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Background The statistical Bayesian approach is widely used in disease mapping and Poisson regression. Results differ depending on the underlying hypothesis. Our objective is to give a comprehensive presentation of the tools that can be used to interpret results and choose between the different hypotheses. Data from the Isere cancer registry (France) illustrate this presentation. Method We consider, first, Bayesian models for disease mapping. Classic heterogeneity (Potthoff-Whithinghill statistic) and spatial autocorrelation tests (Moran statistic) of the SIRs, the DIC criteria of the different Bayesian models and finally the comparison of the empirical variance of the unstructured and structured heterogeneity components of the BYM model are considered. The last two criteria are considered for Bayesian Poisson regression including a covariate. Mapping the components of the BYM model with a covariate is also considered. Results Four cancer sites (prostate, lung, colon-rectum and bladder) in men diagnosed during the 1998–2007 period are used to illustrate our presentation. We show that the different criteria used to interpret and to choose a model give coherent results. Conclusion A relevant interpretation of results is a necessary step in choosing the best-adapted Bayesian model. This choice is easy to make with criteria such as the DIC. The comparison of the empirical variance of the unstructured and structured heterogeneity components of the BYM model is also informative.

Within a dynamical description of nuclear fragmentation, based on the spinodal decomposition scenario, we explore the relation between isovector density fluctuations and nuclear symmetry energy. We show that, inside the fragmenting system, isovector fluctuations follow the evolution of the local density and approach an equilibrium value connected to the local symmetry energy. Higher density domains are characterized by smaller average asymmetry and narrower isotopic distributions. This analysis indicates that fragment isotopic properties and isoscaling can probe the symmetry energy in the density regime corresponding to fragment formation.

A full implementation of the Boltzmann-Langevin equation for fermionic systems is introduced in a transport model for dissipative collisions among heavy nuclei. Fluctuations are injected in phase space and not, like in more conventional approaches, as a projection on suitable subspaces. The advantage of this model is to be specifically adapted to describe processes characterised by instabilities, like the formation of fragments from a hot nuclear system, and by dissipation, like the transparency in nucleus-nucleus collisions., Comment: Conf. proc. 105, IWM2011 http://dx.doi.org/10.1051/epjconf/20123100027

N/Z effects were observed on variables measured in central Xe on Sn collisions around the Fermi energy. Comparisons were made with dynamical simulations of collisions in which the symmetry term of the EOS was varied. In this framework it appeared that the observed effects were due to the dynamics of the reaction and not to the deexcitation of the hot primary fragments. The elaboration of the Equation of State (EOS) for nuclear matter requires more experimental constraints, particularly for the formulation of an adequate symmetry term whose density dependence at sub- and supranormal density is still debated. Isospin dependent observables measured in reactions induced by judiciously chosen projectile-target couples already provide some hints on the symmetry term; the derived form is however highly model-dependent. Thus cross-checks making use of a large body of variables and models are necessary to obtain reliable information.

We examined the role of calcitonin gene-related peptide (CGRP) in cortical spreading depression (CSD)-induced dilation of rabbit pial arterioles. In urethan-anesthetized rabbits instrumented with a closed cranial window, CSD induction with KCl dilated pial arterioles from 86 +/- 10 to 132 +/- 13 (mean +/- SE, n = 6) microns (a 54 +/- 9% increase). Topical administration of 12.8 microM CGRP-(8-37), a competitive inhibitor of the CGRP receptor, reduced CSD-induced pial dilation from 54 +/- 9% baseline to 33 +/- 9% (P < 0.05). Removal of the receptor antagonist from the brain surface restored CSD-induced dilation to 59 +/- 11% (P < 0.05, compared with the response with the antagonist present). In other animals, we showed that this dose of the CGRP antagonist attenuated arteriolar dilation to topically applied 10(-7) M CGRP (n = 5), but it did not alter arteriolar dilation to arterial hypercapnia. We also evaluated the dilator potency of substance P (SP) compared with CGRP. Dilation with 10(-7) M SP was only 22 +/- 11%, whereas arterioles dilated to 57 +/- 7% above baseline diameter with 10(-7) M CGRP. We conclude that CGRP contributes to the transient arteriolar dilation that is characteristic of CSD.

The intent of this study is not to defend a preconceived notion that either the market or the public sector is more defensible, but to inform the reader of the public support of the arts. The issue at hand, is whether or not public support of art activities can generate economic development and revenue in an urban regional economy. The scope of this paper will concentrate on the performing and visual artists.Before proceeding into the investigative background, it is important to establish a protocol statement as to “What Art Is.” In western societies, it has been argued that the core of art includes literature, the media, performing and visual art. The fundamental difference in the performing artist and the visual artist is that the former is rewarded with abundance, where the latter by scarcity. There are several reasons why art would be supported. They are as follows: First, art is not necessarily a daily part of our conscious lives. However, large amounts of primary satisfaction received from art can lead to abstractions and ideas that are distributed and used in all parts of the economy. For example, the influence color tones may have on a particular advertising campaign of a particular product line. Second, art is basic to all human endeavors, collectively and individually. It is a link with the past, present and future. Art thus acts as education does—to influence, move, stimulate, and sustain us. Third, if in fact art plays such an important part of our cultural heritage, we do not want our society to experience a deficit in art supply. Baumol and Bowen, in Performing Arts: The Economics Dilemma, make the argument that the labor intensity of the performing arts and its production cannot maintain the proper tempo with the continuous increase in technology in an industrial economy. Thus the performing arts face the stoic reality that operating costs will continue to be above earned revenue. They maintain that investments in performing arts tend to be labor intensive, therefore having the effect of widening the gap between earned revenue and operating costs.Barton Weisbrod, of the University of Illinois, claims that economics of the arts yield an “option value.” He defines “option value” as the value assigned to an option to consume, which we may not plan to consume in the near future. This creates a scenario that art works and products would have value to a person who may not personally participate. The myopia nature of the market mechanism may very well fail to allocate and distribute works, which would share these characteristics. Cultural capital, like real capital, is a stock variable and is subject to depletion. Art is a part of cultural capital, but must be preserved and replenished. Art as cultural capital can and does stimulate cultural tourism. Thus, cultural capital can and should be used as a possible generator of economic activity. A Heuristic database will be established showing the impact of cultural capital on the growth of art activities, jobs, spending and tourism in urban areas. It is particularly interesting to note that cultural activities may flourish in urban areas while the urban area itself may not flourish economically. Demand and supply economies such as those generated by cultural capital can generate economic development through broadening the economic base of an urban area. A recent study showed the impact of forty-five art organizations in Washington, D.C. These organizations accounted for $619 million dollars or for every one dollar invested, the art community returned an estimated five dollars and ninety cents into the economy. Thus the art community, and support for it, act as an incubator of broad-based demand and supply economies. Public support of cultural capital may very well be providing funds for high participation rates in art endeavors, as well as seed monies for low participation rates of art endeavors. The dilemma for the funding of cultural capital in the arts industry is that there has been a significant cut at the federal, state and local levels. This has forced the arts industry to face the need for expanding viewership and private funding. It can be argued that the lure of a clean, productive and community enhancing industry, such as the arts industry, would certainly be aggressively sought by any urban economics development agency.

Summary Objectives: Little is known about cancer prevalence due to a lack of systematic recording of cancer patient follow-up data. To estimate the annual hospital prevalence of breast cancer in the general population of the Isère department (1.1 million inhabitants) in the Rhône-Alpes region, the second largest region in France (6 million inhabitants), we used the inpatient case-mix data, available in most European countries, to develop a method of cancer case identification. Methods: A selection process was applied to the acute care hospital datasets among women aged 18 years or older, living in the Isère department and treated for breast cancer between 2004 and 2007. The first step in case selection was based on the national anonymous unique patient identifier. The second step consisted of retrieving all hospital stays for each case. The third step was designed to detect inconsistencies in the coding of the primary localization. An algorithm based on ICD-10 code for the hospital admission diagnosis was used to rule out hospitalizations unrelated to breast cancer. Five possible models for estimating prevalence were created combining selection steps with the admission diagnosis algorithm. Results: Hospital prevalence over the four-year period varied from 6073 breast cancer cases for the simplest model (first selection step without the admission diagnosis algorithm) to 4951 when the first selection step was associated with the breast cancer code as admission diagnosis. The model combining the third selection step with a breast cancer-specific admission reason provided 5275 prevalent cases. Conclusion: The last model seems more appropriate for case-mix-data coding. Selecting admission diagnosis improved specificity. Combining all hospital stays for each patient has improved diagnostic sensitivity.

Analysis of the temporal trend of epidemiological data is becoming increasingly popular. For the purpose, the JoinPoint is a widely used software. We present important elements involved when using some of the options of this software.In order to identify potential breakpoints in the trends and estimate average rates of change, JoinPoint applies piecewise regression to model the expectation of a variable that fluctuates over time.Using breast cancer incidence data from Isère, an administrative district in France, during the period 1979-2007, we show the effects of user choices concerning the potential number of breakpoints, the research method used by the final model, the length of the period, and the weighting coefficients.JoinPoint is useful to describe changing trends. Nevertheless, user choices have an impact on output and must be clearly identified. Moreover, the JoinPoint approach cannot replace other possible approaches for temporal analysis of observational data.

Use of French Diagnosis Related Groups (DRGs) program databases, apart from financial purposes, has recently been improved since a unique anonymous patient identification number has been created for each inpatient in administrative case mix database. Based on the work of the group for cancer epidemiological observation in the Rhône-Alpes area, (ONC-EPI group), we review the remaining difficulties in the use of DRG data for epidemiological purposes and we consider a longitudinal approach based on analysis of database over several years. We also discuss limitations of this approach.The main problems are related to a lack of quality of administrative data, especially coding of diagnoses. These errors come from missing or inappropriate codes, or not being in accordance with prioritization rules (causing an over- or under-reporting or inconsistencies in coding over time). One difficulty, partly due to the hierarchy of coding and the type of cancer, is the choice of an extraction algorithm. In two studies designed to estimate the incidence of cancer cared in hospitals (breast, colon-rectum, kidney, ovaries), a first algorithm, including a code of cancer as principal diagnosis with a selection of surgical procedures less performed than the second one including a code of cancer as principal diagnosis only, for which the number of hospitalizations per patient ratio was stable across time and space. The chaining over several years allows, by tracing the trajectory of the patient, to detect and correct inaccuracies, errors and missing values, and for incidence studies, to correct incident cases by removing prevalent cases.However, linkage, complete only since 2007, does not correct data in all cases. Ways of future improvement certainly pass through improved algorithms for case identification and especially by linking DRG data with other databases.

Introduction : This study aimed at modelling the effect of organized breast cancer screening on mortality in France. It combined results from a Markov model for breast cancer progression, to predict number of cases by node status, and from relative survival analyses, to predict deaths. The method estimated the relative risk of mortality at 8 years, in women aged 50–69, between a population screened every two years and a reference population. Methods : Analyses concerned cases diagnosed between 1990 and 1996, with a follow-up up to 2004 for the vital status. Markov models analysed data from 3 screening programs (300,000 mammographies) and took into account opportunistic screening among participants to avoid bias in parameter's estimates. We used survival data from cancers in the general population ( n =918, 7 cancer registries) and from screened cancers ( n =565, 3 cancer registries), after excluding a subgroup of screened cases with a particularly high survival. Sensitivity analyses were performed. Results : Markov model main analysis lacked of fit in two out of three districts. Fit was improved in stratified analyses by age or district, though some lack of fit persisted in two districts. Assuming 10% or 20% overdiagnosed screened cancers, mortality reduction was estimated as 23% (95% CI: 4, 38%) and 19% (CI: −3, 35%) respectively. Results were highly sensitive to the exclusion in the screened cancers survival analysis. Conversely, RR estimates varied moderately according to the Markov model parameters used (stratified by age or district). Conclusion : The study aimed at estimating the effect of screening in a screened population compared to an unscreened control group. Such a control group does not exist in France, and we used a general population contaminated by opportunistic screening to provide a conservative estimate. Conservative choices were systematically adopted to avoid favourable estimates. A selection bias might however affect the estimates, though it should be moderate because extreme social classes are under-represented among participants. This modelling provided broad estimates for the effect of organized biennial screening in France in the early nineteen-nineties. Results will be strengthened with longer follow-up.

L’editeur a le regret de vous informer que cet article ayant deja ete publie dans: Annales d’Endocrinologie, Vol. 71 (2010), pages 95–101, doi:10.1016/j.ando.2009.11.006 , cette seconde publication faite par erreur a ete retiree.

International audience; To explore the effect of age at diagnosis on relative survival from breast cancer at different cancer stages and grades, using appropriate statistical modeling of time-varying and non-linear effects of that prognostic covariate. Data on 4,791 female invasive breast cancers diagnosed between 1990 and 1997 were obtained from a French cancer registry. The effect of age on relative survival was studied using an approach based on excess rate modeling. Different models testing non-linear and non-proportional effects of age were explored for each grade and each stage. In the whole population, the effect of age was not linear and varied with the time elapsed since diagnosis. When analyzing the different sub-groups according to grade and stage, age did not have a significant effect on relative survival in grade 1 or stage 3 tumors. In grade 2 and stage 4 tumors, the excess mortality rate increased with age, in a linear way. In grade 3 tumors, age was a time-dependent factor: older women had higher excess rates than younger ones during the first year after diagnosis whereas the inverse phenomenon was observed 5 years after diagnosis. Our findings suggest that when taking into account grade and stage, the time-varying impact of young age at diagnosis is limited to grade 3 tumors, without evidence of worst prognosis at 5 years for the youngest women.

Describe time trends of incidence and mortality associated with thyroid cancer and provide 1 and 5-year survivals by histological group in French areas covered by cancer registries.Data for 1975 to 2004 were provided by one thyroid-dedicated and 11 general registries. Incidence estimates were obtained by correction of incidence from areas with registries, then projections for 2008 were derived. Overall and relative survivals by sex and age (diagnosis period 1989-1997; cut-off date 1st January 2002) were obtained from the dedicated and nine other registries. Comparisons between areas or time periods used world-standardized rates.Between 1980 and 2005, incidence increased but mortality decreased in men and women. Annual cases increased five times and projections for 2008 were 8,000 cases and 400 deaths. The main increasing subtype was papillary carcinoma. One-year overall and relative survivals were 92 and 94%, respectively. Five-year overall and relative survivals were 87 and 93%, respectively. The highest survival (94%) concerned papillary carcinomas and the lowest (15%) anaplastic carcinomas. Survivals were generally higher in women than in men; precisely, higher in women for papillary and follicular carcinomas but higher in men for medullary and anaplastic carcinomas. Survivals increased with age, but for medullary carcinomas. Survivals from anaplastic carcinomas were very low whatever the age.The increase of thyroid cancer frequency is dramatic but survivals are improving. Though the prognosis of the most increasing histological subtype is generally good, it remains very important to identify the causes of this steady increase to implement adequate preventive measures.

Mayotte fore-slopes exhibit a distinct pattern in overall morphology, starting in the deep with an unlithified sedimentary wedge and slope, followed upwards by a cemented slope, and finally by a steep, almost vertical wall. On top of the wall, drowned reefs occur. Dated corals may reveal the history of sea-level changes indicating pristine reef growth during late isotope stage 3 (at 55–24 ka) at a present-day water depth greater than 80 m. A maximum sea-level drop of 150 m occurred during the last glacial maximum, around 20 ka. This lowering of sea-level is documented by karst features such as small caves and corroded and jagged surfaces. The phase of deglaciation is recorded by two give-up reef levels at 100–90-m water depth and 65–55-m water depth which we may relate to the Bolling (14 ka) and post Younger Dryas (11.5 ka) meltwater pulses, known from the deep-sea record.

International audience; A quantitative comparison regarding absolute cross sections associated to Statistical and Dynamical Fission processes in the 124Sn+64Ni and 112Sn+58Ni collisions experimentally investigated at 35 AMeV beam energy using multi-detector CHIMERA is presented. It results that Dynamical Fission process is about two times more probable in the neutron rich 124Sn+64Ni system than in the 112Sn+58Ni neutron poor one. The observed difference could indicate an influence of the entrance channel Isospin (N/Z) content on the reaction mechanisms.

OBJECTIVE: We examined the incidence of perioperative fever and its relationship to outcome among patients enrolled in the Intraoperative Hypothermia for Aneurysm Surgery Trial. METHODS: One thousand patients with initial World Federation of Neurological Surgeons grades of I to III undergoing clipping of intracranial aneurysms after subarachnoid hemorrhage were randomized to intraoperative normothermia (36 degrees C-37 degrees C) or hypothermia (32.5 degrees C-33.5 degrees C). Fever (> or =38.5 degrees C) and other complications (including infections) occurring between admission and discharge (or death) were recorded. Functional and neuropsychologic outcomes were assessed 3 months postoperatively. The primary outcome variable for the trial was dichotomized Glasgow Outcome Scale (good outcome versus all others). RESULTS: Fever was reported in 41% of patients. In 97% of these, fever occurred in the postoperative period. The median time from surgery to first fever was 3 days. All measures of outcome were worse in patients who developed fever, even in those without infections or who were World Federation of Neurological Surgeons grade I. Logistic regression analyses were performed to adjust for differences in preoperative factors (e.g., age, Fisher grade, initial neurological status). This demonstrated that fever continued to be significantly associated with most outcome measures, even when infection was added to the model. An alternative stepwise model selection process including all fever-related measures from the preoperative and intraoperative period (e.g., hydrocephalus, duration of surgery, intraoperative blood loss) resulted in the loss of significance for dichotomized Glasgow Outcome Scale, but significant associations between fever and several other outcome measures remained. After adding postoperative delayed ischemic neurological deficits to the model, only worsened National Institutes of Health Stroke Scale score, Barthel Activities of Daily Living index, and discharge destination (home versus other) remained independently associated with fever. CONCLUSION: These findings suggest that fever is associated with worsened outcome in surgical subarachnoid hemorrhage patients, although, because the association between fever and the primary outcome measure for the trial is dependent on the covariates used in the analysis (particularly operative events and delayed ischemic neurological deficits), we cannot rule out the possibility that fever is a marker for other events. Only a formal trial of fever treatment or prevention can address this issue.

triple-pressure correlations and to the dissipation rate of the potential temperature variance, respectively. This new parameterization takes into account the dependence of the third-order moments on the integral length scale of the dissipation rate, a quantity related to the eddy size variation across the boundary layer. The time scales are reduced as the integral length increases, and these reductions provide the proper damping of the turbulent vertical transport. In order to test our model, we carried out large eddy simulations (LESs) of boundary layers with shear and buoyancy. We present the results of the comparison with LESs, aircraft measurements, and DNS, which show that the model performs rather well in all the stability conditions and that the proposed damping gives reliable third-order moments that satisfy the realizability constraints.

Highlights on the recent research activity, carried out by the Italian Community involved in the "Nuclear Matter and Nuclear Dynamics" field, will be presented., Proceedings of the 12th Conference on Problems in Theoretical Nuclear Physics, to appear in Journal of Physics, Conference Series

Expérience réalisée au GANIL Soumis à Physical Review C; International audience; Isospin diffusion in semi-peripheral collisions is probed as a function of the dissipated energy by studying two systems $^{58}Ni$+$^{58}Ni$ and $^{58}Ni$+$^{197}Au$, over the incident energy range 52-74\AM. A close examination of the multiplicities of light products in the forward part of phase space clearly shows an influence of the isospin of the target on the neutron richness of these products. A progressive isospin diffusion is observed when collisions become more central, in connection with the interaction time.

A new higher order closure model for the stable boundary layer is presented and compared with Large Eddy Simulation data. The model includes numerical solutions for the mean values, second and third order moments equations. A satisfactory agreement is found between the calculated vertical profiles of the turbulent quantities with those provided by the LES. Furthermore the new model results are compared with profiles obtained with a lower order closure model in order to verify the effective importance of including third order dynamical equations in the model.

Between 1995 and 1997, in the territories of Southern Italy, there were fifteen murders of elderly women over the age of 70 years old. Initially, however, not all the murders were attributed to a single serial killer. The majority of the victims were stabbed multiple times in the neck, except for three cases in which the cause of death was manual strangulation. There was evidence of sexual assault in only one of the cases. All the victims were discovered in their own apartments, which were located on the ground level, with no signs of forced entry. In most of the cases, the offender stole money and/or jewellery. A multi-disciplinary team reviewed the cases during the investigation and created a profile of the killer. The team determined that the method of operation was completely unusual for the local criminal element. They suggested that the perpetrator could be an immigrant, who committed the murders for sexual motivation and who may have been arrested previously for sex-related incidents. On 15th September 1997, a suspect was arrested. He was identified as Ben Mohamed Ezzedine Sebai, a 35-year-old white male, originally from Tunisia. He was charged and convicted of four of the murders and was given a life sentence. In 2005, Sebai confessed to the murders of four additional elderly women, for which nine other people had already been previously tried and convicted, among them, a man who committed suicide in jail. In 2007, Sebai finally confessed to committing fifteen murders that occurred between 1995 and 1997. Sebai also admitted to experiencing sexual gratification at every homicide scene, even though there was no physical proof at most of the crime scenes. The goal of this article is to illustrate a little-known but noteworthy case concerning a serial sexual killer of elderly women that occurred in Southern Italy, highlighting the method of operation, the victim selection process, and the injuries inflicted. The article will also discuss his motivation, the mental health history of the offender, his clinical diagnosis, and his self-reported childhood abuse.

We investigated the dynamical dipole mode, related with entrance channel charge asymmetry effects, in the 40Ar+92Zr and 36Ar+96Zr fusion reactions at Elab = 15.1 A and 16 A MeV, respectively. These reactions populate, through entrance channels having different charge asymmetries, a compound nucleus in the A = 126 mass energy region, identical spin distribution at an average excitation energy of about 280 MeV. The compound nucleus average excitation energy and average mass were deduced by the analysis of the light charged particle energy spectra. By studying the γ‐ray energy spectra and the γ‐ray angular distributions of the considered reactions, the dynamical nature of the prompt radiation related to the dynamical dipole mode was evidenced. The data are compared with calculations based on a collective bremsstrahlung analysis of the reaction dynamics.

The aim of this investigation was to study geographic time trends of thyroid cancer incidence according to tumor size in France, 1983 to 2000.Incidence data were provided from six French registries over the period 1983-2000 covering seven administrative districts. Five tumor size groups were distinguished:10mm, 10-20mm, 20-40mm,40mm and unknown size. Papillary cancers diagnosed in women were analyzed according to tumor size in each geographic area. World age standardized rates were calculated and annual percent change rates were estimated for each tumor size group in each geographic area. Loglinear Poisson regression models were used to study geographic discrepancies in time trends incidences.The six French registries included 2222 papillary thyroid cancers in women between 1983 et 2000. Thyroid cancer incidence was increasing in the six geographic areas. Geographical variations in time trends incidence between registries reflected geographical variations in time trends incidence of small sized tumors (less than 10mm).Wide geographic variations in thyroid cancer incidence were noticed for small size tumors, which may be correlated with geographic variations in medical practices.

Lung cancer epidemics arose and spread in western countries when the tobacco industry created the manufactured cigarette and realised that nicotine addiction was the most adaptable way to increase and secure long-term sales 1. In spite of well-known toxicity of tobacco smoke 2 and the proven relationship of tobacco smoking with lung cancer incidence 3, the tobacco industry took advantage of the lack of response by western governments, concerning the alarms raised by physicians and citizen associations, and set up a very powerful marketing process directed at smokers, adult males and nonsmokers, females and adolescents with devastating effects. In all western countries the percentage of smokers increased, and the age at which the first cigarette was smoked decreased. Since susceptibility of females to tobacco carcinogens is higher, lung cancer in females equalled or exceeded lung cancer in males in different countries 4, even in females with a lower, but regular, cigarette consumption. The age of lung cancer occurrence followed the age that people started smoking. In the 1950s, the average ages for the first cigarette smoked and for lung cancer onset were 20–30 yrs and ≥60 yrs, respectively, but at the turn of the 20th century these were

International audience; BACKGROUND: Mapping a Cancer Atlas for the urban area of Grenoble revealed spatial distribution in the incidence of lung cancer among males at municipality level. Thus, our goal in this work was to use a new finer spatial scale to find out whether or not observed spatial variations might mask intramunicipality spatial variations. METHODS: The use of a Bayesian smoothing approach allowed us to overcome problems related to the very small inframunicipality scale and to take into account the spatial autocorrelation existing between neighbouring units. The relative risks were adjusted on different socioeconomic variables like the median income per consumption unit. RESULTS: After smoothing, areas with statistically significant 30 to 40% excess of cases and lack of cases were identified within the urban area of Grenoble. Median income per consumption unit appeared to be the most discriminating variable for characterizing the studied population. CONCLUSION: The inframunicipality scale enables the study of a health problem as the lung cancer within a context of strong demographic disparities.

The endovascular treatment (ET) of traumatic rupture of the thoracic aorta (TRTA) may represent, particularly in patients with severe multisystemic post-traumatic surgical lesions, an alternative approach to traditional surgery. We observed (October 2001- November 2004) 5 male patients (age: range 23-42 years - average 32,4) affected by TRTA (3 isthmic aortic ruptures - 2 distal descending thoracic aorta ruptures), all successfully treated with an endovascular approach. The Glasgow Coma Score (GCS) ranged between 5 and 13. After performing resuscitation manoeuvres, all patients were investigated with total body CT scans in order to evaluate the thoracic aorta and to identify associated visceral lesions. In 4 cases were evident associated visceral lesions (3 cases: bone, abdominal and neurosurgical trauma - 1 case: bone, abdominal, neurosurgical and thoracic trauma). All the procedures were performed in the operative room using DSA (Digital Subtraction Angiography). The mean operating time was 105 minutes (range 80 - 125). We didn't observed early and late complications (follow-up: average 24 months, range 12-36). In conclusion the ET of TRTA represents in 'critical' patients with severe polytrauma an alternative approach to traditional surgery in order to 'stabilizing' the cardiovascular clinical parameters and to treating 'safety' the other associated surgical lesions.

Bayesian estimates of disease relative risks is currently the gold standard in disease mapping when the disease is rare and/or when the geographical area is small. Its use has become quite easy with adhoc software. However, the implicit mechanisms of the choices made by the user must be clearly identified. We were interested here in the consequences of the choice of the hyper a priori parameters. We have compared results obtained using various hyper a priori parameters. The consequences of these choices are illustrated through the example of the incidence of bladder cancer among men in the urban area of Grenoble. We show that the risks can appear weak from a statistical point of view but important from an epidemiologic point of view in the presentation of the results.

Cancer registries have a complete recording of new cancer cases occurring among residents of a specific geographic area. In France, they cover only 13% of the population. For thyroid cancer, where incidence rate is highly variable according to the district conversely to mortality, national incidence estimates are not accurate. A nationwide database, such as hospital discharge system, could improve this estimate but its positive predictive value and sensibility should be evaluated.The positive predictive value and the sensitivity for thyroid cancer case ascertainment (ICD-10) of the national hospital discharge system in 1999 and 2000 were estimated using the cancer registries database of 10 French districts as gold standard. The linkage of the two databases required transmission of nominative information from the health facilities of the study. From the registries database, a logistic regression analysis was carried out to identify factors related to being missed by the hospital discharge system.Among the 973 standardized discharge charts selected from the hospital discharge system, 866 were considered as true positive cases, and 107 as false positive. Forty five of the latter group were prevalent cases. The predictive positive value was 89% (95% confidence interval (CI): 87-91%) and did not differ according to the district (p=0,80). According to the cancer registries, 322 thyroid cancer cases diagnosed in 1999 or 2000 were missed by the hospital discharge system. Thus, the sensitivity of this latter system was 73% (70-76%) and varied significantly from 62% to 85% across districts (p0.001) and according to the type of health facility (p0.01).Predictive positive value of the French hospital discharge system for ascertainment of thyroid cancer cases is high and stable across districts. Sensitivity is lower and varies significantly according to the type of health facility and across districts, which limits the interest of this database for a national estimate of thyroid cancer incidence rate.

Emergencies of splenic origin in pregnancy involving rupture of the splenic artery or hemorrhage are rare events that can present suddenly and unexpectedly. We report two cases of young women, both in the third trimester of gestation, who suffered sudden malaise while at home and were admitted to the ER. On arrival, both were in severe hemorrhagic shock due to gross hemoperitoneum and they died in the operating theatre during emergency surgery. To better clarify the causes and sequence of these mortalities, forensic autopsy was requested in each case. In the first (a 26-year-old primigravida in the 40th week of pregnancy), cadaveric section demonstrated the rupture of an aneurysm of the splenic artery. In the second (a 28-year-old multipara in the 33rd week of pregnancy), the clinical and anatomopathological data suggested splenic hemorrhage. In both cases histology showed a fibrodysplasia of the arterial wall involving the splenic artery in one case and the hilar branches in the other. In agreement with the data in literature, in such cases particular importance must be attributed to examination of the arterial wall. In pregnancy a synergic effect between hemodynamic and endocrine factors can cause degeneration of the arteries resulting in dramatic hemorrhage. From the forensic pathologist's viewpoint, these cases underline the importance of histopathological study of the splenic artery in the interpretation of the pathogenesis of splenic vessel rupture or hemorrhage.

With the proliferation of GIS data and resources over the Internet, there is an increasing demand for robust geospatial information services that allow interoperation of massive repositories of heterogeneous spatial data and metadata. The purpose of this paper is to show how mediation - a data integration technique - can help in building a transparent Web-based access to geospatial data. The mediator virtually creates hyperlinks between its global schema and local sources ones. This technique has been fully implemented in the context of a geographic mediation/wrapper system that provides an integrated view of the data together with a spatial query language

Introduction: Recent studies have shown lower rates of cancer (2 – 3%) following a single episode of venous thromboembolism (VTE) than previously described. The absence of any proven impact of early diagnosis has revived the debate about systematic screening for cancer in these patients. The aim of this study was to identify whether any sub-groups of patients were at excessive risk of cancer. Methods: Based on available data at baseline and during a 3 years longitudinal follow-up of the OPTIMEV cohort, a French multicenter prospective epidemiological study (N° NCT00670540), we performed a comparative prospective epidemiological study, whose main objective was to reassess the occurrence of cancer after an episode of VTE. We sought to determine whether among the VTE positive (VTE+) patients there was any sub-group of patients at greater risk of cancer and to define classification criteria that would allow them to be identified. Results: Among 1565 VTE+ patients, 2.7% and 4.7% developed cancer during the 1stand 3 years of follow-up respectively. The probability of cancer before 3 years was similar whether the DVT was proximal or distal. In contrast, the probability of cancer before 3 years depended on the number of sites affected by VTE, 4.2 % [3.1 - 5.6] for those who had presented with unilateral DVT without PE, and 8.5% [4.6 - 15.2] for those with bilateral DVT with or without PE. The probability also depended on whether the thrombosis was idiopathic 7.1% [5.1 - 9.9] vsa probability of 4.1% [3.1- 5.5] for those who had non-idiopathic DVT. The probability of cancer was also linked to whether or not the patient was on anticoagulant treatment at the time of VTE recurrence. This was 24.8 % [13.7 - 42.5] for those who had relapsed whilst on anticoagulant treatment, 13.1% [7.4 -22.5 ] for those who have relapsed when not on anticoagulants, compared with 4.0% [3.1 - 5.2] for those who did not relapse (p < 0.01). After adjustment, in VTE+ patients, there was a significantly higher adjusted HR for patients over 50 years of age (HR 11.1 [2.7 - 45.5] (p < 0.01), those with idiopathic VTE (HR 1.8 [1.1-2.8] (p = 0.02), bilateral DVT with or without PE (HR 1.9 [1.01 - 3.7] (p = 0.05), those who had a recurrence during follow-up whilst on anticoagulant treatment (HR 6.5 [3.2 - 13.4] (p For VTE+ patients over 50 (n = 1169), we sought to classify these patients according to their risk of cancer by weighting risk factors according to adjusted HR from the multivariate model. Three points were given for recurrence while on anticoagulants, one point for a recurrence when not on anticoagulant treatment, one point for cases of idiopathic VTE and one point for cases of bilateral DVT. According to the scoring, the probability of developing cancer during follow-up was depicted table 1. Discussion The utility of systematically screening for cancer during an episode of VTE is debatable. The issue of the cost of screening in relation to its benefit in terms of reducing mortality and the problem of the physical and psycho-social consequences caused by such screening are also increasingly questioned. Based on the lower incidence of cancer observed in this prospective cohort, it might be more accurate to focus further studies regarding cancer screening on high risk population. Conclusion: Bilateral DVT, idiopathic but especially recurrent VTE appear to be good criteria for selecting patients over 50 years of age for whom the issue of cancer testing should be posed. Table 1 Class Risk N (% of VTE+ patients) Probability of cancer at 3y Low risk (score 0) 597 (51%) 3.6% [2.4 – 5.6] Intermediate risk (score 1 – 2) 525 (45%) 9.1% [6.8 – 12.2] High risk (score ≥ 3) 47 (4%) 27.3% [15.6 – 45.1] Disclosures Bosson: Sanofi-Aventis: Research Funding.

The participation of natural killer (NK) cells in multiple aspects of innate and adaptive immune responses is supported by the wide array of stimulatory and inhibitory receptors they bear. Here we review the receptor-ligand interactions and subsequent signaling events that culminate in NK effector responses. Whereas some receptor-ligand interactions result in activation of both NK cytotoxicity and cytokine production, others have more subtle effects, selectively activating only one pathway or having distinct context-dependent effects. Recent approaches offer ways to unravel how the integration of complex signaling networks directs the NK response.

The course and prognosis of basaloid squamous cell carcinoma (BSCC) are not well known.To study the course and prognosis in a population of BSCC patients.We analyzed a retrospective cohort of 49 patients with BSCC in comparison with a cross-matched population of 49 patients treated for well- to moderately differentiated squamous cell carcinoma (SCC).The statistical analysis showed that survival in BSCC group was lower than in the SCC group. Local recurrence in the BSCC group was not higher than in the SCC group, but mortality by distant metastasis was six times higher than in the SCC population.We consider BSCC patients as a high-risk population and we complete diagnosis explorations including a FDG-PET before curative treatment. We also recommend post-operative or exclusive radiotherapy which may be associated with concomitant chemotherapy.

We study the isospin dynamics in fragment formation within the framework of an analytical model based on the spinodal decomposition scenario. We calculate the probability to obtain fragments with given charge and neutron number, focussing on the derivation of the width of the isotopic distributions. Within our approach this is determined by the dispersion of N/Z among the leading unstable modes, due to the competition between Coulomb and symmetry energy effects, and by isovector-like fluctuations present in the matter that undergoes the spinodal decomposition. Hence the widths exhibit a clear dependence on the properties of the Equation of State. By comparing two systems with different values of the charge asymmetry we find that the isotopic distributions reproduce an isoscaling relationship., Comment: 18 RevTex4 pages, 6 eps figures

Spinal cord blood flow after ischemic preconditioning is poorly characterized. This study is designed to evaluate spinal cord blood flow patterns in animals after acute ischemic preconditioning. Experiment 1: After a laminectomy and placement of a laser Doppler probe over the lumbar spinal cord to measure spinal cord blood flow, 16 male Sprague-Dawley rats were randomized into two groups: ischemic preconditioning (IPC, n = 8), and control (CTRL, n = 8). Rats in the CTRL and the IPC groups were subjected to 12 min of ischemia directly followed by 60 min of reperfusion. IPC rats received 3 min of IPC and 30 min of reperfusion prior to the 12-min insult period. Experiment 2: After instrumentation, the rats were randomized into three groups: control (CTRL, n = 7), ischemic preconditioning (IPC, n = 7), and time control (TC, n = 4). Rats in the CTRL and the IPC groups were subjected to the same ischemia and reperfusion protocol as above. The TC group was anesthetized for the same time period as the CTRL and the IPC groups, but had no ischemic intervention. Microspheres were injected at baseline and at 15 and 60 min into the final reperfusion. All rats were euthanized and tissue harvested for spinal cord blood flow analysis. In Experiment 1, there was a slight, significant difference in spinal cord blood flow during the ischemic period; however, this difference soon disappeared during reperfusion. In experiment 2, there was no difference in blood flow at any experimental time. The results of these experiments demonstrate that IPC slightly enhances blood flow to the spinal cord during ischemia; however, this effect is not sustained during the reperfusion period.