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Image-based monitoring has emerged as a prevalent technique for sensing mountain environments. Monoscopic time-lapse cameras, which rely on digital image correlation to quantify glacier motion, have limitations due to the need for a Digital Elevation Model for deriving 3D flow velocity fields. Multi-camera systems overcome this limitation, as they allow for a 3D reconstruction of the scene. This paper presents a replicable low-cost stereoscopic system designed for 4D glacier monitoring. The system consists of independent and autonomous units, built from off-the-shelves components, such as a DSLR camera, an Arduino microcontroller, and a Raspberry Pi Zero, reducing costs compared to pre-built time-lapse cameras. The units are energetically self-sufficient and resistant to harsh alpine conditions. The system was successfully tested for more than a year to monitor the northwest terminus of the Belvedere Glacier (Italian Alps). Daily stereo-pairs acquired were processed with Structure-from-Motion to derive 3D point clouds of the glacier terminus and estimate glacier retreat and ice volume loss. By combining the information about ice volume loss with ablation estimates and ice flow velocity information, e.g., derived from monoscopic-camera time series, a multi-camera system enables a comprehensive understanding of sub-seasonal glacier dynamics.

Background: Limited data are currently available on the incidence rates and risk factors for bacterial sepsis and invasive fungal infections (IFIs) among neonates and infants undergoing major surgery. Aim: To assess the incidence of bacterial sepsis and IFI, fungal colonization, risk factors for sepsis, and mortality in neonates and infants aged

The article presents preliminary findings from a family survey about children’s experiences during the COVID-19 lockdown, which was administered through the pediatric network SICuPP (Italian Society of Primary Care Pediatricians – Lombardy) in Northern Italy. The study involved 3443 parents with children aged from 1 to 5 years and from 6 to 10 years living in Lombardy region, the earliest and most severely affected by the COVID-19 emergency. All participants completed an online questionnaire and provided informed consent. Respondents generally displayed confidence and a sense of self-efficacy in relation to how they had coped with the COVID-19 emergency, despite the many difficulties encountered during the lockdown. They reported having observed some unexpected improvements and resources (e.g. parent/child and sibling relationships, adaptiveness and autonomy on the part of children). Parent-to-parent solidarity was commonly reported, although a small percentage of parents had experienced a greater sense of isolation and anxiety. Finally, the study indicated ‘key areas of vulnerability’ (concerning, for example, eating, rules, sleeping, use of technological devices, fears …) that should be monitored in future by strengthening the territorial network linking families, educational services, and health services.

Resume Objectif Evaluer la concordance entre l’histologie des biopsies des masses renales et l’histologie definitive de la piece d’exerese tumorale en fonction des sous-types histologiques, et rechercher les facteurs predictifs de non-concordance. Materiels Nous avons realise une etude mono-centrique retrospective, incluant 156 patients atteints d’une tumeur renale ayant beneficie d’une biopsie de la masse avant traitement chirurgical. La sensibilite et la specificite des biopsies des masses renales pour le diagnostic histologique des differentes tumeurs renales ont ete calculees. Resultats Cent cinquante-huit biopsies de masses renales ont ete realisees entre 2001 et 2016. Cent quarante-trois carcinomes a cellules renales ont ete retrouves sur les pieces operatoires dont 135 avaient ete diagnostiques par la biopsie. Le taux de concordance global etait de 88 %. Le taux de concordance pour la determination du grade nucleaire de Furhman (bas grade vs haut grade) etait de 72,9 %. La cohorte a ete scindee en 2 groupes selon l’existence (groupe 1, n = 139) ou l’absence de concordance (groupe 2, n = 19). Les groupes 1 et 2 differaient par une predominance masculine dans le groupe 1 (66 % vs 37 %, p = 0,013), une distance entre le sinus et la tumeur superieure a 4 mm (65 % vs 42 %, p = 0,05). Conclusion Dans la prise en charge du cancer du rein la ponction biopsie renale est un examen fiable. Cependant, certains facteurs principalement lies a l’anatomie de la tumeur (tumeur intrasinusale) et a sa composition histologique participent a sa non-contribution diagnostique. Niveau de preuve 4.

Evaluate the concordance between the renal lesions biopsy's histology and the final histology of the surgical specimen according to histological subtype, and search for predictive factors of non-concordance.We performed a monocentric retrospective study that included 156 patients suffering from a renal tumor that benefited a lesion biopsy before surgical treatment. Sensibility and specificity of the renal lesion's biopsy for histological diagnostic of the different renal tumors where calculated.One hundred and fifty-eight renal tumor biopsies were realized between 2001 and 2016. One hundred and forty-three renal cell carcinoma were found on the surgical piece, 135 were diagnosed on prior biopsy. Global concordance rate was 88%. For the establishment of the nuclear Fuhrmann grade, the concordance rate (low vs. high grade) was 72.9%. The cohort was divided into 2 groups according to the existence (group 1, n=139) or the absence (group 2, n=19) of concordance. Group 1 and 2 differed by the predominance of men in group 1 (66% vs. 37%, P=0.013), distance between the sinus and the tumor above 4mm (65% vs. 42%, P=0.05).In renal tumor care, renal biopsy is a reliable testing. However, some factors most likely linked to the tumor anatomy (intra-sinusal tumor) and their histological composition were involved in the lack of non-contribution to the diagnosis.4.

Resume Les hemangiomes congenitaux (HC) sont des tumeurs vasculaires congenitales rares, peu decrites. Nous avons conduit une etude retrospective de 10 cas vus entre 2008 et 2014. Il s’agissait de 7 RICH ( rapidly involuting congenital hemangioma ) et 3 NICH ( non involuting congenital hemangioma ) avec une predominance masculine d’enfants eutrophiques. Les RICH etaient situes au pole cephalique ( n = 2), sur le tronc ( n = 2), sur les membres inferieurs ( n = 3) et les NICH sur les mains. Le diagnostic avait ete clinique. Les lesions etaient congenitales, « tumorales », solitaires, bien limitees et n’avaient pas eu de croissance apres la naissance. L’âge moyen du debut d’involution des RICH avait ete de 1,7 mois et le delai moyen d’involution complete de 10,4 mois. Un HC avait ete classe en PICH ( partially involuting congenital hemangioma ) devant une regression partielle, 2 RICH etaient en cours d’involution a 10 et 15 mois, un autre avait regresse en 7 jours. Aucune complication n’avait ete observee pour les NICH. Parmi les RICH, 2 avaient presente des complications benignes (ulcerations, saignements), 2 avaient regresse sans sequelle et 5 avec lipoatrophie, exces cutanes, veines dysplasiques, pigmentation et halo anemique. Cette serie confirme la rarete des HC. Le sex-ratio en faveur des garcons et la localisation des NICH sur les mains n’ont pas ete rapportes. L’element discriminant entre RICH et NICH est le suivi de l’evolution a un an. Le polymorphisme clinique evoque des formes de chevauchement RICH/NICH. Certains HC presentent des criteres proches des malformations vasculaires, suggerant un lien entre phenomenes proliferatifs et malformatifs a l’origine de ces lesions.

The differential cross sections for inclusive production of B+ hadrons are measured as a function of the B+ transverse momentum pT B and rapidity yB in pp collisions at a centre-of-mass energy of 13 TeV, using data collected by the CMS experiment that correspond to an integrated luminosity of 48.1 pb−1. The measurement uses the exclusive decay channel B+→J/ψK+, with J/ψ mesons that decay to a pair of muons. The results show a reasonable agreement with theoretical calculations within the uncertainties. © 2017 The Author(s)

Introduction La principale complication des ponction-biopsies transthoraciques pulmonaires (PTP) est le pneumothorax (PNO). L’objectif principal de cette etude etait d’identifier les facteurs de risque de PNO secondaires aux PTP, et d’en etablir un score predictif, afin de discriminer les patients pour lesquels une prise en charge ambulatoire serait possible. Methodes Cette etude monocentrique (centre hospitalier universitaire de Besancon) a porte sur la periode de novembre 2012 a mars 2017. Les patients ayant beneficie d’une PTP ont ete evalues retrospectivement sur des facteurs cliniques et radiologiques lies au patient, a la lesion, et au geste, potentiellement lies a la survenue de PNO. Une regression logistique multivariee a permis d’identifier les facteurs de risques de survenue de PNO. Le coefficient de regression logistique de chaque facteur a ensuite permis de realiser un score « SPOT ». L’etude SPOT a fait l’objet d’une declaration a la Commission nationale de l’informatique et des libertes (CNIL) et a Clinical trials sous l’identifiant : NCT03488043. Resultats A partir de 498 patients analyses pour le score SPOT 1, les facteurs de risques de PNO identifies etaient l’indice de masse corporelle ≤ 30 kg/m2 (odds-ratio ajuste (ORa) = 4,48 [1,47–13,63]), la presence de BPCO (ORa = 2,46 [1,18–5,13]), plusieurs passages a travers la plevre (ORa = 8,57 [2,08–35,28]), l’abord anterieur (ORa = 6,81 [3,76–12,32]), l’absence de contact hemorragie-plevre (ORa = 2,96 [1,36–6,46]), et une lame d’epanchement aerique > 10 mm (ORa = 5,66 [2,87–11,15]). Un score « SPOT 1 » Fig. 1 ). Conclusion Le score SPOT 1 permet d’identifier les patients a faible risque de survenue de PNO pour lesquels il pourrait etre propose une prise en charge ambulatoire. Une etude prospective de validation est en cours, destinee a confirmer et preciser nos resultats.

BACKGROUND: Combining bevacizumab with platinum-based chemotherapy significantly improves survival for patients with advanced non-squamous non-small cell lung cancer. The objective of this study was to assess the proportion of patients who could receive this combined therapy. METHODS: This was a retrospective single centre analysis of patients treated between 2007 and 2008. Exclusion criteria for bevacizumab included: squamous cell carcinoma, contraindication to platinum-based chemotherapy, uncontrolled hypertension, haemoptysis superior to 2.5 mL, recent surgery, and/or tomodensitometric criteria after independent review by two radiologists (contact with a proximal vessel, tracheobronchial involvement, cavitation). Cardiovascular diseases and central tumour location were not systematically considered as contraindications. RESULTS: Among 194 patients analysed, 21 (10.8%) to 35 (18%) patients were eligible for bevacizumab, whether or not cardiovascular diseases and central tumour location were considered as contraindications. The kappa coefficient was 0.49. CONCLUSION: Even though the proportion of patients who can receive chemotherapy plus bevacizumab may vary according to the eligibility criteria chosen and the interpretation of the CT scan, it is unlikely to exceed 25% of patients in daily practice.

Nowadays, six of the seven species belonging to the Genus Lophius have an important commercial value in the national and international markets. Usually they are sold beheaded and for this reason they are called tails. This kind of preparation is a limit for the specie-identification by means of the morphological characteristics. The mitochondrial cytochrome b (Cyt b) gene is considered a useful genetic marker to identify fish species. In this work, after obtaining the Cyt b complete sequence of the Lophius species that were missed in the databases, we set up a method based on PCR-RFLP able to identify the six species of Lophius with a commercial denomination in the Italian market.

The recent introduction of high-end ultrasound equipment combined with recent contrast agents provides marked improvements in the characterization of focal liver lesions as previously reported by monocentric studies. The aim of the present study was to evaluate the diagnostic performance of Contrast-Enhanced Ultrasonography (CEUS) using SonoVue as well as its medico-economic value for characterization of focal liver lesions. These nodules were not characterized on previous CT or conventional sonography. This prospective multicentric study conducted in 15 French centres found diagnostic performances similar to those reported for CT and MRI, with a concordance rate of 84.5%, sensitivity greater than 80% and specificity greater than 90% for all types of lesions. Higher acceptance was found for CEUS compared to other imaging modalities. Economical assessment based on examination reimbursment and contrast agent cost showed a lower cost for contrast ultrasound versus CT and MRI. This French multicentric study confirmed the high diagnostic value of CEUS for focal liver lesion characterization and demonstrated a lower economical impact compared to other imaging modalities such as CT and MRI.

The main aim of this multicentre prospective study was to determine the clinical value of SonoVue® administration for the characterisation of focal liver lesions incidentally detected in oncological or cirrhotic patients. Eight hundred and seventy four consecutive patients with 1034 nodules (diameter between 5 and 100 mm) not fully characterised by conventional US or previous single-phase CT-scan were imaged using real-time contrast-enhanced scanning after intravenous injection of 2.4 ml of SonoVue® Blinded off-site assessment was conducted to evaluate the diagnostic performance of contrast-enhanced ultrasound (CEUS) in comparison with gold standard, i.e. triphasic CT-scan or contrast-enhanced MRI or histology. In the differentiation between benign and malignant lesions, CEUS yielded a sensitivity of 79.4% and a specificity of 88.1%. In the subgroup of patients with cirrhosis, the kappa value for off-site diagnosis between CEUS and reference modality was slightly lower compared to the non-cirrhotic group: 0.42 and 0.66 (p = 0.0002), respectively. The concordance rate and kappa value of CEUS for benign to malignant differentiation between on-site and blinded review were 90.2% and 0.80%, respectively, compared to 83.4% and 0.66%, respectively, for the reference imaging technique. These results indicate that CEUS using SonoVue® is a competitive and effective diagnostic tool for the characterisation of focal liver lesions compared to other modalities such as CT and MR imaging.

Introduction La pneumonie organisee est une pathologie pulmonaire de presentation clinique et radiologique variable, aux nombreux diagnostics differentiels, dont le diagnostic de certitude est histologique. Ce diagnostic est actuellement obtenu par biopsie transbronchique ou biopsie chirurgicale mais ces deux techniques ont des inconvenients. Le but de ce travail est de discuter la valeur diagnostique de la biopsie pulmonaire transthoracique guidee par scanner pour le diagnostic de pneumonie organisee et de la comparer aux methodes classiques de diagnostic. Methodes Six observations personnelles sont rapportees et discutees, et une revue de la litterature concernant l’interet de la biopsie pulmonaire transthoracique scano-guidee dans le diagnostic de pneumonie organisee a ete realisee. Resultats La biopsie pulmonaire transthoracique scano-guidee a une meilleure rentabilite que la biopsie transbronchique et fournit des prelevements de plus grande taille, minimisant les risques d’erreur diagnostique. Les valeurs diagnostiques sont respectivement de 88-97 % contre 26-55 % dans les lesions pulmonaires localisees et de 42-100 % contre 66-75 % dans les lesions diffuses. Les complications sont rares et le plus souvent benignes. Conclusions La biopsie pulmonaire transthoracique scano-guidee devrait etre evaluee en remplacement de la biopsie transbronchique dans le diagnostic de pneumonie organisee. La biopsie chirurgicale reste la methode diagnostique de reference.

La prise en charge de la douleur cancereuse souvent revelatrice et toujours presente a un moment donne de la maladie est un challenge therapeutique en particulier a un stade evolue. La composante douloureuse ne repond pas toujours aux antalgiques majeurs, a la chimiotherapie et a la radiotherapie. Quand ces traitements sont depasses, les infiltrations, neurolyses, alcoolisations, la vertebroplastie, la cimentoplastie et la radiofrequence par voie percutanee sont des methodes elegantes et efficaces venant en complement des traitements classiques. Les auteurs presentent ici leur expertise dans ces nouvelles techniques sous controle tomodensitometrique qu’ils ont contribue a mettre au point.

The experimental evaluation of vehicular ad hoc networks (VANETs) implies elevate economic cost and organizational complexity, especially in presence of solutions that target large-scale deployments. As performance evaluation is however mandatory prior to the actual implementation of VANETs, simulation has established as the de-facto standard for the analysis of dedicated network protocols and architectures. The vehicular environment makes network simulation particularly challenging, as it requires the faithful modelling not only of the network stack, but also of all phenomena linked to road traffic dynamics and radio-frequency signal propagation in highly mobile environments. In this Chapter, we will focus on the first aspect, and discuss the representation of mobility in VANET simulations. Specifically, we will present the requirements of a dependable simulation, and introduce models of the road infrastructure, of the driver's behaviour, and of the traffic dynamics. We will also outline the evolution of simulation tools implementing such models, and provide a hands-on example of reliable vehicular mobility modelling for VANET simulation.

BACKGROUND Colonization by Candida species is the most important predictor of the development of invasive fungal disease in preterm neonates, and the enteric reservoir is a major site of colonization. We evaluated the effectiveness of an orally supplemented probiotic (Lactobacillus casei subspecies rhamnosus; Dicoflor [Dicofarm spa]; 6 x 10(9) cfu/day) in the prevention of gastrointestinal colonization by Candida species in preterm, very low birth weight (i.e., < 1500-g) neonates during their stay in a neonatal intensive care unit. METHODS Over a 12-month period, a prospective, randomized, blind, clinical trial that involved 80 preterm neonates with a very low birth weight was conducted in a large tertiary neonatal intensive care unit. During the first 3 days of life, the neonates were randomly assigned to receive either an oral probiotic added to human (maternal or pooled donors') milk (group A) or human milk alone (group B) for 6 weeks or until discharge from the NICU, if the neonate was discharged before 6 weeks. On a weekly basis, specimens obtained from various sites (i.e., oropharyngeal, stool, gastric aspirate, and rectal specimens) were collected from all patients for surveillance culture, to assess the occurrence and intensity of fungal colonization in the gastrointestinal tract. RESULTS The incidence of fungal enteric colonization (with colonization defined as at least 1 positive culture result for specimens obtained from at least 1 site) was significantly lower in group A than in group B (23.1% vs. 48.8%; relative risk, 0.315 [95% confidence interval, 0.120-0.826]; P = .01). The numbers of fungal isolates obtained from each neonate (P = .005) and from each colonized patient (P = .005) were also lower in group A than in group B. L. casei subspecies rhamnosus was more effective in the subgroup of neonates with a birth weight of 1001-1500 g. There were no changes in the relative proportions of the different Candida strains. No adverse effects potentially associated with the probiotic were recorded. CONCLUSIONS Orally administered L. casei subspecies rhamnosus significantly reduces the incidence and the intensity of enteric colonization by Candida species among very low birth weight neonates.

We describe a case of listeriosis in Italy associated with the consumption of cheese. Opened samples of two brands of gorgonzola (Italian blue-veined cheese; referred to as brands "B" and "C") were collected from the patient's refrigerator. Unopened samples of the brand suspected to be the source of infection (brand B) were taken from the store where the cheese had been purchased, other local stores, and the production plant. Listeria monocytogenes serotype 1/2b was isolated from the patient and from the opened and unopened cheese samples. The contamination level varied from100 to 1,200 cfu g(-1). Molecular typing of the isolates, using both randomly amplified polymorphic DNA (RAPD) and pulsed-field gel electrophoresis (PFGE), demonstrated that the isolates from the patient's refrigerator, food stores, and production-plant samples were indistinguishable from the clinical isolate. Molecular typing verified the peristence of closely related L. monocytogenes isolates in the production plant B for 5 months. The results stress the importance of developing a code of hygienic practice for preventing, limiting, and where possible, eliminating this pathogen in processed foods and of educating at-risk persons on foods likely to be contaminated.

Resume Introduction. – Le ganglioneurome est une tumeur nerveuse benigne rare de localisation retroperitoneale frequente. Nous rapportons l'observation d'une patiente de 22 ans dont la tumeur a ete revelee par une colique nephretique compliquee d'une pyelite et d'un abces renal. Exegese. – La patiente a presente des douleurs lombaires febriles brutales et des signes urinaires. Une riche iconographie a permis de visualiser, notamment l'echographie avec contraste, une volumineuse masse retroperitoneale. L'exerese chirurgicale par laparotomie a ete realisee. Les modes de revelation du ganglioneurome sont varies et trompeurs. Les examens biologiques et radiologiques permettent de suspecter le diagnostic, mais seule l'histologie de la piece operatoire l'affirmera. Conclusion. – Devant une volumineuse masse retroperitoneale avec etat general conserve, on doit envisager le diagnostic de ganglioneurome car l'exerese chirurgicale complete permet une guerison sans recidive. Prealablement, l'ensemble des autres diagnostics differentiels doit etre elimine.

To determine whether an association exists between either fungal or bacterial sepsis and retinopathy of prematurity (ROP). Retrospective cohort study on all neonates with birth weight

Resume Les metastases osseuses sont la cause la plus frequente de douleur chez les patients atteints de cancer. Leur prise en charge sur le plan antalgique est un challenge therapeutique. La composante douloureuse ne repond pas toujours aux antalgiques majeurs, a la chimiotherapie et a la radiotherapie. Quand ces traitements sont depasses, la vertebroplastie, la cimentoplastie, la radiofrequence par voie percutanee et la radiotherapie metabolique sont des methodes elegantes et efficaces venant en complement des traitement classiques.

In an attempt to improve pulmonary CT scan reading, a computerized model of lung has first been elaborated. The secondary lobule was used as structuring lung element. The entire organ was composed of several lobule layers and of broncho-vascular trees. As pulmonary nodule distribution modes may turn the diagnostic onto specific pathology type, it is very important to define them as precisely as possible. Seven nodule distributions have been modeled: homogenous, peripheral, centrolobular, pleural, lymphatic, and broncho-vascular. A software tool was developed which allows the radiologist to spread nodules either in the whole lung or in anatomical lung areas, using one or more defined distribution modes until the simulated images mimic the CT scans under analysis. First results show a good agreement between scans and synthesized slices. The software tool described here help the physician to determine the true underlying nodule distribution involved in the pulmonary CT under analysis and lead then to a more precise diagnosis. Moreover, it can be used for radiologist education and training.

Background: This study compared the postoperative infusion of 1% lidocaine and 0.2% ropivacaine for continuous interscalene analgesia in patients undergoing open shoulder surgery. Methods: Forty patients undergoing open shoulder surgery received an interscalene brachial plexus block with 30 ml of either 1.5% lidocaine (n = 20) or 0.5% ropivacaine (n = 20), followed by a continuous patient-controlled interscalene analgesia with 1% lidocaine or 0.2% ropivacaine, respectively. A blinded observer recorded the quality of analgesia and recovery of motor function during the first 24 h of infusion. Results: Onset of the block occurred after 7.5 (5–40) min with lidocaine and 30 (10–60) min with ropivacaine (P = 0.0005). Postoperative pain intensity was higher with lidocaine than ropivacaine for the first 8 h of infusion. The ratio between boluses given and demanded from the pump was 0.5 (0.13–0.7) with lidocaine and 0.7 (0.4–1.0) with ropivacaine (P = 0.005). Rescue IV tramadol was required during the first 24 h of infusion by 16 patients of the lidocaine group (84%) and eight patients of the ropivacaine group (46%) (P = 0.05). At the 16 h and 24 h observation times a larger proportion of patients receiving ropivacaine had complete regression of motor block (70% and 95%) than patients receiving lidocaine (50% and 55%) (P = 0.05 and P = 0.013, respectively). Conclusions: Although 1% lidocaine can be effectively used for postoperative patient-controlled interscalene analgesia, 0.2% ropivacaine provides better pain relief and motor function.

Aims: To compare wage earner dental technicians with non-exposed salaried subjects for the prevalence of respiratory symptoms and function, and chest x ray abnormalities. Methods: A total of 134 dental technicians and 131 non-exposed subjects participated. A medical and an occupational questionnaire were filled in to evaluate the prevalence of respiratory symptoms and occupational exposures. Subjects underwent respiratory tests and chest x ray examination. Results: Mean age of the dental technicians was 36.6 years with a mean duration of dental work of 16.5 years. There was a significant risk of cough (day and night) and usual phlegm in dental technicians. Respiratory function parameters were lower in dental technicians with a significant difference between exposed and non-exposed groups for % FVC (forced vital capacity), % FEF25 (forced mid expiratory flow), and % FEF50. The prevalence of small opacities increased with age. Small opacities were significantly related to an exposure to asbestos in the past. Conclusions: Our young population of dental technicians is at risk of respiratory morbidity. They should benefit from adequate technical prevention measures.

Purpose: Epilepsy poses a considerable economic burden on society. However, information is insufficient on the comparative costs of different disease varieties. The purpose of this study was to compare the direct costs of epilepsy in referral patients with disease of different severity and duration. Methods: Patients with newly diagnosed epilepsy (NDE), seizure remission (SR), occasional seizures (OS), frequent non-drug-resistant (NDR) and drug-resistant (DR) seizures, and surgical candidates (SC) from 14 epilepsy centers were the target population. All patients were followed prospectively for 12 months and all medical and paramedical contacts for diagnostic and therapeutic services were noted with details, using ad-hoc diaries and semistructured questionnaires. Results: The study population comprised 525 consecutive children and adults with partial (68%), generalized (25%) and undetermined epilepsy (4%) as follows: NDE 70; SR 131; OS 108; NDR 101; DR 107; SC 8. Ambulatory visits (mean 2.8 per patient per year) were the leading service in all groups, followed by EEG recordings (1.8) and biochemical assays (1.1). At entry, the commonest drugs were carbamazepine (50%), valproate (37%), phenobarbital (21%), vigabatrin (14%) and lamotrigine (11%). New antiepileptic drugs (AED) were used increasingly with the severity of the disease. The total annual costs varied significantly across groups: 3945 Euro (SC), 2198 Euro (DR), 1626 Euro (NDR), 1002 Euro (NDE), 558 Euro (OS), 412 Euro (SR). The main item of expenditure was hospital stay (including day-hospital), followed by drug treatment and outpatient visits. The costs of outpatient services, hospital services and drugs varied significantly across groups. Conclusions: The direct costs of epilepsy vary significantly depending on the severity of the disease and the response to treatment. Hospital admissions and drugs are the commonest items of expenditure.

Congenital hemangiomas (CHs) are rare congenital vascular tumors seldom mentioned in the literature.We carried out a retrospective study of all the cases of CH diagnosed and treated at Besançon Hospital from 2008 to 2014. The clinical, radiological, and histological data of each case were collected. All the children were seen again in 2014.Ten CHs (seven rapidly involuting CHs, RICH and three non-involuting CH, NICH), predominantly full-term eutrophic male infants, were enrolled. RICHs were located on the head (n=2), trunk (n=2), and lower limbs (n=3), and NICHs were found on the hands. Diagnosis was clinical for all ten infants. All CHs resembled "tumor" congenital lesions: single, oval-shaped, nonpulsatile, and well delimited, and their size did not increase after birth. Two RICHs were warm, one had phlebolites, and two had draining veins at the first visit. The mean age of the RICH involution onset was 1.7 months and the mean time to complete involution was 10.4 months. One CH was classified as a PICH (partially involuting CH) due to partial regression, two RICHs were still in the involution process at the age of 10 and 15 months, and one regressed very quickly within 7 days. No complications were observed in the NICH. Two RICHs presented benign complications (ulcerations and bleeding). Two RICHs regressed entirely, and five regressed with sequelae: lipoatrophy (n=3), cutaneous excess (n=2), dysplastic veins (n=3), a pigmented area (n=1), and an anemic halo (n=2).The small number of patients in our cohort, in spite of the length of the study, confirms the rarity of CH. The sex-ratio in favor of male infants and the location of NICH on the hands have not been reported. The most discriminating element remained the follow-up over 1 year. The initial clinical aspect of the NICH and the progression of one RICH into a NICH suggested possible overlapping forms between RICH and NICH. Some CHs, including one PICH, presented clinical and radiological criteria similar to those of vascular malformations (warm lesion, dysplastic veins, and echo-Doppler results in favor of vascular malformation). RICH regressed with sequelae in most cases.This study reveals a polymorphous clinical presentation of CH and provides a thorough description of their progression. It underlines the existence of overlapping phenomena between RICH and NICH, and between CH and vascular malformations, thus suggesting a possible link between proliferation and malformation phenomena at the origin of these lesions.

More than one million neonatal deaths every year in the world are attributable to infection. In nurseries, infections occur with a reported incidence of 0.3-3%; in Neonatal Intensive Care Units (NICUs) the reported incidence is 7-24.5%, and up to 40% in newborns with birth weight less than 1000 g or gestational age at birth28 weeks. Sepsis is the most severe and frequent infection, accounting for 45-55% of all infections. Several practices have been demonstrated to be effective in reducing the incidence of infection in NICUs, including hand hygiene practices, correct management of central venous catheters (CVC), accurate diagnostic strategies and correct use of antimicrobial drugs. Despite the reduction in the incidence of infection after implementation of these practices, nosocomial infections are still a relevant problem, with high mortality and morbidity rates in hospitalized newborns, especially preterm newborns. Searching for new strategies to further reduce the incidence of nosocomial sepsis in NICUs is a priority of clinical research. New and promising strategies for the prevention of nosocomial infection in NICU include: lactoferrin administration, early identification of infants at risk of infection by means of specific markers (e.g. mannose binding lectin), heparin use for the prevention of CVC-related infections, judicious use of antibiotics, and prevention of fungal sepsis with antifungal agents. On the contrary, recent studies demonstrated that the use of specific immunoglobulins directed against different staphylococcal antigens is not effective in preventing neonatal sepsis.

Summary Background Organising pneumonia is a pulmonary disease with variable clinical and radiological features and with many differential diagnoses. Diagnosis is based on histology obtained by either transbronchial or surgical lung biopsy but these techniques have several disadvantages. The aim of this study was to evaluate the diagnostic yield of CT-guided transthoracic lung biopsy in organising pneumonia and to compare it to the usual diagnostic tools. Methods Six cases of organising pneumonia diagnosed with CT-guided lung biopsy are reported and discussed. The role of CT-guided lung biopsy in the diagnosis of organising pneumonia was also reviewed in the literature. Results CT-guided transthoracic lung biopsies provided a higher rate of adequate samples than transbronchial biopsies (92–100% versus 77–86%). The samples were larger, which reduced the risks of misdiagnosis and increased the diagnostic yield (88–97% versus 26–55% in pulmonary nodules and 42–100% versus 66–75% in diffuse pulmonary disease). Complications were rare and generally not serious. Conclusion CT-guided transthoracic lung biopsy may be considered in place of transbronchial biopsy in the diagnosis of organising pneumonia. Surgical lung biopsy remains the gold standard method for diagnosis.

International audience; The recent introduction of high-end ultrasound equipment combined with recent contrast agents provides marked improvements in the characterization of focal liver lesions as previously reported by monocentric studies. The aim of the present study was to evaluate the diagnostic performance of Contrast-Enhanced Ultrasonography (CEUS) using SonoVue as well as its medico-economic value for characterization of focal liver lesions. These nodules were not characterized on previous CT or conventional sonography. This prospective multicentric study conducted in 15 French centres found diagnostic performances similar to those reported for CT and MRI, with a concordance rate of 84.5%, sensitivity greater than 80% and specificity greater than 90% for all types of lesions. Higher acceptance was found for CEUS compared to other imaging modalities. Economical assessment based on examination reimbursment and contrast agent cost showed a lower cost for contrast ultrasound versus CT and MRI. This French multicentric study confirmed the high diagnostic value of CEUS for focal liver lesion characterization and demonstrated a lower economical impact compared to other imaging modalities such as CT and MRI.

A group of infants, affected by congenital hypothyroidism diagnosed through the neonatal screening program, was investigated with echocardiography to detect the presence of pericardial effusion. We studied the relationship between the effusion and the etiology of hypothyroidism, established through thyroid scintiscanning. Our data show a high prevalence of effusion in hypothyroid patients, without other clinical signs of cardiac involvement as well as a relationship between the etiology of hypothyroidism and the presence of effusion. This seems to be much more frequent in those forms which can imply a more severe hormonal defect, particularly during fetal life (agenesis/dyshormonogenesis). Furthermore, the high prevalence of pericardial effusion suggests to start the L-T4 replacement therapy with lower dosages as commonly advised, in order to avoid a cardiac involvement.

Organizing pneumonia is a pulmonary disease with variable clinical and radiological features and with many differential diagnoses. Diagnosis is based on histology obtained by either transbronchial or surgical lung biopsy but these techniques have several disadvantages. The aim of this study was to evaluate the diagnostic yield of CT-guided transthoracic lung biopsy in organizing pneumonia and to compare it to the usual diagnostic tools.Six cases of organizing pneumonia diagnosed with CT-guided lung biopsy are reported and discussed. A review of literature concerning the role of CT-guided lung biopsy in the diagnosis of organizing pneumonia was performed.CT-guided transthoracic lung biopsies provided a higher rate of adequate samples than transbronchial biopsies (92-100% versus 77-86%). The samples were larger, which reduced the risks of misdiagnosis and increased the diagnostic yield (88-97% versus 26-55% in pulmonary nodules and 42-100% versus 66-75% in diffuse pulmonary disease). Complications were rare and generally not serious.CT-guided transthoracic lung biopsy may be considered in place of transbronchial biopsy in the diagnosis of organizing pneumonia. Surgical lung biopsy remains the reference method for diagnosis.

Relationships among Early Onset Neutropenia (EON), i.e. neutropenia in the first week of life, treated with Filgrastim, and subsequent colonization by Candida spp. with eventual systemic fungal infection in ELBW patients are not clear. We tried to analyze these features in a retrospective study on a selected population of a large tertiary NICU.By a database search, we identified a group of VLBW patients who were diagnosed a systemic fungal infection (SFI) during their stay in NICU (n=52), and divided them in two subgroups: those who had presented Early Onset Neutropenia (EON) and thus had been treated with a 3-day course of Filgrastim (n=14)(group A), and those who had not presented EON and thus had not undergone Filgrastim therapy (n=38) (group B). We investigated in both subgroups the following variables: neutrophil count monitoring during the first 2 weeks of life, colonization by Candida spp, day of onset of SFI, outcome. Statistical analysis was performed by Chi-square test, ANOVA and T-test using SPSS 8.0 for Windows.Absolute neutrophil number was obviously lower in group A at recruitment (354/mmc vs 2910\mmc, Chi-square = 9.776, p0.005), but became normal at the end of G-CSF treatment, thus detecting no significant differences between the two groups at day 8 (p0.12) and 14 (p0.34). The onset of SFI occurred significantly earlier ( 9.6 dol vs 14.6 dol., p0.004) in group A neonates. Fungal Colonization rate in the 2nd week of life was significantly higher in previously neutropenic patients (71% vs. 37%, p0.005), who had also a significantly higher number of sites involved (p0.003).Neutropenia in the first days of life in VLBW neonates, even if adequately and succesfully treated, heavily influences rates and severity of colonization by fungal spp., and is associated with an earlier onset of a SFI.

Introduction Les hemangiomes congenitaux (HC) sont des tumeurs vasculaires congenitales rares, peu decrites. Le but de notre travail etait de les decrire et d’observer leur evolution. Patients et methodes Etude retrospective de tous les cas d’HC diagnostiques et suivis au CHU de Besancon entre 2008 et 2014. Pour chaque cas, nous avons recueilli les donnees cliniques, radiologiques et histologiques. Observations Dix HC, 7 RICH et 3 NICH, ont ete recrutes. On notait une predominance masculine d’enfants eutrophes nes a terme. Les RICH se situaient au pole cephalique ( n = 2), sur le tronc ( n = 2), sur les membres inferieurs ( n = 3) et les NICH sur les mains. Le diagnostic etait clinique. Tous les HC se presentaient comme des lesions congenitales « tumorales », solitaires, ovalaires, non pulsatiles, bien limitees et sans augmentation de taille apres la naissance. Pour 4 RICH, la lesion etait strictement sous-cutanee. Deux RICH etaient chauds, un avait des phlebolithes, deux autres des veines de drainage a la 1 re consultation. Les NICH etaient des lesions saillantes erythemateuses ou bleues, sans halo, ne regressant pas en taille. Les examens complementaires (7 echo-Doppler, 1 IRM, 2 biopsies cutanees) permettaient d’identifier une anomalie vasculaire et eliminaient a priori un processus tumoral malin. L’âge moyen du debut d’involution des RICH etait de 1,7 mois et le delai moyen d’involution complete de 10,4 mois. Un HC a ete classe en PICH devant une regression partielle, 2 RICH etaient toujours en cours d’involution a l’âge de 10 et 15 mois, et un autre avait regresse tres rapidement en 7 jours. Aucune complication n’etait observee pour les NICH. Deux RICH ont presente des complications benignes. Deux RICH ont regresse totalement et 5 avec sequelles : lipoatrophie ( n = 3), exces cutane ( n = 2), veines dysplasiques ( n = 3), zone pigmentee ( n = 1) et halo anemique ( n = 2). Discussion Le faible effectif confirme la rarete des HC. Le sex-ratio en faveur des garcons et la localisation des NICH sur les mains ne sont pas rapportes. L’element le plus discriminant restait le suivi de l’evolution a 1 an. L’aspect clinique initial des NICH et l’evolution d’un RICH en NICH evoquaient la possibilite de formes de chevauchement entre RICH et NICH. Certains HC, dont 1 PICH, presentaient des criteres cliniques et radiologiques proches de ceux des malformations vasculaires (lesion chaude, veines dysplasiques sequellaires, echo-Doppler en faveur d’une malformation vasculaire). Les RICH regressaient le plus souvent avec sequelles. Conclusion Notre etude met en evidence une presentation clinique polymorphe des HC et precise leur evolution. Elle souligne l’existence de phenomenes de chevauchement entre RICH et NICH, et entre HC et malformations vasculaires, suggerant la possibilite d’un lien entre phenomenes proliferatifs et malformatifs a l’origine de ces lesions.

Invasion of bone by a metastatic lesion is the most common cause of pain in cancer patients. Pain management in these patients is an important and difficult task. The pain is not always properly controlled by high doses of specific medication, radiation therapy or chemotherapy. When these therapies do not provide adequate pain relief, percutaneous vertebroplasty, cementoplasty, radiofrequency ablation and internal radiotherapy appear to be elegant and efficient complementary alternative pain control methods.

Neonates in NICU (especially when premature) are particularly prone to skin damage by action of external aggressive conditions such as chemical, physical, infectious, radiant, mechanical and iatrogenic factors. Strategies for avoiding disruption of the skin barrier are thus highly needed in such patients.We evaluated the effectiveness of a acetate tocopherol (AT) ointment for topical use in 21 neonates admitted to our NICU and affected by neonatal abstinence syndrome with severe diaper exulcerative and erosive erythema with ulcer and granulation tissue at the bottom of the lesion (group A), and compared them to 19 matched neonates affected by the same condition and treated with a commonly used skin ointment (emollient type, water-in-oil category) (group B). For all newborns we calculated: the dermatological severity score (using a clinical score from 0 to 9 points according to the increasing severity of the lesions) at time 0, 4 and 7 days; the mean days for achieving complete recovery; the rate of therapeutical failures.Mean score at day 0 was 7.8 in group A vs 7.9 in group B (P=0.35 NS). At day 4 it was 4.6 in group A vs 6.5 in group B (P=0.03), at day in 7 it was 3.1 in group A vs 5.2 in group B (P=0.04). A complete recovery with restitutio ad integrum occurred after 9.1 mean days in group A vs 12.2 mean days in group B (P=0.04). The rate of therapeutical failures was significantly lower in group A (4.2% vs 30.6%; OR 0.235; P0.01) than in group B. No adverse effects related to AT use were reported.AT in our experience proved to be safe and more effective than the commonly used skin ointments in the topical treatment of exulcerative skin lesions in NICU neonates.

A computerized model of lung has been elaborated with the aim of simulating lung lesions in CT scans. The secondary lobule was used as structuring lung element. Several lung slices that cover the entire organ are included in the model. Broncho-vascular trees have been modeled, each final leaf pointing to one lobule of the predefined slices. Lobar, segmental and sub-segmental areas are defined from the arterial tree. Information on lobule location regarding scissure and pleura have also been included in the model. The first lesion studied is the pulmonary nodule. A software tool was developed which allows the radiologist to spread nodules on lung model in a defined way until the simulated images mimic the CT. Several nodule shapes, mathematically simulated, are available and systematic and non-systematic nodule distributions have been modeled. Several predefined nodule sizes (mean and dispersion) have been carefully defined. Nodule superimposition is avoided by the distribution algorithm unless explicitly authorized. Manual nodule shifting is available, but restricted to the area defined by the distribution to which the nodule belongs. When a CT has been completely analyzed, the different actions performed to obtain the final result are stored in a file which will be connected to a database in which data concerning the patient and final diagnoses will be stored. This lung model will be used to simulate ground glass and consolidation. The software tool described here is a useful help for radiologist education and training and it can lead to better understanding of the complex information present in HRCT images and to appropriate diagnoses.

This preliminary communication reports data regarding the distribution between intracellular (ICW) and extracellular (ECW) water compartments in a group of 21 prepubertal young obese children of both sexes in comparison with a group of 18 normal children weight matched for age. Our data indicate that obesity is associated with a highly significant relative expansion of extracellular water (ECW/ICW = 0.61 +/- 0.19 and 0.76 +/- 0.09 in control and obese subjects, respectively; P < 0.0015). This observation, which has been already reported in adult women, suggests that some disturbances of water homeostasis have an early onset and stress the need for an early control of energy imbalance in children. These findings are of great concern also in the field of human body composition, suggesting the opportunity for a critical reevaluation of the assumed constancy of some human body characteristics. Body composition methodologies developed for “normal” populations would require adjustment for use in the obese population, since a considerable error would be introduced.

This study compared the postoperative infusion of 1% lidocaine and 0.2% ropivacaine for continuous interscalene analgesia in patients undergoing open shoulder surgery.Forty patients undergoing open shoulder surgery received an interscalene brachial plexus block with 30 ml of either 1.5% lidocaine (n = 20) or 0.5% ropivacaine (n = 20), followed by a continuous patient-controlled interscalene analgesia with 1% lidocaine or 0.2% ropivacaine, respectively. A blinded observer recorded the quality of analgesia and recovery of motor function during the first 24 h of infusion.Onset of the block occurred after 7.5 (5-40) min with lidocaine and 30 (10-60) min with ropivacaine (P = 0.0005). Postoperative pain intensity was higher with lidocaine than ropivacaine for the first 8 h of infusion. The ratio between boluses given and demanded from the pump was 0.5 (0.13-0.7) with lidocaine and 0.7 (0.4-1.0) with ropivacaine (P = 0.005). Rescue IV tramadol was required during the first 24 h of infusion by 16 patients of the lidocaine group (84%) and eight patients of the ropivacaine group (46%) (P = 0.05). At the 16 h and 24 h observation times a larger proportion of patients receiving ropivacaine had complete regression of motor block (70% and 95%) than patients receiving lidocaine (50% and 55%) (P = 0.05 and P = 0.013, respectively).Although 1% lidocaine can be effectively used for postoperative patient-controlled interscalene analgesia, 0.2% ropivacaine provides better pain relief and motor function.

[corrected] Epilepsy poses a considerable economic burden on society. However, information is insufficient on the comparative costs of different disease varieties. The purpose of this study was to compare the direct costs of epilepsy in referral patients with disease of different severity and duration.Patients with newly diagnosed epilepsy (NDE), seizure remission (SR), occasional seizures (OS), frequent non-drug-resistant (NDR) and drug-resistant (DR) seizures, and surgical candidates (SC) from 14 epilepsy centers were the target population. All patients were followed prospectively for 12 months and all medical and paramedical contacts for diagnostic and therapeutic services were noted with details, using ad-hoc diaries and semistructured questionnaires.The study population comprised 525 consecutive children and adults with partial (68%), generalized (25%) and undetermined epilepsy (4%) as follows: NDE 70; SR 131; OS 108; NDR 101; DR 107; SC 8. Ambulatory visits (mean 2.8 per patient per year) were the leading service in all groups, followed by EEG recordings (1.8) and biochemical assays (1.1). At entry, the commonest drugs were carbamazepine (50%), valproate (37%), phenobarbital (21%), vigabatrin (14%) and lamotrigine (11%). New antiepileptic drugs (AED) were used increasingly with the severity of the disease. The total annual costs varied significantly across groups: 3945 Euro (SC), 2198 Euro (DR), 1626 Euro (NDR), 1002 Euro (NDE), 558 Euro (OS), 412 Euro (SR). The main item of expenditure was hospital stay (including day-hospital), followed by drug treatment and outpatient visits. The costs of outpatient services, hospital services and drugs varied significantly across groups.The direct costs of epilepsy vary significantly depending on the severity of the disease and the response to treatment. Hospital admissions and drugs are the commonest items of expenditure.

The hepatopulmonary syndrome (HPS) associates a chronic hepatic affection, hypoxemia70 mm Hg and pulmonary vasodilatation.The mechanisms leading to pulmonary vasodilatation are complex and unclear. There appears to be an imbalance between the vasodilatating and vasoconstricting mediators. Nitrogen monoxide and endotheline-1 are well known. Hypoxia can be explained by the association of heterogenic ventilation-perfusion, shunts (rare), and a default in "diffusion-perfusion".In a hypoxic patient, platypnoea and orthodeoxia are characteristic of HPS. Stellar angioma associated with digital hippocratism and signs of portal hypertension are usually present.The air of blood gases, followed by 100% O2, standing and reclining, must be measured in all cirrhotic patients to detect hypoxemia. Contract sonography is the key diagnostic examination. Pulmonary perfusion scintigraphy establishes prognosis. Pulmonary angiography differentiates two groups of patients and, for type II patients, embolization therapy can be proposed. Preliminary data indicate that densitometry, conducted in rigorous conditions, can show pulmonary vasodilatation. Its interest must be confirmed by further studies on larger cohorts of patients.The only efficient treatment of HPS is hepatic transplant (HT). The placing of an intra-hepatic portal systemic shunt can be proposed while waiting for HT, or in certain patients not requiring HT. No medical treatment has demonstrated its efficacy, but better knowledge of the physio-pathologic mechanisms should improve this situation in the future.

INTRODUCTION Body composition changes with age and sex differences become significant only after puberty. Boys and girls before the age of 8 yr do not differ in fat, lean or bone mineral mass. Hormonal influences during pubertal development determine the physiological adult male and female body composition phenotype. AIM The aim of our study was to evaluate body composition changes due to central precocious puberty (PP) and the specific effects of therapy on these modifications. SUBJECTS AND METHODS Sixteen patients (14 girls, 2 boys) were included in the study. They were diagnosed as affected by idiopathic PP according to standard hormonal and clinical criteria; anatomic alterations of hypothalamus-hypophysis region were excluded by MRI. Mean age at diagnosis was 5.9 +/- 1.9 yr. All patients received GnRH analog (Leuprolide or Triptorelin) treatment subcutaneously every 4 weeks for at least 1 yr. Mean period of treatment was 3.4 +/- 1.9 yr. Standard anthropometry and body composition analysis were performed at baseline and every 6-12 months. A group of healthy subjects with normal timing of puberty was matched (for age or for pubertal stage) served as the control group (CA or CP, respectively). RESULTS Patients with PP showed at baseline a significant increase of BMI and relative body weight; lean and fat compartments were also increased but not significantly. During treatment, the PP group showed increased fat mass compared to CA (p