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Introduction Dans l’essai de phase 2 evaluant le cemiplimab (CEM) chez des patients (pts) ayant un carcinome epidermoide cutane (CEC) localement evolue ou metastatique, le taux de meilleure reponse (TMR) etait de 47 % et la survie globale (SG) a un an de 81 %. Une autorisation temporaire d’utilisation (ATU) nominative a permis a ces pts d’acceder au CEM hors protocole. Notre objectif etait d’analyser les donnees d’efficacite et de tolerance de cette ATU. Materiel et methodes Les 58 centres ayant inclus des pts entre le 08/18 et le 10/19 dans cette etude retrospective ont ete sollicites pour completer une fiche standardisee par pt. L’objectif principal etait le TMR, les objectifs secondaires etaient la survie sans progression (SSP), la SG, la duree de la reponse (DDR) et la tolerance. La reponse etait evaluee dans les centres. Les effets indesirables (EI) etaient evalues selon la classification CTCAEv5. La SSP, la SG et la DDR ont ete calculees par la methode de Kaplan–Meier. La date de point etait le 19/06/20. Resultats Les cas de 245 pts (178H/67F, âge moyen 77,1 ± 13) ont ete analyses. Il y avait 189 pts inclus dans l’ATU nominative et 56 dans celle de cohorte ; 59 % des pts avaient deja recu une radiotherapie et 52 % des pts ont recu le CEM en 1re ligne de traitement systemique ; 68 % des CEC etaient localises a la tete et au cou. Ils etaient localement evolues (35 %), regionaux (39 %) ou metastatiques a distance (26 %) ; 24 % des pts etaient immunodeprimes : hemopathies, 15 % ; VIH, 3 % ; transplantes, 3 % ; immunosuppresseurs, 2 %, autre, 1 % ; 3 % avaient une genodermatose et 12 % une dermatose chronique. Un neurotropisme etait present dans 23 % des CEC. Le PS etait ≥ 2 chez 28 % des pts. Le nombre moyen de perfusions de CEM etait de 10 (4–22). Parmi les 240 pts ayant recu ≥ 1 perfusion, le TMR (IC 95 %) etait de 50,4 % (43,9–56,9) avec 51 RC (21 %) et 70 RP (29 %). Le suivi median etait de 12,6 mois. La SSP mediane (IC95 %) etait de 8,2 mois (6,7–11,7). Les medianes de SG/DDR n’etaient pas atteintes ; la SG (IC95 %) a 1 an etait de 63,1 % (56,8–70,1). La duree mediane de traitement etait de 5,5 mois et 29 % des pts etaient encore traites a un an. Des EI survenaient chez 75 pts (31 %) ; les plus frequents (> 2,5 %) etaient asthenie, diarrhees, cholestase et prurit ; 22 pts (9 %) ont presente ≥ 1 EI de grade 3–4. Un pt est decede d’un syndrome de Lyell lie au CEM et 16 pts (7 %) ont arrete le CEM du fait d’un EI. Discussion Ces premieres donnees d’etude en vie reelle permettent de caracteriser les pts susceptibles d’etre traites par CEM. Ils incluent une frequence elevee (15 %) de pts atteints d’hemopathies. Elles confirment le taux de reponse eleve du CEM ainsi que sa bonne tolerance. L’inclusion dans cette etude d’une proportion importante de pts immunodeprimes et de pts au PS altere, habituellement non inclus dans les essais, a pu contribuer a une SG a un an plus faible que dans l’essai de phase 2.

Resume Introduction Le Francais est souvent considere comme un râleur. Dans un travail recent, nous avons observe une forte proportion de patients consultant une premiere fois pour leur psoriasis avec comme motif une insatisfaction quant a leur prise en charge anterieure. Nous avons voulu essayer d’analyser le profil de ces patients « mecontents ». Methodologie Il s’agissait d’une etude transversale, multicentrique, menee dans 40 centres membres du Groupe d’etudes multicentriques de Resopso, avec inclusions consecutives pendant 11 mois, en 2014. Tous les patients adultes (âge > 18 ans) consultant pour une premiere fois dans le centre pour un psoriasis pouvaient etre inclus. Resultats Parmi les patients, 1205 ont ete inclus ; 249 (20,3 %) consultaient car ils etaient mecontents de leur prise en charge anterieure. En analyse univariee, les patients mecontents etaient plus jeunes (p = 0,02) et avaient un psoriasis qui avait debute plus tot (p 10, p 10 (p = 0,01 ; IC95 : 1,01–1,07) et une duree de soins prolongee (p = 0,004 ; IC95 : 1,23–2,99) etaient associes au mecontentement. Conclusion Vingt pour cent des patients psoriasiques semblent insatisfaits de leur prise en charge. Il est difficile de dessiner un profil demographique ou socioeconomique du patient mecontent. Seule la severite de la maladie et peut-etre l’insuffisance de traitement sont associees, lors d’une premiere consultation, au mecontentement du patient. Des causes liees aux medecins et aux patients peuvent etre proposees. Enfin, si le Francais est reconnu comme râleur, les chiffres de mecontentement observes dans notre etude ne semblent pas superieurs a ceux observes dans d’autres pays.

The French are frequently regarded as grouchy. In a recent study, we observed a high proportion of patients initially consulting for psoriasis because they were dissatisfied with their previous therapy. We analyzed the characteristics of these patients.This was a cross-sectional multicenter study in 40 centers belonging to the ResoPso (psoriasis treatment network) multicenter study group, with consecutive inclusions over a period of 11months in 2014. All adults (age18 years) consulting for the first time for psoriasis at a center were included in the study.Among patients, 1205 were included, of whom 249 (20.3%) were consulting because of their dissatisfaction with treatment. In the univariate analysis, these patients were younger (P=0.02) and presented psoriasis that had begun earlier in life (P0.0001). It consisted mostly of generalized plaque psoriasis (P=0.047) and more severe forms of psoriasis (PASI and/or DLQI score10, P0.02). There were fewer cases of psoriatic arthritis (P=0.01). The "dissatisfied" patients reported significantly more frequent use of topical treatments (P0.0001) and alternative medicines (P=0.02), and more infrequent use of biologics (P=0.006) as well as longer treatment periods (P=0.0005). They consulted at hospitals (P=0.01) and had previously seen more GPs and dermatologists (P≤0.0008). There was no impact of gender on the dissatisfaction profile by either comorbidities (metabolic, blood pressure, alcohol and tobacco consumption, and depression), or socio-economic data. In the multivariate analysis, DLQI10 (P=0.01; 95% CI: 1.01-1.07) and longer duration of care (P=0.004; 95% CI: 1.23-2.99) were associated with dissatisfaction.Twenty percent of our psoriatic patients seem dissatisfied with their treatment. It is difficult to draw a specific demographic and socioeconomic profile of dissatisfied patients. Only disease severity and possibly inadequate treatment at the initial consultation are associated with patient dissatisfaction. Explanations related to the individual patients and doctors may be proposed. Finally, while the French may be considered grouchy, the frequency of patient dissatisfaction seen in our study does not appear to be any greater than that observed in other countries.

Objective The objective of this systematic review was to prepare for evidence-based recommendations on the use of vitamin D analogues, and their combination with topical steroids in psoriasis. Methods Literature systematic review performed in May 2011. The Cochrane, PubMed and Embase databases were systematically searched with different combinations: including Psoriasis AND calcipotriol expanded to all vitamin D analogues. To assess efficacy across studies, we used two predefined criteria to account for the numerous endpoints found in the literature, ‘Treatment success’ corresponding to 90% improvement in severity and ‘Satisfactory response’ corresponding to 75% improvement. We conducted a meta-analysis comparing the efficacy of vitamin D analogues plus topical steroids (VDS) vs. vitamin D analogues alone (VD). To determine the relative cost-efficacy of the topical drugs available on the market, cost/efficacy ratios were calculated for each product according to the approved therapeutic regimen. Results 51 articles were selected. The application duration varied between three to 52 weeks across studies. VD as monotherapy had a satisfactory response rate between 22% to 96% and a treatment success rate ranging from 4% to 40%. VDS had a satisfactory response rate between 35% to 86% and a treatment success rate ranging from 27% to 53%. A meta-analysis found a probability of success twice higher with VDS than with VD in adult plaque psoriasis. The cost/efficacy ratio was evaluated as 1.2–1.8 times higher for VDS than for VD. Conclusion VDS is twice more effective than VD and displays a better cost per success. Additional studies are needed to clarify maintenance treatment, impact on quality of life, treatment of non-plaque psoriasis. It will be important to harmonize outcome measures in future studies with topical agents in psoriasis to better appraise their efficacy.

Background Treatment adherence has been recognized as an important issue in the management of chronic diseases such as psoriasis. Objective The aim of this work was to analyse data about topical treatment adherence in psoriasis. Methods Systematic literature review (62 references) between 1980 and 2011 (database: PubMed, Embase and Cochrane; Mesh keywords: Patient Compliance [Mesh] OR Medication Adherence [Mesh] AND Psoriasis [Mesh]; limits: date of publication >1980, humans subjects, written in French or English, aged ≥19 years). Two parameters were evaluated: (i) the ratio of number of product applications performed vs. number of applications expected according to physician recommendations, (ii) the ratio of amount of product used vs. amount of product prescribed. Results A total of 22 studies were selected. Nine studies reported on the frequency of topical treatment application in a real world setting. Five studies showed a frequency of applications varying between 50% and 60% of those expected. Because of the high variability in medication adherence assessment methods, the data could not be combined. Twelve articles reported on the frequency of topical treatment application in randomized controlled trials with adherence varying between 55% and 100%. Concerning the amount of product use, four studies showed patients applied between 35% and 72% of the recommended dose during a treatment period of 14 days to 8 weeks. The most frequently mentioned reasons for non-adherence to topical treatment were low efficacy, time consumption and poor cosmetic characteristics of topical agents. Patients experiencing adherence issues were significant younger, were men, had younger age at onset of psoriasis and had a higher self-assessed severity. To improve adherence, the following strategies were suggested: to give patients information about psoriasis, to recognize social impact, to give written instructions for use such as a care plan, to explain side effects of topical therapies, to choose treatment and its cosmetic properties in agreement with the patient. Conclusions Literature data about topical treatment adherence are heterogeneous and scarce. They confirm the limited topical treatment adherence in psoriasis in real life, much lower than what is reported in randomized controlled trials. Therapeutic education and clear instructions on the use of topical agents are necessary to improve adherence. Studies are needed to identify predictors of limited adherence and to identify interventions improving adherence to topical medications in psoriasis.

Background Although topical treatments and phototherapy are available for more than 40 years, there is a paucity of evidence-based recommendations regarding their use. Objectives The aim of this work was to develop evidence-based recommendations on topical treatments and phototherapy in psoriasis for daily clinical use. Methods A scientific committee selected clinically relevant questions on efficacy and safety of topical agents and phototherapy in psoriasis. This selection was made using the Delphi method. A systematic literature search was performed in Medline, Embase and the Cochrane Library. The articles selected for analysis were reviewed and the level of evidence was appraised according to the Oxford Levels of Evidence. An Expert consensus meeting took place in June 2011, including 42 dermatologists. Recommendations for use of topical treatments and phototherapy were made during interactive workshops where the evidence was presented and discussed. Agreement among participants was assessed on a 10-point scale. The participants systematically assessed the impact of the recommendations on clinical practice. Results A total of 3555 references were identified, among which 312 articles were included in the systematic reviews. Three recommendations were issued on phototherapy including both PUVA and narrow-band UVB. The recommendations related to administration schedule, clearance rate and risk of side-effects. The mean agreement between participants was good varying from 8.5 to 9.5. Six recommendations were issued on topical treatments focusing on administration schedule, clearance rate, risk of side-effects, cost-effectiveness and measures to improve treatment adherence. The mean agreement between participants varied from 7.3 to 9.9. Conclusions These recommendations for the use of topical agents and phototherapy in psoriasis are evidence-based and supported by a panel of dermatologists. The next step will be to disseminate these recommendations and assess the opinion of physicians who were not involved in generating the recommendations.

BACKGROUND: Oral 8-methoxypsoralen-UV-A (PUVA) and narrowband UV-B (NB-UVB or UVB TL-01) are effective and widely used treatments for chronic plaque psoriasis. Although the role of PUVA therapy in skin carcinogenesis in humans with psoriasis has been clearly demonstrated, there is still controversy regarding the risk of skin cancer with NB-UVB. Furthermore, there is no clear evidence about the maximum cumulative number of sessions not to be exceeded in a lifetime. OBJECTIVES: To assess the respective cutaneous carcinogenic risks of PUVA or NB-UVB in psoriasis; to estimate the respective dose-relationship between skin cancers and PUVA or NB-UVB; to estimate a maximum number of sessions for PUVA or NB-UVB not to be exceeded in a lifetime. METHODS: A systematic literature search was carried out in Medline, Embase and Cochrane Library databases from1980 to December 2010 in English and French, with the keywords 'Psoriasis' AND 'UVB therapy' AND 'UVA therapy' AND 'cancer' AND 'skin' OR 'neoplasm' OR 'cutaneous carcinoma' OR 'melanoma'. RESULTS: Of 243 identified references, 49 published studies were included. Most of them (45/49) concerned PUVA therapy, with 41 assessing the risk of non-melanoma skin cancers (NMSC) following PUVA. All publications referring to the US prospective PUVA follow-up study revealed an increased risk of NMSC with the following characteristics: risk most pronounced for squamous cell carcinomas developing even with low exposures and increasing linearly with the number of sessions, tumors occurring also on non-exposed skin including invasive penile tumors, risk persisting after cessation of treatment. An increased risk of basal cell carcinomas was observed in patients receiving more than hundred PUVA sessions. The four prospective European studies selected in our review and most of the pre-1990 European and US retrospective studies failed to find a link between exposure to PUVA and skin cancer. Only the most recent cohorts, including three large long-term retrospective European studies comparing records with their respective national cancer registries reported on an independent increased risk of NMSC with PUVA, The risk was lower as compared to the US prospective PUVA follow-up study. Six studies assessed the risk of melanoma following PUVA therapy: two of the three US publications coming from the same PUVA prospective follow-up study revealed an increased risk with more than doubled incidence of both invasive and in situ melanoma among patients exposed to at least 200 PUVA treatments compared with patients exposed to lower doses, whereas the three retrospectives European studies, comparing the incidence of melanoma in PUVA users with national cancer registers, did not find any increased risk of melanoma. No increased risk of skin cancer was evidenced in the four studies specifically assessing the potential carcinogenic risk of NB-UVB. CONCLUSION: There is an increased risk of skin cancer following PUVA, shown by both US and European studies. The greater risk measured by the US studies may be at least partly explained by high UVA dose exposure and the lighter phototypes of the treated patients. The lack of prospective studies in psoriasis patients treated with NB-UVB constitutes a barrier to the robust assessment of carcinogenic risk of this phototherapy technique.

BACKGROUND: Oral 8-methoxypsoralen-UV-A (PUVA) and Narrowband UV-B (NB-UVB or UVB TL-01) are well established treatments for chronic plaque psoriasis but there is limited evidence regarding their respective efficacy. OBJECTIVES: To prepare for evidence-based recommendations concerning the practical use of oral 8-methoxypsoralen-UV-A and Narrowband UV-B in psoriasis, a systematic review to assess respective response rates, remission duration and predictive factors of efficacy was performed. METHODS: A systematic search was carried out in PubMed, Cochrane and Embase databases, using the key words 'Psoriasis', 'UVB therapy', 'UVA therapy' for the period from 1980 to December 2010. RESULTS: The initial literature search identified 773 articles. The final selection included 29 randomized controlled trials: 18 were about the efficacy of PUVA, eight about the efficacy of NB-UVB and three directly compared PUVA vs. NB-UVB. The response rate defined by 75% or more improvement in PASI was 80% with PUVA vs. 70% with NB-UVB. The meta-analysis of the three comparative studies found a higher probability of remission at 6 months with PUVA than with NB-UVB [OR = 2.73 (95% CI 1.19-6.27), P = 0.02]. The choice of initial dose, according to skin type, the minimal erythemal dose or minimal phototoxic dose, incremental regimen and periodicity of the sessions did not appear to be predictive factors of efficacy for PUVA or NB-UVB. Despite methodological limitations in trials, the number of sessions needed for psoriasis clearance appeared to be lower with PUVA than with NB-UVB (approx. 17 vs. 25, respectively). CONCLUSION: PUVA and NB-UVB are both effective therapies in treatment of psoriasis. Our results suggest that compared with NB-UVB, PUVA tends to clear psoriasis more reliably, with fewer sessions, and provides with longer lasting clearance. However, the long-term safety of PUVA, especially its cutaneous carcinogenic risk, and the easier administration procedure often lead dermatologists to prefer NB-UVB as first line phototherapy treatment in plaque type psoriasis.

Background Topical steroids have been used for more than 50 years in mild-to-moderate plaque psoriasis and carry a theoretical risk of adverse events. Objectives The aim of this systematic literature review was to evaluate the risk of hypothalamo-pituitary-adrenal (HPA) axis suppression and the risk of skin atrophy with topical steroids in the treatment of plaque psoriasis. Methods A systematic search between 1980 and January 2011 in Medline, Embase and Cochrane databases (English, French language, adults), using the keywords ‘psoriasis’/exp/mj AND ‘corticosteroid’/exp/mj, Results Altogether 1269 references were found. Of these 1124 articles were excluded by reading the abstract and 123 by reading the article. A total of 22 randomized trials were selected. Effects on HPA axis: Thirteen studies, with a sample size varying from 7 to 341 patients, were selected. The effect on HPA axis was evaluated by the morning cortisol level (11 studies), the 24 h urine steroid levels (five studies) and/or by the Synacthen® test (three studies). Reduction of morning cortisol was observed in 0–25% of patients in 10 short-term studies (two in scalp psoriasis, eight in body psoriasis) and in 48% of patients in the remaining short-term study (body psoriasis). Only four of these studies with three on body psoriasis evaluated the effect of long-term treatment defined as 6-month treatment duration or longer and did not identify HPA axis suppression by cortisol level measurement. The Synacthen® test, considered as the gold standard to assess HPA axis, was always normal. There was no evidence of clinically significant HPA axis suppression due to absorption of topical steroids even when treating the scalp or in patients with extensive disease. Risk of skin atrophy: Thirteen studies with topical steroid evaluating treatment durations from 4 weeks to 1 year were analysed. The frequency of skin atrophy assessed clinically, varied from 0% to 5% of patients. Conclusions The literature analysis on topical steroids in psoriasis is reassuring although the quality of safety studies is limited with a majority of short-term studies. Although short-term biological effects of topical steroids on the HPA axis were observed in several clinical studies, they were not associated with clinical signs. Adequately designed long-term studies would be necessary to better determine the risk of skin atrophy using modern methods of evaluation such as dermoscopy and echography.

Introduction Topical steroids are used for more than 50 years to treat mild-to-moderate plaque psoriasis. The purpose of this systematic review was to evaluate the efficacy but also the optimal modalities of administration of topical corticosteroids in psoriasis i.e. influence of steroid potency on clinical response, putative impact of topical formulation, occlusion procedure, rate of application to control the initial response and the potential interest of a maintenance treatment to prolong psoriasis clearance. Material and methods A systematic search was performed between 1980 and January 2011 in Medline, Embase and Cochrane databases (English and French language, adults), using the keywords ‘psoriasis’/exp/mj AND ‘corticosteroid’/exp/mj. To analyse response across studies, three levels of response were categorized depending on the data available in studies: percentage of patients who achieved more than 50%, 75% or 90% improvement of initial psoriasis severity. Results From an initial selection of 1269 references, 1166 references were excluded on reading the title or the abstract and 32 on reading the article and 71 were finally retained and analysed. Fifty randomized controlled trials (RCT) assessing topical steroids in the initial treatment of mild-to-severe psoriasis body plaque psoriasis were retained: 40 were parallel-group studies and 10 were within-patient studies. Treatment duration was mostly 4 weeks. Sample size varied from 30 to 1 603 patients. Outcome measures to assess efficacy were highly variable. A total of 30–90% patients across parallel group studies experienced more than 50% of initial mild-to-severe psoriasis improvement while from 7% to 85% experienced more than 75% improvement and from 5% to 85% experienced at least 90% of improvement. The success rate in the within-patient studies varied from 10% to 70%. Eighteen RCT were performed in scalp psoriasis: 16 were parallel-group and two were within-patient studies, with a treatment follow-up time from 2 weeks to 6 months, enrolling 42–1417 patients. A total from 40% to 75% patients across studies experienced more than 75% of initial scalp psoriasis improvement and from 43% to 90% experienced more than 90% initial psoriasis improvement. Only three RCT studies evaluated topical steroids as a maintenance treatment for body psoriasis and one for scalp lesions. Despite heterogeneity in treatment schedule, topical steroid intermittent maintenance treatment was shown to prolong remission. The literature analysis did not provide with high evidence-based quality data on the role of formulation, topical steroid potency, number of applications per day to obtain the highest rate of success excepting occlusion dressing which provided with additional benefit. Conclusion The clinical development of topical steroids in psoriasis did not follow state of the art modern methodology. Treatment success appears to be highly variable across studies. Maintenance intermittent treatment appears to be useful to prolong remission. Recommendations concerning topical steroids treatment modalities in plaque psoriasis should be mostly based on expert opinion.

Introduction Certaines reactions cutanees paradoxales sont bien connues sous anti-TNFα. En revanche, l’apparition d’un syndrome SAPHO sous anti-TFNα est peu rapportee. A notre connaissance, un seul cas de SAPHO apparu sous infliximab pour une maladie de Crohn est decrit dans la litterature. Nous rapportons un nouveau cas survenant sous adalimumab pour une maladie de Crohn. Observations Une jeune fille avait une maladie de Crohn severe avec pancolite, diagnostiquee en 2014 a l’âge de 16 ans. Un traitement par adalimumab, 40 mg tous les 15 jours, avait stabilise la maladie depuis juin 2015. En decembre 2016, elle developpait simultanement une symptomatologie cutanee et articulaire. Elle avait une pustulose palmoplantaire, une acne, une eruption cutanee psoriasiforme et eczematiforme diffuse, touchant 60 % de surface corporelle. Le tableau clinique articulaire etait celui d’une spondylarthropathie, confirmee a la scintigraphie osseuse et a l’IRM. Les etiologies infectieuses ou auto-immunes etaient eliminees ; l’antigene HLA B27 etait negatif. L’adalimumab etait alors arrete. La maladie de Crohn necessitant un traitement de fond, un autre anti-TNFα, l’infliximab, associe a du methotrexate, etait debute. L’infliximab etait choisi malgre le risque d’effet classe, car c’etait alors la seule autre biotherapie ayant l’AMM dans la maladie de Crohn. Le methotrexate etait associe pour l’atteinte cutanee. L’amelioration etait rapide a l’arret de l’adalimumab tant sur le plan cutane qu’articulaire et digestif. Cette efficacite persistait avec un recul de six mois. Discussion Les hypotheses diagnostiques etaient initialement un authentique SAPHO associe a la maladie de Crohn, une reaction paradoxale aux anti-TNFα, ceux-ci etant efficaces dans le SAPHO ou une spondylarthropathie reactionnelle. Differentes reactions cutanees paradoxales sont desormais decrites, impliquant le role de l’IFN type 1 et du CXCR3. Le SAPHO n’est pas une manifestation paradoxale frequente. A notre connaissance, seul un cas de SAPHO survenant lors d’un traitement par anti-TNFα est rapporte dans la litterature. Il s’agit d’une patiente de 40 ans traitee par infliximab depuis 3 mois pour une maladie de Crohn. Dans notre observation, l’aspect clinique a la fois eczematiforme et psoriasiforme atypique sous anti-TNFα est en faveur d’une reaction paradoxale et l’eruption est concomitante du SAPHO. Le delai d’apparition est compatible, pouvant aller de quelques jours a 48 mois selon les donnees de la litterature. L’amelioration rapide, durable du SAPHO et de l’eruption cutanee a l’arret de l’adalimumab, avec relais par infliximab et methotrexate, est un argument supplementaire pour une reaction cutaneo-articulaire induite par l’adalimumab ( Fig. 1 et 2 ). Conclusion Il s’agit du premier cas rapporte de manifestation inflammatoire cutaneo-articulaire type SAPHO sous adalimumab, regressant a l’arret de ce traitement avec introduction d’infliximab et methotrexate.

Équipe 107 : Physique des plasmas chauds; International audience; In the recent melt experiments with the JET tungsten divertor, we observe that the heat flux impacting on a leading edge is 3-10 times lower than a geometrical projection would predict. The surface temperature, tungsten vaporisation rate and melt motion measured during these experiments is consistent with the simulations using the MEMOS code, only if one applies the heat flux reduction. This unexpected observation is the result of our efforts to demonstrate that the tungsten lamella was melted by ELM induced transient heat loads only. This paper describes in details the measurements and data analysis method that led us to this strong conclusion. The reason for the reduced heat flux are yet to be clearly established and we provide some ideas to explore. Explaining the physics of this heat flux reduction would allow to understand whether it can be extrapolated to ITER.

Arcs are the potentially most dangerous events related to Lower Hybrid (LH) antenna operation. If left uncontrolled they can produce damage and cause plasma disruption by impurity influx. To address this issue an arc real time control and protection imaging system for the Joint European Torus (JET) LH antenna has been implemented. The LH system is one of the additional heating systems at JET. It comprises 24 microwave generators (klystrons, operating at 3.7 GHz) providing up to 5 MW of heating and current drive to the JET plasma. This is done through an antenna composed of an array of waveguides facing the plasma. The protection system presented here is based primarily on an imaging arc detection and real time control system. It has adapted the ITER like wall hotspot protection system using an identical CCD camera and real time image processing unit. A filter has been installed to avoid saturation and spurious system triggers caused by ionization light. The antenna is divided in 24 Regions Of Interest (ROIs) each one corresponding to one klystron. If an arc precursor is detected in a ROI, power is reduced locally with subsequent potential damage and plasma disruption avoided. The power is subsequently reinstated if, during a defined interval of time, arcing is confirmed not to be present by image analysis. This system was successfully commissioned during the restart phase and beginning of the 2013 scientific campaign. Since its installation and commissioning, arcs and related phenomena have been prevented. In this contribution we briefly describe the camera, image processing, and real time control systems. Most importantly, we demonstrate that an LH antenna arc protection system based on CCD camera imaging systems works. Examples of both controlled and uncontrolled LH arc events and their consequences are shown.

Équipe 107 : Physique des plasmas chauds; International audience; The EDGE2D-EIRENE code is applied for simulation of divertor detachment during matched density ramp experiments in high triangularity, L-mode plasmas in both JET-Carbon (JET-C) and JET-ITER-Like Wall (JET-ILW). The code runs without drifts and includes either C or Be as impurity, but not W, assuming that the W targets have been coated with Be via main chamber migration. The simulations reproduce reasonably well the observed particle flux detachment as density is raised in both JET-C and JET-ILW experiments and can better match the experimental in-out divertor target power asymmetry if the heat flux entering the outer divertor is artificially set at around 2-3 times that entering the inner divertor. A careful comparison between different sets of atomic physics processes used in EIRENE shows that the detachment modelled by EDGE2D-EIRENE relies only on an increase of the particle sinks and not on a decrease of the ionization source. For the rollover and the beginning of the partially detached phase, the particle losses by perpendicular transport and the molecular activated recombination processes are mainly involved. For a deeper detachment with significant target ion flux reduction, volume recombination appears to be the main contributor. The elastic molecule-ion collisions are also important to provide good neutral confinement in the divertor and thus stabilize the simulations at low electron temperature (T-e), when the sink terms are strong. Comparison between EDGE2D-EIRENE and SOLPS4.3 simulations of the density ramp in C shows similar detachment trends, but the importance of the elastic ion-molecule collisions is reduced in SOLPS4.3. Both codes suggest that any process capable of increasing the neutral confinement in the divertor should help to improve the modelling of the detachment. A further outcome of this work has been to demonstrate that key JET divertor diagnostic signals-Langmuir probe T-e and bolometric tomographic reconstructions-are running beyond the limit of validity in high recycling and detached conditions and cannot be reliably used for code validation. The simulations do, however, reproduce the trend of the evolution of the line integrated bolometer chord measurements. The comparison between the code results and high-n Balmer line radiation intensity profiles confirms that a strong volume recombination is present during the experimental detachment and may play a role in this process, as suggested by the code.

The former all-carbon wall on JET has been replaced with beryllium in the main torus and tungsten in the divertor to mimic the surface materials envisaged for ITER. Comparisons are presented between Type I H-mode characteristics in each design by examining respective scans over deuterium fuelling and impurity seeding, required to ameliorate exhaust loads both in JET at full capability and in ITER., 55 pages, 15 figures

Équipe 107 : Physique des plasmas chauds; International audience; The ITER-like wall (ILW) at JET provides a unique opportunity to study the combination of material (beryllium and tungsten) that will be used for the plasma facing components (PFCs) in ITER. Both the limiters (Be) and divertor (CFC W coated and bulk W) have been designed to maximize their power handling capability. During the last experimental campaign (October 2010-July 2011) this capability has been assessed and even challenged in the case of the Be wall. The Be limiters' power handling capability (19 MW m(-2) s(-1/2)), predicted with a simple model, has been proven to be robust by the experiments despite an unexpected power load pattern. This capability has been pushed to its limit leading to Be melt events, which revealed that the power load is toroidally asymmetric. The protection system of the ILW did not prevent melt events mainly because the protection strategy relies on the assumption that the power load is toroidally symmetric. The bulk W divertor target performed as predicted. Operations were constrained by: (i) an energy load limit (60 MJ m(-2)); (ii) the limited number of cycles of the surface temperature above 1200 degrees C in order to prevent thermal fatigue. This latter limit has been exceeded about 300 times and no signs of damage or thermal fatigue have been observed by the photogrammetric survey.

Recent experimental studies of H-mode plasmas in JET have revealed an n = 0 m = 1 magnetic oscillation starting immediately at the L to H transition (called M-mode for brevity). While the oscillation is present a weak ELM-less H-mode regime is obtained (medium confinement), with a clear increase of pedestal density (ne,ped) and a weak temperature pedestal (Te,ped). In ICRH heated plasmas or low power, low density NBI plasmas the mode and the pedestal pressure can remain steady for the duration of the heating phase, of order 10s or more. The observed axisymmetric MHD oscillation has period ~1­2ms, and odd parity across the mid-plane: m = 1 with sin(q) dependency. Electron Cyclotron Emission, interferometry, reflectometry, SXR and fast Li beam measurements locate the mode in the pedestal region. Da, fast infrared camera and Langmuir probe measurements show that the mode modulates heat and particle flux to the target. Similar phenomena are described elsewhere, lately described as an "I-phase". From a physics point of view, our fundamental observation is that the M-mode is magnetic, not electrostatic, and its frequency scales with pedestal poloidal Alfvén velocity.

For the design and the operation of large fusion devices a detailed understanding of the power exhaust processes is necessary. This paper will give an overview of the current research on the divertor power load mechanisms. The results shown are obtained in JET with the ITER like wall and ASDEX Upgrade with tungsten coated plasma facing components. The challenges of infrared thermography on an ITER like bulk tungsten divertor are presented. For the steady state heat load, the power fall-off length q in JET-ILW is compared to an empirical scaling found in JET and ASDEX Upgrade with carbon plasma facing components. A first attempt to scale the divertor broadening S in ASDEX Upgrade with tungsten plasma facing components is shown. The ELM duration tELM in JET-C and JET-ILW is compared. For similar pedestal conditions (Te,ped and ne,ped), similar ELM durations are found in JET-C and JET-ILW. For higher ne,ped at the same pedestal pressure pe,ped, longer ELM durations are found in JET-ILW. The pedestal pressure pe,ped is found to be a good qualifier for the ELM energy fluency in both JET-C and JET-ILW. Improved diagnostic capabilities reveal ELM substructures on the divertor target occurring a few milliseconds before the ELM crash.

The ITER-Like Wall recently installed in JET comprises solid beryllium limiters and a combination of bulk tungsten and tungsten-coated carbon fibre composite divertor tiles without active cooling. During a beryllium power handling qualification experiment performed in limiter configuration with 5MW NBI input power, accidental beryllium melt events, melt layer motion and splashing were observed locally on few beryllium limiters at the plasma contact areas. The Lorentz force is responsible for the observed melt layer movement. To move liquid beryllium against the gravity force, the current flowing from the plasma perpendicularly to the limiter surface must be higher than 6kA/m2. The thermo-emission current at the melting point of beryllium is much lower. The upward motion of the liquid beryllium against gravity can be due to a combination of the Lorentz force from the secondary electron emission and plasma pressure force.

The JET Scrape-Off Layer (SOL) has been characterized with a reciprocating probe in inner wall, IW, and outer wall, OW, limited plasmas. Experiments revealed that SOL profiles are substantially broader (by a factor of ~5 ­ 7.5 in the power e-folding length) for IW limited than in OW limited plasmas. Results are consistent with the larger radial turbulent transport found for IW limited plasmas. Major differences are observed between IW and OW limited plasmas on the density and electron temperature e-folding lengths, parallel flow, radial turbulent transport as well as on the temporal and spatial characteristics of the fluctuations. Experimental findings on JET suggest that the differences in the SOL characteristics for both configurations are due to a combination of a poloidal asymmetry in radial transport with a reduced cross-field transport across the last closed flux surface associated with the confinement improvement observed for OW limited plasmas. The dependence of the SOL power e-folding length on the main plasma parameters was also investigated for IW limited plasmas and a modest negative dependence on both the plasma current and the line-averaged density found. Finally, it is shown that the SOL radial transport and the amplitude of the fluctuations increase with plasma current and decrease with line-averaged density for IW limited plasmas.

Installation of the JET ITER-Like Wall (ILW)has brought on the need of a reliable protection system as too high a temperature of the plasma facing components (PFCs) can result in beryllium (Be) melting or thermal fatigue of tungsten (W). A proper temperature measurement relies on the knowledge of three different parameters of equal importance: the sensitivity of the camera sensor, the transmission factor of the optics used and the emissivity of the monitored PFCs. In this paper we first present the calibration process of a wide angle infrared (IR) camera, which has involved the capabilities of the remote handling for introducing a calibrated hot source into the JET vacuum vessel. Then, we describe how the PFCs equipped with embedded thermocouples have been used to assess the emissivity of both Be and W.

G.P. Maddison, C. Giroud, B. Alper, G. Arnoux, I. Balboa, M.N.A. Beurskens, A. Boboc, S. Brezinsek, M. Brix, M. Clever, R. Coelho, J.W. Coenen, I. Coffey, P.C. da Silva Aresta Belo, S. Devaux, P. Devynck, T. Eich , R.C. Felton, J. Flanagan, L. Frassinetti, L. Garzotti, M. Groth, S. Jachmich, A. Järvinen, E. Joffrin, M.A.H. Kempenaars, U. Kruezi , K.D. Lawson, M. Lehnen, M.J. Leyland, Y. Liu, P.J. Lomas, C.G. Lowry, S. Marsen, G.F. Matthews, G.K. McCormick, A.G. Meigs, A.W. Morris, R. Neu, I.M. Nunes, M. Oberkofler, F.G. Rimini, S. Saarelma, B. Sieglin, A.C.C. Sips, A. Sirinelli , M.F. Stamp , G.J. van Rooij, D.J. Ward , M. Wischmeier and JET EFDA contributors The former all-carbon wall on JET has been replaced with beryllium in the main torus and tungsten in the divertor to mimic the surface materials envisaged for ITER. Comparisons are presented between Type I H-mode characteristics in each design by examining respective scans over deuterium fuelling and impurity seeding, required to ameliorate exhaust loads both in JET at full capability and in ITER. Attention is focused upon a common high-triangularity, single-null divertor configuration at 2.5MA, q95 3.5 yielding the most robust all-C performance. Contrasting results between the alternative linings are found firstly in unseeded plasmas, for which purity is improved and intrinsic radiation reduced in the ITER-like wall (ILW) but normalised energy confinement is 30% lower than in all-C counterparts, owing to a commensurately lower (electron) pedestal temperature. Divertor recycling is also radically altered, with slower, inboard-outboard asymmetric transients at ELMs and spontaneous oscillations in between them. Secondly, nitrogen seeding elicits opposite responses in the ILW to all-C experience, tending to raise plasma density, reduce ELM frequency, and above all to recover (electron) pedestal pressure, hence global confinement, almost back to previous levels. A hitherto unrecognised role of light impurities in pedestal stability and dynamics is consequently suggested. Thirdly, while heat loads on the divertor outboard target between ELMs are successfully reduced in proportion to the radiative cooling and ELM recurrence effects of N in both wall environments, more surprisingly, average power ejected by ELMs and estimated scrape-off-layer pressure ratio during the approach to outboard detachment also both decline in the same proportion for the ILW. Finally, inter-ELM W sources in the ILW divertor tend to fall with N input, although core accumulation possibly due to net ELM erosion still leads to significantly less steady conditions than in all-C plasmas. This limitation of ILW H-modes so far will be readdressed in future campaigns to continue progress towards a fully-integrated scenario suitable for D-T experiments on JET and for "baseline" operation on ITER. The diverse changes in behaviour between all-C and ILW contexts demonstrate essentially the strong impact which boundary conditions and intrinsic impurities can have on tokamak-plasma states.

JET is equipped with a first wall material combination comparable to the ITER selection acomprising beryllium (Be) in the main chamber and tungsten (W) in the divertor and some recessed wall areas. Be is selected owing to its low atomic number, its low tritium retention and excellent getter properties, but material erosion limits the lifetime of plasma-facing components PFCs made of Be. Initial ERO modelling of the shaped Be first wall modules close to the ITER separatrix predict high erosion rates and limited armour lifetime. However, uncertainties in the modelling, in particular in the atomic data and sputtering yields, still exist and further bench- mark under ITER-comparable tokamak conditions is required. The ITER-Like Wall in JET (JET-ILW) demonstrated successful plasma operation, strong reduction of the C content (x20), and high plasma purity (Zeff ~ 1.2). Equipped with its bulk Be limiters, the JET-ILW allows the study of Be erosion by optical emission spectroscopy and observation of various transitions of BeI (e.g. 457nm), BeII (e.g. 527nm) and the BeD A-X band under different plasma conditions and surface temperatures. The total Be sputtering consists of the bare physical sputtering and the chemical assisted physical sputtering ­ sometimes referred as swift chemical sputtering. However, the composition of the total sputtering, its dependence on the impact energy and temperature, the strength of the chemical assisted physical sputtering are not known for a high temperature plasma edge conditions as present in the JET-ILW or in future ITER. Here, deuterium plasmas in limiter configuration have been used to vary the local electron temperature (Te) in the scrape-off layer (SOL), or better, scanning the impact energy of the impinging deuterons (Ei), as well as, to vary the PFC surface temperature (Tsurf) by plasma impact as they are only inertially cooled. The increase of Tsurf is expected to inhibit the sputtering channel via BeD which thermally decomposes at about 540K according to studies in PISCES.

The ITER-like wall (ILW) at JET is a unique opportunity to study the combination of material (beryllium and tungsten) that will be used for the plasma facing components (PFC) in ITER. Both the limiters (Be) and divertor (CFC W coated and bulk W) have been designed to maximise their power handling capability. During the last experimental campaign (October 2010 to July 2011) this capability has been assessed and even challenged in the case of the beryllium wall. The Be limiters are composed of highly shaped, castellated tiles. They are optimised for a range of scrape-off layer (SOL) power decay length 5 < lq,design < 20mm. Its power handling capability (19MW/m2s1/2), predicted with a simple model, has been proven to be robust by the experiments despite unexpected power loads pattern. However, this capability has been pushed to its limit leading to Be melt events, which revealed that the power load is toroidally asymmetric. The toroidal asymmetry could be explained by a misalignment of the limiters by 1mm. The protection system of the ILW has now been partially commissioned and the main chamber protection was operational. It did not prevent melt events mainly because the protection. The bulk W divertor target performed as predicted. Operations were constrained by: 1) an energy load limit of 60MJ per stack ( 60MJ/m2), and 2) the limited number of cycles of the surface temperature above 1200oC in order to prevent thermal fatigue. This latter limit has been exceeded about 300 times and no signs of damage or thermal fatigue have been observed by the photogrammetric survey.

Introduction et but de l’etude Le marche des complements alimentaires est en pleine expansion ces dernieres annees. Selon l’etude individuelle nationale des consommations alimentaires 2, realisee en 2006, pres de 20 % des adultes ont consomme des complements alimentaires au cours des 12 derniers mois, et un peu plus de 11 % au cours des 7 jours de l’etude. Ainsi, sportifs amateurs ou confirmes voient arriver sur le marche des produits aux allegations prometteuses, souvent plus seduisants qu’une alimentation variee et equilibree. L’objectif de ce travail est d’analyser la consommation de complements alimentaires chez les triathletes afin de mieux connaitre leurs habitudes quant a leur utilisation. Materiel et methodes L’enquete « Consommation de complements alimentaires chez les triathletes en Franche-Comte » a ete menee durant le mois de novembre 2013. Un questionnaire numerique a choix multiples comprenant 11 questions a ete envoye aux 9 clubs de triathlon de Franche-Comte. Parmi eux, 4 clubs ont repondu favorablement, ainsi, 189 personnes y ont participe. Resultats Que ce soit chez les hommes ou chez les femmes, les deux tiers des triathletes consommaient des complements alimentaires. Globalement, ils etaient 43 % a les consommer occasionnellement, 24 % sous forme de plusieurs cures par an, 2 % a les utiliser quotidiennement, et 31 % n’en consommaient pas. Plus le nombre d’heures d’entrainement augmentait, plus les triathletes consommaient des complements alimentaires. Ils etaient respectivement, 47, 73, et 80 % a en consommer pour ces sportifs s’entrainant entre 3 et 6 h, 6 et 10 h, et plus de 10 h. En ce qui concerne les types de complements alimentaires choisis, 2 etaient majoritairement utilises. Il s’agissait des vitamines et mineraux, ainsi que le fer et le magnesium. Lorsque le nombre d’entrainement augmente, ces sportifs consommaient moins de complexes mineralovitaminiques, mais privilegiaient plutot les complements a base de magnesium et/ou fer, ainsi que les proteines. De meme, ils consommaient peu de substances ergogeniques. La lutte contre la fatigue etait la principale motivation d’achat de complements alimentaires tant chez les sportifs masculins que feminins (38 %), et suivie de pres par le besoin de combler une carence (24 %). Pres de 80 % des adeptes du triple effort ont achete ces produits dans une pharmacie ou une parapharmacie. Conclusion Les resultats de cette enquete demontrent que la consommation de complements alimentaires touche un bon nombre de triathletes et augmente avec le niveau d’entrainement. Les consommateurs ont spontanement tendance a se diriger vers les pharmacies ou parapharmacies pour acheter leurs complements alimentaires.

International audience; BACKGROUND: Oral 8-methoxypsoralen-UV-A (PUVA) and narrowband UV-B (NB-UVB or UVB TL-01) are effective and widely used treatments for chronic plaque psoriasis. Although the role of PUVA therapy in skin carcinogenesis in humans with psoriasis has been clearly demonstrated, there is still controversy regarding the risk of skin cancer with NB-UVB. Furthermore, there is no clear evidence about the maximum cumulative number of sessions not to be exceeded in a lifetime. OBJECTIVES: To assess the respective cutaneous carcinogenic risks of PUVA or NB-UVB in psoriasis; to estimate the respective dose-relationship between skin cancers and PUVA or NB-UVB; to estimate a maximum number of sessions for PUVA or NB-UVB not to be exceeded in a lifetime. METHODS: A systematic literature search was carried out in Medline, Embase and Cochrane Library databases from1980 to December 2010 in English and French, with the keywords 'Psoriasis' AND 'UVB therapy' AND 'UVA therapy' AND 'cancer' AND 'skin' OR 'neoplasm' OR 'cutaneous carcinoma' OR 'melanoma'. RESULTS: Of 243 identified references, 49 published studies were included. Most of them (45/49) concerned PUVA therapy, with 41 assessing the risk of non-melanoma skin cancers (NMSC) following PUVA. All publications referring to the US prospective PUVA follow-up study revealed an increased risk of NMSC with the following characteristics: risk most pronounced for squamous cell carcinomas developing even with low exposures and increasing linearly with the number of sessions, tumors occurring also on non-exposed skin including invasive penile tumors, risk persisting after cessation of treatment. An increased risk of basal cell carcinomas was observed in patients receiving more than hundred PUVA sessions. The four prospective European studies selected in our review and most of the pre-1990 European and US retrospective studies failed to find a link between exposure to PUVA and skin cancer. Only the most recent cohorts, including three large long-term retrospective European studies comparing records with their respective national cancer registries reported on an independent increased risk of NMSC with PUVA, The risk was lower as compared to the US prospective PUVA follow-up study. Six studies assessed the risk of melanoma following PUVA therapy: two of the three US publications coming from the same PUVA prospective follow-up study revealed an increased risk with more than doubled incidence of both invasive and in situ melanoma among patients exposed to at least 200 PUVA treatments compared with patients exposed to lower doses, whereas the three retrospectives European studies, comparing the incidence of melanoma in PUVA users with national cancer registers, did not find any increased risk of melanoma. No increased risk of skin cancer was evidenced in the four studies specifically assessing the potential carcinogenic risk of NB-UVB. CONCLUSION: There is an increased risk of skin cancer following PUVA, shown by both US and European studies. The greater risk measured by the US studies may be at least partly explained by high UVA dose exposure and the lighter phototypes of the treated patients. The lack of prospective studies in psoriasis patients treated with NB-UVB constitutes a barrier to the robust assessment of carcinogenic risk of this phototherapy technique.

The installation of international thermonuclear experimental reactor-relevant materials for the plasma facing components (PFCs) in the Joint European Torus (JET) is expected to have a strong impact on the operation and protection of the experiment. In particular, the use of all-beryllium tiles, which deteriorate at a substantially lower temperature than the formerly installed carbon fiber composite tiles, imposes strict thermal restrictions on the PFCs during operation. Prompt and precise responses are therefore required whenever anomalous temperatures are detected. The new vessel thermal map real-time application collects the temperature measurements provided by dedicated pyrometers and infrared cameras, groups them according to spatial location and probable offending heat source, and raises alarms that will trigger appropriate protective responses. In the context of the JET global scheme for the protection of the new wall, the system is required to run on a 10 ms cycle communicating with other systems through the real-time data network. In order to meet these requirements a commercial off-the-shelf solution has been adopted based on standard x86 multicore technology. Linux and the multithreaded application real-time executor (MARTe) software framework were respectively the operating system of choice and the real-time framework used to build the application. This paper presents an overview of the system with particular technical focus on the configuration of its real-time capability and the benefits of the modular development approach and advanced tools provided by the MARTe framework.

10 pages; International audience; This paper reviews some theoretical and computational aspects of plasma-wall interactions, in particidar the formation of sheaths. Some fundamental residts are derived analytically using a simple fluid model, and are subsequently tested with kinetic simulations. The various regions composing the plasma-wall transition (Debye sheath, colUsional and magnetic presheaths) are discussed in details.

A Vlasov-Poisson code is used in this study to model the transition region between the equilibrium plasma and an absorbing wall in the presence of a tilted magnetic field for a weakly collisional plasma. The phase space structure of the plasma-wall transition is analyzed in detail and theoretical estimates of the magnetic presheath width are tested numerically. Simulations show that even for relatively strong magnetic fields, the average angle of incidence of the impinging ions is never as grazing as the angle between the magnetic field and the wall. This is due to the electric field that manages to partially redirect the ions along the direction normal to the surface.

Purpose: Galectin-3 (Gal-3) is well-known as a very interesting biomarker for heart failure and myocardial fibrosis. Gal-3 is a carbohydrate binding lectin produced by macrophages, upregulated in hypertrophied heart, emerging as an important mediator for fibrosis development and cardiac remodeling. We aimed to examine the evolution of Gal-3 in some endurances runners compared to sedentary subjects and the correlation of its evolution with other cardiac and renal biomarkers. Methods: Twenty-eight males (mean age 37 ± 8.5 yo), 9 healthy non-elite marathon runners (42 km), 10 ultratour runners (67 km) and 9 sedentary subjects (10 km

The JET scrape-off layer (SOL) has been characterized with a reciprocating probe in inner wall (IW), and outer wall (OW), limited plasmas. Experiments revealed that SOL profiles are substantially broader (by a factor of ~5–7.5 in the power e-folding length) for IW limited than in OW limited plasmas. Results are consistent with the larger radial turbulent transport found for IW limited plasmas. Major differences are observed between IW and OW limited plasmas on the density and electron temperature e-folding lengths, parallel flow, radial turbulent transport as well as on the temporal and spatial characteristics of the fluctuations. Experimental findings on JET suggest that the differences in the SOL characteristics for both configurations are due to a combination of a poloidal asymmetry in radial transport with a reduced cross-field transport across the last closed flux surface associated with the confinement improvement observed for OW limited plasmas.The dependence of the SOL power e-folding length on the main plasma parameters was also investigated for IW limited plasmas and a modest negative dependence on both the plasma current and the line-averaged density found. Finally, it is shown that the SOL radial transport and the amplitude of the fluctuations increase with plasma current and decrease with line-averaged density for IW limited plasmas.

This study aimed to identify typical features of burns in rural areas and to improve their prevention by comparing the characteristics of burnt patients and their burns in rural and urban areas. A cross-sectional survey was conducted in 19 of the 23 French burns units over one year, using a structured questionnaire. We analysed the resulting database. Of the 1422 patients, excluding 188 burnt in unclassified areas, 420 (34%) were burnt in rural areas. Burns were more frequent in rural than in urban areas. Occupational burns were more frequent in rural than in urban areas. The characteristics of patients and burns did not differ between the areas. Patients burnt during everyday activities were older and more frequently had predisposing factors in rural than in urban areas. Burns occurred outdoors more often in rural than in urban areas and were frequently due to flames or explosions or to the use of barbecues or open fires. The hands and perineum were burnt more frequently in rural than in urban areas. Rural burns were more severe than urban burns: they were deeper, involved a larger body surface area and caused more deaths. Preventive measures in rural areas should take into account occupation and everyday activities. They should be specifically adapted to the profiles of burnt patients.

OBJECTIVE: The aim of this multicentre prospective study was to analyse microbial pathogens cultured from an infected wound. METHODS: The study was performed in the emergency rooms of 10 public hospitals. All adult patients with a clinical diagnosis of cellulitis after a wound in the upper or lower extremities were included. Cultures were obtained with swabs from infected lesions. Micro-organisms cultured were identified by the usual methods and susceptibility testing was performed. RESULTS: The study population consisted of 214 patients, 153 men and 61 women, with a mean (SD) age of 40 (10) years. Wound cultures remained sterile in 28 cases and infected with micro-organisms in 186 cases. Of the 186 positive cultures, three were not identified. Of the 183 remaining cultures, one micro-organism was present in 132 patients (62%) and several micro-organisms in 51 patients (24%). A total of 248 micro-organisms were isolated in 183 patients. Staphylococcus and streptococcus were the most frequently isolated micro-organisms (56% and 21% respectively) followed by Gram negative bacilli (18%). Determination of the susceptibility to the antibiotics commonly used to treat wound infections showed resistance in some cases. CONCLUSION: These results support the need always to take culture specimens from infected wounds for microbiological evaluation and antibiotic susceptibility determination, so that adapted chemotherapy can be prescribed.