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Excess gestational weight gain (GWG) is associated with adverse long and short-term outcomes for both woman and child, yet evidence demonstrates pregnant women are frequently not engaging in healthy behaviours linked to appropriate weight gain. The purpose of the current study was to explore women's values and beliefs related to weight, nutrition and physical activity during pregnancy and to describe how these beliefs influence their behaviours.As part of a larger randomized controlled trial, we conducted 20 focus groups with 66 pregnant women between 16 and 24-weeks gestation using a semi-structured interview guide. Focus groups were recorded and transcribed verbatim and analyzed using a grounded theory approach.Three personal health schemas emerged from the findings which illustrated women's diverging beliefs about their health behaviours in pregnancy. 'Interconnected health' described beliefs regarding the impact their health had on that of their growing baby and awareness of risks associated with inappropriate weight gain. 'Gestational weight gain as an indicator of health' illustrated perceptions regarding how GWG impacted health and the utility of guidelines. Finally, 'Control in pregnancy' described the sense of agency over one's body and health.Our results showed that health-related behaviours in pregnancy are driven by personal health schemas which are often discordant with clinical evidence. Interventions and health care provider advice aimed at behaviour modification would benefit from first understanding and addressing these schemas. Tackling the conflict between beliefs and behaviour may improve health outcomes associated with appropriate weight gain in pregnancy.

To prospectively evaluate the safety and efficacy of embolization using ethylene vinyl alcohol copolymer (OnyxThis prospective study was approved by the institutional ethics review board. Ten clinical parameters were retained for evaluation of PeVD (pelvic pain, dyspareunia, post-coital pain, menstruation pain, lower limbs pain, difficulty walking, aesthetic discomfort, impact on daily working life, psychological impact and impact on daily life), measured on a visual analogue scale (VAS) between 0 and 10, and a global score out of 100 was noted before embolization, after 3 months during the imaging follow-up, and at the end of follow-up by phone call. The main criterion was clinical efficacy of embolization defined by an impairment score40/100 and a 50% decrease in overall score. Complications were recorded. Visualization of OnyxBetween July 2017 and May 2019, 73 consecutive women (mean age ± SD [range]: 41 ± 11 years [25-77]) treated by embolization with OnyxEmbolization using Onyx• Embolization using Onyx

Background: Canada’s first alongside midwifery unit (AMU) was intentionally informed by evidence-based birth environment design principals, building on the growing evidence that the built environment can shape experiences, satisfaction, and birth outcomes. Objectives: To assess the impact of the built environment of the AMU for both service users and midwives. This study aimed to explore the meanings that individuals attribute to the built environment and how the built environment impacted people’s experiences. Methods: We conducted a mixed-methods study using a grounded theory methodology for data collection and analysis. Our research question and data collection tools were underpinned by a sociospatial conceptual approach. All midwives and all those who received midwifery care at the unit were eligible to participate. Data were collected through a structured online survey, interviews, and focus group. Results: Fifty-nine participants completed the survey, and interviews or focus group were completed with 28 service users and 14 midwives. Our findings demonstrate high levels of satisfaction with the birth environment. We developed a theoretical model, where “making space” for midwifery in the hospital contributed to positive birth experiences and overall satisfaction with the built environment. The core elements of this model include creating domestic space in an institutional setting, shifting the technological approach, and shared ownership of the unit. Conclusions: Our model for creating, shifting, and sharing as a way to make space for midwifery can serve as a template for how intentional design can be used to promote favorable outcomes and user satisfaction.

Resume Introduction Le CIRTACI propose dans cet article des recommandations pour optimiser la qualite des examens oncologiques en tomodensitometrie et la dose d’iode injectee. Points importants La recommandation propose une methodologie de minimisation de la dose d’iode injectee en partant d’une dose de 0,5 gramme d’iode/kg a 120 kV, ou 0,4 gI/kg a 100 kV ou 0,3 gI/kg a 80 kV. Chez les obeses, il faut calculer la dose en fonction de la surface corporelle plutot qu’au poids. Conclusion L’utilisation des produits de contraste iode doit repondre a des objectifs de qualite de prise en charge des patients. Ces recommandations repondent a cet imperatif.

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

Globally, midwife-led units are associated with improved clinical outcomes and childbirth satisfaction, but little is known about the impact of the model on health professionals themselves and interprofessional collaboration. The aim of this research was to describe the experiences of health professionals providing care in Canada's first Alongside Midwifery Unit.A mixed-methods evaluation exploring healthcare provider's experiences using an online survey and qualitative semi-structured interviews and focus groups.Canada's first Alongside Midwifery Unit, opened at X in 2018. In the Ontario context, the model reorganizes the way in which midwifery services are integrated in the hospital.Midwives, obstetricians, nurses, pediatricians, anesthetists, and other healthcare providers participated.82 online surveys, 17 semi-structured interviews and one focus group were completed. Providers agreed that they perceived the Alongside Midwifery Unit was a success (89%) and perceived satisfaction among those receiving care on the unit(93%). The majority of providers were satisfied working on the unit (82%) and reported greater role clarity in the new model (85%) compared to the traditional model of midwifery services. Four main themes emerged from the health professionals' perspectives regarding how the unit impacted care: promoting safety, clarifying roles, facilitating collaboration, and managing change.Overall, healthcare professionals had positive experiences working on the AMU, including improved role clarity and interprofessional relationships, and they perceived high levels of satisfaction among those giving birth on the unit. Our findings indicate the Alongside Midwifery Unit model can be beneficial for health professionals, women and birthing people.

Background In July 2018, Canada's first midwife-led alongside midwifery unit (AMU) opened at Markham Stouffville Hospital (MSH) in Markham, Ontario. Our objectives were to examine how the conditions at MSH made it possible for the hospital to create the first AMU in Canada and to identify lessons to inform spread by examining how characteristics of the intervention, the inner and outer settings, the individuals involved, and the processes used influenced the MSH-AMU implementation process. Methods We conducted key informant interviews and document analysis using Yin's research methods. We used the Consolidated Framework for Implementation Research to conceptualize the study and develop semi-structured interview guides. We recruited key informants, including midwives and other health professionals, hospital leaders, leaders of midwifery organizations, and consumers, by email using both purposive and respondent driven sampling. Interviews were digitally recorded and professionally transcribed. We identified documents through key informants and searches of Nexis Uni, Hansard, and Google databases. We analyzed the data using a coding framework based on Greenhalgh et al.’s evidence-informed theory of the diffusion of innovations. Results Between November 2018 and February 2019, we conducted fifteen key informant interviews. We identified thirteen relevant documentary sources of evidence, including news media coverage, website content, Ontario parliamentary records, and hospital documents. Conditions that influenced implementation of the AMU fell within the following domains from Greenhalgh's diffusion of innovations theory: the innovation, the outer context, the inner context – system antecedents for innovation and system readiness for innovation, communication and influence, linkage – design phase and implementation stage, and the implementation process. While several unique features of MSH supported innovation, factors that could be adopted elsewhere include organizational investment in the development of midwifery leadership skills, intentional use of change management theory, broad stakeholder involvement in the design and implementation processes, and frequent, open communication. Conclusions The example of the MSH-AMU illustrates the value of utilizing best practices with respect to change management and system transformation and demonstrates the potential value of using implementation theory to drive the successful implementation of AMUs. Lessons learned from the MSH-AMU can inform successful spread of this innovative service model.

Genetic discoveries of Alzheimer’s disease are the drivers of our understanding, and together with polygenetic risk stratification can contribute towards planning of feasible and efficient preventive and curative clinical trials. We first perform a large genetic association study by merging all available case-control datasets and by-proxy study results (discovery n = 409,435 and validation size n = 58,190). Here, we add six variants associated with Alzheimer’s disease risk (near APP, CHRNE, PRKD3/NDUFAF7, PLCG2 and two exonic variants in the SHARPIN gene). Assessment of the polygenic risk score and stratifying by APOE reveal a 4 to 5.5 years difference in median age at onset of Alzheimer’s disease patients in APOE ɛ4 carriers. Because of this study, the underlying mechanisms of APP can be studied to refine the amyloid cascade and the polygenic risk score provides a tool to select individuals at high risk of Alzheimer’s disease. © 2021, The Author(s).

Over the past few years, 3D printing has evolved rapidly. This has resulted in an increasing number of scientific publications reporting on the medical use of 3D printing. These applications can range from patient information, preoperative planning, education, or 3D printing of patient-specific surgical implants. The objective of this review was to give an overview of the different applications in urology and other disciplines based on a selection of publications.In the current narrative review the Medline database was searched to identify all the related reports discussing the use of 3D printing in the medical field and more specifically in Urology. 3D printing applications were categorized so they could be searched more thoroughly within the Medline database.Three-dimensional printing can help improve pre-operative patient information, anatomy and medical trainee education. The 3D printed models may assist the surgeon in preoperative planning or become patient-specific surgical simulation models. In urology, kidney cancer surgery is the most concerned by 3D printing-related publications, for preoperative planning, but also for surgical simulation and surgical training.3D printing has already proven useful in many medical applications, including urology, for patient information, education, pre-operative planning and surgical simulation. All areas of urology are involved and represented in the literature. Larger randomized controlled studies will certainly allow 3D printing to benefit patients in routine clinical practice.

Partial nephrectomy is a first-line treatment option for the management of renal tumors. It is a surgical procedure whose complexity and stakes vary according to the specific anatomy of the patient and his tumor. 3D modeling and 3D printing have become a means of representing and thus visualizing the tumor lesion and its anatomical relationships within the organ. This mode of visualization allows the surgeon and his team, but also the patient, to easily realize the tumor complexity, the predictable difficulty of the surgery and therefore the risks of complications. Various publications have reported the benefit to the patient in terms of pre-therapy education. Some have shown a benefit for the operator in terms of surgical planning. Finally, studies on preoperative surgical simulation showed shorter kidney lumpectomy times and less bleeding when surgeons were able to train before the operation on the corresponding 3D printed model. 3D printing therefore represents an innovative tool that would improve patient management prior to partial nephrectomy, through the information it can deliver, but also through surgical simulation.

Excess gestational weight gain is associated with short‐ and long‐term pregnancy complications. Although a healthy diet and physical activity during pregnancy are recommended and shown to reduce the risk of complications and improve outcomes, adherence to these recommendations is low. The aims of this study were to explore women's view of nutrition and physical activity during pregnancy and to describe barriers and facilitators experienced in implementing physical activity and nutrition recommendations. In a substudy of the Be Healthy in Pregnancy randomized trial, 20 semistructured focus groups were conducted with 66 women randomized to the control group when they were between 16 and 24 weeks gestation. Focus groups were recorded, transcribed verbatim, coded and thematically analysed. The results indicate that women felt motivated to be healthy for their baby, but competing priorities may take precedence. Participants described limited knowledge and access to information on safe physical activity in pregnancy and lacked the skills needed to operationalize both physical activity and dietary recommendations. Women's behaviours regarding diet and physical activity in pregnancy were highly influenced by their own and their peers' beliefs and values regarding how weight gain impacted their health during pregnancy. Pregnancy symptoms beyond women's control such as fatigue and nausea made physical activity and healthy eating more challenging. Counselling from care providers about nutrition and physical activity was perceived as minimal and ineffective. Future interventions should address improving counselling strategies and address individual's beliefs around nutrition and activity in pregnancy.

Les faux anévrysmes des artères viscérales chez les patients victimes d’un traumatisme abdominal à foyer fermé sont rares. Nous rapportons le cas d’une femme de 67 ans qui a été hospitalisée pour prise en charge d’un syndrome douloureux abdominal aigu au décours d’une violente agression. L’imagerie initiale objectivait une contusion pancréatique sans saignement actif. Un faux anévrysme de l’artère splénique est secondairement apparu sur le scanner de contrôle à J7. Devant le risque de rupture spontanée de ce faux anévrysme, une embolisation sélective par « packing » du faux anévrysme fut réalisée avec succès. Le contrôle scanographique à 1 mois montrait une exclusion complète du faux anévrysme.

To retrospectively evaluate the safety and efficacy of embolization of persistent type II endoleaks occurring after abdominal endovascular aneurysm repair (EVAR) using ethylene vinyl alcohol copolymer (OnyxBetween 2008 and 2016, 28 consecutives patients (25 men, 3 women) with a mean age of 75.3years±9 (SD) (range: 59-90years) were treated for 29 persistent type II endoleaks with increasing aneurysm size5mm occurring after EVAR. A total of 35 embolization procedures were performed using OnyxNo severe complications were observed during and after embolization. The primary and secondary clinical efficacies were 75% (21/28) and 96.4% (27/28), respectively. Overall primary technical efficacy rate was 58.6% (17/29), greater for transarterial technique (72.8%) than for direct puncture (14.3%) (P=0.01). Secondary technical efficacy was 72.4% (21/29), with no differences between transarterial (81.8%) and direct puncture (42.8%) (P=0.06).Embolization with Onyx

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

RADIOLOGIE ET IMAGERIE MEDICALE : Genito-urinaire - Gyneco-obstetricale - Mammaire - 34-410-A-20

Multiple chronic renal diseases evolve to end-stage kidney disease due to progressive renal tissue fibrosis at the level of the interstitium or glomeruli. Fibrosis often results from transformation of the extracellular matrix by cytokines and chemokines released by activated cells in the setting of recurrent episodes of acute inflammation. Newer techniques to image intrarenal inflammation and fibrosis are mandatory for the non-invasive evaluation of these processes to improve follow-up and monitoring of drug therapy. These techniques are based on methods of cellular and molecular imaging, and methods of functional, such as diffusion weighted imaging, and structural, such as elastography.

La doxorubicine liposomale pegylee (DLP) est devenue l’option de rechange la plus courante chez les patientes atteintes d’un cancer de l’ovaire chez qui la therapie a base de platine a echoue. Dans certains cas, les effets secondaires comme l’erythrodysesthesie palmo-plantaire (EPP) peuvent mener a une exposition sous-optimale au medicament et a l’arret du traitement. Une etude prospective a etiquetage en clair menee dans plusieurs centres au Canada a evalue les effets d’un programme d’education et de soutien administre par le personnel infirmier sur la fidelite et la tolerance au traitement parmi 112 femmes atteintes d’un cancer de l’ovaire recidivant. Le traitement moyen des patientes consistait en quatre cycles de DLP d’une duree de quatre semaines chacun, soit le nombre de cycles recommande pour evaluer l’efficacite de la DLP. Les effets secondaires etaient courants, mais 75 % des patientes ont reussi a completer plus de trois cycles, et 59 % ont complete plus de 4 cycles de chimiotherapie a base de DLP. Grâce a l’intervention infirmiere proactive, l’incidence des toxicites de grade 3/4 associees a la DLP, comme l’EPP et la mucosite, a diminue substantiellement. Il se peut que l’intervention infirmiere permette a un plus grand nombre de patientes de recevoir une chimiotherapie selon l’echeancier recommande, une situation qui reproduit les conditions de l’etude clinique dans laquelle l’efficacite du medicament a ete etablie.

The uterus septum is the most frequently encountered uterine malformation. The prevalence of the uterine septa in the infertile patients is estimated at approximately 1%. On the other hand, it increases to reach 3,3% among women presenting repeated fetal losses. The objective of this article is to propose an updating of the data of the literature concerning the cure of uterine septa by hysteroscopic metroplasty. Operative hysteroscopy, with its simplicity, its reproducibility and its low morbidity between the hands of a trained operator, remains the gold standard treatment of the uterine partitions. The abortive disease always constitutes the main indication of the cure of septum. In the infertile patients, a metroplasty seems to be legitimate in the following situations: women more than 35 years old; unexplained infertility, resistant to any technique of assisted reproduction; discovery of a uterine septum at the time of the coelioscopy and the diagnostic hysteroscopy realized within the framework of an assessment of infertility; patients for whom it is assumed that Assisted reproductive technique (ART) is needed; women with past obstetrical history. The complications related to the hysteroscopic metroplasty are not very frequent. However, the hysteroscopic resection of a uterine septum could expose later to the risk of uterine rupture.

Resume Nous rapportons le cas d'une stimulation ovarienne chez une femme atteinte d'un syndrome de Kallmann–De Morsier, qui a conduit a l'obtention d'une grossesse triple avec accouchement par cesarienne a 36 semaines d'amenorrhee de trois fœtus de sexe feminin pesant de 1950 a 2300 g. A partir d'une revue de la litterature sur le syndrome de Kallmann–De Morsier, nous discutons le role de la LH au cours de la phase folliculaire et les criteres de surveillance d'une stimulation ovarienne.

According to Mc Neal, the prostate gland is characterized by three major glandular compartments: the transition zone, the central zone and the peripheral zone. This zonal anatomy can be identified with endorectal sonography and with MRI. With the later, both endorectal or external surface coils can be used. Internal structure of seminal vesicles and vas deferens is better analyzed with MRI than with sonography. Relationship between these elements is important to know, as well as areas of weakness of the prostatic capsule, mainly in the evaluation of cancer extraprostatic extension. Sonography plays a major role in diagnosis, pre-therapeutic evaluation and follow-up of patients with benign prostatic hyperplasia. The role of imaging in inflammatory disorders is more questionable.

The use of non-enhanced CT as a primary imaging technique for acute lumbar pain is now widely accepted in many centers instead of the traditional association of KUB and ultrasound. This review will present the different features of the disease according to each technique, emphasising on respective performances, advantages and disadvantages. Finally, a strategy will be proposed based on clinical presentation.

Resume La maladie de Takayasu est une aortoarterite aspecifique qui atteint avant tout la femme jeune et parfois l’enfant. Le traitement a la phase inflammatoire initiale repose sur une corticotherapie precoce et prolongee, mais certains patients deviennent cortico-dependants ou souffrent d’effets indesirables. Nous rapportons une observation pediatrique avec amelioration sous methotrexate. Observation. – Marie, six ans, etait atteinte de la maladie de Takayasu avec une hypertension arterielle d’origine renovasculaire. La corticotherapie a ete efficace sur le syndrome inflammatoire, mais n’a pas ralenti l’evolution de l’atteinte renale. La croissance de Marie s’est arretee. L’introduction de methotrexate (10 mg/m 2 /semaine) a permis le controle de la maladie, un sevrage partiel des corticoides et une reprise de la croissance. Conclusion. – Les corticoides sont a utiliser en premiere intention dans la maladie de Takayasu. En cas d’echec, d’effets secondaires ou de cortico-dependance, le methotrexate a faible dose peut dans certains cas permettre le controle de la maladie et un sevrage des corticoides.

Resume Propos. – Les methodes de detection de stenose arterielle renale proposees aujourd’hui sont nombreuses. Elles visent a rechercher soit une stenose anatomique soit une stenose fonctionnelle (mise en jeu du systeme renine–angiotensine). L’objectif de cette revue est de faire le point, pour chaque technique, des performances, des limites et des criteres diagnostiques proposes. Actualites et points forts. – Pour la detection des stenoses anatomiques, la faisabilite de l’examen doppler a ete amelioree par le meilleur niveau des machines et l’utilisation des produits de contraste. Les nouveaux criteres utilises demandent encore a etre evalues a plus grande echelle. L’angioscanner helicoidal permet de mieux detecter les arteres accessoires et les calcifications mais l’angio-IRM a l’avantage d’une meilleure resolution spatiale et de l’absence de nephrotoxicite du gadolinium. Les performances de ces deux techniques n’ont pas ete comparees. Le choix depend aujourd’hui de lˈexperience de chaque groupe dans chacune des techniques et de la disponibilite des appareillages. La detection des stenoses fonctionnelles repose sur la scintigraphie sensibilisee au captopril. Perspectives et projets . – Il serait necessaire de mieux comparer ces methodes, qui ont evolue dans le temps, ainsi que les strategies de detection (stenose anatomique ou stenose fonctionnelle) en termes de rapport cout/efficacite. Il est possible que dans l’avenir lˈIRM puisse s’imposer en fournissant, dans le meme temps, les informations morphologiques et fonctionnelles necessaires a la prise en charge.

OBJECTIVE: Biochemistry and I-6beta-iodomethyl norcholesterol scintigraphy (IMS) have both been used to assess cortisol secretion by adrenocortical incidentalomas. However, which biochemical abnormalities indicate subclinical corticoid excess is still debatable whilst IMS is expensive and cumbersome. The aim of the study was to evaluate prospectively patients with adrenal incidentalomas using both IMS and biochemical methods to examine whether the IMS pattern is associated with biochemical abnormalities and, if this is so, to find a biochemical parameter that could be used as a screening test to identify a subset of patients on whom IMS could subsequently be performed. METHODS: Thirty-one patients with benign cortical adenomas were recruited from 43 consecutive patients with adrenal incidentalomas. All 31 patients underwent IMS and measurement of (i) 0800 h serum cortisol, ACTH, dehydroepiandrosterone and 17-hydroxyprogesterone; (ii) midnight serum cortisol; (iii) 2400 h excretion of urinary free cortisol; (iv) cortisol after the overnight 1 mg dexamethasone (DEX) suppression test; (v) cortisol after an i.v. 4 mg DEX test; (vi) determination of the diurnal variation in serum cortisol. RESULTS: Sixty-one per cent of patients displayed unilateral uptake during IMS and 39% showed bilateral uptake. Patients with unilateral uptake exhibited significantly lower ACTH concentrations (P=0.0005), higher midnight cortisol concentrations (P=0.02), disrupted diurnal variation of serum cortisol (P=0.02) and higher cortisol concentrations after DEX suppression tests (P=0.01). Cortisol concentrations following the two DEX suppression tests correlated closely (r=0.80, P=0.0001). The i.v. 4 mg DEX test was clearly more sensitive for the diagnosis of unilateral uptake than the overnight 1 mg DEX test (76 vs 52%). Using various thresholds of cortisol concentration following the overnight 1 mg DEX test, it was found that the sensitivity of the test could be improved to 100% if the threshold was set at 60 nmol/l rather than the classical value of 138 nmol/l. All patients but one with post-test serum cortisol concentrations above 60 nmol/l as against none of patients with cortisol below 60 nmol/l exhibited at least one associated biochemical abnormality indicating subclinical glucocorticoid excess. CONCLUSION: In adrenocortical incidentalomas, unilateral uptake during IMS suggests subclinically excessive and/or autonomous cortisol secretion. A cortisol concentration above 60 nmol/l following the overnight 1 mg DEX test is highly correlated with unilateral uptake and is associated with biochemical abnormalities indicating subclinical glucocorticoid excess. Our results favour the use of the 1 mg overnight DEX test with revised criteria of interpretation as a screening test for subclinical hypercortisolism among patients with adrenocortical incidentalomas.

Classical approximate Riemann solvers are known to be too much dissipative in the low-Mach number regime. For this reason, since the Mach number in liquids is generally very small, usual upwind schemes may provide inaccurate solutions when applied to the simulation of two-phase flows. In this paper, to circumvent this difficulty while keeping a compressible model for the description of both gas and liquid, an original accurate low-Mach scheme is introduced and theoretically studied. Extending some ideas already used for the gas dynamics system, the proposed scheme is based on a centred formulation for the pressure gradient term in the momentum equation and on the introduction of a stabilising term proportional to the pressure difference between two neighbouring cells. The scheme stability is ensured, and theoretically proved under a convective CFL-like condition, by using a semi-implicit time discretisation algorithm. Finally, the correct asymptotic behaviour of the scheme in the limit of small Mach numbers is assessed on several academic test cases.

In this paper are presented comparisons of SPH variants on academic test cases classically used to validate numerical fluid dynamics software. These comparisons are extracted from NextMuSE FP7 project activities which will be published more extensively in the near future. One of the goals of this project was to better understand the SPH method and to leave the path to its establishment within CFD methods. An important work load was thus dedicated to benchmark SPH variants on selected test cases. A number of results and conclusions of this comparative study are presented in this paper. The studied variants are: standard weekly-compressible SPH, δ-SPH, Riemann-SPH, incompressible SPH, and FVPM. The majority of the test cases also present a reference solution, either experimental or computed using a mesh-based solver. Test cases include: wave propagation, flow past a cylinder, jet impact, floating body, bubble rise, dam break on obstacle, floating body dynamics, etc. Conclusions may help SPH practitioners to choose one variant or another and shall give detailed understanding necessary to derive further improvements of the method.

International audience; Prostate cancer diagnosis is based on PSA rate measurement and ultrasound guided biopsy. Recently criticized for its lack of specificity, new approaches are currently investigated: MRI, elastography, TEP, NIRS and Time Resolved (TR) fluorescence tomography. The advantage of TR fluorescence tomography relies on its good complementarity with the standard ultrasound protocol and on the possible localization of prostate tumors marked by specific probes. After a first TR system based on a bulky titanium-sapphire laser, we designed a new one taking advantage of a more compact white pulsed laser (supercontinuum). The improved compactness is now fully compatible with clinical environment. The light, filtered by two linear variable filters to select a 770±20 nm window, is driven to the transrectal probe which also collects the fluorescence light emitted by the marker. The signal is detected by photomultipliers connected to TCSPC boards. A reconstruction algorithm based on intensities and time of flight allows a fast localization of the fluorophore. We compared the performances of the new white laser system to the previous titanium-sapphire on prostate mimicking phantoms. The laser power delivered on the phantom by the new laser appeared to be suitable to fluorescence measurements, just below cutaneous maximum permitted exposure. The new system allowed us to localize fluorescent inclusions of a fluorescent nanoemulsion at fixed positions inside a prostate mimicking phantom.