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Hexagonal SiGe-2H has been recently shown to have a direct bandgap, and holds the promise to be compatible with silicon technology. Hexagonal Si and Ge have been grown on an epitaxial lattice matched template consisting of wurtzite GaP and GaAs, respectively. Here, we present the growth of hexagonal Si and SiGe nanowire branches grown from a wurtzite stem by the vapor−liquid−solid growth mode, which is substantiated by in situ transmission electron microscopy. We show that the composition can be tuned through the whole range of stoichiometry from Si to Ge, and the possibility to realize Si and SiGe heterostructures in these branches.

Objectives This document presents the fundamentals of speech audiometry in noise, general requirements for implementation and criteria for choice among the tests available in French according to the health-professional's needs. Material and methods The recommendations are based on a systematic analysis of the literature carried out by a multidisciplinary group of doctors, audiologists and audioprosthetists from all over France. They are graded A, B, C or expert opinion according to decreasing level of scientific evidence. Results Eight tests of speech audiometry in noise can be used in France. Conclusion To be complete, evaluation of hearing status requires testing understanding of speech in noise. The examination must begin with a minimum of two measurements familiarizing the subject with the test procedure. For initial diagnosis, adaptive procedures establishing the 50% speech reception threshold (SRT50) in noise are to be preferred in order to obtain a rapid and standardized measurement of perception of speech in noise. When the aim is to measure real-life speech comprehension, tests based on sentences, cocktail-party noise and free-field stimulation are to be preferred. Prosthetic gain is evaluated exclusively in free field. This is the only way to evaluate the contribution of binaurality and to measure perception in noise in an environment as close as possible to real life. In order to avoid acoustic interference in free field, at least five loudspeakers should be used, in particular for evaluating the effectiveness of directional microphones, CROS devices enabling sounds picked up in the damaged ear to be rerouted to the functional ear, or bimodal fitting (i.e., when hearing is enabled by two modalities: for example, hearing aid for one ear, cochlear implant for the other).

The problems with plastic materials and the good film-forming properties of polysaccharides motivated research in the development of polysaccharide-based films. In the last 5 years, there has been an explosion of publications on using green solvents, including ionic liquids (ILs), and deep eutectic solvents (DESs) as candidates to substitute the conventional solvents/plasticizers for preparations of desired polysaccharide-based films. This review summarizes related properties and recovery of ILs and DESs, a series of green preparation strategies (including pretreatment solvents/reaction media, ILs/DESs as components, extraction solvents of bioactive compounds added into films), and inherent properties of polysaccharide-based films with/without ILs and DESs. Major reported advantages of these new solvents are high dissolving capacity of certain ILs/DESs for polysaccharides (i.e., up to 30 wt% for cellulose) and better plasticizing ability than traditional plasticizers. In addition, they frequently display intrinsic antioxidant and antibacterial activities that facilitate ILs/DESs applications in the processing of polysaccharide-based films (especially active food packaging films). ILs/DESs in the film could also be further recycled by water or ethanol/methanol treatment followed by drying/evaporation. One particularly promising approach is to use bioactive cholinium-based ILs and DESs with good safety and plasticizing ability to improve the functional properties of prepared films. Whole extracts by ILs/DESs from various byproducts can also be directly used in films without separation/polishing of compounds from the extracting agents. Scaling-up, including costs and environmental footprint, as well as the safety and applications in real foods of polysaccharide-based film with ILs/DESs (extracts) deserves more studies.

Background/Introduction The natural history of acute myocarditis (AM) remains partially unknown and predictors of outcome are debated. Purpose We sought to assess the impact of various cardiac magnetic resonance (CMR) parameters on early and long-term prognosis in a population of patients with AM. Methods In a two-centre longitudinal study, we included consecutive patients with diagnosis of AM based on CMR and without haemodynamic compromise. The primary endpoint was the occurrence of an event in the acute phase (≤15 days). Secondary endpoints were the occurrence of major adverse cardiac events (MACE) and recurrence of AM during follow-up. Results Three hundred and eighty-eight patients were included (mean age 38.5 years, 77.3% male, mean ejection fraction [EF]:56%) of which 82% (317) presented with chest pain. CMR was performed 4±2 days after index presentation. Overall, 38 patients (9.8%) had an event at the acute phase, 41 (10.6%) presented at least one MACE during follow-up (median 7.5 years, 6.6–8.9) and 30 (7.7%) experienced a recurrence of AM. By multivariate analysis, the independent predictors of initial complications were absence of chest pain (OR [95% CI] = 0.35 [0.15–0.82]), presence of syncope/pre-syncope (OR [95% CI] = 3.56 [1.26–10.02]), lower EF (OR [95% CI] = 0.94 [0.91–0.98] per %), myocardial extent of late gadolinium enhancement (LGE) (OR [95% CI] = 1.05 [1.002–1.100] per %) and absence of edema (OR [95% CI] = 0.44 [0.19–0.97]). Only age (HR [95% CI] = 1.021 [1.001–1.041] per year) and an initial alteration of EF (HR [95% CI] = 0.94 [0.91–0.97] per %) were associated with MACE during follow-up. Factors independently associated with AM recurrence were myocarditis prior to the index episodes (HR [95% CI] = 5.74 [1.72–19.22]) and viral syndrome at the index episode (HR [95% CI] = 4.21 [1.91–9.28]). Conclusion In routine consecutive hemodynamically stable patients with diagnosis of AM based on CMR, absence of edema, reduced EF, and extent of LGE were associated with early adverse outcome. Only age and EF were associated with long-term events. Funding Acknowledgement Type of funding sources: None.

Resume Objectif L’objectif etait d’evaluer les performances de localisation sonore spatiale azimutale dans differentes conditions pour l’optimisation d’un protocole de localisation sonore spatiale de routine. Materiel et methode Deux groupes de sujets sains ont ete testes de facon identique. Le premier groupe devait garder la tete fixe alors que le deuxieme groupe etait autorise a tourner la tete. La localisation sonore spatiale etait testee oreilles nues, puis avec un bouchon d’oreille droit (asymetrie auditive aigue) pour chacun des stimuli sonores suivants : bande etroite centree sur 250 Hz pulse, bandes etroites centrees sur 2000 Hz, 4000 Hz et 8000 Hz continus, wobule 4000 Hz continu, bruit blanc pulse et mot (« lac »). L’erreur quadratique moyenne ou RMS Error (Root Mean Square Error) permettait de calculer la performance de localisation. Resultats Tete fixe, la localisation sonore etait significativement perturbee apres bouchon d’oreille pour l’ensemble des stimuli (p Conclusion Le test realise chez un sujet tete fixe est plus sensible. L’utilisation d’un bruit en bande etroite centre sur 4000 Hz et continu explore la difference d’intensite interaurale. Un bruit en bande etroite centre sur 250 Hz et pulse permet d’explorer la difference de temps interaurale. Le test tete mobile, plus proche des conditions de vie reelle, est optimise avec un bruit en bande etroite centre sur 2000 Hz et continu.

Resume Introduction Devant un controle insuffisant d’une pathologie respiratoire chronique, il est necessaire de s’assurer du bon usage du dispositif inhale deja prescrit avant toute incrementation du traitement. Nous avons souhaite savoir quelle maitrise nos patients ont de la technique d’utilisation, quelles connaissances les soignants ont du bon usage de ces medicaments et proposer des outils pour ameliorer ces deux points. Methodes Nous avons evalue la technique d’utilisation habituelle du patient en nous basant sur les grilles d’evaluation du Cespharm. Pour evaluer les connaissances des soignants, nous avons elabore un questionnaire dans le cadre d’une evaluation des pratiques professionnelles. Resultats L’ensemble des etapes de la technique d’utilisation etait maitrise par le patient dans 22 % (11/50) des observations. Nous avons redige une fiche de bon usage pour chaque type de systeme commercialise, qui est remise lors d’un entretien educatif. Nous avons organise des sessions de formation pour les soignants et elabore un guide institutionnel. Le taux de participants ayant repondu correctement a l’ensemble des questions du questionnaire passe de 1,7 % (1/60) avant formation, a 58,3 % (35/60) apres. Discussion et conclusion La majorite de nos patients n’utilisaient pas leur dispositif inhale de maniere optimale et les soignants avaient des connaissances insuffisantes. Suite a la formation, les necessaires evaluation et education du patient peuvent etre realisees par plusieurs categories de professionnels, a l’appui du guide et des fiches de bon usage.

Objectives The present study aimed to determine normal SNR values per age group for the 50% speech reception threshold in noise (SNR Loss) on the VRB (Vocale Rapide dans le Bruit: rapid speech in noise) test. Material and Methods Two hundred patients underwent pure-tone threshold and VRB speech-in-noise audiometry. Six ages groups were distinguished: 20–30, 30–40, 40–50, 50–60, 60–70 and > 70 years. All subjects had normal hearing for age according to ISO 7029. SNR Loss was measured according to age group. Results Mean SNR Loss ranged from −0.37 dB in the youngest age group (20–30 years) to +6.84 dB in the oldest (> 70 years). Range and interquartile range increased with age: 3.66 and 1.49 dB respectively for 20–30 year-olds; 6 and 3.5 dB for > 70 year-olds. Linear regression between SNR Loss and age showed a coefficient R2 of 0.83. Conclusion The present study reports SNR Loss values per age group in normal-hearing subjects (ISO 7029), confirming that SNR Loss increases with age. Scatter also increased with age, suggesting that other age-related factors combine with inner-ear aging to impair hearing in noise.

Nous avons utilisé alternativement les techniques d’analyse fonctionnelle, d’analyse génétique et de biologie moléculaire pour identifier les gènes qui ont un effet majeur sur le gras intramusculaire du porc indépendamment de ceux qui agissent sur l’épaisseur de du gras souscutané dorsal. L’ensemble des travaux met en évidence : l’influence prépondérante de la région péri-centromérique du chromosome 7, marquée par le complexe majeur d’histocompatibilité SLA, sur le taux de lipides intramusculaires ; le rôle clef de l’enzyme malique, une des enzymes de la lipogenèse, dans la synthèse lipidique intramusculaire tout au long du développement corporel du porc ; l’existence d’un gène proche de SLA, qui contrôle l’activité de cette enzyme et dont le profil est le suivant : ce n’est pas le gène codant pour l’enzyme malique, celui-ci étant localisé sur le chromosome 1, il n’agirait pas par activation de la transcription de la protéine, mais il pourrait intervenir sur le nombre, la différenciation, l’activation ou la migration des adipocytes dans les muscles.

Using its expertise in fatigue analysis, VibraTec has developed an approach to evaluate remaining life aiming to ensure asset durability and optimize operation to extend service life. Remaining life provides visibility of the structure’s future life to anticipate difficulties and guarantee long-term quality of service. Analysis of this parameter is an important part of asset management for structures designed to last for decades, like railway transportation. The approach presented for evaluating remaining life is based on a coupled digital and experimental fatigue analysis. The sensitive areas of the structure under study are firstly determined by Finite Element Analysis according to nominal fatigue loads. The current status of structural mechanical integrity is studied by concentrating nondestructive examinations on sensitive areas (NDT, magnetoscopy, visual observation, etc). Then, operational measurements are performed to identify the real operational loads, to evaluate and tune the Finite Element Model (FEM). Using the final reliable Finite Element Model, the future life of the structure is simulated. Different operation road maps can be evaluated to ensure structural durability and extend asset service life. To conclude the paper, the method is then applied to quantitatively assess the remaining life car bodies for railway networks. Operation and maintenance road maps serve as guides to reach service life objectives. Structural modification can also be evaluated to optimize life duration. This analysis provides support for investment teams, helping them optimize their asset management strategy.

While 5G wireless networks are currently deployed around the world, preliminary research activities have begun to look beyond 5G and conceptualize 6G standard. Although it is envisioned that 6G may bring an unprecedent transformation of the wireless networks in comparison with previous generations, the necessity to develop analog and RF specialized technologies to address new frequency spectra will remain. In this paper, we review the development of PD-SOI CMOS and SiGe BiCMOS technologies addressing 5G RF Integrated Circuits (RFICs) and their evolutions for 6G.

Resume La localisation sonore spatiale est primordiale pour le confort de vie. Elle permet de definir la position d’une source sonore dans les trois dimensions de l’espace (azimut, hauteur et distance). Elle repose sur trois types d’indices differents : deux indices binauraux (difference de temps interaurale et difference d’intensite interaurale) et 1’indice monaural spectral (fonction de transfert liee a la tete). Ces indices sont complementaires et varient selon les caracteristiques acoustiques du son incident. L’objectif de cette mise au point est de realiser une synthese des connaissances actuelles sur les fondements physiques de la localisation sonore spatiale.

International audience; ILLIAD is a French national project in which food-chain sustainability is being evaluated on four products ( wheat, rice, peach and apricot). For apricot, two difficulties for French production have been identified: i) the high cost of manpower in this culture and ii) fruit processors' dependence on surplus fruits from fresh consumption. This leads to very high variability in supply, price and quality from year to year. In this context, one solution might be dedicated orchards for processing industries. At first, cultivars well adapted to processing and with a low demand for inputs were screened for their behavior in mechanical harvest. Mechanical harvest was carried out using tree shaking ( at 40 cm from the ground) and collection on a fabric screen. Results obtained over 2 years on more than 15 cultivars and in two production areas are presented. The low mechanical damage observed just after harvesting or after 7 days of storage for a few cultivars and the possibility of optimizing shaking parameters according to agronomic and physiologic criteria ( fruit falling, maturity heterogeneity, etc.) confirm the suitability of mechanical harvesting and the opportunity to create dedicated orchards.

Sound source localization is paramount for comfort of life, determining the position of a sound source in 3 dimensions: azimuth, height and distance. It is based on 3 types of cue: 2 binaural (interaural time difference and interaural level difference) and 1 monaural spectral cue (head-related transfer function). These are complementary and vary according to the acoustic characteristics of the incident sound. The objective of this report is to update the current state of knowledge on the physical basis of spatial sound localization.

International audience; Aim: To evaluate azimuthal sound-source localization performance under different conditions, with a view to optimizing a routine sound localization protocol.Material and method: Two groups of healthy, normal-hearing subjects were tested identically, except that one had to keep their head still while the other was allowed to turn it. Sound localization was tested without and then with a right ear plug (acute auditory asymmetry) for each of the following sound stimuli: pulsed narrow-band centered on 250Hz, continuous narrowband centered on 2000Hz, 4000Hz and 8000Hz, continuous 4000Hz warble, pulsed white noise, and word ("lac" (lake)). Root mean square error was used to calculate sound-source localization accuracy.Results: With fixed head, localization was significantly disturbed by the earplug for all stimuli (P

Background The development and expansion of oral anti-cancer agents provide multiple benefits, including improvement in patients’ quality of life but also create numerous challenges such as side-effect management or medication adherence. In January 2018, we implemented pharmaceutical consultations, as part of a multidisciplinary consultation programme for patients receiving oral chemotherapy agents. Purpose The aim of this study was to evaluate patients’, community pharmacists’ and oncologists’ satisfaction with the pharmaceutical consultations. Material and methods A paper-based questionnaire (10 questions) was distributed to patients receiving oral anti-cancer drugs at the end of the pharmaceutical consultation. The overall community pharmacists’ and oncologists’ satisfaction was measured using an online survey tool. The surveys consisted of 14 questions divided into five sections. The survey design was based on a 4-point scale, with answers ranging from strongly agree to strongly disagree, and also included yes/no and short answer questions. All the answers to the questionnaires were collected in an anonymous way. Results Between 1 January 2018 and 20 July 2018 a total of 20 patients, nine oncologists and 15 community pharmacists completed the survey. The response rates were respectively 49%, 53% and 35%. Overall, pharmacists, doctors and patients were highly satisfied with the services of the oral anti-cancer therapy programme (100%). Most patients (90%) felt that the majority of their questions and concerns were answered during the consultation. They found the written information useful (85%) and expressed that they had gained new and clarifying information about their medication (70%). Community pharmacists were satisfied to have been informed of the oral cancer drug initiation (93%), most of the time it allowed them to order the treatment before the patient’s arrival (80%). Oncologists felt that pharmaceutical consultations were always (56%) or sometimes (44%) useful for the patients. Most of them (89%) considered there would be sometimes an interest in conducting consultations together with the pharmacist. Conclusion This study showed that all participants highly appreciated the pharmaceutical consultations. These results are consistent with previous studies showing the key role of the clinical pharmacist in multidisciplinary programmes established for patients taking oral anti-cancer treatment. References and/or acknowledgements 1. Ma C. Role of pharmacists in optimizing the use of anticancer drugs in the clinical setting. Integr Pharm Res Pract 2014. No conflict of interest.

Understanding speech in noise is a major challenge for most hearing-impaired subjects, with or without hearing aids. To overcome the weaknesses of French-language speech-in-noise tests, we developed a new instrument, with a balanced mix of difficulty of the speech material.The speech material comprised 127 sentences taken from the "Marginal Benefit from Acoustic Amplification" (MBAA) corpus, each including 3 keywords. The noise was created using the "onde vocale globale" (global vocal wave: OVG), described by Dodelé. The 127 speech/noise pairs were recorded individually after root-mean-square equalization. The first experiment, on 10 normal-hearing adults, determined the signal-to-noise ratio (SNR) associated with 50% correct keyword identification in each sentence (SNR-50), using an ascending method with noise level set at 73dB SPL. Relative levels between sentences and noise were then adjusted sentence by sentence to achieve an SNR-50 of 0dB. The second experiment, with 12 normal-hearing adults, validated the equalization of sentence difficulty.Mean SNR-50 was -6.64dB (σ=1.47). Mean adjusted SNR-50 was 0.08dB (σ=0.55). Mean psychometric curve slope was 19.3%/dB, with low standard deviations, testifying to the sensitivity of the speech material.The VRB (vocale rapide dans le bruit: rapid speech in noise) test is based on sentences from the MBAA corpus with background noise based on the OVG at different signal-to-noise ratios. The test is feasible and able to detect slight variations in speech-in-noise performance between subjects.

The PLEIADES-HR Earth observing satellites, under CNES development, combine a 0.7m resolution panchromatic channel, and a multispectral channel allowing a 2.8 m resolution, in 4 spectral bands. The 2 satellites will be placed on a sun-synchronous orbit at an altitude of 695 km. The camera operates in push broom mode, providing images across a 20 km swath. This paper focuses on the specifications, design and performance of the TDI detectors developed by e2v technologies under CNES contract for the panchromatic channel. Design drivers, derived from the mission and satellite requirements, architecture of the sensor and measurement results for key performances of the first prototypes are presented.

Resume Fruit de la course a l’armement durant la guerre froide, le VX russe, ou VR, est un compose organophosphore, isomere structural du neurotoxique VX occidental avec lequel il partage une tres forte toxicite. Il a ete beaucoup moins decrit et etudie que le VX car la connaissance de son existence est relativement recente. Compose tres peu volatil et resistant dans l’environnement, le VR est un agent persistant. L’intoxication est principalement realisee par penetration du liquide a travers la peau ou les muqueuses, mais l’inhalation de vapeurs dans certaines conditions reste possible. La presentation clinique peut parfois etre differee de plusieurs heures et l’absence de symptomes ne doit pas exclure contamination ou intoxication. Cet agent presente une longue remanence dans la circulation sanguine, une caracteristique qui le differencie nettement des agents de type sarin. Les protocoles d’administration des antidotes sont ainsi susceptibles de devoir etre modifies. La plus faible reponse des intoxications par le VR au traitement antidotique classique utilise en France, la 2-PAM, et le fait qu’il represente une menace plus elevee que le VX du fait de sa possession probable par certains pays proliferants font l’interet de ce toxique.

L’usage de drogue est incompatible avec l’emploi des militaires. Le dépistage des conduites addictives en milieu professionnel repose sur des textes réglementaires, dont l’application dans les armées fait largement intervenir le Service de santé. Depuis quelques années, se développe un commerce tout particulier autour de ces actions de dépistage : celui des substances capables de prendre en défaut les tests urinaires, autrement nommée adultération. Après le rappel du cadre dans lequel se déroulent les tests de dépistage des toxiques dans les urines dans les armées, nous présenterons les différentes méthodes permettant de fausser ces tests. À l’aide d’un exemple d’adultération réalisé dans notre laboratoire, nous montrerons l’efficacité de certaines techniques. Enfin nous résumerons les précautions simples à mettre en oeuvre pour éviter une grande partie de ces conduites trompeuses.

Summary Introduction Although ureteral length (UL) is highly variable in children, reliable data on this topic are scarce. During urinary tract surgery, the use of an inappropriately dimensioned ureteral stent is associated with adverse effects. This study aimed to evaluate UL as a function of the child's age, using contrast-enhanced computed tomography (CT) of the abdomen and pelvis, and to calculate a new equation for predicting UL (and thus the optimal length of ureteral stents) in children. Material and methods A retrospective, single-centre study of children (younger than 16 years) who are free of abdominal mass syndrome and severe scoliosis was conducted. After three-dimensional reconstruction of the CT data, the ureter was measured between the ureteropelvic junction and ureterovesical junction by two observers. The lengths of the right and left ureters were analyzed by age, with at least 10 CT measurements per age class. Results The mean ULs on the right and left were, respectively, 9.7 and 9.91 cm before the age of 1 year, 20.10 and 21.08 cm at the age of 7 and 26.55 and 27.46 cm at the age of 16. The interobserver reproducibility of UL determination was high (intraclass correlation coefficient [95% confidence interval]: 0.97 [0.94–0.99]). On the basis of these results, the length of the double-J catheter should be equal to the child's age +12 cm (Table 1). Conclusion Computed tomography measurement of the UL in healthy children is reproducible and reliable and enabled the estimation of the UL by age group. This knowledge should facilitate the choice of the stent used in ureteral surgery. To confirm the study results, the stent size suggested here should be evaluated in routine practice.

A new type of ring-imaging Cherenkov detector is being used for hadronic particle identification in the B a B ar experiment at the SLAC B Factory (PEP-II). This detector is called DIRC, an acronym for Detection of Internally Reflected Cherenkov (Light). This paper will discuss the construction, operation and performance of the B a B ar DIRC in detail.

Originally designed as a new nuclear reactor monitoring device, the Nucifer detector has successfully detected its first neutrinos. We provide the second shortest baseline measurement of the reactor neutrino flux. The detection of electron antineutrinos emitted in the decay chains of the fission products, combined with reactor core simulations, provides an new tool to assess both the thermal power and the fissile content of the whole nuclear core and could be used by the Inter- national Agency for Atomic Energy (IAEA) to enhance the Safeguards of civil nuclear reactors. Deployed at only 7.2m away from the compact Osiris research reactor core (70MW) operating at the Saclay research centre of the French Alternative Energies and Atomic Energy Commission (CEA), the experiment also exhibits a well-suited configuration to search for a new short baseline oscillation. We report the first results of the Nucifer experiment, describing the performances of the 0.85m3 detector remotely operating at a shallow depth equivalent to 12m of water and under intense background radiation conditions. Based on 145 (106) days of data with reactor ON (OFF), leading to the detection of an estimated 40760 electron antineutrinos, the mean number of detected antineutrinos is 281 +- 7(stat) +- 18(syst) electron antineutrinos/day, in agreement with the prediction 277(23) electron antineutrinos/day. Due the the large background no conclusive results on the existence of light sterile neutrinos could be derived, however. As a first societal application we quantify how antineutrinos could be used for the Plutonium Management and Disposition Agreement., 22 pages, 16 figures - Version 4

Objective The hearing level is a major point to take into account for managing a patient with an acoustic neuroma. The Gardner–Robertson classification is the most frequently reported as well as the AAO-HNS classification. It combines the use of pure tone audiometry and speech audiometry. The goal of this study is to determine the effect of the level of presentation for the speech material and the effect of the type of list selected for the determination of the speech discrimination score. Methods The speech determination score has been determined for 94 patients with different type of lists of 20 items: sentences, bi and monosyllabic words at two levels of presentation: at speech recognition threshold level plus 35 dB and at the most comfortable level. The impact of the choice of the frequencies selected to determine the pure tone average, especially 3000 Hz or 4000 Hz has been also evaluated. Results There is a statistical difference when the frequency 4000 Hz is selected rather than 3000 Hz in the determination of the pure tone average. The speech discrimation score obtained with the use of monosyllabic word lists is statistically different than those obtained with bisyllabic words. Conclusion To classify a patient's hearing whatever the classification, the speech discrimination score should be determined using monosyllabic word lists. Any other type of lists (sentences, spondees) leads to a significantly different score.

Des cannabinoïdes de synthèse, intégrés dans des mélanges d’herbes, sont vendus sur internet sous forme d’encens à brûler. La dénomination fréquemment retrouvée pour ces mélanges à fumer est spice. Ils contiennent des substances plus puissantes que le Δ9 tétrahydrocannabinol, reconnu comme l’agent psychoactif du cannabis. Malgré la classification de ces composés comme stupéfiants par la France en 2009, le phénomène « spice » continue de se développer. Les noms et les emballages de ces produits se sont diversifiés et les composés psycho-actifs sont modifiés en réponse aux mesures de répression. À l’heure actuelle, aucune technique rapide ne permet leur dépistage en routine au laboratoire ou dans les centres médicaux des armées.

Introduction La morbi-mortalite cardiovasculaire au cours des maladies inflammatoires systemiques est un probleme de plus en plus reconnu. Les patientes atteintes de lupus systemique ont vu leur pronostic lie a la maladie s’ameliorer, tandis qu’une mortalite tardive liee notamment aux evenements cardiovasculaires se faisait jour. L’osteoporose est une autre complication frequente au cours du lupus. De plus, certains auteurs ont montre une relation entre osteoporose et calcifications vasculaires au cours du lupus. L’objectif de notre travail est d’etudier le metabolisme osseux de patientes lupiques (RANK ligand et osteoprotegerine [OPG] notamment) et de le correler a la presence de calcifications vasculaires, ainsi qu’a la densite minerale osseuse. Patients et methodes Les patientes lupiques suivies dans 2 centres hospitaliers universitaires francais se sont vu proposer, apres information et recueil de leur consentement ecrit, un examen clinique, une recherche de calcifications arterielles (scanner des arteres coronaires et de l’aorte, echographie doppler des troncs supra-aortiques, de l’aorte abdominale, des arteres des membres inferieurs), une densitometrie osseuse, ainsi qu’un bilan biologique determinant notamment RANKL, OPG, osteocalcine, fetuine A, telopeptide C du collagene. Toutes les patientes devaient etre âgee de plus de 18 ans, et repondre aux criteres de classification du lupus de l’American College of rheumatology 1997. Les criteres de non-inclusion etaient : la presence d’une affection maligne, d’une maladie auto-immune autre que le lupus, d’un syndrome de chevauchement, d’une infection par le VIH, VHB, VHC, d’une cirrhose hepatique, d’une insuffisance renale chronique, ou d’un desordre parathyroidien connu. L’etude a ete approuvee par le comite de protection des personnes (CPP Nord-Ouest II). Resultats Nous avons inclus 74 patientes d’avril 2013 a septembre 2015. Trois d’entre-elles ont ete exclues (retrait de consentement, presence d’une autre pathologie auto-immune). L’âge moyen des patientes a l’inclusion etait de 45,7 (± 13,7) ans, avec une duree mediane d’evolution du lupus de 7,2 [2,1–13] ans. La mediane du SLEDAI a l’inclusion etait de 4 [0–6]. Des facteurs de risque cardiovasculaires « classiques » etaient presents frequemment : 21 % des patientes hypertendues, 23 % tabagisme actif, 14 % hypercholesterolemie. L’IMC median etait de 25,7 [21,7–30,1]. Au moins une calcification arterielle etait relevee chez 45,7 % des patientes : 22,8 % des patientes avec au moins une calcification des coronaires, 28,5 % de l’aorte thoracique, 24,2 % de l’aorte abdominale, 5,7 % des arteres des membres inferieurs, 8,5 % des troncs supra-aortiques. Une osteoporose etait presente chez 5,8 % des patientes (T-score ≤ -2,5), une osteopenie chez 37,6 % (T-score entre −1 et −2,5), tandis que l’osteodensitometrie etait normale pour 56,5 % des patientes. Un plus grand âge a l’inclusion etait associe a la presence de calcifications arterielles (p = 0,0018, regression logistique). L’OPG etait correlee a l’etendue des calcifications arterielles (rho = 0,3, p = 0,011, correlation de Spearman). Nous n’avons pas mis en evidence d’autre relation significative entre la presence de calcification (ou leur etendu), et les autres marqueurs du remodelage osseux. Nous n’avons pas mis en evidence de relation entre la presence d’une corticotherapie ou sa duree, et les calcifications arterielles. La presence (ou l’etendue) des calcifications arterielles n’etait pas correlee aux donnees de la densitometrie. Le rapport RANKL/OPG etait diminue chez les patientes osteopeniques et osteoporotiques, sans atteindre le seuil de significativite. Le T-score etait correle significativement aux marqueurs de remodelage osseux : rho = −0,25, p = 0,04 pour l’OPG, et rho = −0,29, p = 0,01 pour le telopeptide C. Discussion Dans la litterature l’OPG a deja etait associee aux calcifications vasculaire chez les patients diabetiques [1] , ou a la progression des calcifications coronaires chez les patients hemodialyses [2] . Il faut egalement souligner la forte prevalence de facteurs de risque cardiovasculaires « classiques », accessibles a une prise en charge dans notre population. La prevalence de l’osteopenie et de l’osteoporose dans notre population etait conforme aux donnees de la litterature. Conclusion Chez les patientes lupiques, l’OPG est correlee a l’etendue des calcifications arterielles. Dans la population etudiee, il n’existe pas de relation entre l’osteoporose et les calcifications arterielles.

Resume Objectifs Degager les caracteristiques en imagerie des metastases pancreatiques d’origine renale. Patients et methodes Etude retrospective clinico-radiologique de 17 patients atteints de metastases pancreatiques isolees metachrones d’un carcinome renal avec confirmation anatomopathologique apres chirurgie pancreatique. Resultats Le diagnostic preoperatoire a ete evoque sur l’examen echographique dans 13 cas. L’examen TDM avec injection de contraste objectivait une prise de contraste intense au temps arteriel de lesions homogenes ou parfois heterogenes. Les lesions etaient multiples dans six cas. Apres exerese chirurgicale complete, le taux de survie etait relativement bon. Conclusion Un suivi de longue duree par scanographie avec injection de produit de contraste et un protocole d’acquisition biphasique en phase arterielle et portale est indispensable. Pour le diagnostic de metastase pancreatique d’origine renale, la phase arterielle est essentielle au diagnostic.

Arsines family includes many compounds with various toxicities. Arsenic trihydride or arsine is the most toxic form of arsenic. Powerful haemolytic gas, it has never been used as a chemical weapon because its toxicity is not immediate and it is non persistent. However, cases of industrial poisoning with arsine are still identified in spite of a strict regulation at work. It is also identified as a potential toxic of chemical terrorism. This agent, of which the mechanism of action is still not well defined, is badly recognized because of intoxications rarity. However, fast detection means are available. Health professionals and especially those who are involved in piratox plan need to learn to recognize arsine intoxication (hematuria, oliguria, haemolytic anemia) in order to provide early, specific treatment and avoid damages.

Resume But de l’etude Les brules graves presentent un hypermetabolisme avec catabolisme. Le but du travail etait d’evaluer notre protocole de nutrition. Methodes Vingt-et-un brules graves ont ete inclus de maniere prospective en trois mois. Le poids etait mesure au moins deux fois par semaine. Les marqueurs biologiques de l’inflammation (C-reactive proteine, CRP) et de la nutrition etaient doses chaque semaine. Le protocole comprenait : nutrition enterale precoce, un objectif calorique de 40 Kcal/kg par jour, mesure quotidienne des apports caloriques. Resultats Le pourcentage moyen de brulures etait de 51,1 ± 27 % de la surface corporelle totale (extremes 20–90), l’âge de 38,7 ± 13,1 ans (18–67) et 57,3 % des patients avaient inhale des fumees. Vingt-et-un patients etaient ventiles et 19 ont survecu. La duree de sejour etait de 75,7 ± 47 jours (22–184). Seulement 58,9 ± 10 % des calories recommandees par les societes savantes ont ete recues. La perte de poids etait de 15,2 ± 9 kg (3–31) soit 19,1 ± 10 % du poids d’admission (5–37). Cet amaigrissement n’etait pas correle a la surface brulee (p = 0,08), aux calories recues (p = 0,26), a l’inhalation de fumees (p = 0,46), a la duree de sejour (p = 0,53), a la duree de ventilation (p = 0,08) ou de nutrition (p = 0,12), aux traitements antibiotiques (p = 0,72), au nombre de pansements (p = 0,6) ou de chirurgies (p = 0,64). La biologie montrait une baisse reguliere de la CRP et une progression de la prealbumine. Conclusion De nouvelles strategies nutritionnelles sont necessaires pour ameliorer l’evolution et reduire l’amaigrissement des brules.

Resume Nous rapportons dans cet article un cas d’accident du travail avec brulure chimique au dichloromethane (DCM). Cet hydrocarbure halogene est un solvant present dans les decapants pour peinture. Son metabolisme conduit a la formation de monoxyde carbone qui se fixe ensuite sur l’hemoglobine pour former de la carboxyhemoglobine. Cela permet de suivre les patients intoxiques non pas par le dosage du toxique mais par celui de la carboxyhemoglobine. C’est un excellent biomarqueur dont la cinetique a pour particularite de continuer a croitre apres arret de l’exposition et sous oxygenotherapie qui stimule son metabolisme.