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Background/Introduction Cardiac biomarker elevations are frequently observed in Takotsubo syndrome (TTS). The clinical relevance of cardiac troponin (cTn) elevations in TTS patients remains uncertain and threshold values indicating clinically relevant myocardial injury are unknown. Purpose This study sought to investigate the role of cTn elevations in mortality prediction of patients with TTS. Methods A total of 2,938 patients enrolled in the prospective International Takotsubo (InterTAK) Registry from January 2011 to February 2020 and with available data on baseline and peak cTn levels were included in the analysis. The threshold at which myocardial injury drives mortality was identified using restricted cubic spline analysis. Results Out of 2,938 patients, 222 (7.6%) patients died during 1-year follow-up. A more than 28.8-fold increase of cTn above the upper reference limit was identified as threshold for clinically relevant myocardial injury. Mortality at 1 year was significantly higher in patients with clinically relevant myocardial injury than in those without (Log Rank p Conclusions This study for the first time determined a troponin threshold for the identification of TTS patients at excess risk of mortality. These findings advance risk stratification in TTS and assist in identifying patients in need for close monitoring and follow-up. Funding Acknowledgement Type of funding sources: Foundation.

Background/Introduction The obesity paradox has been described in different cardiovascular conditions. Data on the association between obesity and outcomes in patients with Takotsubo syndrome (TTS) are lacking. Purpose The aim of this study was to determine the relation of body weight to mortality in TTS patients. Methods Patients enrolled in the International Takotsubo (InterTAK) Registry from January 2011 to July 2021 and with available data on BMI were included in the analysis. Patients were stratified according to BMI (underweight, Results Of the 2'707 patients, 222 (8.2%) were underweight, 1340 (49.5%) of normal weight, 759 (28.0%) overweight, 268 (9.9%) obese, and 118 (4.4%) very obese. Mortality at 1 year as a function of BMI with 95% confidence interval is given in Figure 1. Mortality at 1 year was 11.3%, 6.9%, 5.5%, 4.9%, and 9.3% in underweight, normal weight, overweight, obese, and very obese patients (p=0.02, Figure 2). Being overweight or obese was significantly associated with a lower mortality at 1 year (HR 0.70, 95% CI 0.51–0.96, p=0.03), and associations remained significant after multivariable adjustments (adjusted HR 0.67, 95% CI 0.46–0.97, p=0.03). Associations were observed when including patients without emotional stressors (adjusted HR 0.64, 95% CI 0.43–0.94, p=0.02), but not when including those with emotional stressors (adjusted HR 1.14, 95% CI 0.30–4.27, p=0.85). Conclusion A U-shaped mortality curve across BMI categories was observed in TTS patients, with lowest mortality rates in obese patients. These observations provide first evidence for the existence of the obesity paradox in TTS. Funding Acknowledgement Type of funding sources: Foundation.

Many situations can be considered as a crisis in radiotherapy (failure of equipment, absenteeism, excessive workload, errors, urgent care, pandemic, etc.). Such events are defined as difficult situations in the course of daily activity, they can at any time escape the vigilance of the concerned actors when they are not prepared for it. The crisis can induce a disruption of balance between the normal course of the radiation therapy and the obligation for the manipulators to reconcile the consequences of the ongoing crisis with the objective of taking charge of all patients scheduled for the program. The crisis and its management will inexorably cause stress, fatigue and, as a consequence, impact patient safety. Management has an essential role to play in maintaining team dynamics when a crisis occurs, the work environment may no longer be the same. The aim of this article is to describe these situations in order to highlight the needs of the teams and more specifically the needs of the radiation therapist. It highlights the organization of patient care in the event of crisis management (Covid-19), during palliative radiotherapy with an opportunity to develop advanced practice. The reflection on the ethical concern of the radiation therapist in the prioritization of patients leads us to analyze the knowledge of medical ethics provided during initial training. When they perform their duties, manipulators seem to be confronted with situations that give rise to ethical dilemmas. It is then a question of understanding how they reflect on their practice in order to make it evolve. Is the radiation therapist confronted with ethical issues in the course of his practice? What solutions can be implemented to deal with these issues?

Highlights • Hypofractionated stereotactic ablative radiotherapy (SABR) in patients with spinal oligometastases. • High rates of efficacy and minimal toxicity. • Oligometastatic patients with metachronous spinal metastases seem to benefit the most., Background To investigate progression free survival (PFS), local control (LC) and overall survival (OS) outcomes for patients treated with spine hypofractionated stereotactic ablative radiotherapy (SABR) and to evaluate possible predictors of rapid progression in view of a correct patient selection for this potentially curative SABR. Materials and methods A cohort of 59 patients with spinal metastases were treated with SABR. Patient selection criteria were the following: histologically proven diagnosis of a solid tumor, a World Health Organization (WHO) score ≤ 2, life expectancy > 6 months, Spinal Instability Neoplastic Score (SINS) ≤ 12 points and presenting with radically treated oligometastatic disease (≤5 lesions) or stable polymetastatic disease with an oligoprogressive lesion. Results From March 2015 to June 2019, 59 patients were treated with Linac-based SABR to 64 spinal metastases with a median follow-up of 55 months. SABR was standard delivered every other day in 3 to 10 fractions with median prescription dose of 27 Gy (range 21–49 Gy). The 1-,2- and 5-year PFS was 98%, 85% and 75% for all patients. OS at 5 years for all patients was 92%. Metachronous lesions (p

IMPORTANCE: Machine learning algorithms enable the automatic classification of cardiovascular diseases based on raw cardiac ultrasound imaging data. However, the utility of machine learning in distinguishing between takotsubo syndrome (TTS) and acute myocardial infarction (AMI) has not been studied. OBJECTIVES: To assess the utility of machine learning systems for automatic discrimination of TTS and AMI. DESIGN, SETTINGS, AND PARTICIPANTS: This cohort study included clinical data and transthoracic echocardiogram results of patients with AMI from the Zurich Acute Coronary Syndrome Registry and patients with TTS obtained from 7 cardiovascular centers in the International Takotsubo Registry. Data from the validation cohort were obtained from April 2011 to February 2017. Data from the training cohort were obtained from March 2017 to May 2019. Data were analyzed from September 2019 to June 2021. EXPOSURE: Transthoracic echocardiograms of 224 patients with TTS and 224 patients with AMI were analyzed. MAIN OUTCOMES AND MEASURES: Area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, and specificity of the machine learning system evaluated on an independent data set and 4 practicing cardiologists for comparison. Echocardiography videos of 228 patients were used in the development and training of a deep learning model. The performance of the automated echocardiogram video analysis method was evaluated on an independent data set consisting of 220 patients. Data were matched according to age, sex, and ST-segment elevation/non-ST-segment elevation (1 patient with AMI for each patient with TTS). Predictions were compared with echocardiographic-based interpretations from 4 practicing cardiologists in terms of sensitivity, specificity, and AUC calculated from confidence scores concerning their binary diagnosis. RESULTS: In this cohort study, apical 2-chamber and 4-chamber echocardiographic views of 110 patients with TTS (mean [SD] age, 68.4 [12.1] years; 103 [90.4%] were female) and 110 patients with AMI (mean [SD] age, 69.1 [12.2] years; 103 [90.4%] were female) from an independent data set were evaluated. This approach achieved a mean (SD) AUC of 0.79 (0.01) with an overall accuracy of 74.8 (0.7%). In comparison, cardiologists achieved a mean (SD) AUC of 0.71 (0.03) and accuracy of 64.4 (3.5%) on the same data set. In a subanalysis based on 61 patients with apical TTS and 56 patients with AMI due to occlusion of the left anterior descending coronary artery, the model achieved a mean (SD) AUC score of 0.84 (0.01) and an accuracy of 78.6 (1.6%), outperforming the 4 practicing cardiologists (mean [SD] AUC, 0.72 [0.02]) and accuracy of 66.9 (2.8%). CONCLUSIONS AND RELEVANCE: In this cohort study, a real-time system for fully automated interpretation of echocardiogram videos was established and trained to differentiate TTS from AMI. While this system was more accurate than cardiologists in echocardiography-based disease classification, further studies are warranted for clinical application.

Resume Les solutes de perfusion sont frequemment utilises chez les enfants hospitalises. L’administration de solutes hypotoniques par voie intraveineuse a longtemps constitue la reference en pediatrie. Cela peut s’expliquer par l’empirisme des recommandations initiales qui ont prone l’utilisation preferentielle de solutes glucosees, mais hypotoniques du fait d’un contenu insuffisant en sodium. Le risque d’hyponatremie (

Resume En cas de pathologie organique, un examen medical est necessaire afin d’identifier l’origine du trouble en vue de proposer un traitement adapte. Dans certaines situations, chez des personnes presentant des troubles du comportement avec de graves alterations des capacites de communication, l’acces aux soins somatiques est tres difficile dans les milieux de soins habituels. En 2013, un centre medical dedie a ces populations a ete cree au sein de l’etablissement public de sante Barthelemy Durand a Etampes (France). Afin de permettre l’examen clinique par le medecin ou la realisation d’un prelevement sanguin, diverses techniques de distraction et d’apaisement de l’anxiete sont proposees, mais ne suffisent pas toujours. La contention physique peut parfois alors etre necessaire. Ce moyen d’acces aux soins necessite des reperes ethiques communs afin d’eviter les derives potentielles et reste toujours questionnant.

Optimal local treatment for nodal oligorecurrent prostate cancer is unknown. The randomized phase 2 PEACE V-STORM trial will explore the best treatment approach in this setting. Early results on the acute toxicity profile are projected to be published in quarter 3, 2021. ispartof: EUROPEAN UROLOGY FOCUS vol:7 issue:2 pages:241-244 ispartof: location:Netherlands status: published

mRNA translation and degradation are strongly interconnected processes that participate in the fine tuning of gene expression. Particularly, targeting mRNAs to translation-dependent degradation (TDD) could attenuate protein expression by making any increase in mRNA translation self-limiting. However, the extent to which TDD is a general mechanism for limiting protein expression is currently unknown. Here we describe a comprehensive analysis of basal and signal-induced TDD in mouse primary CD4 T cells. Our data indicate that most cellular transcripts are decayed to some extent in a translation-dependent manner, both in resting and activated cells. Our analysis further identifies the length of untranslated regions, the density of ribosomes and the GC content of the coding region as major determinants of TDD magnitude. Consistent with this, all transcripts that undergo changes in ribosome density upon T cell activation display a corresponding change in their TDD level. Surprisingly, the amplitude of translation-independent mRNA decay (TID) appears as a mirror image of TDD. Moreover, TID also responds to changes in ribosome density upon T cell activation but in the opposite direction from the one observed for TDD. Our data demonstrate a strong interconnection between mRNA translation and decay in mammalian cells. Furthermore, they indicate that ribosome density is a major determinant of the pathway by which transcripts are degraded within cells.

Purpose: Increasing evidence suggests that patients with a limited number of metastases benefit from SABR to all lesions. However, the optimal dose and fractionation remain unknown. This is particularly true for bone and lymph node metastases. Therefore, a prospective, single-center, dose-escalation trial was initiated. Methods: Dose-Escalation trial of STereotactic ablative body RadiOtherapY for non-spine bone and lymph node metastases (DESTROY) was an open-label phase 1 trial evaluating SABR to nonspine bone and lymph node lesions in patients with up to 3 metastases. Patients with European Cooperative Oncology Group performance status = grade 3 toxicity, scored according to the Common Toxicity Criteria for Adverse Events v. 4.03, up to 6 months after SABR, was the primary endpoint. The trial was registered on clinicaltrials.gov (NCT03486431). Results: Between July 2017 and December 2018, 90 patients were enrolled. In total 101 metastases were treated. No >= grade 3 toxicity was observed in any of the enrolled patients (95% CI 0.0%- 12.3% for the first cohort with 28 analyzable patients; 95% CI 0.0%-11.6% for the second and third cohort with 30 analyzable patients each). Treatment-related grade 2 toxicities occurred in 4 out of 30 versus 2 out of 30 versus 2 out of 30 patients for the 5, 3 and 1 fraction schedule, respectively. Actuarial local control rate at 12 months was 94.5%. Conclusion: All 3 treatment schedules were feasible and effective with remarkably low toxicity rates and high local control rates. From a patient and resource point of view, the single-fraction schedule is undoubtedly most convenient. (C) 2020 The Authors. Published by Elsevier Inc.

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Objectif Evaluer le cout de la prise en charge medicale de certaines pathologies rares a partir des bases du systeme national des donnees de sante (SNDS) et estimer le surcout specifique lie a la maladie. Methode L’etude etait fondee sur l’exploitation des donnees du SNDS en ciblant cinq pathologies rares identifiables a partir de codes diagnostics dans le SNDS et selectionnees de maniere a illustrer des situations et manifestations morbides contrastees (Syndrome de Rett, Drepanocytose, Maladie de Willebrand, Amyotrophie spinale infantile (SMA), Syndrome de Marfan). Les patients ont ete identifies a partir des codes diagnostics des hospitalisations et/ou des motifs d’ALD (Affection de longue duree) entre 2012 et 2016. Les analyses ont permis d’identifier, sur l’annee 2017, la consommation totale de soins (soins de ville et hospitaliers) des patients presentant les maladies identifiees, par postes de consommation et la consommation attribuable a la pathologie (fardeau) a travers une comparaison cas-temoins apparies sur l’annee de naissance, le genre et le departement de residence. Resultats Les bases du SNDS ont permis d’identifier 694 patients atteints du syndrome de Rett (95,1 % de femmes ; 19,3 ans en moyenne), 19 016 patients drepanocytaires (60,3 % d’hommes ; 29 ans en moyenne), 5243 patients atteints du syndrome de Marfan (53,2 % d’hommes ; 37,7 ans en moyenne), 1085 patients atteints de SMA (hors type 1) (51,8 % d’hommes ; 33,9 ans en moyenne) et 8762 de patients atteints de la maladie de Willebrand (34,7 % d’hommes ; 41,1 ans en moyenne) toujours vivants au 31/12/2017. Le cout total de la consommation de soins en 2017 variait de 5003 en moyenne pour le syndrome de Marfan (mediane : 1682) a 18 762 pour les patients atteints SMA (hors type 1 et hors patients traites par Spinraza®) (mediane : 10 389), avec un surcout attribuable a la maladie (differentiel avec les temoins) de respectivement 3375 et 17 317 en moyenne. Ce surcout s’elevait a 3685 pour la maladie de Willebrand, 7456 pour la drepanocytose et 12 364 pour le syndrome de Rett. Discussion Malgre une methodologie exploratoire, des difficultes d’identification des pathologies dans les bases du SNDS et une forte variabilite des resultats, l’etude a permis de mettre en evidence pour chaque pathologie un surcout significatif lie a la maladie et a ses complications. Les depenses non presentees au remboursement, et donc certains restes a charge, ne sont pas prises en compte mais seront estimees dans un volet complementaire de l’etude, via un recueil aupres des patients/familles.

The Spectral Imaging of the Coronal Environment (SPICE) instrument is a high-resolution imaging spectrometer operating at extreme ultraviolet (EUV) wavelengths. In this paper, we present the concept, design, and pre-launch performance of this facility instrument on the ESA/NASA Solar Orbiter mission. The goal of this paper is to give prospective users a better understanding of the possible types of observations, the data acquisition, and the sources that contribute to the instrument's signal. The paper discusses the science objectives, with a focus on the SPICE-specific aspects, before presenting the instrument's design, including optical, mechanical, thermal, and electronics aspects. This is followed by a characterisation and calibration of the instrument's performance. The paper concludes with descriptions of the operations concept and data processing. The performance measurements of the various instrument parameters meet the requirements derived from the mission's science objectives. The SPICE instrument is ready to perform measurements that will provide vital contributions to the scientific success of the Solar Orbiter mission., Comment: A&A, accepted 19 August 2019; 26 pages, 25 figures

Background Bone metastases represent an important source of morbidity in cancer patients, mostly due to severe pain. Radiotherapy is an established symptomatic treatment for painful bone metastases, however, when conventional techniques are used, the effectiveness is moderate. Stereotactic body radiotherapy (SBRT), delivering very high doses in a limited number of fractions in a highly conformal manner, could potentially be more effective and less toxic. Methods This is a phase III, randomized-controlled, single-blind, multicenter study evaluating the response rate of antalgic radiotherapy for painful bone metastases and the acute toxicity associated with this treatment. A total of 126 patients will be randomly assigned to receive either the standard schedule of a single fraction of 8.0 Gy delivered through three-dimensional conformal radiotherapy or a single fraction of 20.0 Gy delivered through SBRT. Primary endpoint is pain response at the treated site at 1 month after radiotherapy. Secondary endpoints are pain flare at 24-48-72 h after radiotherapy, duration of pain response, re-irradiation need, acute toxicity, late toxicity, quality of life and subsequent serious skeletal events. In a supplementary analysis, patient-compliance for a paper-and-pencil questionnaire will be compared with an electronic mode. Discussion If a dose-escalated approach within the context of single fraction stereotactic body radiotherapy could improve the pain response to radiotherapy and minimize acute toxicity, this would have an immediate impact on the quality of life for a large number of patients with advanced cancer. Potential disadvantages of this technique include increased pain flare or a higher incidence of radiation-induced fractures. Trial registration: The Ethics committee of the GZA Hospitals (B099201732915) approved this study on September 4th 2018. Trial registered on Clinicaltrials. gov (NCT03831243) on February 5th 2019.

In an oligometastatic setting, metastasis-directed treatment could render patients disease free, possibly for a protracted interval. Stereotactic ablative radiotherapy (SABR) is one of the treatment modalities that can be offered to these patients. In addition, the radiobiological qualities of SABR are promising for the use in perceived radioresistant tumours. There is also emerging evidence that SABR can stimulate the immune response, and a specific therapeutic window may exist for the optimal use of radiotherapy as an immune adjuvant. However, when SABR is considered for non-spine bone or lymph node metastases, the optimal fractionation schedule is not yet known. The DESTROY-trial is a non-randomized prospective phase I trial determining a regimen of choice for patients with non-spine bone and lymph node metastases. A total of 90 patients will be included in three different treatment regimens. They will be offered stereotactic ablative radiotherapy in 5, 3 or 1 fractions. Dose-limiting toxicity will be recorded as primary endpoint. Acute and late toxicity, local response and local recurrence, and progression-free survival are secondary endpoints. Liquid biopsies will be collected throughout the course of this study from the second fractionation schedule on. Despite its almost universal use in (oligo-)metastatic patients, the level of evidence supporting radical local treatment in general, and stereotactic radiotherapy in particular, is low. This prospective phase I trial will evaluate different SABR regimens for metastases and the differences in immune-stimulatory effects. The Ethics committee of the GZA Hospitals (B099201732915) approved this study on 05/07/2017. Amendment for translational research was approved on 06/02/2018. Trial registered on Clinicaltrials.gov ( NCT03486431 ) on 03/04/2018 – Retrospectively registered.

Introduction et but de l’etude Les effets secondaires lies a la radiotherapie sont habituellement rapportes par les medecins a la place des patients. Les patient-reported outcomes (PROs) s’utilisent de plus en plus en clinique et dans des essais. Dans le cadre de developpement d’une application pour evaluer des PROs electroniques (ePROs), le young Radiation Oncology Group (yROG) de l’European Organization for the Research and Treatment of Cancer (EORTC) a mene une enquete pour evaluer l’utilisation, l’acceptation et les benefices ressentis des PROs et quantifier ses caracteristiques souhaitables. Materiel et methodes L’enquete a ete adressee a des medecins, des manipulateurs en electroradiologie et des infirmiers de 26 pays qui traitent des patients par irradiation. Cette enquete d’acces publique en ligne incluait 40 questions qui cotaient les caracteristiques des ePROs sur une une echelle Likert bipolaire a 5 points, allant de 1 (peu important) a 5 (tres important). Les sous-groupes ont ete compares par le test de Mann-Whitney-Wilcoxon. L’enquete etait promue par les newsletters du reseau l’EORTC et les societes savantes nationales de radiotherapie. Resultats et analyse statistique Entre juillet et decembre 2018, 367 reponses ont ete recues, dont 354 eligibles comportant 4,5 % reponses francaises, le sixieme pays le plus participatif apres l’Allemagne (24,3 %), l’Italie (13,3 %), la Chine (12,2 %), le Danemark (11,6 %), et Israel (9,9 %). En France les PROs etaient utilises dans un quart des reponses (contre 42,4 % des reponses des autres pays ; p Conclusion L’utilisation des PROs en France est significativement moins importante qu’internationalement. Tous les repondeurs francais utiliseraient un ePRO en routine s’ils y avaient acces.

Resume Introduction La prise en charge des fractures diaphysaires des deux os de l’avant-bras reste controversee. Le but de cette etude etait d’analyser les resultats de la prise en charge aux urgences des fractures diaphysaires de l’avant-bras chez l’enfant. Materiels et methode Dans une etude prospective menee sur 2 ans, toutes les fractures diaphysaires fermees des deux os de l’avant-bras chez les patients moins de 15 ans, de plus de 15° d’angulation et traitees par reduction orthopedique aux urgences ont ete incluses. Les fractures avec chevauchement du foyer de fracture etaient exclues. La reduction etait effectuee par un medecin urgentiste senior, avec un protocole antalgique standardise. Une analyse radiographique et clinique etait effectuee. Resultats Au dernier recul, 60 patients (41 garcons et 19 filles) ont ete inclus. L’âge moyen etait de 5,2 ans (± 3 ans). L’angulation initiale etait de 30° (± 11,3°). Apres reduction, l’angulation maximale etait significativement plus faible (5° vs 30°, p Discussion Le traitement des fractures diaphysaires de l’avant-bras est generalement orthopedique pour les fractures fermees sans chevauchement. Cette reduction est generalement faite au bloc operatoire par des chirurgiens orthopedistes, au prix d’une anesthesie generale et d’une hospitalisation. Les resultats de cette etude montrent qu’il est possible d’avoir une prise en charge efficace dans un service d’accueil des urgences par une equipe formee et experimentee. Ces resultats sont aussi encourageants que ceux rapportes pour les fractures metaphysaires distales, ce qui doit amener a elargir les indications de reduction aux urgences. Niveau de preuve IV. Etude retrospective.

IntroductionDiaphyseal forearm fractures are very common pediatric traumas. At present, distal radius metaphyseal fractures are often successfully treated with closed reduction by emergency physicians. However, the management of diaphyseal fractures remains controversial. The purpose of this study was to analyze the results of diaphyseal forearm fractures in the emergency department (ED) in children.Materials and methodsIn a prospective 2-year-study, all closed diaphyseal forearm fractures in patients under 15, with an angle of >15° and treated by closed reduction in the ED were included. Fractures with overlapping fragments were excluded. Reduction was performed by an emergency physician, with a standardized analgesic protocol (painkillers and nitrous oxide). Clinical tolerance was checked within the first 24hours, and the radiographic stability of reduction was assessed at days 8 and 15. Initial and final follow-up radiographs were analyzed. Elbow and wrist range of motion was assessed at the final follow-up.ResultsSixty patients (41 boys and 19 girls) were included. Mean age was 5.2 years old (±3). At initial evaluation, the maximum angle was 30° (±11.3). After reduction, the maximum angle was significantly reduced (30° vs. 5°, P

As rock textures reflect the physical conditions and the mechanisms of formation of the rocks, new approaches are used for improving texture analyses, both qualitatively and quantitatively. Pioneer work has recently boosted interest in fractal analysis for quantifying and correlating patterns. Fractal-like patterns relate to a degree of multiscale organization, and fractal dimensions (FD) and their potential variations can be used to infer the physical conditions of rock formation at various scales of observation. Here, we characterize quantitatively the shape and distribution of orthopyroxene grains in ultramafic xenoliths in terms of FD and their relation with temperature of equilibration. Fractal analysis has been applied to several populations of mantle xenoliths: 7 xenoliths collected in the vicinity of Pico Santa Isabel on Bioko Island, an alkaline basaltic volcano in oceanic domain (Gulf of Guinea, Equatorial Atlantic), 9 samples from Sangilen, in the Agardag alkaline lamprophyre dyke (Russia), and 11 samples form Śnieznik (Lutynia, Poland), in the continental domain. Fractal analysis has been conducted to characterize the degree of complexity of the petrographic textures: it is indeed known that large values of FD are associated to more complex textures. The correlation here observed between the orthopyroxene fractal dimension and the temperature of equilibration suggests that FD captures a significant textural feature directly related to the temperature (i.e. generated by a temperature-controlled process). The significant difference in the FD–T correlation observed for the continental and oceanic mantle domains suggests that the mechanical and rheological behaviour is distinct in the oceanic and continental lithospheres. These first promising results should be confirmed by analysing other mantle suites of rocks in different geodynamic settings. Copyright © 2015 John Wiley & Sons, Ltd.

Resume Les tentatives de suicide (TS) chez l’enfant sont souvent considerees comme rares et sont encore peu etudiees. L’objectif de ce travail etait de decrire les caracteristiques cliniques des TS chez les enfants de moins de 12 ans. Pour cela, nous avons conduit une etude descriptive retrospective chez les enfants de moins de 12 ans pris en charge au Service d’accueil des urgences (SAU) du Centre hospitalo-universitaire (CHU) Robert-Debre a Paris de 2007 a 2010 ou au SAU du CHU de Besancon de 2000 a 2008. L’ensemble des suicidants ont ete evalues directement sur le plan somatique et sur le plan psychiatrique. Trente enfants ont ete inclus. La moyenne d’âge etait de 10,2 ± 0,8 ans et le sex-ratio de 0,9. Les modalites employees lors de la TS etaient : une intoxication medicamenteuse volontaire (53,3 %), une pendaison ou strangulation (23,3 %), une defenestration (16,7 %), une intoxication par des produits chimiques (3,3 %) et des lesions auto-infligees par l’utilisation d’objet tranchant (3,3 %). Les TS avaient eu une letalite elevee dans 43,7 % des cas, ce qui contraste avec une intentionnalite suicidaire moderee (56,2 %) ou faible (43,8 %). En conclusion, nos resultats suggerent que les TS des enfants different de celles des adolescents par leur plus grande letalite du fait de la dangerosite des moyens utilises et par leur moindre intentionnalite.

International audience; В рамках данной статьи авторами сформулирована рабочая гипотеза о постепенном ста-новлении глобальной тенденции реиндустриализации с особым сущностным наполнением, отлич-ным для каждого реализующего ее в рамках проводимой промышленной политики государства. Воснову методологии исследования лег широкий спектр различных инструментов и методов науч-ного познания, включая системный подход к изучению сущности реиндустриализации, структури-рование представленных в отечественной и зарубежной экономической науке взглядов, критери-альный анализ близких по смысловому наполнению явлений и исторический анализ статистиче-ских данных, а также общенаучные методы аналитического обобщения, количественной оценки,дедукции и абстрагирования. С целью доказательства выдвинутого авторами предположения про-ведено сопоставление некоторых ключевых трендов в мировой экономике с теоретическими под-ходами к пониманию процесса реиндустриализации в отечественной и зарубежной литературе.Проанализированы представленные в экономической литературе подходы исследователей к опре-делению реиндустриализации как набирающей обороты глобальной экономической тенденции и какособого вида государственной политики. Рассмотрено сущностное наполнение данного процесса иего отличие от реофшоризации. Систематизированы наиболее распространенные трактовки та-ких терминов, как «неоиндустриализация» и «новая индустриализация» в контексте их взаимо-зависимости. Выполнен критериальный анализ процессов реиндустриализации, неоиндустрилиза-ции и новой индустриализации с целью выявления общих черт и особенностей данных процессов.Выявлены важнейшие качественные и количественные характеристики реиндустриализации какглобальной экономической тенденции, а также сгруппированы и систематизированы базовые ин-струменты государственной политики реиндустриализации в практике ряда ведущих развитых иразвивающихся стран.

Innate immune responses combat infectious microorganisms by inducing inflammatory responses, antimicrobial pathways and adaptive immunity. Multiple genes within each of these functional categories are coordinately and temporally regulated in response to distinct external stimuli. The substantial potential of these responses to drive pathological inflammation and tissue damage highlights the need for rigorous control of these responses. Although transcriptional control of inflammatory gene expression has been studied extensively, the importance of post-transcriptional regulation of these processes is less well defined. In this Review, we discuss the regulatory mechanisms that occur at the level of mRNA splicing, mRNA polyadenylation, mRNA stability and protein translation, and that have instrumental roles in controlling both the magnitude and duration of the inflammatory response.

Background Transgender women face many health disparities including higher rates of acquiring Human Immunodeficiency Virus (HIV). The prevalence of HIV in the transgender population is 14.1% with 31% of this population engaging in sex work. PrEP is an effective method to prevent HIV acquisition. With transgender women among the highest risk in acquiring HIV, this study aimed to describe the transgender population while identifying risk factors for acquiring HIV and barriers transgender females face in acquiring PrEP. Methods An IRB approved, cross-sectional study utilized an electronic questionnaire administered to 54 people at a community resource center who specializes in the care for transgender individuals between January and April 2019. Using a pre-questionnaire survey, participants were eligible for inclusion if they were deemed at high risk for acquiring HIV. A second survey was given to those who were deemed high risk and met the inclusion criteria ( ≥18 years old). Survey questions inquired about the individuals’ high-risk behaviors, social determinants of health and knowledge about PrEP. Descriptive statistics were used for data analysis. Results Of the 54 participants, 51 individuals met inclusion for enrollment. Two of the enrolled people were excluded due to incomplete surveys. Of the 49 individuals who completed the study, 43 of the participants had a gender identity other than their assigned sex. Nearly half of the people in this study were American Indian. Over 60% of the cohort had sex for money or other goods. Depression was reported by 71% of participants while homelessness by 59%. Approximately 69% were aware of PrEP however 70.8% had never taken PrEP. When asked about HIV risk, 41.7% felt that they were not at risk for HIV and chose not to take PrEP. Lack of self-awareness of HIV risk factors was the predominant barrier to PrEP. Conclusion This is, to the best of our knowledge, the first study to describe a significant proportion of transgender individuals of American Indian heritage who are at high-risk for HIV. Participants were aware of PrEP however despite high-risk behaviors they underestimated their risks and few took PrEP. Negative health determinants were reported in the majority of participants. Disclosures All authors: No reported disclosures.