Search

Hyperventilation syndrome (HVS) is a common source of dyspnea and disability. While pulmonary rehabilitation (PR) including breathing exercises is indicated, randomized controlled trial are warranted to recommend one type of breathing exercise than another. We aimed to compare during PR, the effect of 5 sessions of nasal ventilation exercise (NV+PR) versus voluntary hypoventilation (vHV+PR) on exercise dyspnea (primary outcome) and capacity and health-related quality of life in patients. In this open label randomized controlled trial, 19 HVS patients (age=48.3 ± 15.2 y.o, female/male=18/1, Nijmegen score=33 ± 7.7) were randomized in a NV+PR (n = 9) or vHV+PR (n = 10) group. Modified Medical Research Council (mMRC) dyspnea, 6-minute walking distance (6MWD) with nasal/oral ventilation were assessed before and after 3 months of PR, and questionnaires (Nijmegen, VQ-11). There was a significant effect of PR of but no significant difference between groups in the improvements of dyspnea@max exercise (time effect (T): p 0.01; group (G): p = 0.63; group*time interaction (G*T): p = 0.49), mMRC dyspnea (T: p 0.01; G: p = 0.45; G*T: p = 0.62), 6MWD (T: p 0.05; G: p = 0.36; G*T: p = 0.31), VQ-11 (T: p 0.001; G: p = 0.16; G*T: p = 0.09) and plasma HCO

Fil: Baeza, Rosa. Pontificia Universidad Católica Argentina. Facultad de Ingeniería y Ciencias Agrarias; Argentina Sanchez, Virginia Estela. Pontificia Universidad Católica Argentina. Facultad de Ingeniería y Ciencias Agrarias; Argentina Fil: Salierno, Gabriel. Consejo Nacional de Investigaciones Científicas y Técnicas ; Argentina Fil: Salierno, Gabriel. Pontificia Universidad Católica Argentina. Facultad de Ingeniería y Ciencias Agrarias; Argentina Fil: Molinari, Fabricio. Instituto Nacional de Tecnología Industrial. Materiales Avanzados; Argentina Fil: López, Paula. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; Argentina Fil: López, Paula. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: López, Paula. Instituto de Química y Metabolismo del Fármaco; Argentina Fil: Chirife, Jorge. Pontificia Universidad Católica Argentina. Facultad de Ingeniería y Ciencias Agrarias; Argentina Abstract Berry fruits are well recognized for health-promoting constituents due to their properties of free radical scavengers which confer antioxidant activity against cellular oxidation reactions. Elderberry fruit contains one of the highest levels of anthocyanins. The objective of this work was to evaluate the storage stability of total monomeric anthocyanins, cyanidin-3-glucoside (one of two major anthocyanins in elderberry), and color parameters in freeze-dried elderberry encapsulated with a low proportion of different carriers (Maltodextrin, CapsulTM, Promitor TM, and k-carrageenan). Encapsulated samples were stored at two different water activities (aw) 0.10–0.20 and 0.43 at 38 C for 90 days and evaluated for the content of monomeric anthocyanins, cyanidin-3-glucoside, color parameters, and physical characteristics. Freeze-dried powders remained freeflowing during storage at 38 C with aw 0.12–0.20, but agglomeration occurred at aw ¼ 0.43. Total anthocyanins and color parameter a* (redness) remained unchanged during storage at the lower aw. Glass transition temperatures (Tg) were determined and mostly correlated with observed physical phenomena. The powders had a very high total monomeric anthocyanin contents as high as 13 mg/g (cyanidin-3-glucoside). The addition of encapsulants in low proportions allowed the researchers to obtain elderberry powders with a very high concentration of total monomeric anthocyanins. aw plays a key role in all stability parameters studied.

Commercial urea-formaldehyde (UF) resin was blended with a renewable and environmentally friendly soy protein concentrate (SP) adhesive in order to reduce the emission of volatile organic compounds. The UF resin was replaced by SP in different proportions (10 wt%, 20 wt%, and 30 wt%). Rheology showed pseudoplastic behavior of UF/SP slurries, even at low SP content, caused by the entanglements between polymer chains. Nevertheless, viscosity of UF/SP slurries dropped to 100 mPa·s at high shear rate, reaching the viscosity value of the UF resin alone. Fourier transform infrared spectroscopy, thermogravimetric analysis, and scanning electron microscopy confirmed a chemical reaction between the two components. Shear strength in wet conditions of UF/SP blends was 29% higher than SP alone. Water extraction showed an increase of 55% in the insoluble fraction caused by the formation of methylene bridges between UF and SP. Finally, the incorporation of soy protein slurries to a urea-formaldehyde resin led to the development of adhesives with high solid content and appropriate viscosity to be used by the spray method, and environmentally friendlier than the resins currently used by the wood industry.

Mosquito repellent textiles are increasingly in demand from consumers as protective textiles against mosquito-borne diseases like malaria, yellow fever or dengue. In this work, the production and behaviour of repellent-containing electrospun ethylcellulose nanofibrous mats for the control of disease vectors is presented. Citriodiol (CD), a naturally and sustainably sourced biorepellent, was used as against Aedes aegypti mosquitoes, the main insect vector of dengue virus. The effect of electrospinning solvent and CD content and distribution on the morphology of monolithic and core-enriched nanofibers was examined. The effectiveness of these novel CD-loaded nanofibrous mats to repel mosquitoes was assessed using standard methods. The use of biopolymer-based core-enriched nanofibrous mats resulted a very promising strategy for the development of functional nanofibrous textiles containing a natural repellent cargo, such as disposable outdoor goods. Fil: Muñoz, Vanesa. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mar del Plata. Instituto de Investigaciones en Ciencia y Tecnología de Materiales. Universidad Nacional de Mar del Plata. Facultad de Ingeniería. Instituto de Investigaciones en Ciencia y Tecnología de Materiales; Argentina Fil: Buffa, Fabián Alejandro. Universidad Nacional de Mar del Plata; Argentina Fil: Molinari, Fabricio Nicolás. Instituto Nacional de Tecnología Industrial; Argentina Fil: Hermida, Laura Graciela. Instituto Nacional de Tecnología Industrial. Centro de Investigación y Desarrollo en Química; Argentina Fil: García, Juan J.. Centro de Estudios Parasitológicos y de Vectores; Argentina Fil: Abraham, Gustavo Abel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mar del Plata. Instituto de Investigaciones en Ciencia y Tecnología de Materiales. Universidad Nacional de Mar del Plata. Facultad de Ingeniería. Instituto de Investigaciones en Ciencia y Tecnología de Materiales; Argentina

Introduction Notre objectif était de décrire la prévalence de la séroconversion au SARS-CoV-2 par un dépistage sérologique systématique des patients atteints de rhumatisme inflammatoire chronique (RIC) et d’en étudier les facteurs associés. Matériels et méthodes COVID-RIC1 est une étude transversale multicentrique nationale menée dans 17 centres tertiaires en France. Critères d’inclusion : – ≥ 18 ans ; – diagnostic de polyarthrite rhumatoïde (PR), spondylarthrite axiale (axSpA) ou rhumatisme psoriasique (RPso) ; – traitement ≥ 1 mois par AINS, corticoïdes ou DMARD ; – accepter un test sérologique SARS-CoV-2. Données collectées par formulaire électronique centralisé et anonyme : démographiques, RIC, traitements symptomatiques et de fond, symptômes évocateurs de COVID-19. Les tests sérologiques pour le SARS-CoV-2 pouvaient être réalisés soit au centre tertiaire, soit dans le laboratoire habituel du patient. En cas de tests sérologiques antérieurs, les résultats ont également été recueillis. La séroprévalence était estimée comme le rapport du nombre de tests positifs sur le nombre de tests sérologiques SARS-CoV-2. Une régression logistique a été réalisée pour étudier l’impact des différentes covariables sur la séroconversion. Toutes les variables avec p

International audience; Agreement between observers (i.e., inter-rater agreement) can be quantified with various criteria but their appropriate selections are critical. When the measure is qualitative (nominal or ordinal), the proportion of agreement or the kappa coefficient should be used to evaluate inter-rater consistency (i.e., inter-rater reliability). The kappa coefficient is more meaningful that the raw percentage of agreement, because the latter does not account for agreements due to chance alone. When the measures are quantitative, the intraclass correlation coefficient (ICC) should be used to assess agreement but this should be done with care because there are different ICCs so that it is important to describe the model and type of ICC being used. The Bland-Altman method can be used to assess consistency and conformity but its use should be restricted to comparison of two raters. (C) 2020 Societe francaise de radiologie. Published by Elsevier Masson SAS. All rights reserved.

Policy makers increasingly rely on hospital competition to incentivize patients to choose high-value care. Amongst all possible drivers, the travel distance without any doubt is one of the most important. In this paper we propose the use of a spatial Bayesian hierarchical model to assess the impact of distance on the number of patient admissions in hospitals, and thereby, compare hospital attractiveness. To this aim a MCMC sampler has been designed. We apply our methodology to patient admissions for asthma in four hospitals located in the Herault department of France. Results indicate that the most attractive hospital is the CHU Montpellier.

pH sensors are extremely useful in various applications such as health, food and environmental monitoring. Due to this fact the development of planar, low-cost and high-performance pH sensors that can be fabricated in large scale are highly appreciated. In this work we fabricated a polyaniline-based potentiometric pH sensor using two printing techniques. The working electrode was fabricated by printing a carbon ink layer onto Valox® by screen printing and subsequently modifying its active area by printing with a polyaniline ink by inkjet printing. Different water-based formulations of the polyaniline ink using acrylic dispersions as binders were tested in order to optimize printability, adhesion, rub resistance and functionality of the printed electrodes. These electrodes showed an outstanding sensitivity (up to 69.1 mV/pH), slightly higher than polyaniline electrodes fabricated by electropolymerization onto carbon paste electrodes and also comparable to glass electrodes. Moreover, their response to synthetic sweat was analyzed, demonstrating that there are suitable for application in wearable technology.

Resume L’estimation du delai post-mortem a partir de la temperature tympanique est une methode precise mais qui necessite de perforer le tympan avec une sonde metallique. Les thermometres infrarouges pourraient etre une solution pour rendre cette mesure plus acceptable pour des operateurs qui ne sont pas medecins legistes, mais aucune etude n’a etudie specifiquement l’accord (ou concordance) de la mesure entre un thermometre infrarouge et un thermometre a sonde. Notre objectif est d’etudier l’exactitude de la mesure de deux thermometres infrarouges, auriculaire et temporal, par rapport a la valeur de reference d’un thermometre a sonde. Cinquante-trois cadavres de l’institut medico-legal de Montpellier ont ete inclus. La mesure du thermometre infrarouge auriculaire etait biaisee avec une surestimation de la temperature tympanique de +1,38 °C en moyenne. L’accord entre le thermometre infrarouge auriculaire et la sonde metallique etait pauvre avec des limites d’accord de −2,2 °C et +5,0 °C autour de la valeur de reference, et un coefficient de correlation intraclasse de 0,24 [−0,48 ; 0,61]. La mesure du thermometre infrarouge temporal etait encore plus biaisee avec une sous-estimation de la temperature tympanique de −3,73 °C en moyenne. Les limites d’accord etaient de −7,4 °C et 0,0 °C, et le coefficient de correlation intraclasse 0,64 [0,19 ; 0,83]. Ainsi, les thermometres infrarouges, auriculaires ou temporaux, prevus pour l’utilisation sur des patients ne peuvent pas se substituer a un thermometre thermocouple dote d’une sonde metallique. Neanmoins, les perspectives nous encouragent a developper un thermometre infrarouge adapte aux caracteristiques du cadavre, qui pourrait etre utilise par des operateurs non specialises voire non-medecin lorsque cela s’avere necessaire.

Background:Clinical assessment of swollen joint count (SJC) in rheumatoid arthritis (RA) might be affected by obesity in terms of obesity-related excess adipose tissue.Objectives:To compare the level of agreement between synovitis evaluated by Power Doppler ultrasound (PDUS) and clinical examination (SJC as component of SDAI) in obese (O) (i.e. Body Mass Index (BMI) >30) versus non-obese (NO) (BMI≤30) RA patients.Methods:RA patients ≥18 years fulfilling 2010 ACR-EULAR criteria were included in the cross-sectional multicentre (13 centres) French observational RABODI study (ClinicalTrials.gov Identifier:NCT03004651). Clinical synovitis was evaluated on 44 joints. ESR and CRP were collected and SDAI, DAS28, DAS were calculated. A standard US examination on 44 joints was performed by an independent investigator blinded to clinical data. US synovitis was defined by a synovial hypertrophy ≥1 and PD signal≥1 on a semi-quantitative scale according to the EULAR-OMERACT scoring system. Levels of agreement between number of synovitis defined by PDUS and clinical examination were compared in O versus NO patients using Chi2 test, and Kappas (k) and ORs were calculated. A patient was considered “discordant” if ≥1 joint was discordantly classified by PDUS and clinical examination. SDAI was calculated and compared, with SJC defined either by clinical examination or PDUS.Results:121 patients were included: mean (SD) age of 58.5 (12.7) years, mean disease duration of 11.1 (9.7) years. 81% were female, 84.3% anti-CCP positive, 63.6% had erosive disease. Mean SDAI was 12.6 (±10.2). 53 (43.8%) had a BMI >30 and 68 (56.2%) ≤30. 59 (48.7%) and 62 (51.2%) had a SDAI≤11 and >11, respectively. The 2 groups were comparable, except for weight (mean (SD) 65.4 (13.5) vs 96.7 (14.7) kg, p< 0.001), some comorbidities (diabetes, asthma and fibromyalgia more frequent in O patients), tender joint count (mean 4.04 (±5.23) in NO vs 7.38 (±8.64) in O, p=0.021). Mean number of SJC was 2.4 (3.3), and PDUS 6.7 (±6.3). Levels of agreement between clinical and PDUS findings were comparable in O vs. NO patients regarding SDAI and other scores (Table). Patients with ≥3 discordant joints were numerically higher in O patients compared to NO (26/53 (49.1%) vs 22/68 (32.4%), p=0.062). At the joint level, discordance was higher in O patients in MCP4 (p=0.057), wrist (p=0.089).Table.Level of agreement between PDUS synovitis and SJC in obese versus normally weighted RA patientsScore with PDUS vs. SJCBMI ≤ 30N=68BMI > 30N=53OR(95%CI)P*SDAINon-Discordant (ND)63461.92(0.57-6.42)0.28Discordant (D)57Kappa0.850.73DAS28ND62471.32(0.4-4.35)0.64D66Kappa0.810.77DAS44ND63520.24(0.03-2.14)0.23D51Kappa0.830.96≥1 synovitisND51351.54(0.7-3.4)0.28D1718Kappa0.500.32Conclusion:In RA patients, despite a perceived higher difficulty to clinically detect SJ in O patients, the discrepancy between clinically- and PDUS defined synovitis was not significantly higher than in NO patients, and did not impact the extend of the definition of disease activity level.Disclosure of Interests:Gael Mouterde: None declared, Federico Manna: None declared, Benoit Le Goff: None declared, Jean-David Albert: None declared, Sandrine Jousse-Joulin: None declared, Frederique Gandjbakhch: None declared, Damien LOEUILLE: None declared, Philippe Gaudin Speakers bureau: Lilly, Muriel PIPERNO: None declared, BANAL Frédéric: None declared, Bénédicte Jamard: None declared, Carine Salliot: None declared, Nicolas Molinari: None declared, Bernard Combe Grant/research support from: Novartis, Pfizer, Roche-Chugai, Consultant of: AbbVie; Gilead Sciences, Inc.; Janssen; Eli Lilly and Company; Pfizer; Roche-Chugai; Sanofi, Speakers bureau: Bristol-Myers Squibb; Gilead Sciences, Inc.; Eli Lilly and Company; Merck Sharp & Dohme; Pfizer; Roche-Chugai; UCB, Maria-Antonietta D’Agostino: None declared, Cédric Lukas: None declared

Functional polymer nanocomposites with distinctive electrical properties made of nanocarbon structures and biodegradable polymers are promising materials for the development of flexible and eco-friendly smart systems. In this work, a novel electrospun conductive polymer nanocomposite made of polycaprolactone with an exohedral complex made of multiwalled carbon nanotubes and fullerene C60 was prepared and characterized. The preparation was straightforward and the complexes self-assembled within the nanocomposite fibers. The nanocomposite showed electrical switching behavior due to charge accumulation of fullerene C60 upon electrical stimulation. Write-once read-many memory devices were fabricated by electrospinning a nanocomposite with 0.8%wt. fullerene C60 onto interdigitated coplanar electrodes. The device retained the ON state for more than 60 days and could be thermally reset, reprogrammed and erased with subsequent electrical and thermal cycling. Moreover, the electrical resistance of the device could be modulated by applying different programming voltage amplitudes and programming times, which revealed its adaptive behavior and potential application to neuromorphic systems.

This work presents the synthesis and characterization of oriented nanofibers made of polycaprolactone (PCL) and multiwalled carbon nanotubes (MWCNT) obtained by electrospinning. The preparation of MWCNT/PCL solutions and electrospinning conditions were studied in order to maximize electrical conductivity of the composite and fiber alignment. The characterization of MWCNT/PCL solutions and fibers revealed the occurrence of different dispersion states for MWCNTs for different loads, which in turn affected the properties of the electrospun composite, such as its double electrical percolation and the in-fiber orientation of the PCL crystals. As the same dispersion states of MWCNT were present in both PCL/MWCNT dispersions and fibers, the rheology of the former can be correlated to the final properties of the latter. Fil: Molinari, Fabricio Nicolás. Instituto Nacional de Tecnología Industrial; Argentina Fil: Medrano, Anahí V.. Instituto Nacional de Tecnología Industrial. Centro de Micro y Nanoelectrónica del Bicentenario; Argentina Fil: Bacigalupe, Alejandro. Instituto Nacional de Tecnología Industrial; Argentina Fil: Escobar, Mariano Martin. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto Nacional de Tecnología Industrial; Argentina Fil: Monsalve, Leandro Nicolas. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto Nacional de Tecnología Industrial. Centro de Micro y Nanoelectrónica del Bicentenario; Argentina

Background Some studies revealed an association of Power Doppler (PD) ultrasound (US)-detected residual synovitis (PDUSS) and risk of relapse and radiographic progression (RP), in individual patients in rheumatoid arthritis (RA). However, the longitudinal relationship between clinical remission and repeated US residual lesions during follow-up is not so well-known. Objectives The aim of this study was to evaluate the ability of PDUSS in consecutive examinations to predict unfavorable outcome (i.e. clinical relapse or RP) at 1 year. Methods RA patients ≥18 years fulfilling 2010 ACR-EULAR criteria, treated with synthetic or biologic (b) DMARDs and in clinical remission (DAS28-ESR 3.2 at ≥1 follow-up visits AND a change of DMARDs, excluding change due to safety issues; or an increase in the DMARD or Corticosteroid (CS) dosage (≥5mg/d). Baseline variables, including PDUSS and its persistence during the follow-up, were assessed for their association with time to progression to unfavorable outcome using univariate then stepwise multivariate Cox regression analyses to obtain adjusted HRs. Results The 115 included patients had a mean (SD) age of 58.9 (±12.8) years, mean disease duration of 9.3 (±9.3) years, a mean duration of remission of 2.1 (±2.3) months. 74.8% were female, 79.1% of the patients were anti-CCP positive, 51.4% had erosive disease. The mean DAS28-ESR was 2.03 (±0.63). 59.2% received methotrexate, 59.9% bDMARD and 11.7% CS. PDUSS was detected in ≥1 joint in 75 patients (72.1%) at baseline. 41/75 (54.7%) had persistence of at least one PDUSS during the follow-up. 26 (23.2%) had a relapse (after a mean duration of 9.1 (±2.6) months) or a RP at 1 year. In multivariate analysis, persistence of at least one PDUSS during the follow-up (HR=5.24 [1.74–22.5], p=0.009) and baseline number of tender joints (HR=1.32 [0.95–1.68], p=0.052) were predictors of relapse or RP at 1 year. Duration of remission, other baseline US findings including baseline PDUSS, autoantibodies, and erosive disease had no additional predictive value. Conclusions Persistence of a PDUSS during the follow-up, rather than baseline PDUSS, predicts unfavorable outcome at 1 year in RA patients in clinical remission. This suggests that initial US findings are not sufficient to justify therapeutic change, but that the persistence of a residual PDUSS requires careful follow-up, and might even potentially merit strategy adaptation. Disclosure of Interest None declared

International audience; Chronic obstructive pulmonary disease (COPD) is the chronic respiratory disease with the most important burden on public health in terms of morbidity, mortality and health costs. For patients, COPD is a major source of disability because of dyspnea, restriction in daily activities, exacerbation, risk of chronic respiratory failure and extra-respiratory systemic organ disorders. The previous French Language Respiratory Society (SPLF) guidelines on COPD exacerbations were published in 2003. Using the GRADE methodology, the present document reviews the current knowledge on COPD exacerbation through 4 specific outlines: (1) epidemiology, (2) clinical evaluation, (3) therapeutic management and (4) prevention. Specific aspects of outpatients and inpatients care are discussed, especially regarding assessment of exacerbation severity and pharmacological approach.

International audience

We introduce a chemically inspired, all-atom model of hydrogenated nitrile butadiene rubber (HNBR) and assess its performance by computing the mass density and glass-transition temperature as a function of cross-link density in the structure. Our HNBR structures are created by a procedure that mimics the real process used to produce HNBR, that is, saturation of the carbon-carbon double bonds in NBR, either by hydrogenation or by cross-linking. The atomic interactions are described by the all-atom "Optimized Potentials for Liquid Simulations" (OPLS-AA). In this paper, first, we assess the use of OPLS-AA in our models, especially using NBR bulk properties, and second, we evaluate the validity of the proposed model for HNBR by investigating mass density and glass transition as a function of the tunable cross-link density. Experimental densities are reproduced within 3% for both elastomers, and qualitatively correct trends in the glass-transition temperature as a function of monomer composition and cross-link density are obtained.

Resume Objectifs Le controle de la glycemie en reanimation est l’objet de nombreuses controverses. En France, il n’existe pas de donnee sur l’adhesion aux recommandations. Type d’etude Etude ancillaire d’une enquete un jour donne faite entre janvier et mai 2009. Patients et methodes Lors d’un audit realise dans 66 unites de reanimation, les donnees concernant l’existence d’un protocole de controle glycemique et son application ont ete recueillies par des internes. Resultats Le jour de l’audit, un protocole formalise de controle glycemique a ete identifie pour 89 % des patients hospitalises dans les 66 unites du reseau. Six [4–9] mesures de la glycemie ont ete realisees par patient, soit un total de 3645 mesures sur l’ensemble des sites. La mediane de glycemie la plus haute etait de 1,6 g/L [1,4–2,1]. Une hypoglycemie ( 1,4 g/L chez les non-diabetiques et > 1,8 g/L pour les diabetiques) ont ete observees chez 81 (15 %) et 326 (58 %) patients, respectivement. Deux (0,36 %) hypoglycemies severes ( Discussion Des protocoles de controle glycemique sont presents dans plus de 80 % des services de reanimation, mais leur suivi est imparfait. Neanmoins, la glycemie mediane respecte les recommandations actuelles. L’hypoglycemie severe est un evenement tres rare en reanimation.

Resume Introduction L’evaluation des pratiques professionnelles (EPP) est obligatoire avec la certification des etablissements de sante. L’EPP fait appel a des methodes complexes qui doivent etre fiables et reproductibles. L’objet de ce travail etait d’evaluer une methode d’EPP a travers l’exemple d’une etude sur la prise en charge des pneumopathies aigues communautaires (PAC). Methode Cette EPP utilisait la methode de l’audit clinique de facon retrospective. L’antibiotherapie des PAC a ete evaluee pour 124 patients par un pharmacien et deux infectiologues independamment et en aveugle a l’aide d’un index d’adequation therapeutique (IAT) compose de neuf items ponderes. La concordance entre les evaluations des experts a ete estimee en calculant l’indice de concordance kappa (K). Resultats La concordance entre les experts etait mauvaise concernant l’antibiotherapie initiale (K = 0,16) et la voie d’administration (K = 0,14), faible pour la duree du traitement (K = 0,34) et nulle pour la posologie et l’adaptation a 72 heures. Conclusion Les resultats divergents entre les experts peuvent etre expliques par la complexite des dossiers medicaux, la multiplicite des items evalues, l’interpretation de la grille d’evaluation et par la specialisation et l’experience des experts. Ainsi, l’EPP des PAC necessite l’utilisation de methodes ciblant des criteres simples et precis a evaluer.

Summary Background. Data are lacking on the prevalence of acne, its effects on quality of life (QOL) and the treatment usage among Chinese patients in late adolescence. Aim. To derive data about the prevalence and predictive factors of acne, the disability caused by acne and choice of treatment used by Chinese late adolescents in Hong Kong. Methods. This was a cross-sectional study of a random sample of 389 entrants in a university in Hong Kong, using the Global Acne Grading System (GAGS) to measure the clinical severity of acne and the Cardiff Acne Disability Index (CADI) to measure QOL. Results. The response rate was 99.3%. The prevalence of acne was of 81.5% (95% CI 77.6–85.4%) and coexisted with a high frequency of acne disability at a rate of 81.8% (95% CI 78.1–85.6%). Assessment of the clinical severity of acne did not correlate strongly with the effect on QOL (γs = 0.445, P < 0.001). Over the previous 6 months, 30.3% of subjects had used topical treatments, 3.9% had taken systemic conventional western drugs and 3.2% of the subjects had used traditional Chinese medicine. Multivariate logistic regression was used to explore the predictive factors for acne disability. Female gender (P = 0.002), higher GAGS score (P < 0.001), higher perceived stress (P = 0.01) and willingness to pay Hong Kong$15 000 (£970) for a hypothetical permanent cure (P = 0.03) were positive predictors. Conclusions. Acne is prevalent in Hong Kong and has considerable psychological effects. The association between clinical severity and impaired QOL is not strong.

Summary Background. The association between diet and acne vulgaris has long been suggested but remains unproven in western medicine. In contrast, the diet–acne relationship is considered important in traditional Chinese medicine (TCM). Aim. To investigate the association between diet and acne, using a TCM approach. Methods. Using a cross-sectional study of 322 entrants to a university in Hong Kong, China, we examined the participants’ clinical severity of acne using the Global Acne Grading System and the participants’ yin and yang scores using a quantitative method. We then divided them into two groups, a yin-predominant group (yin-PG) and a yang-predominant group (yang-PG) before the diet–acne relationship was investigated. Results. In total, 82 (25.2%) participants were in the clinical acne group and 240 (74.5%) were in the reference group. There were 155 (48.1%) participants in the yin-PG and 167 (51.9%) in the yang-PG group. No association of diet and acne was found when the participants were considered as a homogenous group. In yin-PG, intake of foods from street stalls (P = 0.04) was significantly associated with a lower incidence of acne. In yang-PG, the intake of desserts (P = 0.04) and fresh fruit juices (P = 0.02) was significantly associated with a higher incidence of acne, whereas the intake of dairy and soy products (P = 0.04) was significantly associated with a lower incidence of acne. Conclusions. The application of a TCM approach led to the detection of significant associations between diet and the incidence of acne.

Sensitivity of models to input variables and parameters should be analysed before evaluating and using them in order to identify (a) the minimum input data required for satisfactory simulations, (b) the major cultivation techniques to adapt when designing new cropping systems and (c) the main parameters to be estimated with special care. Conventional methods of sensitivity analysis being inadequate, a new method based on Monte Carlo simulations was developed in the present work. The analysed model was G ene S ys which quantifies the effects of cropping system on demography and genotype of cropped and volunteer rape plants. The studied output variables were the proportion of harvested rape seeds polluted by unwanted genes and the density and herbicide sensitivity of rape volunteers in winter cereals. Sensitivity of the model to the initial seed bank was first tested by simulating rape evolution from initial seed banks resulting from various seed density, genotype, age and distribution. Then, the effect of cropping systems was studied by simulating rape evolution for 100 000 randomly chosen combinations of crop succession and cultivation techniques. The effect of the model parameters was finally analysed by simulating rape evolution in six contrasted cropping systems and 100 000 randomly chosen parameter values. At all steps, linear models were used to test the significance of seed bank, cropping system variables or parameters. If the number of variables was too large for directly applying a linear model, a segmentation tree was used first to eliminate negligible variables. The study showed that the seed bank influenced simulated output during 5–6 years, which is therefore the minimum duration for simulations with an unknown initial seed bank. A survey list of cropping system variables to determine was established for comparing simulated and observed output. Major variables such as crop succession must be known for at least 3 years preceding the analysed crop, minor variables such as the date of set-aside cutting only for the preceding year. The major model parameters were those determining seed movements and survival in soil and seedling emergence. Seedling survival parameters relative to inter- and intra-specific competition were significant only when analysing volunteer density.

Introduction Les AINS sont les medicaments les plus frequemment impliques dans les reactions d’anaphylaxie en pediatrie [1] . Il existe divers mecanismes d’hypersensibilite (HS) medicamenteuse aux AINS. Les differentes classifications basees sur ces mecanismes sont issues de populations adultes et n’ont pas ete etudiees chez les enfants [2] , [3] . Notre objectif principal etait de decrire une population d’enfants diagnostiques hypersensibles aux AINS en classant chaque patient dans la classification d’HS aux AINS la plus recente [3] . Methodes Nous avons mene une etude descriptive de 1996 a 2015, dans le service d’allergologie de l’hopital Arnaud-de-Villeneuve au CHU de Montpellier. Six cent trente-cinq patients ayant presente au moins une reaction aux AINS pendant l’enfance et ayant ete explores par test de provocation oral ont ete inclus. Notre critere de jugement principal etait le pourcentage de patients repondant aux criteres des groupes de la classification ENDA de reference [3] . Resultats L’HS aux AINS a ete diagnostiquee chez 107 patients sur 635 (17 %). Dans ce groupe de patients hypersensibles aux AINS, 43 patients (40 %) n’ont pas pu etre classes dans la classification ENDA [3] . La plupart de ces patients divergeaient des groupes de la classification ENDA de part leurs manifestations cliniques et la pathologie sous-jacente (asthme, urticaire chronique). Les facteurs de risque d’HS aux AINS retrouves etaient : l’atopie, la rhino-conjonctivite allergique et l’urticaire chronique. Conclusion A la lumiere de ces resultats, nous avons propose une nouvelle classification d’HS aux AINS pediatrique incluant les cofacteurs tels que l’allergie alimentaire et l’activite physique.

We have conducted a segregation analysis in order to characterise the transmission of Behcet Disease (BD), a multifactorial condition with a strong genetic component. Complete information about BD status and pedigree was obtained on 104 probands from our database. We used the criteria of the International Study Group for BD (ISBD) to delineate the clinical status of the sibs: possible BD (patients meeting two criteria), or ascertained BD (patients meeting at least three criteria). A proband was defined as "paediatric" when he/she completed ISBD criteria before/by the age of 16 years. Families were distinguished as paediatric (n = 67) (ascertained through a paediatric proband), and non-paediatric (n = 37) ones. An Expectation Maximization (EM) algorithm was used to estimate the Mendelian segregation ratio P in nuclear families (two parents and their offspring). The maximum likelihood estimate: Pcirc; = 0.248, calculated in the paediatric data set, was consistent with the theoretical value of P = (1/4) for autosomal recessive inheritance, whereas the Pcirc; value was 0.08 when using the non-paediatric data set. Our work provides the first evidence of genetic heterogeneity in BD, and of the existence of a Mendelian entity in the paediatric BD subgroup. Previous studies failed to show any simple mode of inheritance in BD, probably because they were performed on the whole BD population.

Introduction Cardiologists need to assess the mortality risk of their patients with heart failure (HF). The meta-analysis global group in chronic heart failure (MAGGIC) validated a precise score, but its complexity prevents cardiologists to use it in clinical settings. We aimed to derive a simple mortality score on a small cohort of HF patients of the CHU of Montpellier, using a piecewise constant Poisson model. Our secondary objectives were to compare the estimates and the validity of our model with those of other models. Methods At inclusion, we assessed age, sex, body mass index, ejection fraction, serum creatinin, NT-ProBNP, NYHA status, diabetes, chronic obstructive pulmonary disease, smoking habits, and treatment by beta-blockers. The outcome measure was the time to death. The censoring date was 4.4 years after first inclusion. The assumptions of linearity and of proportional hazards were assessed in Cox models, and potential predictive variables were defined on clinical and statistical arguments. The time intervals of the Poisson Model PM1 were chosen on clinical and statistical arguments. Variables were selected with a backward procedure, targeting the minimal AIC of PM1. We converted the Poisson model predictor to an integer score, and represented discrimination (ROC curve) and calibration (observed and predicted mortality risk) graphs. We built 4 other models, with the same variables as PM1: PM2/with 1 time interval, PM3/with 3 time intervals, defined on statistical arguments, PM4/with age as a time-dependent variable, and a Cox model. In order, to compare the global results and clinical interpretation of these models, we represented graphically the relative risks and hazard ratios of these models, with their confidence intervals. In order to compare the validity of the individual predictions, we performed a cross-validation for each Poisson model. The size of our training samples was 2/3 of the size of our complete sample. We present the mean percent of the validation samples that was correctly classified. Results We included 182 patients, and performed a complete case analysis on 134 patients. Selected variables were age >75 years, Ejection Fraction 5000, NYHA 3–4, no beta-blockers, diabetes, chronic pneumopathy, current smoker. Age did not verify the assumption of proportional hazard, but the interaction with time was not included for usability reasons. The integer risk score was built in attributing 1 point to each risk factor. The c-statistic of this score was of 0.77. Patients with scores ≤2, 2–5, and ≥6, had mortality risks ≤0.2, 0.2–0.8, and ≥0.8, respectively. The relative risks of the 4 Poisson models and the hazard ratios of the Cox model were not graphically different (figure). We performed the cross-validation on 100 training samples of 89 subjects. The mean percent of correctly classified patients in the validation samples was of 63.3, 63.4, 60.1, and 63.0% for PM1, PM2, PM3, and PM4, respectively. Discussion We propose a simple mortality risk score for chronic heart failure patients. Its discriminative ability and its calibration were moderate. The statistical choices seem to be of mild importance, as more complicated or simpler models did not increase or decrease the predictive ability. The research of a user-friendly score could be pursued in larger cohorts, keeping in mind that the clinical aim and the statistical choices should be simplified.

Background: Acute transverse myelitis (ATM) in children is a rare and often severe disease for which there are few known prognostic factors, particularly the subsequent risk of multiple sclerosis (MS) diagnosis. Objectives: To determine the clinical course and prognostic factors after a first episode of ATM in children. Methods: Thirty children below 16 years of age diagnosed with a first neurological episode of ATM were included retrospectively. Clinical evaluation, treatment, laboratory, and MRI data were collected. Results: Median age at onset was 11 years (range 3–15 years). Follow-up data were available for a median of 4 years (range 0.5–16.7 years). Five patients subsequently had a diagnosis of MS (17%), which was associated with acute partial transverse myelitis (odds ratio 5; 95% confidence interval 2.3–11), with a 60% probability of having a relapse at five years ( p < 0.01). The 2011 Verhey criteria correctly identified MS in children with the highest specificity (96%) and sensitivity (80%). Conclusion: Acute partial transverse myelitis and brain MRI abnormalities at initial presentation are significantly predictive of a subsequent diagnosis of MS in children with ATM. These findings suggest that closer brain MRI monitoring after acute partial transverse myelitis might make the earlier introduction of disease-modifying therapies possible.

La meta-analyse en reseau est un outil statistique permettant de combiner l’information de plusieurs essais d’une meme aire therapeutique dans le but d’agreger de l’information pour gagner en precision sur les estimateurs mais aussi de classer les effets traitements. Cette methode statistique consiste en la generalisation de la meta-analyse classique, ou comparaison directe, qui combine l’information de plusieurs essais comparant directement les memes effets traitement. Elle reprend aussi une generalisation de la comparaison indirecte. Une comparaison indirecte permet de comparer deux traitements qui n’ont pas ete directement confronte mais seulement evalue contre un troisieme traitement faisant le lien avec des deux traitements d’interet. Du fait de cette generalisation differentes hypotheses sont a verifier dans la mise en place de la methode, notamment l’exhaustivite des essais inclus aussi que la coherence du reseau. Le non-respect de la seconde hypothese se caracterise par une difference (heterogeneite) entre l’information directe d’une comparaison et l’information indirecte apportee par le reseau. Plusieurs methodes existent afin d’evaluer l’incoherence du reseau. Ces methodes sont plus ou moins faciles a appliquer. Elles sont limitees soit par la taille du reseau, soit par leurs difficultes d’interpretation. Une methode classiquement utilisee permettant a la fois d’estimer les parametres du reseau ainsi que d’en evaluer l’incoherence consiste a modeliser le reseau grâce a un modele bayesien hierarchique. L’ajout d’un l’effet aleatoire permet, tout comme dans le cadre d’une meta-analyse classique, d’evaluer l’heterogeneite du reseau, et donc par consequent son incoherence. Cette methode est limitee car ne permet pas de distinguer la part d’heterogeneite source d’incoherence de l’heterogeneite latente du reseau. Il existe aussi des tests statistiques et des methodes graphiques permettant d’evaluer l’incoherence du reseau, mais sont tres rapidement limitees par la taille de celui-ci, en partie due a la multiplicite des tests a effectuer. La presentation reprendra rapidement le concept de la meta-analyse en reseau pour se concentrer essentiellement sur les limites methodologiques, notamment l’incoherence. Il sera fait une revue de methodes utilisees lors de la mise en place de l’analyse ainsi que celles permettant d’en evaluer les limites.