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To assess the effectiveness, safety and risk factors of failure and complications associated with Adjustable Continence Therapy (ACT®) balloons as a treatment for female stress urinary incontinence (SUI).In the present multicentric retrospective study, all women implanted with ACT® balloons between 2000 and 2018 were considered eligible. Effectiveness and safety were assessed at 1 year, and risk factors for failure and complications were sought. The effectiveness was categorized into three distinct groups: Success = maximum 1 pad/day and patient's impression of improvement using a numerical rating scale (NRS) ≥ 8/10; Improvement = decrease of daily pad use and NRS ≥ 5/10; Failure = increase or stability of daily pad use or NRS5/10. The intra- and postoperative surgical complications were collected.Over the study period, 281 women were included. Among them, 104 (37.0%), 94 (33.5%) and 83 (29.5%) were categorized as success, improvement, and failure, respectively. Intra-, early and late postoperative complications occurred in 13 (4.6%), 35 (12.5%) and 75 (26.7%) women, respectively. Most early surgical complications were minor according to the Dindo-Clavien classification. Of women that presented a late postoperative surgical complication, 64 (22.8%) underwent an explantation performed under local or general anesthesia without associated sequalae.The short-term effectiveness associated with ACT® balloons, their minimally invasive implantation and the frequent but easily manageable and sequelae-free complications suggest that they should be part of the therapeutic arsenal for female SUI.

Resume Le score de propension, de plus en plus rencontre dans la litterature des etudes observationnelles, est une methode alternative aux essais randomises controles qui permet de limiter les biais de confusion dans l’evaluation de l’effet d’une strategie de traitement. L’objectif de cet article est d’initier le lecteur au concept du score de propension afin qu’il puisse en faire une lecture critique dans les articles scientifiques. Nous definissons le score de propension et decrivons les quatre principales methodes basees sur ce score. Nous presentons les techniques permettant de verifier la propriete equilibrante (« balancing score ») du score de propension. Nous exposons les avantages a l’utilisation de ces methodes mais aussi les ecueils a eviter. Parmi les methodes presentees, l’appariement sur le score de propension et la ponderation par l’inverse de la probabilite d’etre traite (IPTW) sont les methodes les plus rencontrees dans la litterature. En pratique, il est souhaitable d’appliquer ces deux methodes : l’une en analyse principale et l’autre en analyse de sensibilite. Nous illustrons les notions presentees dans cet article en les appliquant sur des donnees de patients ayant subi un AVC ischemique aigu.

Diabetes mellitus (DM) is a common comorbidity among cancer patients, but its impact on chemotherapy tolerance has not been widely studied. We aimed to compare the occurrence of severe grade 3/4 adverse events (G3/4 AEs) within 90 days of starting chemotherapy between patients with and without diabetes. We conducted a retrospective single-center study in Lille University Hospital Oncology Department, France. Patients who received the first cycle of chemotherapy for gastrointestinal, gynecological or cancer of unknown primary source between 1 May 2013 and 1 May 2016, were included. Overall, 609 patients were enrolled: 490 patients without diabetes (80.5%) and 119 patients with diabetes (19.5%). Within 90 days of starting chemotherapy, patients with diabetes had a significantly higher occurrence of AEs G3/4 compared to those with no diabetes (multivariate odds ratio [OR]: 1.57 [1.02-2.42], P = .04). More frequent G3/4 AEs in patients with diabetes were infection (26%), hematological disorders (13%), endocrine disorders (13%) and deterioration of the general condition (13%). In the year following the beginning of chemotherapy, patients with diabetes were twice as likely to be hospitalized as those without diabetes (univariate OR: 2.1 [1.40-3.15], P = .0003). After multivariate adjustment, diabetes was no longer significantly associated with the risk of hospitalization (P = .051). There were no differences between patients with and without diabetes regarding dose reduction and chemotherapy treatment delays (P = .61 and P = .30, respectively). Our study suggests the need for better consideration of DM in the personalized care plan to improve chemotherapy tolerance and quality of life of patients with DM.

International audience; The purpose of this multicentric study was to evaluate the prevalence and causes of Elevated Bone Mass (EBM) in patients who underwent DXA scanning over a 10-year period. The prevalence of EBM was 1 in 100. The main causes of EBM were degenerative spine disorders and renal osteodystrophy. Introduction Reports of elevated bone mass (EBM) on routine dual energy X-Ray absorptiometry (DXA) scanning are not infrequent. However, epidemiological studies of EBM are few and definition thresholds are variable. The purpose of this French multicentric study was to evaluate the prevalence and causes of EBM in adult patients who underwent DXA scanning over a 10-year period. Methods This multicentric, retrospective study was conducted in six French regional bone centres. DXA databases were initially searched for individuals with a bone mineral density (BMD) Z-score >= +4 at any site in the lumbar spine or hip from April 1st, 2008 to April 30st, 2018. Results In all, 72,225 patients with at least one DXA scan were identified. Of these, 909 (322 men and 587 women) had a Z-score >= + 4, i.e. a prevalence of 1.26% [1.18-1.34%]. The DXA scan reports and imagery and medical records of the 909 EBM patients were reviewed and 936 causes were found. In 42 patients (4%), no cause could be determined due to unavailability of data. Artefactual causes of EBM were found in 752 patients (80%), in whom the predominant cause was degenerative disease of the spine (613 patients, 65%). Acquired causes of focal EBM-including Paget's disease (n = 7)-were found in 12 patients (1%), and acquired causes of generalized EBM-including renal osteodystrophy (n = 32), haematological disorders (n = 20) and hypoparathyroidism (n = 15)-in 84 patients (9%). Other causes were rare hereditary diseases and unknown EBM in 19 (2%) and 27 (3%) cases respectively. Conclusions The prevalence of EBM was approximately 1 in 100. These findings suggest that degenerative disease of the spine is the main cause of EBM, but that acquired or hereditary diseases are also causal factors.

Context Despite optimization of metabolic balance during pregnancy in type 1 diabetes (T1D), maternal–fetal complications remain higher than in the background population. Objective We examined whether there is an association between glycated hemoglobin (HbA1c) levels and these complications. Methods Retrospective study of pregnancies in 678 T1D subjects at Lille Hospital (1997-2019). The association between variations in HbA1c levels and complications was examined. The composite criterion (CC) was defined as having at least 1 of the following complications: prematurity, pre-eclampsia, large for gestational age (LGA), small for gestational age (SGA), or cesarean section. Results Among the 678 births, median preconception HbA1c was 7.2% (55 mmol/mol), 361 were LGA (56%), 29 were SGA (4.5%), and 504 were births without preterm delivery (76.1%). The CC occurred in 81.8%. Higher HbA1c during the first trimester was associated with the CC (OR 1.04; 95% CI 1.02-1.06 per 0.1% increase; P 6.5% (48 mmol/mol) and a third trimester HbA1c Conclusion Elevated HbA1c is associated with maternal–fetal complications. Despite optimization of metabolic balance during the third trimester, for patients with early glycemic imbalance the risk of LGA persists.

Purpose/introduction A Fracture Liaison Service (FLS) was set up at Lille University Hospital in 2016. The purpose of this study was to assess persistence with osteoporosis treatment in patients from the FLS over a period of 1 year, and to determine predictors of discontinuation. Methods The study population comprised adults of both genders, aged 50 or over, admitted to Lille University Hospital between January 2016 and January 2019 for a low-trauma fracture and managed in our FLS. Outcomes included (1) persistence rate at 1 year after treatment initiation, (2) persistence rate at 2 years after treatment initiation, (3) persistence rate at 1 and 2 years after treatment initiation according to type of treatment, (4) predictors of non-persistence, and (5) reasons for discontinuing treatment over 1 year after initiation. Persistence was determined using the Kaplan–Meier method. Results In all, 1224 patients (≥50 years old) with a recent history of low-trauma fracture (≤12 months) were identified. Of these, 380 patients – 79.2% female; mean (SD) age 76 (11) years – were seen at the FLS. In those 380 patients, 410 fractures were found and 360 of them (87.8%) were major fractures, breaking down as follows: vertebra (44%), hip (19%), proximal humerus (10%), and pelvis (8%). Osteoporosis treatment was prescribed for 367 (96.6%) patients and 275 of them began the prescribed treatment. The following anti-osteoporosis drugs were prescribed: zoledronic acid (n=150, 54.5%), teriparatide (n=63, 22.9%), and denosumab (n=39, 14.2%). Oral bisphosphonates were prescribed for a few patients (n=23, 8.4%). Persistence with osteoporosis medication (any class) was estimated at 84.1% (95% CI: 79.1% to 88.1%) at 12-month follow-up, and dropped to 70.3% (95% CI: 63.7% to 75.9%) at 24 months. When drug-specific analyses were performed using the Kaplan–Meier method, persistence rates at 12 and 24 months were found to be higher with denosumab than with any other treatment. Independent predictors of non-persistence at 12 months were ‘follow-up performed by a general practitioner (GP)’ – Odds Ratio (OR) for GP vs. FLS = 3.68; 95% CI, 1.52 to 8.90, p=0.004 – and ‘treatment with zoledronic acid’ – OR for zoledronic acid vs. denosumab = 3.39; 95% CI, 1.21 to 9.50, p=0.019; OR for zoledronic acid vs. teriparatide = 8.86; 95% CI, 1.15 to 68.10, p=0.035. Conclusions This study provides evidence of the success of our FLS in terms of long-term persistence with osteoporosis treatments. However, osteoporosis treatment initiation still needs to be improved.

International audience; Change point detection methods have an important role in many hydrological and hydraulic studies of river basins. These methods are very useful to characterize changes in hydrological regimes and can, therefore, lead to better understanding changes in extreme flows behavior. Flood events are generally characterized by a finite number of characteristics that may not include the entire information available in a discharge time series. The aim of the current work is to present a new approach to detect changes in flood events based on a functional data analysis framework. The use of the functional approach allows taking into account the whole information contained in the discharge time series of flood events. The presented methodology is illustrated on a flood analysis case study, from the province of Quebec, Canada. Obtained results using the proposed approach are consistent with those obtained using a traditional change point method, and demonstrate the capability of the functional framework to simultaneously consider several flood features and, therefore, presenting a comprehensive way for a better exploitation of the information contained in a discharge time series.

There is little consensus on the best treatment algorithm for unstable severe slipped capital femoral epiphysis (SCFE). Subcapital osteotomy, which is one of the surgical options, is performed either anteriorly (anterior cuneiform osteotomy, CO) or laterally with trochanteric osteotomy (Dunn procedure, DP). The CO is technically easier and decreases operating time. Moreover, because the DP was the standard in our department before it was replaced by the CO, we had a series of consecutive patients. Therefore, we did a retrospective case-control study in unstable, severe SCFEs treated by CO versus DP, which is to our knowledge the first one aiming to compare: (1) postoperative complications and in particular avascular necrosis, (2) functional outcome, (3) radiologic findings.CO is less or just as likely to cause avascular necrosis and has the same clinical and radiologic findings as DP.A total of 41 patients (24 girls, i.e. 58.5%) were included between 2005 and 2018: 23 in the CO group and 18 in the DP group. The median age was 12.9 years (range, 11.5-14.9) and the median slip angle 70̊ (range, 62.5̊-80̊) with a median follow-up of 3 years (range, 2-4). Preoperative, intraoperative, and postoperative clinical and radiologic parameters (Southwick and alpha angles, and femoral head-neck offset) were analyzed, and all complications were documented.Two (8.7%) cases of avascular necrosis were reported in the CO group and 6 (33.3%) in the DP group (p=.11), with an overall rate of avascular necrosis of 19.5% (8/41). Five out of the 41 patients (12.2%) underwent a total hip arthroplasty: 1/23 (4.3%) in the CO group and 4/18 (22.2%) in the DP group (p=.16). Two (9.5%) patients in the CO group and 7 (38.9%) in the DP group developed postoperative limping before any arthroplasty was performed (p=.055). The alpha angle at follow-up (54±6.1̊ vs. 59.1±7.2̊; p=.027), Oxford hip score at follow-up (17/60 [range, 14-20] vs. 23.5 [range, 19-27]) (p=.021), operating time (132 min [range, 103-166] vs. 199.5 min [range, 142-215]) (p=.011) and intraoperative bleeding (250 mL [range, 100-350] vs. 300 mL [range, 197-450]) (p=.088) were more favorable in the CO group than in the DP group.The CO has similar results to DP in the surgical management of unstable severe SCFE.III; retrospective comparative study.

Objectif Malgre l’optimisation de l’equilibre metabolique pendant la grossesse, les complications materno-fœtales des diabetiques de type 1 (DT1) restent superieures a celles de la population generale. L’objectif etait d’evaluer si les taux d’HbA1c avaient une valeur predictive des complications. Patients & methode s Etude retrospective de 678 grossesses DT1 au CHU de Lille (1997-2019). L’association entre variations de l’HbA1c et complications a ete etudiee. Le critere composite (CC) a ete defini comme au moins une des complications suivantes: prematurite, preeclampsie, LGA, SGA ou cesarienne. Resultats Parmi les 678 naissances, l’HbA1c mediane pregestationnel etait de 7,2 % (6,5 % a 8,1 %), Le taux de LGA etait de 56 % et de SGA de 4,5 %. 504 etaient des naissances sans accouchement premature (76,1 %). Le CC est present dans 81,8 %. Une HbA1c plus elevee au cours du 1er trimestre etait associee au CC (OR = 1,04 [IC 95 %, 1,02 a 1,06] pour une augmentation de 0,1 %; p Discussion L’HbA1c est associee aux complications materno-fœtales. Malgre l’optimisation de l’equilibre metabolique au 3e trimestre, pour les patients presentant un desequilibre glycemique precoce, le risque de macrosomie persistait. L’HbA1c est un marqueur pour surveiller l’equilibre glycemique permettant une prise en charge personnalisee qui pourrait etre couplee a la mesure continue de glucose.

Objectif La greffe d’ilots de Langerhans est une alternative a l’insulinotherapie exogene en cas de diabete de type 1 (DT1) instable et d’hypoglycemies severes. Elle implique une immunosuppression prolongee. Les traitements immunosuppresseurs comme le desequilibre glycemique peuvent influencer les fonctions cognitives. L’objectif de ce travail etait de comparer une evaluation cognitive realisee chez des DT1 greffes ou non d’ilots de Langerhans et d’identifier les facteurs pouvant l’influencer. Materiel et methodes Cette etude cas-temoins monocentrique a compare le MMSE (Mini Mental State Examination) et les fonctions cognitives superieures de patients DT1 greffes d’ilots de Langerhans entre 2003 et 2020 et de DT1 temoins candidats a une greffe d’ilots de Langerhans. Le critere d’exclusion etait le refus du patient (n = 12). Resultats Un total de 43 patients inclus : 34 greffes (14 sous mycophenolate mofetil (MMF) et 20 sous sirolimus) et 9 temoins. Il n’y avait pas de difference de MMSE entre les 3 groupes (p = 0,70), ni dans l’alteration des fonctions cognitives superieures. Dans la population totale (n = 43), le MMSE etait negativement correle a l’HbA1c (r = −0,30 ; p = 0,047) et au temps passe en hypoglycemie sur le CGMS (r = −0,32 ; p = 0,04). Il n’y avait pas de correlation entre le MMSE et le C-peptide ou le temps passe sous immunosuppresseur. Discussion Cette premiere etude evaluant les troubles cognitifs chez les DT1 greffes d’ilots n’a pas montre de difference entre les sujets greffes et non greffes, ni entre les groupes sous sirolimus et MMF avec la methodologie employee. Le MMSE semblait davantage correle a l’equilibre glycemique qu’au traitement immunosuppresseur.

Introduction Lors de l’evaluation de la densite minerale osseuse (DMO) basee sur l’absorptiometrie biphotonique a rayons X (DXA), la decouverte d’une hyperdensite osseuse est inhabituelle. La frequence et les etiologies des hyperdensites osseuses restent largement meconnues. L’objectif de cette etude multicentrique etait d’evaluer la frequence et les etiologies des hyperdensites osseuses parmi des patients adultes ayant beneficie d’une mesure de la DMO sur une periode de 10 ans. Patients et methodes Il s’agit d’une etude observationnelle, retrospective et multicentrique, portant sur l’ensemble des patients ≥ 18 ans ayant beneficie d’une DMO par DXA sur une machine Hologic® entre avril 2008 et avril 2018 dans 6 centres de reference des pathologies osseuses. L’hyperdensite osseuse etait definie par un Z-score ≥ +4 sur au moins 1 site de mesure (rachis lombaire, col femoral, hanche totale). Les donnees ont ete reinterpretees selon les courbes de reference, a la hanche NHANES pour les 2 sexes, au rachis IOG pour les femmes et BMDCS pour les hommes. Les frequences des hyperdensites osseuses et des differentes etiologies ont ete estimees avec un intervalle de confiance a 95 % (methode exacte de Clopper-Pearson, intervalle asymetrique). Resultats Parmi les 72 225 patients ayant eu une DXA, 909 avaient un Z-score ≥ + 4 sur au moins l’un des sites de mesure, soit une frequence de 1,26 % [1,18 %-1,34 %]. Une hyperdensite osseuse etait plus frequemment retrouvee chez les hommes : 1,83 % [1,63 %-2,04 %]) que chez les femmes : 1,08 % [0,99 %-1,17 %]), p Conclusion Dans cette premiere etude multicentrique Francaise ayant porte sur plus de 72 000 patients, la prevalence de l’hyperdensite osseuse est de l’ordre de 1 % environ dont 80 % de causes artefactuelles essentiellement arthrosiques, suivies par les causes acquises locales et generalisees (osteodystrophies renales, myelofibroses, hypoparathyroidie…) et quelques rares causes genetiques.

Introduction L’objectif de ce travail est d’etudier les alterations du proteome serique des patients atteints d’hypertension arterielle pulmonaire (HTAP) associee a la clerodermie systemique (SSc), d’identifier les proteines correlees a la severite hemodynamique et determiner leur role potentiel dans la physiopathologie de la maladie. Patients et methodes Les patients eligibles ont ete recrutes dans les centres de reference SSc et/ou HTAP de Boston, Lille, Le Kremlin-Bicetre et Grenoble. Les patients etaient inclus s’ils remplissaient les criteres suivants : diagnostic de SSc selon les criteres ACR/EULAR 2013, forme cutanee limitee, pas de pneumopathie interstitielle diffuse (PID) etendue selon les criteres de Goh, et pas de traitement specifique de l’HTAP. Les patients etaient consideres comme des cas s’ils avaient un diagnostic d’HTAP confirme par catheterisme cardiaque droit (KTD) et un echantillon de serum preleve le meme jour que le KTD. Ils etaient consideres comme des temoins s’ils n’avaient aucun signe evocateur d’HTAP a l’echocardiographie. Resultats Dans une premiere etape exploratoire, l’expression serique de 1129 proteines a ete evaluee chez 15 cas et 16 temoins par analyse proteomique a haut debit (SOMAscan). Nous avons identifie 53 proteines exprimees differentiellement entre les 2 groupes. Parmi ces 53 candidats, seules 2 etaient significativement correlees avec les resistances vasculaires pulmonaires (RVP) : chemerine (p = 0,01, ρ = 0,62) et SET nuclear proto-oncogen (SET) (p = 0,01, ρ = 0,62). Pour valider ces resultats, les taux seriques de chemerine et SET ont ete mesures en ELISA chez 25 cas et 19 controles supplementaires. Les dosages de chemerine etaient de nouveau significativement plus eleves chez les cas (p = 0,01) et correles avec les RVP (p = 0,01, ρ=0,46) dans cette cohorte independante. Dans une deuxieme etape, pour etudier le role physiopathologique potentiel de la chemerine, nous avons realise des marquages en immunofluorescence confocale sur des poumons explantes de temoins sains, de patients SSc-PID sans HTAP et de patients SSc-HTAP. Le marquage du recepteur de chemerine, CMKLR1, etaient significativement augmente sur les cellules musculaires lisses d’artere pulmonaire (CML-AP) de patients SSc-PID et de patients SSc-HTAP. Nous avons ensuite teste l’effet de la chemerine sur la proliferation des CML-AP en stimulant les CML-AP de patients presentant une HTAP idiopathique (HTAPi) avec du serum de patients SSc avec et sans HTAP, en presence ou en l’absence d’un inhibiteur de CMKLR1. On confirmait que les CML-AP d’ HTAPi surexprimaient l’ARNm de CMKLR1 par rapport aux temoins sains (p = 0,03). Le serum des patients SSc-HTAP induisait une proliferation de CML-AP significativement plus elevee (p = 0,005) que le serum des temoins. Cette difference n’etait plus significative (p = 0,69) lors de l’ajout de l’inhibiteur CMKLR1 a-NETA. Conclusion La chemerine semble etre un biomarqueur de substitution valide des RVP dans l’HTAP-SSc. L’elevation de la chemerine circulante et la surexpression de son recepteur, CMKLR1, contribuent a la physiopathologie de l’HTAP-SSc en induisant la proliferation des CML-AP.

Introduction La prise en charge de l’osteoporose reste largement insuffisante, et son amelioration passe notamment par la prevention secondaire des fractures avec la creation de filieres fractures au sein de structures hospitalieres. L’objectif de cette etude etait d’evaluer la persistance des traitements anti-osteoporotiques des patients de la filiere fracture d’un centre tertiaire sur une periode d’un an, et de determiner les facteurs de non-persistance. Patients et methodes Il s’agit d’une etude de cohorte monocentrique et ambispective. Les patients âges d’au moins 50 ans et presentant une fracture osteoporotique recente (≤ 12 mois) etaient inclus dans la filiere fracture sur une periode de 3 ans (de janvier 2016 a janvier 2019) avec un suivi d’au moins 12 mois. Les analyses portaient sur : – le taux de persistance de l’ensemble des traitements anti-osteoporotiques a 12 et a 24 mois de l’initiation du traitement ; – sur les taux de persistance de chaque type de traitement (bisphosphonates oraux, acide zoledronique, teriparatide et denosumab) ; – sur les facteurs predictifs de non-persistance ; – sur les causes d’interruption therapeutique a 12 mois. La non-persistance etait definie par l’interruption (ou l’absence de renouvellement) d’un traitement antiosteoporotique au-dela d’une periode de 90 jours. Les courbes de survie ont ete etablies par la methode de Kaplan-Meier. Resultats 1224 patients ont ete identifies sur une periode de 3 ans. Parmi eux, 380 (79,2 % de femmes, âge moyen (DS) 76 (11) ans) ont pu etre inclus dans notre filiere fracture. Il existait 410 fractures dont 360 (87,8 %) etaient des fractures severes : vertebre (44 %), hanche (19 %), humerus proximal (10 %) et bassin (8 %). Un traitement anti-osteoporotique etait prescrit selon les recommandations Francaises chez 367 (96,6 %) patients mais seulement 275 d’entre eux ont reellement initie leur traitement : acide zoledronique (n = 150, 54,5 %), suivi du teriparatide (n = 63, 22,9 %) et du denosumab (n = 39, 14,2 %). Les bisphosphonates oraux etaient prescrits pour une minorite de patients (n = 23, 8,4 %). Le taux de persistance therapeutique (tous traitements confondus) etait estime a 84,1 % (IC95 % : 79,1 %-88,1 %) a 12 mois de suivi, et a 70,3 % (IC95 % : 63,7 %-75,9 %) a 24 mois. Concernant les taux de persistance de chaque type de traitement, l’analyse de Kaplan-Meier a montre que la persistance a 12 et 24 mois etait plus elevee avec le denosumab qu’avec tout autre traitement ( Fig. 1 ). Les facteurs predictifs independants de non-persistance a 12 mois etaient le fait d’etre suivi par le medecin generaliste (Odds Ratio (OR) pour MG vs. FLS = 3,68 ; IC95 % : 1,52-8,90, p = 0,004) et la prise d’acide zoledronique (OR pour acide zoledronique vs. denosumab = 3,39 ; IC95 % : 1,21-9,50, p = 0,019 et OR pour acide zoledronique vs. teriparatide = 8,86 ; IC95 % : 1,15-68,10, p = 0,035). 1 : acide zoledronique ; 2 : teriparatide ; 3 : denosumab ; 4 : bisphosphonates oraux. Conclusion Cette etude menee dans une population specifique (patients âges et fragiles avec des fractures severes et un traitement de l’osteoporose majoritairement parenteral) apporte donc une preuve de l’efficacite de notre filiere fracture sur la persistance a court et moyen terme des traitements anti-osteoporotiques. Une meilleure collaboration avec la medecine generale est souhaitable pour ameliorer l’initiation therapeutique, la persistance des traitements et notamment de l’acide zoledronique.

The primary objective of this study was to establish sex- and age-specific physical fitness percentiles for French children. The secondary aim was to assess sex, weight status, and age differences for physical fitness levels in French children. A sample of 31 484 children (16 023 boys, 15 461 girls) aged 6-11 years participated in the Diagnoform programme. Cardiorespiratory fitness, muscular endurance, speed, flexibility, and agility were assessed in this national programme. Percentile values were estimated as a function of age stratified by sex using a parametric method providing smooth centile curves and explicit formulae for the centile estimates. Values from the 10th to the 90th percentile are reported. The influence of body weight according to sex on the physical fitness level was also examined using an analysis of covariance adjusted for age. Physical fitness levels were slightly better in boys, except for agility and flexibility, in which girls performed better (Cohen's coefficient, 0.20-0.45; P

BACKGROUND AND PURPOSE: Objective and quantitative data to define cerebellar vermis and/or brain stem hypoplasia in children are lacking. Our aim was to provide MR imaging biometric references for the cerebellar vermis and brain stem from a large cohort of children with normal cerebellums. MATERIALS AND METHODS: The MR imaging data were retrospectively selected from our hospital data base from January 1, 2014, to December 31, 2017. All MR imaging examinations of children between 1 day and 15 years of age, including midline sagittal sections, were included. Children with a clinical history or MR imaging abnormalities that may affect the posterior fossa were excluded. We manually measured four 2D parameters: vermian height, anterior-posterior diameter of the vermis, anterior-posterior diameter of the midbrain-pons junction, and anterior-posterior midpons diameter. The inter- and intraobserver agreement was evaluated. RESULTS: Seven hundred eighteen children were included (372 boys and 346 girls), from 1 day to 15 years of age. Normal values (third to 97th percentiles) were provided for each parameter. The vermis parameters showed a rapid growth phase during the first year, a slower growth until the fifth year, and finally a near-plateau phase. The brain stem parameters showed more progressive growth. The intra- and interobserver agreement was excellent for all parameters. CONCLUSIONS: We provide reference biometric data of the vermis and the brain stem using simple and reproducible measurements that are easy to use in daily practice. The relevance of these 2D measurements should be further validated in diseases associated with cerebellar abnormalities.

This paper investigates a nonparametric spatial predictor of a stationary multidimensional spatial process observed over a rectangular domain. The proposed predictor depends on two kernels in order to control both the distance between observations and that between spatial locations. The uniform almost complete consistency and the asymptotic normality of the kernel predictor are obtained when the sample considered is an alpha-mixing sequence. Numerical studies were carried out in order to illustrate the behaviour of our methodology both for simulated data and for an environmental data set.

Introduction Reports of elevated bone mass (EBM) on routine DXA scanning are not infrequent. However, epidemiological studies of EBM are few in number and definition thresholds variable. The purpose of this study was to assess the prevalence and causes of EBM in the general population referred to a single university hospital - catering for a population of 4 million inhabitants - for DXA scanning. Material and methods DXA databases were initially searched for individuals with a bone mineral density (BMD) Z-score ≥+4 at any site in the lumbar spine or hip from April 1st, 2008 to April 30st, 2018. Two Hologic scanners were available at the Lille University Hospital (France). Prevalence of EBM was evaluated, as were causes associated with EBM. Results At the lumbar spine, 18,229 bone density tests were performed in women and 10,209 in men. At the hip, 17,390 tests were performed in women and 9857 in men. The total number of patients who had at least one bone density test was 14,745, of which 64.2% were female. Of these 14,745 patients, 211 had a Z-score ≥+4 at any site, i.e. a prevalence of 1.43% [1.25%-1.64%]. The DXA scans and medical records of 92 men and 119 women with elevated BMD were reviewed to assess causes. An artefactual cause was found in 164 patients (75%) with EBM (mostly degenerative disease of the spine), and an acquired cause of focal EBM was found in only 2 patients, both of whom had sclerotic bone metastases from prostate cancer. An acquired cause of generalized EBM was found in 32 patients (15%), the vast majority of whom had renal osteodystrophy (n = 11), followed by hematological disorders (n = 9; e.g. myeloproliferative syndromes and mastocytosis) and diffuse bone metastases from solid cancer (n = 5). Of the remaining causes, rare hereditary diseases (e.g. osteopetrosis…) and unexplained EBM were found in 10 and 6 cases respectively. Conclusion The prevalence of EBM (Z-score ≥+4 at any site) was 1.43% [1.25%-1.64%]. In nearly all instances (97.1%) the explanation for EBM could be found in the medical record and through conventional investigations. This study suggests that the main cause of EBM is degenerative disease of the spine. Further studies are needed to differentiate artefactual EBM from hereditary or acquired EBM, and to investigate unexplained EBM. Genetic testing may prove useful in elucidating rare unknown causes.

Introduction Il n’est pas demontre qu’un seuil d’HbA1c serait utile pour predire la survenue de complications materno-foetales en cas de DG, ni si ce seuil pourrait etre different en cas de DG precoce versus DG tardif. Materiels et methodes Etude observationnelle chez 4384 patientes DG avec facteurs de risque entre 2011 et 2018. L’HbA1c etait divisee en 5 classes. L’association entre l’HbA1c et les complications a ete evaluee apres ajustement sur les facteurs de risque de DG, en comparaison au groupe avec HbA1c la plus basse. Resultats L’HbA1c a ete dosee a 25 ± 7,5 SA pour une valeur de 5,2 % ± 0,4. 41,6 % ont presente au moins une complication parmi LGA, SGA, la pre-eclampsie, la prematurite, le transfert en neonatologie et la dystocie des epaules (critere composite). L’HbA1c ≥ 5,6 % est associee a une augmentation du risque de LGA (OR pour 5,6-5,9 = 2,12 (IC 95 % = 1,29-3,46) et OR > 5,9 =2,06 (IC 95 % = 1,14-3,7)) et de cesarienne (OR pour 5,6-5,9 = 1,64 (IC 95 % = 1,06-2,53) ; OR pour > 5,9 = 1,58 (IC 95 % = 0,93-2,7)). La prematurite augmente en cas d’HbA1c > 5,9 % (OR = 3,33 (IC 95 % = 1,27-8,71)). Apres ajustement, nous confirmons ces resultats pour LGA, prematurite, et cesarienne. L’association entre l’HbA1c et le critere composite reste significative. Les resultats sont similaires en cas de DG precoce ou tardif. Conclusion L’HbA1c est utile pour identifier des patientes les plus a risque de complications. Il n’apporte pas d’interet supplementaire que le DG soit precoce ou tardif.

Objectives:To investigate alterations in the serum proteome of patients with systemic sclerosis (SSc)-associated pulmonary hypertension (PAH), to identify proteins that correlated with hemodynamic severity and to determine their possible pathogenic role.Methods:Patients were included if they fulfilled the following criteria: diagnosis of limited cutaneous SSc, no extensive interstitial lung disease (ILD), and no treatment with PAH-specific therapy. Patients were classified as cases if they had a definitive diagnosis of PAH confirmed by right heart catheterization (RHC) and a serum sample collected on the same day as RHC. They were classified as controls if they had no sign suggestive of PAH on echocardiography.Results:In a first exploratory step, serum expression of 1129 proteins was assessed in 15 cases and 16 controls by a high-throughput proteomic assay (SOMAscan). We identified 53 proteins differentially expressed between the 2 groups. Among these 53 candidates, only 2 correlated significantly with pulmonary vascular resistance (PVR): chemerin (p=0.01,ρ=0.62) and SET nuclear proto-oncogen (SET) (p=0.01,ρ=0.62).To validate these results, serum levels of chemerin and SET were measured by ELISA assay in 25 additional cases and 19 additional controls. Chemerin levels were confirmed to be significantly higher in cases (p=0.01) and correlated with PVR (p=0.01,ρ=0.46).In a second step, to study the potential pathophysiological role of chemerin, we performed confocal immunofluorescence analyses on explanted lungs of healthy controls, SSc-ILD without PAH and SSc-PAH patients. Chemerin receptor, CMKLR1, was significantly increased on SSc-ILD and SSc-PAH pulmonary artery smooth muscle cells (PA-SMC).We then tested the effect of chemerin on PA-SMC proliferation by stimulating PA-SMCs from idiopathic pulmonary arterial hypertension (iPAH) patients with serum from SSc patients with and without PH, in the presence or absence of a CMKLR1 inhibitor. PA-SMCs from iPAH were confirmed to have higher mRNA expression of CMKLR1 than controls (p=0.03). Serum from SSc-PH patients induced a significantly higher PA-SMC proliferation (p=0.005) than serum from controls. This difference was no longer significant (p=0.69) when adding the CMKLR1 inhibitor α–NETA.Conclusion:Chemerin is a surrogate biomarker for PVR in SSc-PAH. Increased chemerin and its receptor, CMKLR1, contribute to the SSc-PAH pathogenesis by inducing PA-SMC proliferation.Acknowledgments:NoneDisclosure of Interests:Sebastien SANGES: None declared, Lisa Rice: None declared, Ly Tu: None declared, Jean-Luc Cracowski Grant/research support from: JL Cracowski received grants from United Therapeutic, Bioprojet and Topadur, David Montani Grant/research support from: Dr. MONTANI reports grants and personal fees from Actelion, grants and personal fees from Bayer, personal fees from GSK, personal fees from Pfizer, personal fees from MSD, personal fees from Chiesi, outside the submitted work, Julio Mantero: None declared, Camille Ternynck: None declared, Guillemette Marot: None declared, Eric Hachlla: None declared, David Launay Grant/research support from: Dr. Launay reports personal fees from Actelion, grants and personal fees from Takeda, grants and personal fees from CSL Behring, outside the submitted work., Marc Humbert Grant/research support from: Dr. Humbert reports personal fees from Actelion, grants and personal fees from Bayer, grants and personal fees from GSK, personal fees from Merck, from United Therapeutics, personal fees from Acceleron, outside the submitted work., Christophe Guignabert: None declared, Robert Lafyatis Grant/research support from: RL holds research grants from Formation, Elpidera and Kiniksa., Consultant of: R.L. has served as a consultant for Bristol Myers Squibb, Boehringer-Mannheim, Merck, Magenta and Genentech/Roche

A nonparametric density estimate that incorporates spatial dependency has not been studied in the literature. In this article, we propose a new spatial density estimator that depends on two kernels: one controls the distance between observations while the other controls the spatial dependence structure. The uniform almost sure convergence of the density estimate is established with the rate of convergence. The consistency of the mode of this kernel density is also studied. Then a spatial hierarchical unsupervised clustering algorithm based on the mode estimate is presented. Some simulations as well as an application to the Monsoon Asia Drought Atlas data illustrate the efficiency of our algorithm, and a comparison of the spatial structures of these data detected by the density estimate and clustering algorithm are done.

Objective To identify clinical parameters and intrapartum fetal heart rate parameters associated with a risk of umbilical cord acidosis at birth, using an automated analysis method based on empirical mode decomposition. Methods Our single-center study included 381 cases (arterial cord blood pH at birth pHa ≤7.15) and 1860 controls (pHa ≥7.25) extracted from a database comprising 8,383 full datasets for over-18 mothers after vaginal or caesarean non-twin, non-breech deliveries at term (>37 weeks of amenorrhea). The analysis of a 120-min period of the FHR recording (before maternal pushing or the decision to perform a caesarean section during labor) led to the extraction of morphological, frequency-related, and long- and short-term heart rate variability variables. After univariate analyses, sparse partial least square selection and logistic regression were applied. Results Several clinical factors were predictive of fetal acidosis in a multivariate analysis: nulliparity (odds ratio (OR) 95% confidence interval (CI)]: 1.769 [1.362–2.300]), a male fetus (1.408 [1.097–1.811]), and the term of the pregnancy (1.333 [1.189–1.497]). The risk of acidosis increased with the time interval between the end of the FHR recording and the delivery (OR [95%CI] for a 1-min increment: 1.022 [1.012–1.031]). The risk factors related to the FHR signal were mainly the difference between the mean baseline and the mean FHR (OR [95%CI]: 1.292 [1.174–1.424]), the baseline range (1.027 [1.014–1.040]), fetal bradycardia (1.038 [1.003–1.075]) and the late deceleration area (1.002 [1.000–1.005]). The area under the curve for the multivariate model was 0.79 [0.76; 0.81]. Conclusion In addition to clinical predictors, the automated FHR analysis highlighted other significant predictors, such as the baseline range, the instability of the FHR signal and the late deceleration area. This study further extends the routine application of automated FHR analysis during labor and, ultimately, contributes to the development of predictive scores for fetal acidosis.

Classification of streamflow hydrographs plays an important role in a large number of hydrological and hydraulic studies. For instance, it allows decisions to be made regarding the implementation of hydraulic structures and characterization of different flood types, leading to a better understanding of extreme flow behavior. The employed hydrograph classification methods are generally based on a finite number of hydrograph characteristics and do not include all the available information contained in a discharge time series. In this paper, two statistical techniques from the theory of functional data classification are adapted and applied for the analysis of flood hydrographs. Functional classification directly employs all data of a discharge time series and thus contains all available information on shape, peak, and timing. This potentially allows a better understanding and treatment of floods as well as other hydrological phenomena. The considered functional methodology is applied to streamflow datasets from the province of Quebec, Canada. It is shown that classes obtained using functional approaches have merit and can lead to better representation than those obtained using a multidimensional hierarchical classification method. The considered methodology has the advantage of using all of the information contained in the hydrograph, thus reducing the subjectivity that is inherent in multidimensional analysis of the type and number of characteristics to be used and consequently diminishing the associated uncertainty.

International audience; In this note, we propose a nonparametric spatial estimator of the regression function View the MathML sourcex→r(x):=E[Yi|Xi=x],x∈Rd, of a stationary (d+1)(d+1)-dimensional spatial process View the MathML source{(Yi,Xi),i∈ZN}, at a point located at some station j. The proposed estimator depends on two kernels in order to control both the distance between observations and the spatial locations. Almost complete convergence and consistency in LqLq norm (q∈N⁎)(q∈N⁎) of the kernel estimate are obtained when the sample considered is an α-mixing sequence.