of-pressure parameters before and immediately after a 20-min tDCS session. No main effect of group and no interaction considering this factor were observed, regardless of the centre-of-pressure variables (all p values > 0.1). No evidence of a more efficient postural control emerged after a tDCS session. Beyond promising research on tDCS to maximize cognitive and behavioural enhancement, the current results indicate that caution needs to be taken when drawing firm conclusions, at least in young healthy adults.

International audience; The aim of this study was to identify young elite athletes’ personality profiles using a person-centered approach, and to investigate whether the profiles significantly differ in stress and sleep. 260 athletes from a variety of sports completed a questionnaire package to assess neuroticismand conscientiousness traits, stress appraisals (i.e. intensity and directional interpretation of stress, challenge and threat appraisals), and various indicators of sleep (i.e. sleep quality, social jet lag, Ford insomnia response to stress test (FIRST)). A latent profile analysis (LPA) approach was used to identify personality profiles based on the scores of neuroticism and conscientiousness. A multivariate analysis of variance was performed to examine if the athletes belonging to different personality profiles differ on stress appraisals and indicators of sleep.Three profiles emerged: Maladaptive profile (high levels of conscientiousness and neuroticism); Highly adaptive profile (moderate level of conscientiousness and low level of neuroticism); Adaptive profile (high level of conscientiousness and moderate level of neuroticism). Results showed that athletes from the adaptive profile reported significantly lower scores of stress intensity and threat appraisal than those from other profiles. Athletes from the maladaptive profile reported significantly higher levels of FIRST than those from other profiles as well as worse sleep quality and lower levels of challenge appraisal than the athletes from the highly adaptive profile. These results suggest that investigating personality profile may be useful in identifying athletes at higher risk of stress sensitivity and worsening sleep that are likely to benefit from preventive actions (e.g. cognitive behavioural therapy interventions).

International audience; INTRODUCTION: Blood-based biomarkers are the next challenge for Alzheimer's disease (AD) diagnosis and prognosis. METHODS: Mild cognitive impairment (MCI) participants (N = 485) of the BALTAZAR study, a large-scale longitudinal multicenter cohort, were followed-up for 3 years. A total of 165 of them converted to dementia (95% AD). Associations of conversion and plasma amyloid beta (Aβ)1-42 , Aβ1-40 , Aβ1-42 /Aβ1-40 ratio were analyzed with logistic and Cox models. RESULTS: Converters to dementia had lower level of plasma Aβ1-42 (37.1 pg/mL [12.5] vs. 39.2 [11.1] , P value = .03) and lower Aβ1-42 /Aβ1-40 ratio than non-converters (0.148 [0.125] vs. 0.154 [0.076], P value = .02). MCI participants in the highest quartile of Aβ1-42 /Aβ1-40 ratio (>0.169) had a significant lower risk of conversion (hazard ratio adjusted for age, sex, education, apolipoprotein E \epsilon4, hippocampus atrophy = 0.52 (95% confidence interval [0.31-0.86], P value = .01). DISCUSSION: In this large cohort of MCI subjects we identified a threshold for plasma Aβ1-42 /Aβ1-40 ratio that may detect patients with a low risk of conversion to dementia within 3 years.

Background Chronic Kidney Disease (CKD) is associated with reduced muscular strength resulting in profound fatigue. The physiopathology of these changes, their prevalence and evolution are still debated. Moreover, we have little data on elderly CKD patients. The present study protocol aims to 1) quantify the prevalence of low muscle strength (dynapenia) in a cohort of elderly patients with advanced CKD and to 2) characterize their force production coupled with electromyographic features and the symptoms of fatigue compared to a matched control group. Methods This is a case-control, prospective, interventional study. Inclusion criteria: age ≥ 60 years; CKD Stage 3b-5; clinical stability (i.e. no hospitalization and ≤ 25% in creatinine increase in the previous 3 months). Controls with normal kidney function will be matched in terms of age, gender and diabetes mellitus (requisite: estimated glomerular filtration rate ≥ 60 ml/min/1.73m2 available in the last 6 months). Exclusion criteria for cases and controls: neuromuscular disease, life expectancy The handgrip strength protocol is an intermittent test consisting in 6 series of 9 repetitions of 3-s sub-maximum contractions at 40% of the maximum voluntary contraction (MVC) and 2 s of resting time between contractions. Each series is separated by one fast sub-maximum contraction and one MVC. Strength is assessed with a high-frequency handgrip dynamometer paired with surface electromyography. Symptoms of fatigue are assessed using MFI-20 and FACIT-F questionnaires. In order to reach a statistical power of 96%, we plan to enroll 110 subjects in each group. Discussion The novelty of this study resides in the application of an already validated set of tests in a population in which this combination (dynamometer, electromyography and questionnaires) has not previously been explored. We expect a high prevalence of dynapenia and a higher fatigability in CKD patients. A positive correlation is expected between reported fatigue and fatigability. Better appreciation of the prevalence and the relationship between fatigability and a sensation of fatigue can help us target interventions in CKD patients to improve quality of life and survival. Trial registration The study was approved by Ethical Committee EST III n°20.03.01 and was recorded as a Clinical Trial (NCT04330807) on April 2, 2020.

International audience; Attention deficit with or without hyperactivity disorder (ADHD) is one of the most frequent neuropsychiatric disorders, and affects 2-4% of adults. In contrast with many European countries, the identification and management of adult ADHD remains underdeveloped in France, and a subject of controversy. This review provides a practical update on current knowledge about ADHD in adults for French-speaking professionals who have to detect or manage adult patients with ADHD. ADHD is classified as a neurodevelopmental disorder in the recent update of the international diagnostic classification. While symptoms and impairment due to ADHD are frequently severe during childhood, they often evolve as children grow older, with frequent persistent disabilities in adulthood. In adulthood, the clinical presentation, as in childhood, involves the symptom triad of inattention, hyperactivity and impulsivity. However, differences are noted: hyperactivity is more often internalized, symptoms of inattention may be masked by anxiety symptoms or obsessive-like compensation strategies. ADHD is often diagnosed during childhood, but it is not rare for the diagnosis to be made later. Failure to recognise symptoms resulting in misdiagnosis, or alternatively well-developed compensation factors could be two underlying reasons for the long delay until diagnosis. Other symptoms, such as emotional deregulation or executive function-related symptoms are also usually observed in adults. In addition, in adults, ADHD is often associated with other psychiatric disorders (in 80% of cases); this makes the diagnosis even more difficult. These disorders encompass a broad spectrum, from mood disorders (unipolar or bipolar), to anxiety disorders, and other neurodevelopmental disorders and personality disorders, especially borderline and antisocial personality disorder. Substance-use disorders are very common, either as a consequence of impulsivity and emotional dysregulation or as an attempt at self-treatment. Sleep disorders, especially restless leg syndrome and hypersomnolence, could share common pathophysiological mechanisms with ADHD. ADHD and comorbidity-related symptoms are responsible for serious functional impairment, in various domains, leading to academic, social, vocational, and familial consequences. The impact on other psychiatric disorders as an aggravating factor should also be considered. The considerable disability and the poorer quality of life among adults with ADHD warrant optimal evaluation and management. The diagnostic procedure for ADHD among adults should be systematic. Once the positive diagnosis is made, the evaluation enables characterisation of the levels of severity and impairment at individual level. A full examination should also assess medical conditions associated with ADHD, to provide personalized care. In recent years, a growing number of assessment tools have been translated and validated in French providing a wide range of structured interviews and standardized self-report questionnaires for the evaluation of core and associated ADHD symptoms, comorbidities and functional impairment. The treatment of ADHD in adults is multimodal, and aims to relieve the symptoms, limit the burden of the disease, and manage comorbidities. The most relevant and validated psychological approaches are psycho-education, cognitive-behavioural therapy and "third wave therapies" with a specific focus on emotional regulation. Cognitive remediation and neurofeedback are promising strategies still under evaluation. Medications, especially psychostimulants, are effective for alleviating ADHD symptoms with a large effect size. Their safety and tolerance are satisfactory, although their long-term clinical benefit is still under discussion. In France, methylphenidate is the only stimulant available for the treatment of ADHD. Unfortunately, there is no authorization for its use among adults except in continuation after adolescence. Hence the prescription, which is subject to the regulations on narcotics, is off-label in France. This article aims to provide practical considerations for the management of ADHD and associated disorders in adults, in this particular French context.

International audience; Vaginal delivery is reported as a main risk factor of pelvic floor dysfunction. Nevertheless, data with a high level of evidence are lacking to confirm the hypothetic protective effect of pre-labor caesarean section. In order to promote a preventive strategy for a disease, it is necessary to know perfectly its pathophysiology and to be sure that the strategy is in place before the beginning of the pathological process. In other words, the causality between the exposure factor and the disease must be certain. Due to the maternal and neonatal morbidities associated with caesarean section it is essential to be careful before promoting prophylactic pre-labor caesarean section policies [1,2]. The objective of this scientific review is to provide a systematic analysis of the causality between vaginal delivery and pelvic floor dysfunction using Hill’s criterion for causality in order to devise a policy of advising pre-labor caesarean section to prevent pelvic floor dysfunction

BACKGROUND Nutrition plays an important role in the aging process. Adherence to the Mediterranean diet (MedDiet) has been shown to be associated with lower rates of diseases. Cognitive status seems to be strongly interrelated with physical well-being, so that one influences the other. Physical performance measures are not only associated with clinical and subclinical age-related modifications, but are also able to predict disability, institutionalization, and mortality. OBJECTIVE To evaluate prospectively the associations between Mediterranean-Style Dietary Pattern Score (MSDPS), clinical characteristics, and cognition of the population sample of The TREVISO LONGEVA (TRELONG) Study, in Treviso, Italy. METHODS Global cognition, physical performance measures, MSDPS, and other clinical features were detected in 2010 in 82 men and 108 women. These characteristics were evaluated in relation to the physical performance measures identified 3.8 years later in 2013 in the same subjects, using a semantic connectivity map, through Auto-CM system, to grasp further and non-linear associations between variables which might remain, otherwise, undetected. RESULTS The Auto-CM system's map showed a close association between better levels of global cognition and MSDPS in 2010 and higher physical performance in 2013. On the other hand, worse levels of global cognition and MSDPS in 2010 were associated with lower physical performance in 2013. CONCLUSION The prevention models for successful aging may benefit from integrated programs that include cognitive, physical, and dietary interventions, since these aspects are mutually interrelated.

Background Cancer-related fatigue (CRF) is the most common side effect of cancer and cancer treatment. CRF prevalence is up to 50% in breast cancer patients and can continue several years after cancer remission. This persistent subjective sense of exhaustion is multifactorial. Numerous parameters have been evidenced to be related to CRF across biological, physical, psychological, social and/or behavioral dimensions. Although CRF has been studied for many years, the majority of previous studies focused on only one dimension, i.e., physical function. Moreover, few studies investigated CRF longitudinally with repeated measures. These are the two main obstacles that limit the understanding of CRF mechanisms. The purpose of this study is to create a biopsychosocial model of CRF with simultaneous and longitudinal anthropometric, clinical, biological, physical, psychological and sociological parameters. Methods BIOCARE FActory is a multicentric prospective study that will consist of an 18-month follow-up of 200 women diagnosed with breast cancer. Four visits will be scheduled at diagnosis, after treatments, and 12 and 18 months after diagnosis. The same procedure will be followed for each visit. Each session will be composed of anthropometric data collection, a semi-structured interview, cognitive tests, postural control tests, neuromuscular fatigability tests and a cardiorespiratory fitness test. Clinical and biological data will be collected during medical follow-ups. Participants will also complete questionnaires to assess psychological aspects and quality of life and wear an actigraphy device. Using a structural equation modeling analysis (SEM), collected data will build a biopsychosocial model of CRF, including the physiological, biological, psychological, behavioral and social dimensions of CRF. Discussion This study aims to highlight the dynamics of CRF and its correlates from diagnosis to post treatment. SEM analysis could examine some relations between potential mechanisms and CRF. Thus, the biopsychosocial model will contribute to a better understanding of CRF and its underlying mechanisms from diagnosis to the aftermaths of cancer and its treatments. Trial registration This study is registered at ClinicalTrials.gov (NCT04391543), May 2020.

Our main objective was to assess the intraoperator intersession reproducibility of transperineal ultrasound Shear Wave Elastography (SWE) to measure the levator ani muscle (LAM) elastic properties. Secondary objective was to compare reproducibility when considering the mean of three consecutives measurements versus one. In this prospective study involving non-pregnant nulliparous women, two visits were planned, with a measurement of the shear modulus (SM) on the right LAM at rest, during Valsalva maneuver and maximal contraction. Assessments were done with a transperineal approach, using an AIXPLORER device with a linear SL 18–5 (5-18 MHz) probe. For each condition, 3 consecutive measures were performed at each visit. The mean of the three measures, then the first one, were considered for the reproducibility by calculating intraclass correlation coefficient (ICC), and coefficient of variation (CV). Twenty women were included. Reproducibility was excellent when considering the mean of the 3 measures at rest (ICC = 0.90; CV = 15.7%) and Valsalva maneuver (ICC = 0.94; CV = 10.6%), or the first of the three measures at rest (ICC = 0.87; CV = 18.6%) and Valsalva maneuver (ICC = 0.84; CV = 19.9%). Reproducibility was fair for measurement during contraction. Transperineal ultrasound SWE is a reliable tool to investigate LAM elastic properties at rest and during Valsalva maneuver.

The ways in which locations of ischemia and ischemic pain affect spatiotemporal gait parameters and leg electromyographic activity during walking have never been investigated in patients with peripheral arterial disease presenting intermittent claudication. Two groups were classified according to unilateral location of ischemia (distal, n = 10, or proximo-distal, n = 12). Patients described pain and three gait phases—initial pain-free, onset of pain and maximum pain—were analyzed. Patients with proximo-distal ischemia walked less (230 ± 111 m vs 384 ± 220 m), with increased step length, step time (+ 5.4% and + 5.8%) and reduced cadence (− 8.2%), than patients with distal ischemia. In both, the peaks of vertical ground reaction force were reduced in maximum pain (Peak1-distal: − 11.4%, Peak1-proximo-distal: − 10.3%; Peak2-distal: − 11.8%, Peak2-proximo-distal: − 9.0%). In the proximo-distal group, tibialis anterior activation peak and time were lower than in the distal group (− 4.5% and − 19.7%). During the maximum pain phase, this peak decreased only in the proximo-distal group (− 13.0%), and gastrocnemius medialis activation peak and time decreased in both groups (− 2.5% in distal and − 4.5% in proximo-distal). Thus, proximo-distal ischemia leads to more adverse consequences in gait than distal ischemia only. Increasing ischemic pain until maximum, but not onset of pain, induced gait adaptations.

Rest-activity rhythm (RAR) disruptions are frequently associated with chemotherapy in breast cancer (BC), but they are less known in BC with endocrine therapy (ET). The aim of this ancillary study was to characterize the RAR and estimated sleep characteristics from actigraphy in BC patients either treated (ET+) or untreated with ET (ET−), compared to healthy controls (HC) and using a cross-sectional design. Eighteen ET+, 18 ET−, and 16 HC completed questionnaires and wore wrist actigraphs at home for 2 weeks. Parametric and nonparametric RAR, sleep parameters, and quality of life were compared between groups (p < .05). BC groups presented lower daytime activity than HC according to RAR analysis (mesor and M10 parameters). Compared to HC, ET− had lower inter-daily stability and ET+ had greater sleep complaints. Compared to ET−, ET+ had lower sleep efficiency, more time awake, and higher activity levels at night, as assessed with actigraphy. Our results suggest an effect of cancer independent of treatment on RAR in BC, highlighting the need for further investigation of this topic. In contrast, sleep as assessed with actigraphy seems modified only during ET which matches with patients’ sleep complaints. Further longitudinal studies would aid in confirming the latter hypothesis.

Depression as well as a treatment by antidepressant are factors that may interfere with sexuality. Due to this complex relationship between depression, antidepressant and sexuality, it is difficult to incontestably establish the exclusive accountability of a treatment or of a psychiatric disorder on sexual dysfunctions. The main purpose of the SADD (for Sexuality, Anti-Depressant and Depression) study is to evaluate sexual dysfunctions in depressed men treated with antidepressant or not.Participants of this transversal, observational study were men aged over 18 years old, suffering from unipolar major depressive disorder and treated by a psychiatrist, with or without antidepressant. Assessment of sexual functioning through three times: euthymia (before depression), untreated depression and treated depression if applicable was performed based on the ASEX scale.Seventy patients were included. Eight percent of euthymic patients presented a sexual dysfunction (average score on the ASEX=12.4) whereas 56% of untreated patients presented a sexual dysfunction (average total score on the ASEX=17.7) and 62% (34/55) of patients treated with antidepressant (average total score on ASEX=18.5) (P0.001). Sexual functioning of men receiving treatment is not significantly different to that among men not receiving any antidepressant, even if patients treated with antidepressant reported that they had a better mood than those untreated.Our results reveal a high prevalence of sexual dysfunction within the framework of major depressive disorder and its treatment and underlines the complex relationship between major depressive disorder, antidepressant and sexuality.

International audience; La marche est généralement évaluée par une observation simple, mais de plus en plus de bilans cliniques sont filmés pour ensuite être analysés. Grâce à l'utilisation de la caméra ultra-rapide Miro Phantom C110, nous avons étudié la marche dans le plan sagittal de 10 sujets sains. L'approche a consisté à détecter des marqueurs placés au niveau de repère anatomique précis sur le membre inférieur, d’en extraire les coordonnées en 2D pour calculer différents paramètres de la marche. Les objectifs de ce projet sont de vérifier l’utilisation d’une caméra ultra-rapide pour déterminer des paramètres cinétiques et cinématiques de la marche ainsi que d’analyser l’intérêt de la haute fréquence d’acquisition sur la détection d’évènement précis au cours du cycle de marche.

The functional difference between the medial gastrocnemius (MG) and lateral gastrocnemius (LG) during walking in humans has not yet been fully established. Although evidence highlights that the MG is activated more than the LG, the link with potential differences in mechanical behavior between these muscles remains unknown. In this study, we aimed to determine whether differences in activation between the MG and LG translate into different fascicle behavior during walking. Fifteen participants walked at their preferred speed under two conditions: 0% and 10% incline treadmill grade. We used surface electromyography and B-mode ultrasound to estimate muscle activation and fascicle dynamics in the MG and LG. We observed a higher normalized activation in the MG than in the LG during stance, which did not translate into greater MG normalized fascicle shortening. However, we observed significantly less normalized fascicle lengthening in the MG than in the LG during early stance, which matched with the timing of differences in activation between muscles. This resulted in more isometric behavior of the MG, which likely influences the muscle–tendon interaction and enhances the catapult-like mechanism in the MG compared with the LG. Nevertheless, this interplay between muscle activation and fascicle behavior, evident at the group level, was not observed at the individual level, as revealed by the lack of correlation between the MG–LG differences in activation and MG–LG differences in fascicle behavior. The MG and LG are often considered as equivalent muscles but the neuromechanical differences between them suggest that they may have distinct functional roles during locomotion.

Cancer patients are especially prone to several side-effects during or after treatment which impairs their engagement in activities of daily living. Cancer-related fatigue (CRF) is the most reported side-effect of cancer with prevalence between 59 and 100%, according cancer and treatment type. CRF is defined as a distressing persistent subjective sense of physical, emotional, and/or cognitive tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent activity that interferes with usual functioning. Being that CRF is a subjective symptom, the standard assessment method is to use questionnaires. Nevertheless, this method does not distinguish between the different underlying mechanisms of CRF. Indeed, the supposed mechanisms of CRF are numerous and include physical, psychological and behavioral dimensions and the three most commonly reported are sleep disturbances, anxiety and depression. CRF might also be related to neuromuscular fatigability. Some studies reported greater fatigability amplitude after fatiguing exercise and a greater contribution from central fatigability mechanisms but the results are equivocal. Therefore, the objective of this thesis is to affirm the links between CRF and fatigability and to understand the underlying mechanisms of CRF. This thesis work is therefore articulated around three studies and the construction of a clinical research protocol to be carried out in the near future within the laboratory. The main results of these studies are i) fatigability seems to be an individual characteristic; ii) the fatigability amplitude is correlated with CRF severity; et iii) fatigability is among the underlying mechanisms of CRF.; Le cancer et ses traitements entraînent un certain nombre d’effet secondaire qui impacte la qualité de vie des patients. Le principal effet secondaire est la fatigue liée au cancer (FLC), sa prévalence se situe entre 59 et 99% des patients, en fonction du type de cancer et de traitement. La FLC est définie comme une sensation persistante d’épuisement due au cancer et à ses traitements, qui n’est pas proportionnelle aux activités réalisées. Etant subjective, la FLC est évaluée par le biais de questionnaires. Cependant, cette modalité d’évaluation ne permet de prendre en compte les différents mécanismes sous-jacents de la FLC. Car en effet, il est communément admis que de multiples mécanismes appartenant aux dimensions physique, psychologique, sociale et comportementale peuvent être à l’origine de la FLC. Parmi les principales origines décrites dans la littérature, on retrouve les troubles du sommeil et les symptômes émotionnels d’anxiété et de dépression. Il semblerait également que la fatigabilité soit un mécanisme potentiel de la FLC, néanmoins les résultats des précédentes études sont équivoques. Par conséquent, l’objectif de ce travail de thèse est d’affirmer les liens entre la FLC et la fatigabilité et déterminer si la fatigabilité fait parti des mécanismes sous-jacents de la FLC. Pour répondre à ces objectifs, nous avons mis en place différentes expérimentations et proposé un protocole de recherche qui sera prochainement mis en place. Les principaux résultats de ces études sont que i) la fatigabilité semble être une caractéristique individuelle ; ii) l’amplitude de la fatigabilité est associée à la FLC ; et iii) la fatigabilité est un des mécanismes sous-jacents de la FLC.

Recent evidence suggests that older adults may have difficulty controlling whole-body angular momentum (H) during volitional stepping, which could impose a major challenge for balance control and result in potential falls. However, it is not known if and how H is influenced by speed when stepping. This study aimed to investigate the effect on H of increasing speed during step initiation in older adults. Twenty-seven healthy individuals over 60 were enrolled in the current study and were instructed to perform a series of step initiations with their dominant leg under two speed conditions: at preferred speed and as fast as possible. Two force plates and a motion-capture system were used to record H and the components of the net external moment (moment arms and ground reaction forces) during the double support and step execution phases of stepping. Results revealed that increasing speed of stepping affected H differently in both stepping phases and in the different planes. H ranges in all three planes increased with speed during the double support phase. During the step execution phase, while H ranges in frontal and transversal planes decreased, sagittal plane H range significantly increased with speed. This increased H range in the sagittal plane, which may result from the task demands, could impose a greater challenge for balance control in the elderly.

Videofluoroscopic Swallow studies (VFSS) are useful radiological examinations to explore swallowing disorders but which require ionizing radiation. The aim of our study was to evaluate the comparability of pediatric VFSS at 15 frames per second (fps) with 30 fps. Fifty-five loops including 190 swallowings of VFSS at 30 fps performed on 32 consecutive pediatric patients in a University Hospital Center were retrospectively modified by a software to delete one image out of two to obtain secondary loops with a frame rate of 15 fps. An otorhinolaryngologist-phonatrician and a radiologist reviewed all swallowings blindly and randomly using the penetration and aspiration scale (PAS). In case of discordance, they concluded a consensual interpretation. Fifteen girls and seventeen boys were included. The median age was 4 years and 8 months (range = 4 months-16 yr.). 144 swallowings were normal. Swallowing disorder was confirmed in 46 swallowings, (23 supraglottic penetrations and 23 aspirations). Considering each swallowing at 15 fps, sensitivity and specificity were, respectively, 93% (CI 0.82-0.98) and 98% (CI 0.94-0.99). The Cohen'Kappa coefficient between each interpretation at 15 and 30 fps was "almost perfect" (κ = 0.95; CI 0.88-0.99). Considering each loop, conclusion was identical. Reducing frame rate at 15 fps during pediatric VFSS seemed to be acceptable with comparable diagnostic performances without clinical impact compared to 30 fps, while being an efficient way to reduce the ionizing radiation exposition in children. We would suggest reconsidering the possibility of using VFSS with a 15 fps in a pediatric population.

Peripheral arterial disease (PAD) is defined by arterial obstruction of the lower limbs related to atheroma deposits. This results in blood flow limitation. One of its manifestations is exercise intermittent claudication. When walking, muscle ischemia causes exercise intolerance (pain and / or fatigability) modifying the gait pattern and forcing people to stop. PAD-IC therefore impacts the biomechanical and neuromuscular gait characteristics. The former has been analyzed in several studies, but the latter has been less studied, highlighting the interest to focus on these parameters and possibly link them. In addition, the location of this exercise ischemia - and associated muscle pain - is variable. It can be present at a distal (calves) or proximo-distal (buttocks and / or thighs and calves) level, but also unilaterally or bilaterally (one or two affected legs). It is likely that ischemic location impacts the gait parameters, but this aspect has not yet been studied. In this thesis, we show that different damages of the biomechanical and neuromuscular activation gait parameters are altered depending on ischemia location (distal vs. proximo-distal and unilateral vs. bilateral.These results highlight a more deleterious functional impact in subjects with proximo-distal ischemia (greater length and duration of step, maximum walking distance, reduced amplitude and duration of muscle activation). In fact, pain and ischemia, localized on several sites, induce the development of a specific mechanism of adaptation to pain that is greater than in patients with distal ischemia. Likewise, unilateral damage generates an asymmetry in the parameters of walking with the aim of reducing the use of the painful limb (phase of unilateral stance, muscle coactivation, vertical component of the ground reaction force), impacting the ability to maintain balance while walking.These studies therefore indicate an impact of ischemic location on the gait parameters, suggesting the importance of its consideration, in particular when implementing rehabilitation protocols through physical activity in order to increase its efficiency.; L'Artériopathie Oblitérante des Membres Inférieurs (AOMI) est définie par une obstruction artérielle des membres inférieurs liée à des dépôts d'athérome et aboutissant à une limitation du flux sanguin. L'une de ses manifestations est la claudication intermittente d'effort. A la marche, l'ischémie musculaire provoque une intolérance à l'effort (douleur et/ou fatigabilité) modifiant le patron de marche et obligeant à l'arrêt. L'AOMI impacte donc les caractéristiques biomécaniques et neuromusculaires de la marche. La localisation de cette ischémie d'effort - et des douleurs musculaires associées - est variable. Elle peut être présente à un niveau distal (mollets) ou proximo-distal (fesses et/ou cuisses et mollets), mais également de manière unilatérale ou bilatérale (une ou deux jambes atteintes). Il est donc probable que la localisation ischémique impacte les paramètres de la marche, or cet aspect n'a pas encore été étudié. Dans ce travail de thèse, des atteintes différentes des paramètres biomécaniques de la marche et des paramètres d'activation neuromusculaire ont été mis en évidence selon la localisation distale ou proximo-distale, et aussi unilatérale ou bilatérale.Ces résultats mettent en avant un impact fonctionnel plus délétère chez les sujets présentant une atteinte proximo-distale (longueur et durée du pas supérieures, distance maximale de marche, amplitude et durée d'activation musculaire réduites). En effet, la douleur et l'ischémie, localisées sur plusieurs sites, induisent la mise en place d'un mécanisme spécifique d'adaptation à la douleur (ayant pour objectif la réduction de l'utilisation du membre douloureux) plus important que chez les sujets distaux. De même, l'atteinte unilatérale engendre une asymétrie des paramètres de la marche (phase d'appui unilatéral, coactivation musculaire, composante verticale de la force de réaction du sol), impactant les capacités d'équilibration à la marche. Ces travaux indiquent donc un impact de la localisation ischémique sur les paramètres de la marche, suggérant l'importance de sa prise en considération dans les protocoles de réadaptation par l'activité physique afin d'en augmenter l'efficience.

Aims Peripheral neuropathy (PN) in patients with diabetes can lead to changes in the distribution of plantar pressure during walking, which can be recorded with pedobarography. Compared to traditional spatial data reduction analysis, the pedobarographic Statistical Parametric Mapping (pSPM) allows comparison of the footprints with the advantage that sub-regions do not need to be defined a priori. Aim of the study was to test the potential of pSPM in identifying specific distribution of spatial pressure in different stages of PN. Methods PN was defined according to usual tools (i.e., tendon reflexes and sensory tests). Four groups were compared: patients with diabetes without PN (n = 24; 239 steps); with signs of mild PN (n = 12; 117 steps); with signs of severe PN (n = 6; 52 steps) and a control group without diabetes (n = 12; 124 steps). Traditional spatial data reduction and pSPM were performed to compare plantar pressures in the different groups. Results In patients with PN, traditional spatial data reduction analysis showed lower plantar pressures with PN severity. pSPM analysis is able to better define the initial changes: mild PN patients presents higher pressures on the anterior side of the metatarsal heads compared to patients without neuropathy. Patients with severe PN are characterised by higher pressures under the medial foot arch compared to other groups. Conclusions pSPM may identify specific features of plantar pressure distribution during walking in patients with mild PN and may become a useful screening tool for a timely identification of this complication.

The world population is aging, and the prevalence of chronic kidney disease (CKD) is increasing. Whether this increase is also due to the methods currently being used to assess kidney function in the elderly is still a matter of discussion. We aimed to describe the actual referral pattern of CKD patients in a large nephrology unit and test whether the use of different formulae to estimate kidney function could affect the staging and the need for specialist care in the older subset of our population. In 2019, 1992 patients were referred to our center. Almost 28% of the patients were aged ≥80 and about 6% were ≥90 years old. Among the causes of kidney disease, glomerulonephritis displayed a higher prevalence in younger patients whereas hypertensive or diabetic kidney disease were more prevalent in older patients. The prevalence of referred patients in advanced CKD stages increased with age, estimated glomerular filtration rate (eGFR) decreased with age regardless of which equation was used (chronic kidney disease epidemiology collaboration (CKD-EPI), Lund–Malmö Revised (LMR), modification of diet in renal disease (MDRD), Full Age Spectrum (FAS), or Berlin Initiative Study 1 (BIS)). With CKD-EPI as a reference, MDRD and FAS underestimated the CKD stage while LMR overestimated it. The BIS showed the highest heterogeneity. Considering an eGFR threshold limit of 45 mL/min for defining “significant” CKD in patients over 65 years of age, the variability in CKD staging was 10% no matter which equation was used. Our study quantified the weight of “old” and “old-old” patients on follow-up in a large nephrology outpatient unit and suggested that with the current referral pattern, the type of formula used does not affect the need for CKD care within the context of a relatively late referral, particularly in elderly patients.

Background: Research has shown important between-individual variations in physical activity (PA) during the COVID-19 lockdown.Objectives: The objectives of this is study are to examine the individual, sociodemographic, and environmental factors related to PA during the spring 2020 COVID-19 lockdown in France and to explore the mediating and moderating role of intention and self-efficacy toward PA in the relationships between sociodemographic/environmental variables and PA.Design: In this cross-sectional study, participants living in France (N = 386) completed an online survey between March 30 and April 10, 2020.Method: Minutes per week of moderate-to-vigorous PA during the lockdown; usual physical activity before the lockdown; and psychological (e.g., intention, self-efficacy, and autonomous and controlled motivation), sociodemographic (gender, age, and number of children), and environmental (habitat surface area and type of housing) factors were measured in the survey. Multiple linear regressions were used to investigate the role of these predictors on PA. Intention and self-efficacy were also examined as moderators and mediators of the association between sociodemographic/environmental factors and PA.Results: Usual physical activity before the COVID-19 lockdown, intention toward PA, habitat surface area, and controlled motivation significantly predicted PA during the lockdown. No mediating effects of intention or self-efficacy were found. Intention significantly moderated the association between gender and PA and the association between part-time work and PA.Conclusions: PA during the COVID-19 lockdown was mainly predicted by individual factors and notably usual PA. These results highlight the important role of habits in a highly changing context.

We present an accurate, fast and efficient method for segmentation and muscle mask propagation in 3D freehand ultrasound data, towards accurate volume quantification. A deep Siamese 3D Encoder-Decoder network that captures the evolution of the muscle appearance and shape for contiguous slices is deployed. We uses it to propagate a reference mask annotated by a clinical expert. To handle longer changes of the muscle shape over the entire volume and to provide an accurate propagation, we devise a Bidirectional Long Short Term Memory module. Also, to train our model with a minimal amount of training samples, we propose a strategy combining learning from few annotated 2D ultrasound slices with sequential pseudo-labeling of the unannotated slices. We introduce a decremental update of the objective function to guide the model convergence in the absence of large amounts of annotated data. After training with a small number of volumes, the decremental update transitions from a weakly-supervised training to a few-shot setting. Finally, to handle the class-imbalance between foreground and background muscle pixels, we propose a parametric Tversky loss function that learns to adaptively penalize false positives and false negatives. We validate our approach for the segmentation, label propagation, and volume computation of the three low-limb muscles on a dataset of 61600 images from 44 subjects. We achieve a Dice score coefficient of over $95~\%$ and a volumetric error \textcolor{black}{of} $1.6035 \pm 0.587~\%$., Comment: 14 pages, 18 figures, 10 Tables

International audience; The Volodalen® field method permits to classify runners into aerial or terrestrial, based on vertical oscillation, upper-body motion, pelvis and foot position at ground contact, and foot strike pattern. The present study aimed to compare the sprint running force-velocity profiles between aerial and terrestrial runners. Sixty-Four French National-Level young soccer players (28 females, 36 males) performed three trials of unloaded maximal 40 m sprints. External horizontal power-force-velocity relationships were computed using a validated biomechanical model and based on the velocity-time curve. Accordingly, the participants were classified into patterns in aerial and terrestrial runners. Terrestrial runners showed a higher maximal horizontal force (F(0)) (6.73 ± 1.03 vs 6.01 ± 0.94 N·kg(-1)), maximal horizontal power (P(max)) (14.04 ± 3.24 vs 12.51 ± 3.31W·kg(-1)), maximal acceleration (Acc) (6.83 ± 0.85 vs 6.26 ± 0.89 m·s(-2)), and maximal rate of horizontal force (RF(max)) (57.41 ± 4.64 vs 52.81 ± 5.69%) compared to aerial runners. In contrast, terrestrial runners displayed a more negative rate of decrease of RF (D(RF)) (-11.65 ± 1.71 vs -10.23 ± 1.66%) and slope of the Force-Velocity relationship (F-V slope) (-0.83 ± 0.11 vs -0.77 ± 0.10 N·s·m(-1)·kg(-1)) than aerial runners. The results indicate that terrestrial runners displayed more efficient force production in the forward direction and displayed more "force-oriented" F-V profiles. Nevertheless, aerial runners were more effective in maintaining a net horizontal force production with increasing speed. Our results suggest that terrestrial runners could be more adapted to the specific short distance and high acceleration sprints running.

Les innovations technologiques participent aux évolutions de la culture technique des disciplines sportives. Le domaine de la voile sportive offre actuellement une opportunité pour étudier le développement d’une culture technique liée à la diffusion d’une innovation matérielle : les « foils », permettant aux voiliers de voler au-dessus de l’eau. La présente étude visait à : (a) appréhender la nature et la structure des connaissances de pratiquants et praticiens pionniers de la navigation volante, en relation avec la question de la gestion et du contrôle de la stabilité de vol, et (b) à appréhender le développement d’une culture technique propre à la navigation volante. Nous avons réalisé des entretiens de partage d’expérience avec douze participants reconnus pour leur implication dans la pratique ou l’encadrement de la voile volante. L’analyse a consisté en l’identification d’expériences types associées à la reconnaissance et au contrôle de la stabilité de vol, ainsi qu’à la catégorisation et la mise en réseau d’éléments explicatifs d’états de stabilité du vol, du point de vue des connaissances des participants. Ces deux versants de l’analyse ont permis d’appréhender l’émergence d’une culture partagée au sein du groupe de participants. Nos résultats permettent de suggérer un développement de la culture technique de la voile volante comme intégrant une forte dimension émotionnelle, et mettant en avant l’incorporation de l’équipage à un bateau présentant les caractéristiques d’un système autonome. Technological innovations contribute to developments in the technical culture of sports. The current field of competitive sailing provides an opportunity to study the development of a technical culture linked to the spread of an innovation in equipment – that of “hydrofoils”, which allow sailboats to “fly” over the water. The objectives of this study were to investigate: (i) the nature and structure of the knowledge of “pioneering” hydrofoil sailors, in relation to the question of flight stability management and control, and (ii) the development of a technical culture specific to hydrofoil sailing. We conducted “experience sharing” interviews with 12 participants recognized for their involvement in the practice or teaching of hydrofoil sailing. The analysis consisted in identifying typical experiences related to flight stability recognition and control, and in the categorization and inter-linking of explanatory elements on flight stability states, from the point of view of the participants’ knowledge. These two sides of the analysis helped to apprehend the emergence of a shared culture within the group of participants. Our results suggest the development of a technical culture of hydrofoil sailing that integrates to a greater extent the emotional dimension of this practice, and highlight the crew's incorporation into a boat that presents the characteristics of an autonomous system.

International audience; The manual segmentation of multiple organs in 3D ultra-sound (US) sequences and volumes towards their quantitative analysis is very expensive and time-consuming. Fully supervised segmenta-tion methods still require the collection of large volumes of annotated data while unlabeled images are abundant. In this work, we propose a semi-automatic deep learning approach modeled as a weak-label learning problem: given a few 2-D incomplete annotations for selected slices, the goal is to propagate the masks to the entire sequence. To this end, we make use of both positive and negative constraints induced by incomplete labels to penalize the segmentation loss function. Our model is composed of one encoder and two decoders to model the segmentation and an auxiliary reconstruction task. Moreover, we consider the spatio-temporal information by deploying a Convolutional Long Short Term Memory module. Our findings suggest that the reconstruction decoder and the spatio-temporal information lead to a better geometrical estimation of the mask shape. We apply the model to the task of low-limb muscle segmentation in a dataset of 44 patients and 6160 images.

The purposes of this study were to investigate the combined effects of age and obesity on gait and to analyze the relationship between age and obesity on ankle muscle activities during walking.4 groups; the young non-obese control group (CG, n = 50, age = 31.8 ± 4.5 years; BMI = 21.4 ± 2.2 kg/mCompared to OB, OBOA walked with higher CoP velocity, shorter stride, spending more time in support phase (p .05). These manifestations were associated with higher TA and SOL activities during the 1st double support (1st DS) and higher TA activity during the single support (SS) (p .05). Compared to OA, OBOA walked with lower GRFv, shorter and wider stride and spend more time in SU (p .05). Moreover, SOL, TA and GM activities of OBOA were higher compared to OAG during 1st DS, SS and 2nd Double support (2nd DS), respectively (p .05). During the 1ST DS, the stepwise multiple regression revealed that age accounted for 87% of the variance of TA activity. The addition of age contributed a further 16% to explain the variance TA activity. During the SS, age accounted for 64% and 46% of the variance of SOL and TA activity respectively. The addition of the body weight added further 15% and 66% of the variation of SOL and TA activity respectively. During the 2nd DS, body weight accounted for 86% of the variance and the addition of the body weight added a further 17% to explain the high level of GM.Age in obese adults and obesity in older adults should be considered separately to evaluate neuromuscular responses during walking and, subsequently, optimize the modality of treatment and rehabilitation processes in obese individuals in order to reduce and/or prevent the risk of falls.

International audience; Obesity is known to have a detrimental effect on balance and motor performance during daily motor tasks. However, it remains unclear whether these obesity-related impairments are due to deficient anticipatory postural adjustments (APA) that precede voluntary movement. The objective of this study was to examine the effects of obesity on APA and the impacts related on motor performance and mediolateral postural stability during gait initiation. Fifteen obese and ten normal-weight young participants performed a series of gait initiation at their preferred speed. Our results showed that the durations and amplitudes of APA along both anteroposterior and mediolateral directions did not differ between the two groups (P > 0.05). In contrast, compared to normal-weight participants, mechanical effectiveness of APA was reduced in obese participants (P < 0.05). As a result, we observed a decreased motor performance (P < 0.05), in terms of peak anteroposterior center-of-mass velocity at the end of the first step, and a reduced mediolateral stability at swing foot contact in obese participants compared to normal-weight participants (P < 0.05). These findings suggest that APA effectiveness during gait initiation is reduced in obese adults, resulting in a decrease of both mediolateral stability and motor performance compared to their lean counterparts.

It is well established that obesity is associated with deterioration in postural control that may reduce obese adults' autonomy and increase risks of falls. However, neuromuscular mechanisms through which postural control alterations occur in obese adults remain unclear.To investigate the effects of obesity on muscle coactivation at the ankle joint during static and dynamic postural control.A control group (CG; n = 20; age = 32.5 ± 7.6 years; BMI = 22.4 ± 2.2 Kg/m²) and an obese group (OG; n = 20; age = 34.2 ± 5.6 years; BMI = 38.6 ± 4.1 Kg/m²) participated in this study. Static postural control was evaluated by center of pressure (CoP) displacements during quiet standing. Dynamic postural control was assessed by the maximal distance traveled by the CoP during a forward lean test. Electromyography activity data for the gastrocnemius medialis (GM), soleus (SOL) and tibialis anterior (TA) were collected during both quiet standing and forward lean tests. Muscle activities were used to calculate two separate coactivation indexes (CI) between ankle plantar and dorsal flexors (GM/TA and SOL/TA, respectively).CoP displacements were higher in the OG than in the CG for quiet standing (p0.05). When leaning forward, the maximal distance of the CoP was higher in the CG than in the OG (p0.05). Only the CI value calculated for SOL/TA was higher in the OG than in the CG for both static and dynamic tasks (p0.05). The SOL/TA CI value in the OG was positively correlated with CoP displacements during quiet standing (r = 0.79; p0.05).Obesity increases muscle coactivation of the soleus and tibialis anterior muscles at the ankle joint during both static and dynamic postural control. This adaptive neuromuscular response may represent a joint stiffening strategy for enhancing stability. Consequently, increased ankle muscle coactivation could not be considered as a good adaptation in obese adults.

Intermittent Claudication due to Peripheral Arterial Disease (PAD-IC) induces ischemic pain in exercising muscles, and therefore impaired gait. In a pathological context, the analysis of the Vertical component of Ground Reaction Force (VGRF) is frequently used to describe gait pattern. This paper aims to define gait profiles according to the relative difference between peaks of VGRF; a Rearfoot and a Forefoot profile revealing a more loading or push-off strategy. We evaluated 70 participants (24 with unilateral disease (Unilat-IC), 22 with bilateral disease (Bilat-IC) and 24 Controls) during a walk test on an instrumented treadmill. Results indicate that Unilat-IC patients present a Rearfoot-profile in both legs during the pain-free gait period, likely to stabilize their gait. With the onset and increase of pain, the asymptomatic leg changes for a Forefoot-profile. This asymmetrical pattern suggests that a compensatory mechanism occurred to unload the symptomatic (painful) leg, possibly creating an imbalance. In Bilat-IC and Controls subjects, a Forefoot-profile is found, with a symmetrical pattern. However, there is a trend for lower propulsive capacity in case of Bilat-IC due to ischemic pain, but patients did not have the ability to compensate as in Unilat-IC. Therefore, Bilat-IC should not be considered as a "double" Unilat-IC. This study highlights the existence of gait profiles based on VGRF in PAD-IC patients. These profiles are dependent on the type of disease. Analysis of these gait profiles can 1) provide a simple way to identify gait alterations and 2) participate in improving physical rehabilitation strategies in PAD-IC patients.

International audience; Attention Deficit/Hyperactivity Disorder (ADHD) often persists into adulthood. However, few screening tools have been adaptedto assess adult ADHD using the DSM-5 criteria. This study assessed the diagnostic accuracy of a French version of the ADHDSelf-Report Screening for DSM-5 (ASRS-5). This multicentric cross-sectional study included 557 participants: 309 adult ADHDoutpatients without bipolar disorder (BD)/borderline personality disorder (BPD) (n = 236) or with BD/BPD (n = 36) and 285adults without ADHD who were either healthy volunteers (n = 248) or outpatients with BD or BPD (n = 37). Measures includedADHD diagnosis and the ASRS-5. The ASRS-5 was a good predictor of ADHD diagnosis (cut-off score ! 13/24: sensitivity =84.3%, specificity = 91.9%) in the sample of adult outpatients without comorbid disorders/healthy controls. Performances werelower with this cut-off score in some subgroups, notably low-severity ADHD symptomatology (sensitivity = 63.5%) and participantswith BD or BPD (sensitivity = 91.7%, specificity = 54.1%). The French ASRS-5 had acceptable screening properties,even if its performance varied according to clinical variables. Further evidence is needed for patients with comorbid disordershaving overlapping symptoms.

Resume La pandemie du COVID-19 a des consequences majeures sur l’organisation des soins. En France et dans le monde, les centres pratiquant l’electroconvulsivotherapie (ECT) ont vu leur activite diminuer, voire s’arreter, pour de diverses raisons. Dans ce contexte, le maintien ou la reprise de cette activite therapeutique essentielle pour de nombreux patients souffrant de troubles psychiatriques necessite des adaptations materielles, humaines et logistiques qu’il convient d’encadrer. L’objectif de ce travail collectif et national est de proposer des recommandations simples et applicables immediatement par tout etablissement de sante, public ou prive, pratiquant les ECT. Elles sont issues d’un retour d’experiences pluriprofessionnelles et interetablissements. Declinees en trois etapes, ces recommandations sont accompagnees d’une fiche pratique qui decrit, de facon precise, les conditions necessaires et prealables a toute reprise d’activite ECT.

International audience; Objectives: The coronavirus disease 2019 (COVID-19) pandemic has caused major sanitary crisis worldwide. Half of the world has been placed in quarantine. In France, this large-scale health crisis urgently triggered the restructuring and reorganization of health service delivery to support emergency services, medical intensive care units and continuing care units. Health professionals mobilized all their resources to provide emergency aid in a general climate of uncertainty. Concerns about the mental health, psychological adjustment, and recovery of health care workers treating and caring for patients with COVID-19 are now arising. The goal of the present article is to provide up-to-date information on potential mental health risks associated with exposure of health professionals to the COVID-19 pandemic.Methods: Authors performed a narrative review identifying relevant results in the scientific and medical literature considering previous epidemics of 2003 (SARS-CoV-1) and 2009 (H1N1) with the more recent data about the COVID-19 pandemic. We highlighted most relevant data concerning the disease characteristics, the organizational factors and personal factors that may contribute to developing psychological distress and other mental health symptoms.Results: The disease characteristics of the current COVID-19 pandemic provoked a generalized climate of wariness and uncertainty, particularly among health professionals, due to a range of causes such as the rapid spread of COVID-19, the severity of symptoms it can cause in a segment of infected individuals, the lack of knowledge of the disease, and deaths among health professionals. Stress may also be caused by organizational factors, such as depletion of personal protection equipment, concerns about not being able to provide competent care if deployed to new area, concerns about rapidly changing information, lack of access to up-to-date information and communication, lack of specific drugs, the shortage of ventilators and intensive care unit beds necessary to care for the surge of critically ill patients, and significant change in their daily social and family life. Further risk factors have been identified, including feelings of being inadequately supported, concerns about health of self, fear of taking home infection to family members or others, and not having rapid access to testing through occupational health if needed, being isolated, feelings of uncertainty and social stigmatization, overwhelming workload, or insecure attachment. Additionally, we discussed positive social and organizational factors that contribute to enhance resilience in the face of the pandemic. There is a consensus in all the relevant literature that health care professionals are at an increased risk of high levels of stress, anxiety, depression, burnout, addiction and post-traumatic stress disorder, which could have long-term psychological implications.Conclusions: In the long run, this tragic health crisis should significantly enhance our understanding of the mental health risk factors among the health care professionals facing the COVID-19 pandemic. Reporting information such as this is essential to plan future prevention strategies. Protecting health care professionals is indeed an important component of public health measures to address large-scale health crisis. Thus, interventions to promote mental well-being in health care professionals exposed to COVID-19 need to be immediately implemented, and to strengthen prevention and response strategies by training health care professionals on mental help and crisis management.

International audience; ObjectiveThe aim of this study was to develop specific prediction equations based on acceleration data measured at three body sites for estimating energy expenditure (EE) during static and active conditions in middle-aged and older adults with and without type 2 diabetes (T2D).Research methodsForty patients with T2D (age: 40–74 yr, body mass index (BMI): 21–29.4 kg·m−2) and healthy participants (age: 47–79 yr, BMI: 20.2–29.8 kg·m−2) completed trials in both static conditions and treadmill walking. For all trials, gas exchange was monitored using indirect calorimetry and vector magnitude was calculated from acceleration data measured using inertial measurement units placed to the participant's center of mass (CM), hip and ankle. Stepwise multiple regression analyses were conducted to select relevant variables to include in the three EE prediction equations, and three Monte Carlo cross-validation procedures were used to evaluate each separate equation.ResultsVector magnitude (p < 0.0001) and personal data (gender, diabetes status and BMI; p < 0.0001) were used to develop three linear prediction equations to estimate EE during static conditions and walking. Cross-validation revealed similar robust coefficients of determination (R2: 0.81 to 0.85) and small bias (mean bias: 0.008 to −0.005 kcal·min−1) for all three equations. However, the equation based on CM acceleration exhibited the lowest root mean square error (0.60 kcal·min−1 vs. 0.65 and 0.69 kcal·min−1 for the hip and ankle equations, respectively; p < 0.001).ConclusionThe three equations based on acceleration data and participant characteristics accurately estimated EE during sedentary conditions and walking in middle-aged and older adults, with or without diabetes.

To determine if using a telephone can induce forearm pain and ischemia.Prospective case-control trial.Vascular laboratory in the university hospital in Angers between September 2018 and March 2019.Fifteen apparently healthy subjects (controls) and 32 patients with suspected thoracic outlet syndrome (TOS) of vascular or non-vascular origin.Hand-holding a cellular phone to answer a call from investigators.Presence of forearm fatigue or pain (primary outcome), ability to hold the phone with each hand for 1 min (secondary outcome 1) and decrease in forearm transcutaneous oxygen pressure DROP index indicating forearm ischemia (secondary outcome 2). A DROP -15 mm Hg defined ischemia.Answering a phone call resulted in 25(78%) patients with forearm fatigue or pain and in 18 (56%) cases in the inability to hold the phone for 1 min, on one or both arms in patients with suspected TOS, but never occurred in healthy volunteers (p .05 and p .001). The presence of ischemia was observed in one or both arms in 10 (31%) patients with proved TOS and was always associated to phone-induced pain. Three (20%) of the controls had phone-induced ischemia. All had asymptomatic TOS and remained asymptomatic during the phone test (p = .42 from suspected-TOS patients).The phone conversation resulted in pain in many patients with suspected TOS. Transcutaneous oximetry can document the underlying ischemia. Forearm phone-call-induced pain may be indicative of TOS provided that no earplug or headset is used. Trial registrationClinicalTrials.govNCT03355274.

Objectives Mindfulness- and acceptance-based interventions (MABI) in sport settings need further development and validation to fulfil the desired outcomes related to sport performance. The current study aimed to design and implement a MABI integrated into the badminton training of young elite players (MBI programme), and to investigate its impact on sport performance-related outcomes. Design Two stages: (a) design and implementation of the MBI programme, and (b) evaluation using a mixed methods approach. Method Participants were young elite badminton players, assigned either to the 8-week MBI programme (n = 18; Mage = 16.22), or the 8-week placebo programme (n = 11; Mage = 16.64). Participants completed pre- and post-intervention measures of mindfulness skills, cognitive interference, and performance satisfaction. Social validation interviews were conducted with MBI participants to collect their overall perceptions of the programme. Results MANCOVA indicated a large intervention effect on the main outcome variables (partial η2 = 0.58). The results of univariate ANCOVAs showed that post-intervention awareness, performance worries and task-irrelevant thoughts differed significantly across the groups. In addition, follow-up t-tests provided additional information regarding changes from pre- to post-intervention among the MBI and control groups separately. Social validation data gave further insights into what athletes had retained and applied from the MBI programme. Conclusions Contrasting results highlighted the need to better explore mindfulness mechanisms in MABI and the way they are inter-related, in order to strengthen changes in sport performance-related outcomes.

Objective: To evaluate the role of obesity in the effects of physical activity (PA) on postural control and functional and physical capacities in the older adults and to assess the effectiveness of a PA program on these capacities. Methods: Six obese (age = 78.8 [3.7] y; body mass index > 30 kg/m2), 7 overweight (age = 80.9 [2.8] y; 25 2), and 6 normal weight (age = 80.8 [5.7] y; body mass index 2) older adults performed the time up and go test, the 6-minute walk test, and the Tinetti test. Static and dynamic (forward leaning) postural control tests were also assessed. All these tests were similarly assessed 4 months later, during which only the obese group and overweight group participated in a PA program. Results: Before PA, results of the time up and go test, 6-minute walk test, Tinetti test, quiet standing, and forward lean tests revealed that physical capacities and static and dynamic postural control were impaired in the obese group when compared to the normal weight group. After PA, results of quiet standing, physical and functional tests were improved for obese group. Conclusions: Obesity is an additional constraint to age-related postural control and functional and physical capacities deteriorations. Nevertheless, a PA program is effective in improving balance and functional capacities in obese older adults.

Muscular explosivity is associated with the notion of power (i.e., product of force and velocity) and represents the skill to produce as much work as possible in a short time period. During multi-articular movement, such as squat, bench press and pedalling, the force-velocity relationship has been described by a negative linear relationship. However, during more complex movements that involve the whole-body, the linearity of the force-velocity relationship has not yet been established yet. Moreover, the impact of fatigue on the force-velocity relationship remains uninvestigated. This work intended i) to investigate the force-velocity relationship during a movement that involved all body segments, the deadlift high pull; and ii) to explore the impact of fatigue on this relationship.In the experimental part of our work, we first determined the shape of the force-velocity relationship during the deadlift and high pull movement and evaluated the reproducibility of the performance and the force-velocity associated with this movement. Then, we compared the difference and correlation between the two commonly methods used to assess force-veloctiy relationships: the force platform and the accelerometer. At last, the impact of fatigue on the force-velocity performance and the force-velocity relationship was analyzed.; L'explosivité musculaire, associée à la notion de puissance (i.e., produit de la force et de la vitesse), représente la capacité à produire le plus de travail possible en un temps restreint. Au cours des mouvements pluri-articulaires tels que le squat, le développé-couché ou le pédalage, la relation entre la force et la vitesse est représentée par une relation linéaire négative. Cependant, au cours de mouvements plus complexes impliquant l’'ensemble de la chaîne segmentaire tels que le soulevé de terre haut , la linéarité de cette relation force-vitesse n’'a, à notre connaissance, jamais été étudiée. D plus, au cours de protocole de fatigue, la modification du profil force-vitesse des individus est également peu étudiée. Ce travail de thèse se propose d'explorer l’'impact de la fatigue sur la relation force-vitesse lors d’'un mouvement explosif impliquant le corps entier. Dans le cadre d'une série d’études expérimentales, nous avons d'abord fait une étude pour évaluer la reproductibilité de la performance et de la relation force-vitesse lors du mouvement de soulevé de terre haut. Ensuite, nous avons comparé la différence et la corrélation entre les deux méthodes couramment utilisées, la plateforme de force et l'accéléromètre. Enfin, nous avons analysé l'impact de la fatigue sur la performance réalisée lors du mouvement de soulevé de terre haut et la relation force-vitesse.

Muscular explosivity is associated with the notion of power (i.e., product of force and velocity) and represents the skill to produce as much work as possible in a short time period. During multi-articular movement, such as squat, bench press and pedalling, the force-velocity relationship has been described by a negative linear relationship. However, during more complex movements that involve the whole-body, the linearity of the force-velocity relationship has not yet been established yet. Moreover, the impact of fatigue on the force-velocity relationship remains uninvestigated. This work intended i) to investigate the force-velocity relationship during a movement that involved all body segments, the deadlift high pull; and ii) to explore the impact of fatigue on this relationship.In the experimental part of our work, we first determined the shape of the force-velocity relationship during the deadlift and high pull movement and evaluated the reproducibility of the performance and the force-velocity associated with this movement. Then, we compared the difference and correlation between the two commonly methods used to assess force-veloctiy relationships: the force platform and the accelerometer. At last, the impact of fatigue on the force-velocity performance and the force-velocity relationship was analyzed.; L'explosivité musculaire, associée à la notion de puissance (i.e., produit de la force et de la vitesse), représente la capacité à produire le plus de travail possible en un temps restreint. Au cours des mouvements pluri-articulaires tels que le squat, le développé-couché ou le pédalage, la relation entre la force et la vitesse est représentée par une relation linéaire négative. Cependant, au cours de mouvements plus complexes impliquant l’'ensemble de la chaîne segmentaire tels que le soulevé de terre haut , la linéarité de cette relation force-vitesse n’'a, à notre connaissance, jamais été étudiée. D plus, au cours de protocole de fatigue, la modification du profil force-vitesse des individus est également peu étudiée. Ce travail de thèse se propose d'explorer l’'impact de la fatigue sur la relation force-vitesse lors d’'un mouvement explosif impliquant le corps entier. Dans le cadre d'une série d’études expérimentales, nous avons d'abord fait une étude pour évaluer la reproductibilité de la performance et de la relation force-vitesse lors du mouvement de soulevé de terre haut. Ensuite, nous avons comparé la différence et la corrélation entre les deux méthodes couramment utilisées, la plateforme de force et l'accéléromètre. Enfin, nous avons analysé l'impact de la fatigue sur la performance réalisée lors du mouvement de soulevé de terre haut et la relation force-vitesse.

IntroductionDepression is among the most widespread psychiatric disorders in France. Psychiatric disorders are associated with considerable social costs, amounting to €22.6 billion for treatment and psychotropic medication in 2011. Treatment as usual (TAU), mainly consisting of pharmacotherapy and psychotherapy, is effective for only a third of patients and in most cases fails to prevent treatment resistance and chronicity. Transcranial direct current stimulation (tDCS) consists in a non-invasive and painless application of low-intensity electric current to the cerebral cortex through the scalp. Having proved effective in depressed patients, it could be used in combination with TAU to great advantage. The objective is to compare, for the first time ever, the cost-utility of tDCS-TAU and of TAU alone for the treatment of a depressive episode that has been refractory to one or two drug treatments.Methods and analysisThis paper, based on the DISCO study protocol, focuses on the design of a prospective, randomised, controlled, open-label multicentre economic study to be conducted in France. It will include 214 patients with unipolar or bipolar depression, assigning them to two parallel arms: group A (tDCS-TAU) and group B (TAU alone). The primary outcome is the incremental cost-effectiveness ratio, that is, the ratio of the difference in cost between each strategy to the difference in their effects. Their effects will be expressed as numbers of quality-adjusted life-years, determined through administration of the EuroQol Five-Dimension questionnaire over a 12-month period to patients (EQ-5D-5L). Expected benefits are the reduction of treatment resistance and suicidal ideation as well as social and professional costs of depression. Should depression-related costs fall significantly, tDCS might be considered an efficient treatment for depression.Ethics and disseminationThis protocol has been approved by a French ethics committee, the CPP-–Est IV (Comité de Protection des Personnes–Strasbourg). Data are to be published in peer-reviewed medical journals.Trial registration numberRCB 2018-A00474-51;NCT03758105

International audience; The COVID-19 epidemic that started in November in China became a national epidemic from March 16, 2020 with the declaration of population containment in order to reduce the spread of the virus in France. From March 17 to March 27, 2020, the monitoring unit of the French society of geriatrics and gerontology decided to conduct a survey to analyze the implementation of the mobilization of geriatric units, given that this epidemic had shown that it resulted in excess mortality mainly among the elderly. The survey was able to bring together the response of 34 services, nine of which were located in a high epidemic cluster zone. Dedicated acute geriatric units for patients infected with COVID-19 were present in eight facilities, only outside the cluster zones. Nine geriatric follow-up and rehabilitation services were dedicated, an additional telemedicine activity concerned 35% of the facilities, and family listening and tablet communication facilities concerned 36% of the facilities. This survey is a snapshot of an initial moment in the epidemic. It provides an opportunity to describe the context in which this epidemic occurred in terms of geriatric policy, and to assess the responsiveness and inventiveness of these services in meeting the needs of the elderly.; L’épidémie de Covid-19 qui avait débuté en novembre en Chine est devenue une épidémie en France à partir du 16 mars 2020 avec la déclaration du confinement de la population afin de diminuer la propagation du virus. Dès le 17 mars et jusqu’au 27 mars 2020, la cellule de veille de la Société française de gériatrie et gérontologie décide de mener une enquête pour analyser la mise en place de la mobilisation des structures de gériatrie, étant donné que cette épidémie avait montré qu’elle entraînait une surmortalité majoritairement chez les personnes âgées. L’enquête a pu réunir la réponse de 34 structures, dont neuf étaient situées en zone cluster de forte épidémie. Des services de court séjour gériatriques dédiés pour les patients infectés par le Covid-19 étaient présents dans huit établissements, uniquement hors des zones clusters. Neuf soins de suite et de rééducation gériatriques ont été dédiés, une activité supplémentaire de télémédecine concernait 35 % des établissements, et des moyens d’écoute des familles, d’animation et de communication par tablettes concernaient 36 % des établissements. Cette enquête est une photographie d’un moment initial de l’épidémie. Elle donne l’occasion de décrire le contexte dans lequel cette épidémie est survenue en ce qui concerne la politique gériatrique, et d’apprécier la réactivité et l’inventivité de ces services pour répondre aux besoins des personnes âgées.

Background Animal studies have reported an increase in pelvic floor muscle stiffness during pregnancy, which might be a protective process against perineal trauma at delivery. Our main objective is to describe the changes in the elastic properties of the pelvic floor muscles (levator ani, external anal sphincter) during human pregnancy using shear wave elastography (SWE) technology. Secondary objectives are as follows: i) to look for specific changes of the pelvic floor muscles compared to peripheral muscles; ii) to determine whether an association between the elastic properties of the levator ani and perineal clinical and B-mode ultrasound measures exists; and iii) to provide explorative data about an association between pelvic floor muscle characteristics and the risk of perineal tears. Methods Our prospective monocentric study will involve three visits (14–18, 24–28, and 34–38 weeks of pregnancy) and include nulliparous women older than 18 years, with a normal pregnancy and a body mass index (BMI) lower than 35 kg.m− 2. Each visit will consist of a clinical pelvic floor assessment (using the Pelvic Organ Prolapse Quantification system), an ultrasound perineal measure of the anteroposterior hiatal diameter and SWE assessment of the levator ani and the external anal sphincter muscles (at rest, during the Valsalva maneuver and during pelvic floor contraction), and SWE assessment of both the biceps brachii and the gastrocnemius medialis (at rest, extension and contraction). We will collect data about the mode of delivery and the occurrence of perineal tears. We will investigate changes in continuous variables collected using the Friedman test. We will look for an association between the elastic properties of the levator ani muscle and clinical / ultrasound measures using a Spearman test at each trimester. We will investigate the association between the elastic properties of the pelvic floor muscles and perineal tear occurrence using a multivariate analysis with logistic regression. Discussion This study will provide original in vivo human data about the biomechanical changes of pregnant women’s pelvic floor. The results may lead to an individualized risk assessment of perineal trauma at childbirth. Trial registration This study was registered on https://clinicaltrials.gov on July 26, 2018 (NCT03602196).

International audience; Rare diseases usually concern small and disseminated population. Implementing clinical research with the right design, outcomes measures and the recruitment of patients are challenges. Collaborations, training and multidisciplinary approach are often required. In this article, we provide an overview of a successful collaboration in nephropathic cystinosis (NC), focusing on what was the key of success, the interactions between academics, the pharmaceutical company and patients organizations. NC is considered as a very rare disease. In 2010, a new formulation of cysteamine, the only available treatment to improve renal outcome of the disease, was proposed by a small American company. Studies were implemented in France under the coordination of an expert of the disease and the clinical investigation center of Lyon. The collaboration resulted in a good recruitment and retention of the patients in the study and most of all in the availability of the new formulation in France. Patients could have facilitated the research by being involved in the early stages of the studies. Involving patients and public early in the process is particularly important in rare diseases as the patient is a great source of knowledge and has his own expectations. Priorities of research, design, conduct and reporting of clinical trials can be defined in collaboration with adults but also with young patients or public, the first concerned in rare diseases. This concept is still to be developed and improved especially with paediatric patients.