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BACKGROUND Trastuzumab increases the incidence of cardiac events (CEs) in patients with breast cancer (BC). Dual blockade with pertuzumab (P) and trastuzumab (T) improves BC outcomes and is the standard of care for high-risk human epidermal growth factor receptor 2 (HER2)-positive early BC patients. We analyzed the cardiac safety of P and T in the phase III APHINITY trial. PATIENTS AND METHODS Left ventricular ejection fraction (LVEF) ≥ 55% was required at study entry. LVEF assessment was carried out every 3 months during treatment, every 6 months up to month 36, and yearly up to 10 years. Primary CE was defined as heart failure class III/IV and a significant decrease in LVEF (defined as ≥10% from baseline and to 65 years, body mass index ≥ 25 kg/m2, baseline LVEF between 55% and more...

Les audits effectués au Bénin ont révélé de part et d’autre de mauvaise gestion des ressources financières puisque la gestion axée sur les résultats affiche un signe négatif et entorse le développement durable. A cet effet, ce papier vise à apprécier l’effet de l’audit interne sur la gestion des ressources financières dans les administrations publiques au Bénin. Dans une démarche méthodologique à la fois qualitative et quantitative, nous avons enquêté les cadres avec un échantillon est constitué de 90 personnes prises dans 30 administrations publiques au Bénin. L’analyse des données a été faite par la régression, l’analyse bivarriée et les tests de khi-deux pour faire ressortir les liens qui existent entre les variables. Les résultats montrent que l’inefficacité du contrôle interne, le non fonctionnement de l’audit interne et la non application de la fonction d’audit interne ont une influence négative sur la gestion des ressources financières allouées aux administrations publiques au Bénin. Cette recherche va réguler le problème de l’inefficacité du dispositif d’audit interne, de malversations ou détournements persistants au sein de ces administrations du Bénin afin que son image de haut lieu de corruption et de gestion peu efficace soit corrigée. more...

Context The National Federation of State High School Associations previously implemented 2 lacrosse rule modifications: Rule 5.4 in the 2012–2013 academic year to heighten the penalty for a head or neck hit to the head, face, or neck (HFN) and Rule 5.3.5 in the 2013–2014 academic year to minimize body checking. Objective To determine if the rates of overall injury, HFN injuries, and concussions due to intentional contact (checking) differed for boys' high school lacrosse players after Rule 5.4 and 5.3.5 modifications were enacted. Design Descriptive epidemiology study. Setting Web-based online surveillance system. Patients or Other Participants Boys' high school lacrosse players during the 2008–2009 to 2016–2017 seasons whose teams involved athletic trainers participating in the High School Reporting Information Online sports injury-surveillance system. Intervention(s) Rule 5.4 in the 2012–2013 academic year increased the penalty for any intentional hits to the HFN, and Rule 5.3.5 in the 2013–2014 year eliminated body checking to a player in a defenseless position. Main Outcome Measure(s) Overall, HFN, and concussion injury rate ratios (IRRs) by checking mechanism; overall and checking-related injury ratios by competitions and practices. Results A decrease was shown in checking-related HFN injuries (IRR = 0.29, 95% CI = 0.13, 0.65) and checking-related concussions (IRR = 0.29, 95% CI = 0.12, 0.70) during practices in the seasons after both rule modifications were imposed, but no decreases occurred in any checking-related injuries during competitions. By injury mechanism, no decreases were evident after the Rule 5.4 modification. When both rule modifications (Rules 5.4 and 5.3.5) were enacted together, concussion rates due to delivering body checks (IRR = 0.51, 95% CI = 0.29, 0.91) and overall injury risk due to being body checked (IRR = 0.72, 95% CI = 0.53, 0.97) decreased. Conclusions When both Rule 5.4 and 5.3.5 modifications were in effect, concussion and overall injury risks decreased for the body checker and the player being body checked, respectively. more...

In Human immunodeficiency virus infected (HIV+) patients, deregulation of regulatory T (Treg) cells can be deleterious for the development of an efficient anti-HIV specific immune response with an inappropriate immune activation despite anti-retroviral therapy (ART). In addition, infection and ART have the potential to cause hematological and biochemical abnormalities that can lead to the discontinuation of ART. The aim of this study was to assess hematological, biochemical and immunological abnormalities in HIV+ patients’ naive to ART and 6 months after ART initiation. In a cross-sectional study, 11 HIV+ patients and 09 healthy individuals (control group) were voluntarily recruited. At inclusion, blood samples were taken before administration of ART. All hematological, biochemical, immunological parameters and viral load were measured and assessed at inclusion (M0) and three and/or six months later (M3, M6). Higher level of white blood cells and CD4+ T lymphocytes (p = 0.032, 0.038 respectively) were observed in HIV+ patients. ART also had significantly effect on the level of red blood cells (p = 0.04) and Hb (p = 0.015). The inflammatory markers, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) that were significantly increased by HIV infection, tended to decrease for ESR and revert to levels similar to those of control for CRP. Analysis of CD4+CD25+ cells and CD4+Foxp3+CD25+ showed significantly elevated levels of activated form of all CD4+ cells and Treg cells. Interestingly, six months after initiation of ART, the average percentage of CD4+CD25+ was not significantly different from control group (p = 0.382). Our study provides information about the evolution of the activated form of all CD4 cells and Treg cells and points out the necessity to monitor hematological and biochemical parameters in order to detect and prevent toxicity, improve the quality of life and reduce the risk of mortality. more...

Cette recherche vise à apprécier l’effet de la crise sanitaire du Covid-19 sur l’endettement des Très Petites Entreprises agro-alimentaires au Bénin. L’échantillon de cette étude est constitué de 150 responsables de TPE agro-alimentaires installées au Bénin. Nous avons fait recours à une méthode qualitative complétée par la méthode quantitative basée sur la régression linéaire. Après le traitement des données, nous avons abouti à des résultats probants. Les résultats de notre étude montrent que l’endettement est statistiquement significatif au seuil de 0,01 (β=,497 ; P< ,000) et qu’il est négativement influencé par la crise sanitaire du Covid-19. De même, la relation entre la crise sanitaire du covid-19 et l’endettement des TPE est modérée par l’âge des TPE agro-alimentaires au Bénin (β = -0,019 ; t = -2,14 et p < 0,05). Les TPE agro-alimentaires n’ont pas honoré à leurs engagements auprès des institutions financières et sont quasiment en faillite. De ce fait, des apports managériaux ont été soulignés pour surmonter les dettes des TPE agro-alimentaires en contexte de crise sanitaire. more...

Anorexia nervosa (AN) is a serious mental illness. It is frequently accompanied by a history of childhood maltreatment (CM) that may constitute a specific ecophenotype in patients with eating disorders necessitating special assessment and management. This retrospective study tested whether in patients with AN, CM-related chronic stress may manifest through low-grade inflammation reflected by an increase in white blood cell ratios (neutrophil-to-lymphocyte ratio, NLR, platelet-to-lymphocyte ratio, and monocyte-to-lymphocyte ratio).Participants (N = 206) were enrolled at an eating disorder daycare unit in Montpellier, France, from March 2013 and January 2020. CM was assessed using the childhood trauma questionnaire (CTQ). The Eating Disorder Examination Questionnaire (EDE-Q) and the MINI were used to assess AN severity and the other clinical characteristics, respectively.NLR was higher in patients with AN and history of CM (p = 0.029) and in patients with AN and history of emotional abuse (p = 0.021), compared with patients with AN without history of CM. In multivariate analysis, emotional abuse (β = 0.17; p = 0.027) contributed significantly to NLR variability.In patients with AN, NLR is a low-grade inflammation marker that is influenced by various sociodemographic, clinical and biological factors. It is more directly affected by some CM types, especially emotional abuse, than by the presence/absence of CM history. Future studies should focus on mediators between CM and increased inflammation, such as interoceptive awareness, emotional dysregulation, food addiction, and stress sensitization.III. Evidence obtained from well-designed cohort or case-control analytic studies. more...

A prototype rod-net for a fabric formwork system is described, including the fabrication, control of the geometry via turnbuckles, and the measurement of nodal co- ordinates via an image-based theodolite system. Such a net and fabric formwork system consists of a network of tie elements, either discrete or continuous, forming the main falsework structure, onto which is placed a fabric membrane acting as the flexible formwork for the pouring of wet concrete for the forming of a concrete shell. The fabrication of the plastic and steel net components of the prototype is described in detail, including the arrangement of the nodes, rods and boundary conditions. A control system was developed to determine the necessary adjustments at the boundary elements to move the rod-net to a target geometry to eliminate deviations that may arise from fabrication and construction tolerances. This control system showed that with minimal adjustments the rod-net could be directed effectively, resulting in deviations from the target surface reduced from up to 3–9mm to below 1–2mm for a 3D rod-net of approximate dimension 2.5 m × 4.5 m × 2.0 m. Additionally, the algorithm provided a more symmetric distribution of deviations around the target. The control system was coupled with 3D point-cloud measurements of markers placed on and around the rod-net by using a motorised image-assisted theodolite and specialised software for spherical and circular targets. This semi-automated process proved to be both efficient and accurate for determining the spatial co-ordinates of the markers and hence the node locations., Automation in Construction, 96, ISSN:0926-5805 more...

Introduction La population pediatrique est sous-representee dans la pandemie actuelle, en termes de nombre de cas et de severite. De surcroit le risque evolutif de l’infection au SARS-CoV-2 dans cette population, en cas de maladies inflammatoires sous traitements immuno-modulateurs, est peu connu. Cette population de jeunes patients immuno-deprimes est consideree comme une population a risque de formes severes de COVID-19. L’objectif de notre etude est d’evaluer le degre de severite et l’issue de l’infection a SARS-CoV-2 chez les patients atteints de RMD (avec une arthrite juvenile idiopathique, une maladie auto-inflammatoire, une vascularite ou une maladie auto-immune systemique) exposes a des traitements immuno-modulateurs, au travers d’une cohorte prospective francaise. Patients et methodes Cette etude ancillaire, multicentrique, observationnelle, descriptive et prospective, de cohorte nationale francaise a inclus de jeunes patients, suivis dans les centres de pediatrie et de rhumatologie pediatrique francais, presentant une maladie inflammatoire associee a une infection COVID diagnostiquee par PCR (reaction en chaine par polymerase), serologie, scanner ou par une clinique fortement evocatrice. Les donnees demographiques, cliniques et therapeutiques, les comorbidites, de ces jeunes patients ainsi que des donnees sur l’infection par le SARS-CoV-2, l’issue et l’impact sur l’activite de la maladie inflammatoire (RMD) ont ete documentes par un questionnaire SARS-CoV-2 specifique mis en œuvre par la FAI2R. Resultats D’avril 2020 a juin 2021, des donnees ont ete recueillies aupres de 95 patients âges de 13,1 ± 4,4 ans, de predominance feminine (62,1 %), atteints de RMD : une arthrite juvenile idiopathique 44 (46,3 %), maladie auto-inflammatoire 6 (6,3 %), vascularite 1(1,1 %) et maladie systemique auto-immune 37 (39 %), avec un diagnostic hautement suspecte/confirme de COVID-19. 33 patients (34,7 %) ont recu des DMARDS, 35 (36,84 %) des bioDMARD,10 (10,6 %) des glucocorticoides systemiques et 11(11,7 %) des AINS. Quatre vingt onze patients (95,8 %) avaient une forme benigne et 4 patients (4,2 %) une forme moderee. Vingt quatre patients (25,3 %) ayant au moins une comorbidite (dont 22 (24,2 %) avaient une forme benigne). Aucun cas d’hospitalisation en soins intensifs ni de detresse respiratoire n’a ete releve. L’evolution etait benigne sans sequelles a 21 jours et sans retentissement sur l’activite de la maladie. Conclusion Dans notre cohorte French RMD Covid pediatrique, il n’y a pas d’augmentation de la severite de l’infection COVID chez les patients ayant une maladie inflammatoire lies a leur maladie ou a leur traitement immunosuppresseur. L’evolution est benigne sans signes de severite ni sequelles et sans retentissement sur l’activite de la maladie. more...

An increasing number of studies are using landscape genomics to investigate local adaptation in wild and domestic populations. The implementation of this approach requires the sampling phase to consider the complexity of environmental settings and the burden of logistic constraints. These important aspects are often underestimated in the literature dedicated to sampling strategies.In this study, we computed simulated genomic datasets to run against actual environmental data in order to trial landscape genomics experiments under distinct sampling strategies. These strategies differed by design approach (to enhance environmental and/or geographic representativeness at study sites), number of sampling locations and sample sizes. We then evaluated how these elements affected statistical performances (power and false discoveries) under two antithetical demographic scenarios.Our results highlight the importance of selecting an appropriate sample size, which should be modified based on the demographic characteristics of the studied population. For species with limited dispersal, sample sizes above 200 units are generally sufficient to detect most adaptive signals, while in random mating populations this threshold should be increased to 400 units. Furthermore, we describe a design approach that maximizes both environmental and geographical representativeness of sampling sites and show how it systematically outperforms random or regular sampling schemes. Finally, we show that although having more sampling locations (between 40 and 50 sites) increase statistical power and reduce false discovery rate, similar results can be achieved with a moderate number of sites (20 sites). Overall, this study provides valuable guidelines for optimizing sampling strategies for landscape genomics experiments. more...

This study aimed to evaluate the effects of diet supplementation with monensin and saponins alone or combined with essential oils (EOs) on the nutrient intake and apparent digestibility, rumen fermentation parameters, microbial population, nitrogen balance, ruminal microbial protein synthesis, blood metabolites, and milk composition, yield and fatty acid profile of mid- to late-lactating Jersey cows. Eight ruminally cannulated lactating Jersey cows (average 17.6 ± 5.5 kg/day of milk yield and 100.5 ± 26.6 days of milk (mean ± SD)) were distributed in a replicated 4 × 4 Latin square design with 21-day periods (last seven days for sampling). Treatment sequences were randomly designated to cows and consisted of: (1) CON - Control, no feed additive; (2) SAP - 16 g/cow/day of a supplement based on whole-seed fenugreek powder (variety Fenucold) standardized to diosgenin, one of the major steroidal sapogenins of fenugreek (2000 mg/kg); (3) SAPEO - SAP supplement combined with a blend of natural EOs with major components of carvacrol (2500 mg/kg), cinnamaldehyde (5600 mg/kg) and limonene (3000 mg/kg); and (4) MON - Monensin, inclusion of monensin sodium in the diet at 24 mg/kg DM. Cows fed CON showed higher dry matter, organic matter, crude protein and ether extract intakes than animals fed MON, whereas higher neutral detergent fibre intake was observed in animals fed SAPEO than those fed MON (P more...

Summary For most organisms, early life-history stages are the most sensitive to environmental stress and so transgenerational phenotypic plasticity, whereby the parental environment and offspring environment interact to alter the phenotype of the offspring, is viewed as key to promoting persistence in the face of environmental change. While there has been long-standing interest in the role of transgenerational plasticity via the maternal line (traditionally the field of maternal effects), increasingly it appears that paternal effects can also play a role. Despite the emerging role of paternal effects in studies of global change, key knowledge gaps remain: first, whether paternal effects act to increase or decrease offspring performance remains largely unexplored; second, the relative roles of maternal and paternal effects are rarely disentangled; and third, the role of environmental variation, a key determinant of the benefits of transgenerational plasticity, has not been explored with regard to paternal effects. Here, we explore all three issues using the marine tubeworm Galeolaria caespitosa, an important habitat-forming species in southern Australia. We found that both paternal and maternal experiences affected key stages of offspring performance (fertilization and larval development) and, surprisingly, paternal effects were often stronger than maternal effects. Furthermore, we found that paternal effects often reduced offspring performance, especially when environments varied compared with when environments were stable. Our results suggest that, while transgenerational plasticity may play an important role in modifying the impacts of global change, these effects are not uniformly positive. Importantly, paternal effects can be as strong, or stronger, than maternal effects and environmental variability strongly alters the impacts of paternal effects. more...

Background Uveitis in children is rare. Intensive interactions between ophthalmologists and paediatric rheumatologists are needed in order to choose the best therapeutic strategies for severe uveitis attacks. Objectives Describe a cohort of 74 patients with paediatric uveitis. Methods Retrospective analysis of children followed for uveitis before 18, by one paediatric rheumatologist (SGC) for systemic treatments9 management and members of 3 ophthalmologic departments specialized in uveitis care in children (AR, CT, ML and BB) in Paris, during the 2006–16 period. Results There were 74 paediatric uveitis, 42 anterior (57%, group1), 16 intermediate (21%, gr2), 7 posterior (9%, gr3) and 9 pan-uveitis (12%, gr4). Gender was equal in gr2–4, but there were more females in gr1. At presentation, mean ages were 8.6±4.1, 9.8±3.9, 9.1±3.6 and 10±4.2 years old. Mean follow-up was 3.7±3.7 years. JIA was the leading cause of gr1 uveitis (45%); gr2–3 uveitis were idiopathic in 81% and 86%, respectively. In gr4, etiologies were found in 7 out of 9 patients (Behcet-3, JIA-2, BBS-1, TINU-1). Conclusions Paediatric uveitis induce a very high-level burden in children, even when anterior and sometimes despite optimal therapeutic management in tertiary care centers. Their early recognition and tight control in specialized units are absolutely required in order to decrease the level of definitive complications. Disclosure of Interest None declared more...

Background Ultrasound (US) was found to have face and content validity for detecting synovitis in juvenile idiopathic arthritis (JIA) with higher sensitivity than clinical examination. In order to test validity and improve the applicability of US in JIA, the OMERACT US pediatric subtask force recently published preliminary definitions for the sonographic features of synovitis in children. Objectives Aim of this study was to confirm and improve B-mode and color power/Doppler (PD) US definitions for synovial components and grading in children, by using an image and patient based exercise. Methods The definitions were confirmed and modified in a multi-step process. In the 1st step, definitions were developed in multi-round Delphi web based consensus process were ≥80% of participants would need to reach ≥80% of agreement on a Likert scale from 1–5 (1 strongly disagree, 2 disagree, 3 neutral, 4 agree, 5 strongly agree). In the 2nd step, in a face to face meeting, a subgroup of these experts revised the definitions for final wording and performed intra- and inter-observer reliability exercise study in JIA patients as the final 3rd phase of the process. The definitions were tested in four joints (wrist, 2nd MCP, knee and ankle) of JIA patients divided in four age groups following standardized image acquisition and machine setting protocol. Statistics program R (version 3.3.0) was used for the statistical analyses. For intra-rater agreement Cohen kappa and for inter-rater agreement prevalence and bias adjusted kappa (PABAK) were calculated if needed. Results Reliability exercise included 20 JIA patients (distributed in equal numbers by age groups), 14 observers, 4 joints/observer, 3 observers/joint, 360 intra- and 360 inter-observer tests. A 0–3 semi-quantitative B-mode and color power/Doppler US definitions for synovial components and grading, were agreed (presented in Figure 1). Conclusions The proposed synovitis grading for children showed to be reliable why the next step should be to test sensitivity to change in order to possibly be used as an outcome tool in JIA. Disclosure of Interest None declared more...

Deficits in emotional processes are often observed by clinicians in anorexia nervosa and may have an impact on social functioning. Recognition of emotion was mostly investigated using visual stimuli as faces of emotional scenes. Only one study (Kucharska-Pietura et al., 2004) demonstrated impairments in emotional prosody using positive and negative valenced stimuli. However, this study did not provide a highlight for the identification of emotional bias (for example, to recognize an intense fear in a friendly voice). The aim of this study is to better understand the recognition of emotional prosody in anorexia nervosa using a wide range of positive, negative and neutral stimuli (Belin et al., 2008).In order to test emotion recognition biases in emotional prosody, we exposed 15 patients with anorexia nervosa and 15 healthy controls (HCs) to emotional vocal tasks asking them to rate emotional intensity on visual analog scales. In addition, we assessed clinical symptomatology and cognitive functioning for all participants.We showed that patients with anorexia nervosa provided higher intensity ratings on the non-target scales (e.g., surprise scale for fear stimuli) than HCs for sadness, fear and neutral voices. Furthermore, with the exception of neutral vocal stimuli, they provided the same intensity ratings on the target scales as the HCs.These findings suggested a bias in the processing of emotional prosody and may impact the social functioning of patients with anorexia nervosa. The bias may result from a sensorial deficit or a high-order cognitive dysfunction and have to be investigated in future studies.Disclosure of interestThe authors have not supplied their declaration of competing interest. more...

In this paper, we propose a new method to construct fuzzy partitions from data. The procedure generates a hierarchy including best partitions of all sizes from n to two fuzzy sets. The maximum size n is determined according to the data distribution and corresponds to the finest resolution level. We use an ascending method for which a merging criterion is needed. This criterion is based on the definition of a special metric distance suitable for fuzzy partitioning, and the merging is done under semantic constraints. The distance we define does not handle the point coordinates, but directly their membership degrees to the fuzzy sets of the partition. This leads to the introduction of the notions of internal and external distances. The hierarchical fuzzy partitioning is carried independently over each dimension, and, to demonstrate the partition potential, they are used to build fuzzy inference system using a simple selection mechanism. Due to the merging technique, all the fuzzy sets in the various partitions are interpretable as linguistic labels. The tradeoff between accuracy and interpretability constitutes the most promising aspect in our approach. Well known data sets are investigated and the results are compared with those obtained by other authors using different techniques. The method is also applied to real world agricultural data, the results are analyzed and weighed against those achieved by other methods, such as fuzzy clustering or discriminant analysis. more...

International audience; Background: The aim of our study was to investigate, in bipolar patients, the association between tobacco status (use and dependence) and history of suicide attempt, and to assess the possible role of inflammation as a missing link in the association between smoking status and history of suicide attempt. Methods: A total of 453 adult bipolar outpatients recruited in the French FondaMental Advanced Centres of Expertise for Bipolar Disorder were divided into two subgroups: 274 patients without past history of suicide attempt (non-SA), and 179 patients with a past history of suicide attempt (SA). Tobacco use and dependence, psychiatric and somatic comorbidities, history of childhood abuse, family history of suicide were assessed. Fasting blood tests yielded samples collected for the measurement of high sensitivity (hs-)CRP. Results: The risk of suicide attempt increased with smoking dependence. Notably, bipolar patients with a history of suicide attempt were three times more likely to have severe tobacco dependence, independently of confounding factors. However, we failed to find arguments promoting the hypothesis of inflammatory markers (through hs-CRP measure) in the link between tobacco dependence and suicidal behavior. Conclusions: We found a significant association between severe tobacco dependence and history of suicide attempt, but not with level of CRP, independently of confusing factors. Longitudinal studies taken into account all these potential confusing factors are needed to confirm our results. more...

Objectives The aim of this study was to investigate whether the quadrivalent human papillomavirus (HPV) vaccine Gardasil is associated with a change in the risk of autoimmune disorders (ADs) in young female subjects. Design Systematic case–control study of incident ADs associated with quadrivalent HPV vaccination in young women across France. Participants and setting A total of 113 specialised centres recruited (from December 2007 to April 2011) females aged 14–26 years with incident cases of six types of ADs: idiopathic thrombocytopenic purpura (ITP), central demyelination/multiple sclerosis (MS), Guillain–Barre syndrome, connective tissue disorders (systemic lupus erythematosus, rheumatoid arthritis/juvenile arthritis), type 1 diabetes mellitus and autoimmune thyroiditis. Control subjects matched to cases were recruited from general practice. Analysis Multivariate conditional logistic regression analysis; factors included age, geographical origin, smoking, alcohol consumption, use of oral contraceptive(s) or vaccine(s) other than Gardasil received within 24 months before the index date and personal/family history of ADs. Results Overall, 211 definite cases of ADs were matched to 875 controls. The adjusted odds ratio (OR) for any quadrivalent HPV vaccine use was 0.9 [95% confidence interval (CI) 0.5–1.5]. The individual ORs were 1.0 (95% CI 0.4–2.6) for ITP, 0.3 (95% CI 0.1–0.9) for MS, 0.8 (95% CI 0.3–2.4) for connective disorders and 1.2 (95% CI 0.4–3.6) for type 1 diabetes. No exposure to HPV vaccine was observed in cases with either Guillain–Barre syndrome or thyroiditis. Conclusions No evidence of an increase in the risk of the studied ADs was observable following vaccination with Gardasil within the time periods studied. There was insufficient statistical power to allow conclusions to be drawn regarding individual ADs. more...

Selon les recommandations actuelles, les traitements de choix des troubles alimentaires compulsifs type boulimie et hyperphagie boulimique reposent sur plusieurs aspects. Tout d’abord, une prise en charge hygiéno-diététique ayant pour objectif de restructurer les prises alimentaires, modifier les comportements alimentaires en dehors des crises, tester les croyances erronées vis-à-vis des aliments, aider à la gestion des vomissements… Elles sont le plus souvent associées à une prise en charge psychothérapique et/ou médicamenteuse. La psychothérapie de choix est la thérapie cognitivo-comportementale (TCC). Compte tenu de leurs cibles thérapeutiques les TCC sont plutôt à réserver à des patientes euthymiques, ayant de fortes préoccupations pour la minceur. L’alternative psychothérapique peuvent être les thérapies interpersonnelles et éventuellement les thérapies psychanalytiques dans certaines situations. Le traitement médicamenteux de première ligne est la fluoxetine à dose anti-compulsive (60 mg/j). D’autres prises en charge médicamenteuses sont proposées (epitomax, naltrexone…) mais doivent être réservées à des deuxièmes lignes après avis spécialisé. Quelle que soit la prise en charge retenue, il est fondamental dans le cadre de l’hyperphagie boulimique d’expliquer aux patients que ces prises en charge n’auront pas d’effets amaigrissants En complément de ces prises en charge, des techniques de self-help devraient être systématiquement associées. Ces techniques consistent en l’utilisation de différents outils (livres, des sites Internet, CD…) qui seront utilisé par le patient seul ou accompagné par le thérapeute dans le but d’augmenter ses connaissances par rapport sa problématique et lui apporter des compétences et des outils pour diminuer les symptômes voir les faire disparaître. Ces techniques simples et pouvant être facilement utilisées par tous ont été validées scientifiquement dans plus d’une trentaine d’études y compris en population française. Certains de ces supports de self-help, actuellement disponibles en France, seront présentés. more...

Early definition of oenologically significant zones within a vineyard is one of the main goals of precision viticulture, as it would allow an increase in profitability through the adaptation of agronomic practices to the specific requirements of each zone, and/or segregation of the harvest into different batches to produce wines with different qualities. The aim of this work was to evaluate whether early grape sampling is a relevant tool for within-vineyard zone definition. The study was carried out in 2010 and 2011 in a 4.2 ha vineyard, where a grid of 60 sampling points was defined. 300-berry samples were picked from each sampling point after veraison and at harvest, post-veraison information being used to define zones within the vineyard after fuzzy k-means analysis and subsequent application of a zoning procedure that took into account membership degree and neighbourhood criteria. Two variations of the zoning procedure were used, standard (StdZ) and top (TopZ) zoning. Each was designed to meet different requirements of wineries; StdZ gave the same oenological relevance to all the zones, and TopZ differentiated the zones producing 'top class' grapes, minimizing the within-zone variability in the top-class zone. Grape composition obtained at harvest from the zones delineated post-veraison was compared. Zone delineation using post-veraison data was proved to be oenologically relevant, provided sampling is performed once veraison is completed. The two zoning algorithms designed were shown to be suitable for objective zone delineation according to the goals intended for each. This work was funded by the Dpt. Innovación, Industria & Empleo of the Government of Navarra (MODELVID, Ref: IIM11879.RI.1), by the Centro para el Desarrollo Tecnológico Industrial CDTI (Ref: IDI-20100729, co-funded by the European Union ERDF as part of the Operational Programme I+D+i Technology Fund 2007-2013) and by Fundación Fuentes Dutor. I.U. The Spanish Ministry of Education funded I.U. stage in SupAgro, Montpellier (EDU/2719/2011). more...

Background Mevalonate Kinase Deficiency (MKD) is one of the autoinflammatory fever syndromes, caused by mutations in the MKD gene. Systemic inflammatory symptoms may be mild to severe leading to early death, and recurrent bacterial infections frequently develop in the disease course. On demand NSAID and steroids are the most commonly used. Few case-reports suggested that interleukin-1 (IL-1) antagonists could alleviate MKD symptoms. more...

International audience; Fuzzy inference systems (FIS) are widely used for process simulation or control. They can be designed either from expert knowledge or from data. For complex systems, FIS based on expert knowledge only may suffer from a loss of accuracy. This is the main incentive for using fuzzy rules inferred from data. Designing a FIS from data can be decomposed into two main phases: automatic rule generation and system optimization. Rule generation leads to a basic system with a given space partitioning and the corresponding set of rules. System optimization can be done at various levels. Variable selection can be an overall selection or it can be managed rule by rule. Rule base optimization aims to select the most useful rules and to optimize rule conclusions. Space partitioning can be improved by adding or removing fuzzy sets and by tuning membership function parameters. Structure optimization is of a major importance: selecting variables, reducing the rule base and optimizing the number of fuzzy sets. Over the years, many methods have become available for designing FIS from data. Their efficiency is usually characterized by a numerical performance index. However, for human-computer cooperation another criterion is needed: the rule interpretability. An implicit assumption states that fuzzy rules are by nature easy to be interpreted. This could be wrong when dealing with complex multivariable systems or when the generated partitioning is meaningless for experts. This paper analyses the main methods for automatic rule generation and structure optimization. They are grouped into several families and compared according to the rule interpretability criterion. For this purpose, three conditions for a set of rules to be interpretable are defined.; Les systèmes d'inférence floue (SIF) sont très utilisés pour la simulation ou le contrôle des procédés. Ils peuvent être conçus à partir de l'expertise ou bien à partir d'un ensemble de données. Ceux qui sont basés sur la seule expertise humaine souffrent généralement d'un manque de précision, tandis que les règles inférées à partir des données sont souvent difficiles à interpréter pour les experts. La coopération des deux types de SIF, indispensable pour la gestion des systèmes complexes, est envisageable sous réserve que l'induction automatique des règles produise de la connaissance, sous forme de règles, qui soit réutilisable par les experts. L'induction de règles peut être décomposée en deux phases : la génération automatique des règles et l'optimisation du système. Cette dernière inclut la sélection de variables et la réduction de la base de règles. Cet article analyse les principales méthodes disponibles et les compare suivant un critère essentiel pour la coopération homme-machine : l'interprétabilité des règles. more...

The objective of this work was to characterise the particle size of milling products by image analysis. Four classes of milling products were obtained by varying the roll gap of the second break roll of the mill. Images were acquired by using an in-flow imaging system implemented in the mill, and 1300 images were recorded for each class. Three methods of image analysis were investigated: morphological opening, constant grey level run lengths and grey level spatial interdependences. Discriminant anlyses were applied to the data extracted from the images by the three methods in order to identify each class of milling product. More than 77% of the samples were correctly assigned to their group both for the calibration and validation sets. The best results were obtained by applyng morphological openings or by computing parameters from the co-occurrence matrices. The number of correct classifications rose to 81% of samples with only three variables selected for the opening curves and to 83% with three co-occurrence parameters., L'objectif de ce travail était de caractériser la granulométrie de blé en cours de broyage par analyse d'image. Quatre classes de produits ont été obtenues en faisant varier l'écartement des rouleaux du deuxième broyeur du moulin. Le dispositif d'analyse d'image a été installé en ligne et 1300 images ont été enregistrées pour chaque classe. Trois méthodes globales d'analyse d'image ont été testées : l'ouverture morphologique, les longueurs de lignes à niveaux de gris constant, l'interdépendance spatiale des niveaux de gris. Une analyse discriminante a été appliquée sur les données extraites par ces trois méthodes. Plus de 77% des échantillons, de l'ensemble d'apprentissage ou de l'ensemble de validation, ont été correctement classés. Les meilleurs résultats ont été obtenus par le traitement des données issues de par la distribution par ouverture d'une part, et des matrices de co-occurrences d'autre part. Les performances en classification atteignent 81% avec seulement 3 paramètres pour la distribution par ouvertures et, 83% avec 3 paramètres des matrices de co-occurrences. more...

This study compared the personality self-representations of 288 hand injured patients with those of 959 young people (15-25 years old) randomly selected from the general population (noted GP), and with those of 336 unemployed people of all ages in professional training (U) in Lorraine (north-eastern France). The relationship between patients' personality self-representations and injury was also investigated. Personality self-representations included 14 questions: in your own opinion are you sociable?, at ease with others?, serious?, careful?, dynamic?, optimistic?, worried?, irritable?, clumsy?, solitary?, organised?, ambitious?, do you have a sense of responsibility?, and many plans? The patients had similar self-representations to GP except for the items non clumsy (odds ratio adjusted on age and sex OR = 2.40, p0.05) and optimistic (OR = 1.70, but 0.05p0.10). The frequencies of non irritable, non clumsy and non solitary people were higher in patients than in the U group (OR about 2.40, p0.01). By contrast, the other items were more favourable for the U group except for the items sociable, organised and having many plans. Self-representation items were significantly related to some socio-demographic data. The work injured workmen having one or more previous work injuries during the last five years were more at ease with others than the other subjects. Among the work injured workmen who had had no previous work injury during this time, the people aged 29 or less (the highest risk age class) were more optimistic than the others (71% vs 49%, p0.05); a difference was also found for the items at ease with others, careful, dynamic, and non worried, but it was not significant possibly due to the small number of subjects. The sum of these five items differed between the two age groups (3.29 +/- 1.49 vs 2.55 +/- 1.68, p0.05). These simple items would provide an interesting approach in terms of personality which could explain in part the excess of work injuries in young people, though the work requirement still seemed to be the highest risk factor. more...

As part of a process to improve the quality of care, the French Society of Biological Psychiatry developed recommendations for clinical practice in bipolar disorder.MethodThe method chosen for these guidelines is a formalized consensus of experts. It enables, through a series of specific clinical situations proposed to the experts, to provide recommendations for the management of bipolar disorder. The situations where defined because they are not associated to evidence-based recommendations according to the lack of controlled studies.Results40 experts participate to this consensus. As in most of the guidelines for the treatment of bipolar disorder, more than 50 % of experts (51,3 to 72,9%) recommend the same therapeutic strategies to treat major depressive episode whichever the type (bipolar I or II).Unlike to other guidelines, French experts propose different therapeutic according to the presence or absence of rapid cycling. For major depressive episode without rapid cycling, 63% experts recommend a combination of an antidepressant with a mood stabilizer. In rapid cyclers, 51% experts recommend the use of a mood stabilizer in monotherapy or in combinaison, but never associated with antidepressant.ConclusionThis methodological approach enables to get closer to everyday clinical practice and integrate specificities of prescription through a national panel of experts. On the other hand, this type of methodology highlights the research perspectives: i.e. management of acute depression with rapid cycle in bipolar disorder. more...

Stratigraphic and mineralogic study of the heavy and light minerals from Cretaceous (Aptian-upper Albian) localities in the Jura (France) indicate their similarity to the neighboring regions. The formations show a uniform mineralogic composition. Qualitative mineralogical analysis of the heavy minerals shows that the Albian sands are homogeneous, essentially composed of tourmaline, zircon, rutile, anatase, and garnet. Andalusite is found frequently and is more abundant than epidote. Mineralogical analysis of the light minerals from the different areas shows that quartz is abundant in all the beds in varying degrees. Glauconite is present in some of the sand beds. more...

With the help of microstratigraphic analyses, a study was made of the transition in the Neocomian (lower Cretaceous) from the Jura-type facies to the Subalpine facies on Outheran mountain south of Chambery (Savoie, French Alps). The lower Cretaceous boundary of the Jura-type and Subalpine facies has a different direction from the present structure. The transition zone between the platform and the deep basin shifted from southeast to northwest during the Valanginian and Hauterivian. more...

VII, 516 p.