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The objective of the ACACIA project was to develop processes for post-combustion CO2 capture at a lower cost and with a higher energetic efficiency than first generation processes using amines such as MonoEthanolAmine (MEA) which are now considered for the first Carbon Capture and Storage (CCS) demonstrators. The partners involved in this project were: Rhodia (Solvay since then), Arkema, Lafarge, GDF SUEZ, Veolia Environnement, IFP Energies nouvelles, IRCE Lyon, LMOPS, LTIM, LSA Armines. To validate the relevance of the breakthrough processes studied in this project, techno-economic evaluations were carried out with comparison to the reference process using a 30 wt% MEA solvent. These evaluation studies involved all the industrial partners of the project, each partner bringing specific cases of CO2 capture on their industrial facilities. From these studies, only the process using demixing solvent, DMXTM, developed by IFPEN appears as an alternative solution to the MEA process.

La pneumopathie interstitielle diffuse (PID) associée à la polyarthrite rhumatoïde (PR) n'est pas une entité unique comme l'indique les différents aspects histologiques rencontrés, les différents facteurs de risques et les pronostics variés. Notre objectif était d'identifier différents sous-phénotypes au sein d'une importante population de patients atteints de PR-PID à l'aide d'une analyse en cluster non supervisée. Dans cette collaboration internationale (22 centres, 13 pays), nous avons inclus des patients PR (ACR/EULAR 2010) ayant une PID définie par TDM thoracique. Les données cliniques, biologiques, scanographiques et fonctionnelles ont été recueillies rétrospectivement par relecture complète des dossiers médicaux. Les données manquantes ont été analysées avec imputations multiples par équation de chaîne. Une analyse des correspondances multiples a été effectuée pour chaque échantillon afin de réduire les dimensions et un algorithme non-paramétrique Bayésien a été utilisé afin d'attribuer un cluster à chaque patient. La distribution de l'allèle a risque T de MUC5B rs35705950 a été analysée au sein de chaque cluster. Au total, 1696 patients ont été inclus. Sur les 37 variables initiales, 20 variables actives ont été sélectionnées pour construire les clusters. Nous avons détecté 2 clusters: le cluster #1 (n = 1015) et le cluster #2 (n = 681). Comparativement au second, les patients du premier cluster étaient plus fréquemment des hommes (45,5 % vs 38,3 %, p = 0,003), plus vieux au diagnostic de PR (56,9 ± 13,3 ans vs 53,8 ± 14,5 ans ; p < 0,001) et de PID (65,5 ± 10,1 ans vs 61,9 ± 12,3 ans ; p < 0,001), plus fréquemment européens (85,9 % vs 68,3 % ; p < 0,001), plus fréquemment fumeurs au diagnostic de PID (64,2 % vs 55,7 % ; p < 0,001) et moins fréquemment sujets au syndrome de Sjörgen (10,8% vs 20,6%; p < 0,001). Ils étaient plus fréquemment positifs pour les anticorps anti-peptides citrullinés (90,7 % vs 70,0 % ; p < 0,001) et pour le facteur rhumatoïde (95,8% vs 67,4% ; p < 0,001). L'aspect de pneumopathie interstitielle commune (PIC) était largement majoritaire dans le cluster #1 (72,5 %) tandis que le cluster #2 était plus hétérogène concernant le type de PID (30,8 % de PIC, pneumopathies interstitielles non-spécifiques 17,2 %) p < 0,001. Le génotype de MUC5B rs35705950 était disponible pour 444 patients. La fréquence de l'allèle a risque était plus élevée pour le cluster #1 (33 %) que pour le cluster #2 (18 %), p < 0,001. Nous avons pu construire un arbre décisionnel permettant de prédire le cluster d'un nouveau patient avec un taux d'erreur de 9,8 %. Nos résultats apportent la preuve d'une hétérogénéité au sein de la PR-PID avec l'identification d'au moins 2 sous-phénotypes, suggérant des mécanismes physiopathologiques distincts. Ces sous-phénotypes influencent probablement le pronostic et l'efficacité des différents traitements. [ABSTRACT FROM AUTHOR]

Retrospective studies have been conducted in Lyon (33 patients) and Montreal (24 patients) in order to compare the results of transventricular valvotomy (TVV, 20 cases) and aortic valvotomy with cardiopulmonary bypass (CPB, 37 cases) in neonatal critical aortic stenosis. Clinical, echocardiographic, catheterization and operative data were analyzed in order to determine prognostic factors. Mortality rate was 59%: 30/34 perioperative deaths in the first month, and 4 late deaths after a reintervention for severe residual obstruction. Long term follow up was available for 23 patients (41%) for a 2 to 16 year period (mean 7.5). Five patients (7%) required a reintervention six years after the initial operation. Two of them required valve replacement. Eighteen patients (31%) surviving the initial operation, displayed a satisfactory result, being free of symptoms, endocarditis, reoperation and sudden death. Factors that influenced the outcome included severe heart failure, a left ventricular end-diastolic diameter below 14 mm, an aortic valve annulus below 8 mm, and a poor shortening fraction. Factors that did not influence the prognosis were age, pulmonary hypertension, and the anatomic type of the valve. Trans-aortic valvotomy with CPB was associated with a smaller operative mortality and a better long term result than TVV.

59 cases of Plasmodium falciparum malaria fever occurring in non-immune Caucasian subjects having got a correct chemoprophylaxis by chloroquine were treated by halofantrine (HALFAN). They were given 1500 mg divided in 3 doses of 500 mg every 6 hours from D1 to D8. All them were back from a malarial highly endemic zone with chloroquine resistance. Analysis of the main biological and clinical efficiency parameters displayed very satisfactory results: disappearances of fever (mean 22 H) and parasitemia (mean 36 H) are short. After two months of monitoring, no malaria recrudescence was noted. With an efficacy of 10 p.c. associated to a noticeable clinical and biological tolerance Halofantrine is a first-class treatment of chloroquine resistant malaria fever.

Maximum oxygen uptake (VO2 max) was measured in 11 chronic bronchitics without heart failure or hypoxemia at rest and during maximal work load, using a triangular type of excerise with increasing power (30 W/3 min). Glycolysis was studied in these patients during rectangular exercises lasting 10 minutes, in which power was increased by steps from an average value of 45 % to 72 and 94 % of VO2 max. The metabolic response of lactate in blood is similar to normal, during the limited performances of these patients.

Six children (4 boys and 2 girls) aged from 3 to 7 years who had an accessory pathway and were suffering from paroxysmal (n = 4) or permanent (n = 2) refractory reciprocating tachycardia underwent transcatheter ablation of the accessory pathway alone in 5 cases and of the normal and accessory pathways in 1 case. Conduction in the accessory pathway was interrupted in 3 cases and sufficiently modified in 2 cases for the attacks of tachycardia to be suppressed by a simple and previously ineffective medical treatment. There was one failure. The authors underline the value of two-dimensional echocardiography in such cases. This technique is useful in the preoperative evaluation, during catheter insertion, and also in the choice of the electrodes to be used, for the ablation itself and in the search for postoperative lesions. Transcatheter ablation seems to be feasible and safe enough to be offered as an alternative to surgery in the treatment of refractory reciprocating tachycardia in children.

Fourteen young men (on the average 25 years), well trained (maximal oxygen consumption, VO2 max., between 2.7 to 3.5 1) have been studied at two different levels of exercise: 90 and 140 watts (about 40 and 70% of VO2 max.) in chamber, where the atmosphere was regulated. The subjects performed the exercise after a sojourn of six hours in the chamber, at the same level, either in air or in hypercapnic conditions (FICO2: 0.04; FIO2: 0.21); the order of the exercise tests was determined at random. The rise of total ventilation (VE) during exercise in CO2 atmosphere was particularly related to the increased tidal volume (VT). In spite of the larger increase of VE in hypercapnia, CO2 output (VCO2) and respiratory quotient (R) were lower while PaCO2 was elevated (48 at rest and 54 mmHg during exercise). Oxygen consumption during exercise was the same in both conditions. Values of arterial lactic acid concentration were not different at 90 watts level. On the contrary, at the level of 140 watts, the lactic acid concentration was significantly lower in CO2 atmosphere. The well known changes during exercise of other electrolytes (rise of Na+, K+ and total Ca) was similar in air and in CO2. Only the inorganic phosphorus was higher in CO2 atmosphere at 140 watts.

Cardio-respiratory changes were studied during light exercise (20 or 40 W) in 45 patients with diminished vital total lung capacity. Diagnosis was : fibrosis (8 subjects, group I), lobectomy (7 subjects, group II), pachypleuritis (11 subjects, group III), thoracoplasty (7 subjects, group IV) and kyphoscoliosis (12 subjects, group V). Changes during exercise were characterized by : an increase in breathing rate much more marked than normally, with a lesser increase in tidal volume, so that ventilatory equivalent was steady, and below 30 except in group I; an increase in PaCO2, even in group I which was hypocapnic at rest, very marked in groups III and V, with worsening of hypoxemia in most cases; and enhancement of pulmonary artery hypertension, severe at rest already in group I.

42 normal male subjects from 19 to 27 years, are examined in conditions of field studies once a week for 9 weeks. At each session are measured: flow volume curves with determination of vital capacity (VC), forced expiratory volume in one second (FEV 1.0), peak flow (V peak), flows at 0.75, 0.50, 0.25 of VC (V 0.75 VC, V 0.50 VC, V 0.25 VC). Single breath nitrogen test, with determination of slope of phase III (delta N2/liter) and closing volume/vital capacity (CV/VC). Single breath and steady state tests with carbon monoxide. Variability of functional pulmonary indices in this study is greater than those observed in the literature during shorter period of term. Some indices varied significantly during these 9 weeks of observation like V 0.25 CV, indices of transfer factor of CO and CV/VC (according to repetition of test or meteorologic factors?). Relevance of studying variations during a relatively long period, is pointed out in interpretation of results observed in prospective studies.

The rehabilitation of patients with chronic airflow obstruction consists of a number of complementary treatments, one of which is respiratory physiotherapy (KR). Breathing exercises (RE), bronchial drainage and controlled coughing are all part of current techniques in physiotherapy. As problems with the rhythm of breathing are frequently encountered in patients with chronic pulmonary disease, their correction is attempted with KR. In order to acquire a new, more efficient breathing pattern, training in simple every day measures is used (such as talking, reading watching TV, walking, climbing stairs, etc.) or techniques using mechanical devices, including inventive spirometers and magnetometers. With a few exceptions, most of the studies show an immediate objective benefit on blood gases and alveolar ventilation, due to a reduced respiratory rate and increased tidal volume. Although dynamic ventilatory work increases, neither the pulmonary haemodynamics nor energy expenditure are altered as judged by oxygen consumption during RE. The long term results are contradictory and more difficult to interpret. Many studies have noted a clinical and functional improvement with fewer relapses and hospital admissions; these studies often lack adequate controls and the clinical state is not always precisely defined; nor whether associated therapy has been changed or not. Other studies have given negative results, and lately the causes of these failures have been better defined. There is insufficient theoretical and practical training of KR at all medical levels, an absence of uniformity in the KR rehabilitation teams, and treatment courses which are both too few in number and too short in duration. An appreciation of these points of criticism should make for greater objectivity in the future analysis of pulmonary rehabilitation.

The variability and reproducibility of maximal static respiratory pressure measurements was evaluated in 22 healthy subjects and 17 patients with chronic respiratory disease. The difference between consecutive measurements represented 4 to 8 per cent of the result in healthy subjects and 10 to 11 per cent in patients. The difference between the first and the second measurement was not significant and the two values were highly correlated. At 1 to 3 days interval, the results may differ by 10 to 15 per cent in healthy subjects and 20 to 22 per cent in patients. These differences tend to be greater for expiratory (as compared to inspiratory) pressures and for females (as compared to males). A preliminary assessment of the variability and reproducibility of maximal respiratory pressures is compulsory for a valid interpretation of their change in clinical studies.