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Background Despite a solid rationale, the usefulness of antioxidants in treating vitiligo has not been clearly demonstrated. Combining superoxide dismutase (SOD) with a wheat gliadin biopolymer protects it during the passage through the gastrointestinal tract. Objective To evaluate the efficacy of gliadin‐protected SOD (GP‐SOD), associated with narrowband ultraviolet B(NB‐UVB), for treating vitiligo. Methods We conducted a 24‐week monocentric interventional prospective randomized placebo‐controlled trial in the tertiary center for vitiligo care in the department of Dermatology of Nice University hospital, Nice, France. Subjects with non‐segmental vitiligo affecting more than 5% of the total body surface were included. The subjects received gliadin‐protected SOD (GP‐SOD; 1 g/day for 12 weeks followed by 0.5 g/day for 12 weeks) or placebo in combination with twice‐weekly sessions of NB‐UVB. The primary endpoint was the total repigmentation rate at 24 weeks, compared with baseline, as assessed by investigator‐assessed Vitiligo Extent Score (VES) on standardized pictures. Results A total of 50 patients were included. After 24 weeks, a greater improvement in VES was observed in the GP‐SOD group (19.85%; SE 4.63, P

Background Febrile urinary tract infection (UTI) is common in infants and needs to be diagnosed quickly. However, the symptoms are non-specific, and diagnosis can only be confirmed after high quality urinalysis. The American Academy of Pediatrics recommends suprapubic aspiration (1–9% contamination) and urinary catheterization (8–14% contamination) for urine collection but both these procedures are invasive. Recent studies have shown a new non-invasive method of collecting urine, bladder stimulation, to be quick and safe. However, few data about bacterial contamination rates have been published for this technique. We hypothesize that the contamination rate of urine collection by bladder stimulation to diagnose febrile UTI in infants under 6 months is equivalent to that of urinary catheterization. Methods/design This trial aims to assess equivalence in terms of bacterial contamination of urinary samples collected by urinary catheterization and bladder stimulation to diagnose UTI. Seven hundred seventy infants under 6 months presenting with unexplained fever in one of four Pediatric Emergency Departments in France will be enrolled. Each child will be randomized into a bladder stimulation or urinary catheterization group. The primary endpoints will be the validity of the urine sample assessed by the presence of contamination on bacterial culture. Conclusion A high recruitment rate is achievable due to the high prevalence of suspected UTIs in infants. The medical risk is the same as that for routine clinical care as we analyze patients with isolated fever. If our hypothesis holds true and the rate of urine contamination collected by bladder stimulation is acceptable, the infants included in the study will have benefited from a non-invasive and reliable means of collecting urine. Trial registration ClinicalTrials.gov, NCT03801213. Registered on 11 January 2019.

Introduction Skin diseases are common, with an estimated overall prevalence of 27% to 55% [1] , [2] . Topical treatments are commonly prescribed and are usually the first-line treatment. Patients may have a single lesion, multiple lesions or extensive body surface areas [3] Variability in the topography of the skin lesions offers different possibilities for randomized controlled trials (RCTs) evaluating topical treatments. Randomization units may be patients or lesions; all lesions may be assessed or just one. We may perform a classical individually RCT, a cluster RCT (in which clusters are actually patients, and units within clusters are lesions), or a within-person RCT. Each design has its own methodological and statistical constraints and may not be used for all skin diseases. Methods This work aimed to: – identify and discuss key methodological aspects for each design; – report sample size consequences of selecting a particular design; – illustrate statistical aspects using data from an RCT evaluating topical tacrolimus in vitiligo [4] . Results Methodological points to consider are those listed in the CONSORT statement and SPIRIT checklist. Each point was discussed by a group of three of us. Then a larger working group of seven dermatologists and statisticians who have been involved in the planning, analysis and reporting of results of dermatologic RCTs attended a 1-day meeting to discuss each potential key methodological point. For sample size issues, graphs were drawn to compare the different designs and a simulation study based on real data was used to illustrate these results. Conclusion Our work will help dermatologists and methodologists design future RCTs evaluating a topical treatment.

Resume Les psychotropes sont frequemment utilises en psychiatrie de l’enfant et de l’adolescent en France avec un taux de prescription en augmentation constante. Neanmoins, peu d’antipsychotiques (AP) atypiques ont une autorisation de mise sur le marche (AMM) chez l’enfant et l’adolescent. De plus, certains patients sont pharmaco-resistants et presentent une inefficacite des traitements psychotropes impliquant des prescriptions hors AMM, de nombreuses molecules, des hospitalisations longues, des rechutes, et des ruptures de parcours de soin. La plupart des traitements psychotropes est metabolisee majoritairement au niveau hepatique par le cytochrome P450 (CYP) et notamment sa sous-unite 2D6. Une duplication du gene CYP2D6 est liee a un phenotype metaboliseur ultrarapide et donc a une inefficacite clinique du traitement. Nous realisons actuellement une etude dont l’objectif principal est d’etudier la prevalence de duplications et des polymorphismes genetiques du CYP2D6, associes a un phenotype metaboliseur ultrarapide, dans une population d’enfants et d’adolescents pharmaco-resistants aux psychotropes. Le protocole de cette etude est presente dans cet article. Les objectifs secondaires sont d’etudier l’association de ces anomalies avec les caracteristiques liees au patient et a sa pathologie, ainsi que la recherche d’autres anomalies fonctionnelles du gene CYP2D6. Cette etude inclue 22 patients mineurs de 4 secteurs de pedopsychiatrie ayant presente une pharmacoresistance a au moins deux psychotropes metabolises par CYP2D6. La mise en evidence d’un lien entre pharmacoresistance et polymorphismes genetiques du CYP2D6 associes a un phenotype metaboliseur ultrarapide pourrait permettre de privilegier l’utilisation de molecules non metabolisees par le CYP2D6 ayant une AMM tres restrictive, plus precocement dans l’evolution de la maladie psychiatrique.

ResumeIntroduction Les centres de readaptation cardiologique concentrent une population a fort risque cardiovasculaire. Nous avons evalue la prevalence des troubles respiratoires nocturne (TRN) chez des patients admis en centre de readaptation cardiologique. Methode D’aout 2007 a decembre 2008, nous avons propose une oxymetrie nocturne (SpO2noc) aux patients admis dans le secteur cardiologique de notre etablissement et qui n’avaient jamais ete explores. Resultats Durant cette periode, 603 patients jamais explores ont eu une SpO2noc. Parmi ces derniers, 257 (42,6 %) presentaient un index de desaturation (ID) nocturne ≥ 10/heure. En analyse multivariee, les facteurs de risque d’un ID ≥ 10/heure etaient un âge plus avance (72,6 ± 10 ans vs 69,1 ± 12,5 ans ; p = 0,001), un index de masse corporel plus important (26,1 ± 4,3 vs 24,6 ± 5,4 ; p

Additional file 2. informed consent form.

Introduction L’obesite est associee a la maladie renale chronique (MRC) et la chirurgie bariatrique (CB) est le moyen le plus efficace de perdre du poids si l’indice de masse corporelle (IMC) > 35 kg/m2. On ignore si la CB ameliore la fonction renale. La definition classique de la fonction renale par le rapport debit de filtration glomerulaire (DFG)/surface corporelle (SC) est discutee chez l’obese [1] . Le rapport DFG/volume extracellulaire (VEC) pourrait lui etre preferable. Methodes Nous comparons les variations des rapports DFG/SC et DFG/VEC avant et apres CB. Le nombre de sujets necessaires pour montrer une difference de DFG/VEC avant et un an apres chirurgie bariatrique est estime a 10 au risque alpha de 5 %. La clairance renale du 51Cr-EDTA (DFG) et son volume de distribution (VEC) sont mesures, la SC est calculee selon Haycok. Les variables sont comparees avec le test t de Student. Resultats obtenus ou attendus Les 10 patients sont âges de 57 ± 7 ans. L’IMC est de 43 ± 4 kg/m2 avant CB et le pourcentage de perte d’exces d’IMC apres CB de 58 ± 18 %. Le rapport DFG/VEC passe de 42 ± 13 a 50 ± 14 ml/min/12,9 L (p = 0,037) et le rapport DFG/SC passe de 53 ± 18 a 56 ± 17 ml/min/1,73 m2(p = 0,57). La pente de la relation DFG/VEC versus DFG/SC est significativement differente de 1 avant chirurgie (p Fig. 1 . Conclusion La SC n’est pas le meilleur parametre anthropometrique pour comparer la fonction renale des IMC > 35 kg/m2 avec celle des sujets moins corpulents. Le rapport DFG/VEC s’ameliore apres CB signifiant que la cette procedure diminue la charge de travail des glomerules au stade 3 de la MRC. Il reste a prouver que la CB previenne la deterioration de la fonction renale a long terme [2] .

Resume Introduction L’interet de la rehabilitation respiratoire (RR) pour les patients ayant subi une resection pulmonaire pour cancer reste controverse. Nous avons etudie les effets de la RR et son impact sur la qualite de vie et le niveau d’anxiete et de depression chez les patients. Methodes En 2011 et 2012, une RR a ete proposee aux patients adresses dans notre centre apres une resection pulmonaire pour cancer. Les patients etaient evalues a l’entree et au depart par un test de marche de 6 minutes, une echelle visuelle analogique de la douleur, un questionnaire de qualite de vie (EORTC QLQ C30) et un questionnaire d’anxiete et de depression (HAD). Ces memes questionnaires etaient envoyes par courrier 6 mois apres la fin de la RR. Resultats Entre le debut 2011 et la fin 2012, 133 patients ont ete admis dans notre centre dans les suites d’une resection pulmonaire pour cancer. Parmi ceux-ci, 59 (44 %) patients ont beneficie d’une RR et nous ont renvoye leurs questionnaires a 6 mois. Durant la RR, le score moyen de qualite de vie augmentait de 56,3 a 65,9 ( p p p p = 0,8), le score median d’anxiete remontait a 6 ( p p Conclusion Cette etude observationnelle realisee au cours d’une RR, montrait que la qualite de vie et le niveau d’anxiete et de depression des patients etaient ameliores a la fin de la prise en charge. Apres le retour a domicile, on notait une degradation du niveau d’anxiete et de depression.

Oxytocin, a neurohypophysial hormone, regulates bone metabolism in animal studies and postmenopausal women. In men, oxytocin is not associated with bone mineral density, bone turnover markers, or prevalent fractures, but weakly negatively with incident fragility fracture requiring further studies. We previously showed that serum oxytocin (OT) level is associated with bone mineral density (BMD) and bone turnover rate in postmenopausal women. The aim of our study was to assess the relationship between circulating OT levels and bone status in men. In 552 men aged 50 and older from the MINOS cohort, we measured serum levels of OT. We assessed the association of serum OT levels with BMD (lumbar, femoral neck, total hip), bone turnover markers (BTM) (serum N-terminal propeptide of type I procollagen (PINP), bone-specific alkaline phosphatase (bone ALP), and C-terminal telopeptide of type I collagen (CTX-I)) and fracture risk. In the univariate analysis, serum OT level was not associated with BMD at any site, BTM levels, or with prevalent or incident fracture. OT was significantly correlated with body mass index (BMI) (r = 0.17, p

Resume But La generalisation du recours a l’echographie en mode B pour surveiller des lesions testiculaires suspectes a favorise l’emergence de nodules limites de nature controversee. L’elastographie en temps reel (ETR) pourrait ameliorer la precision diagnostique. Nous en avons evalue sa faisabilite et sa valeur diagnostique en pratique clinique courante. Patients Tous les patients adresses consecutivement dans notre centre pour masse testiculaire etaient explores par echographie/doppler mode B et ETR. La durete estimee sur le score d’Itho modifie, la perte d’architecture du parenchyme testiculaire et l’effet « billot » ainsi que d’autres criteres elastographiques secondaires etaient evalues pour chaque lesion. Leur valeur diagnostique (precision [Acc], sensibilite [Se], specificite [Sp] et valeur predictive positive [Vpp] et negative [Vpn]) etait appreciee en utilisant les resultats histologiques definitifs des tumeurs traitees par orchidectomie. Resultats Au total, 34 lesions testiculaires etaient analysees, entre mars 2008 et octobre 2011, chez 30 patients, correspondant a 26 (76 %) tumeurs malignes et 8 (24 %) benignes (4 hematomes, 3 orchites et 1 ischemie). Les sensibilite, specificite, valeur predictive positive, valeur predictive negative et precision diagnostique etaient respectivement de 82,3 %, 96,2 %, 37,5 %, 83 % et 75 % pour la durete elastographique ( p = 0,03), de 88,2 %, 92,3 %, 75 %, 92,3 % et 75 % pour la perte architecturale ( p = 0,01), et de 85,3 %, 84,6 %, 87,5 %, 95,6 % et 63,6 % pour l’effet « billot » ( p Conclusion L’ETR pourrait contribuer a caracteriser des nodules testiculaires limites avec des criteres diagnostiques prometteurs. Des analyses complementaires prospectives controlees sont necessaires pour valider ces resultats. Niveau de preuve 3.

Summary Background Acral naevi are a peculiar subtype of naevus with specific dermoscopic patterns. Little is known about congenital melanocytic naevi affecting acral volar skin in children. Objectives To determine the dermoscopic features of acquired and congenital acral melanocytic naevi in children and to assess their key differences in this age group. Methods This was a prospective observational controlled study conducted in two outpatient dermatology university hospitals in Nice, France. We recruited 24 children with 24 congenital acral melanocytic naevi (CAMNs) and 26 children with 33 acquired acral melanocytic naevi (AAMNs), and determined the clinical and dermoscopic features of both. Images were evaluated and compared by two dermatologists. Fourteen patients with CAMN were followed up. Results CAMNs were larger, and more asymmetrical and comma shaped than AAMNs. The parallel furrow pattern was predominant in CAMN (75%) and AAMN (79%). Globules were more frequent in CAMN (88%) than in AAMN (61%) (P = 0·026), often with a ‘pearl necklace’ distribution along skin markings. Central blue-grey pigmentation was present in 50% of CAMNs vs. 9% of AAMNs (P = 0·001). A new dermoscopic feature of central enlarged pink ridges was observed in 54% of CAMNs vs. 6% of AAMNs (P

Resume Introduction Etudier la faisabilite et l’efficacite d’un programme de rehabilitation respiratoire en institution (RR-i) chez des patients ayant subi une resection pulmonaire (RP) pour tumeur. Methode Entre janvier 2007 et decembre 2009, nous avions mene une etude observationnelle prospective sur les patients admis dans notre etablissement. Une RR-i etait proposee a tous les patients. Ils realisaient des epreuves fonctionnelles respiratoires et remplissaient un questionnaire de qualite de vie (QdV) au debut et a la fin du stage. Resultats Au cours de l’etude, 154 des 175 patients ayant subi une RP ont suivi cette RR-i. Les 21 patients restants ont ete exclus en raison de re-hospitalisations d’urgence (dix), departs anticipes (six) ou de refus de participer (cinq). Les parametres fonctionnels des 154 patients ayant suivi cette RR-i s’amelioraient entre le debut et la fin de leur sejour : CVF (69,9 % contre 79,6 % ; p p p p p Conclusion La RR-i postoperatoire apparaissait sure et influencait positivement les parametres fonctionnels respiratoires et la QdV de ces patients.

Recessive dystrophic epidermolysis bullosa (RDEB) is a rare genodermatosis with severe blistering. No curative treatment is available. Scientific data indicated that epigallocatechin-3-gallate (EGCG), a green tea extract, might improve the phenotype of RDEB patients. In a multicentre, randomized, crossover, double-blind, placebo-controlled clinical trial, we evaluated a 4-month oral EGCG treatment regimen in 17 RDEB patients. We found that EGCG treatment was not more effective than placebo in modified intention to treat and per protocol analysis (n = 16; p = 0.78 and n = 10; p = 1 respectively). Tolerance was good. Specific organizational and technical difficulties of controlled randomized double-blind trials in EB patients are discussed. Trial registration US National Institutes of Health Clinical Trial Register (NCT00951964). Electronic supplementary material The online version of this article (doi:10.1186/s13023-016-0411-5) contains supplementary material, which is available to authorized users.

Introduction Malgre des bases scientifiques in vitro et chez l’animal, les donnees cliniques chez l’Homme sur l’Interet des LED dans la cicatrisation restent tres limitees. Seules 3 etudes ont ete realisees et semblent montrer l’interet du traitement par LED afin de favoriser le processus de cicatrisation. Ces etudes ont ete realisees sur de faibles effectifs, avec des parametres differents et avaient des limitations importantes dans leur conception et dans l’evaluation des resultats. Ainsi, il n’est toujours pas clairement defini si les LED ont un reel interet dans la cicatrisation cutanee. Materiel et methodes Objectif : evaluer l’efficacite des LED pour favoriser le processus de cicatrisation et determiner les parametres optimaux pour y parvenir. Etude de phase 1, monocentrique, randomisee, controlee sur 10 volontaires sains. Une abrasion cutanee par laser CO2 ablatif fractionne etait realisee sur 7 mini-zones de 2,25 cm2 sur les avant-bras. Des seances de LED (jaune a 590 nm [25mW/cm2] : 0,3 J/cm2 [12s]et 0,1 J/cm2 [4s] rouge a 630 nm ([55mW/cm2] a 50 J/cm2 [15 min] et 15 J/cm2 [4min30s] et proche infrarouge a 830 nm [90mW/cm2] a 66 J/cm2 [12 min] et 32 J/cm2 [6 min]) etaient realisees dans les suites immediates du laser et repetees a 24 h (V2) et 48 h (V3). Une zone controle n’etait pas illuminee. Les differents parametres etaient alloues aux differentes zones par randomisation. Des mesures colorimetriques et de perte insensible en eau etaient realisees avant, en post-laser immediat ; et avant la seance de LED a 24 h, 48 h, ainsi qu’a 72 h (V4), 7j (V5) et 21j (V6). Une evaluation clinique ainsi que des photos etaient realisees a chaque visite. Resultats Une augmentation de l’erytheme (parametre a* du colorimetre) etait observee en post-laser et etait maximale a 24 h. L’erytheme diminuait ensuite progressivement jusqu’a la 3e semaine ( Fig. 1 ). Une augmentation de la perte en eau etait observee en post-laser (maximale en post-laser immediat) et revenait ensuite a la normale au 3e jour. Aucune difference statistiquement significative a 72 h n’a ete observee entre les differents groupes, bien qu’une diminution plus importante de l’erytheme fut notee avec les 3 LED en colorimetrie, non perceptible cliniquement. Discussion L’utilisation des LED est de plus en plus repandue en post-acte afin d’accelerer les processus de cicatrisation. Nous avons utilise les longueurs d’onde et les fluences rapportees dans la litterature mais aucune des LED n’a permis de gain statistiquement significatif en termes de reduction de l’erytheme ou de perte en eau par rapport au bras controle. Conclusion Ces resultats ne sont pas en faveur de l’utilisation de LED en post-actes et soulignent la necessite d’etudes rigoureuses avec une evaluation objective des dispositifs medicaux.

Summary Background The treatment of vitiligo remains unsatisfactory. Objectives To assess in patients with vitiligo the effect of a laser dermabrasion in addition to the association of topical steroids and ultraviolet (UV) B in difficult-to-treat areas. Methods This was a single-centre prospective randomized trial including patients with nonsegmental vitiligo who had at least two symmetrical lesions located on bony prominences and/or extremities. An erbium laser-assisted dermabrasion was first performed on one side (randomly assigned). After 48 h, hydrocortisone 17-butyrate cream applied daily for three periods of 3 weeks followed by a 1-week steroid-free interval and narrowband UVB treatment was performed on both sides twice weekly for 12 weeks. The evaluation was performed on standardized pictures by two physicians blinded to the type of treatment received. The criterion of success was a repigmentation of at least 50%, 1 month after the end of the treatment. Results Eighteen patients were included (24 paired lesions treated). Two patients dropped out for personal reasons. Almost 50% of lesions achieved at least 50% repigmentation in the dermabrasion side while only 4·2% did so with topical steroids and UVB alone (P

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 40 - N° 7 - p. 639-650

Introduction Le mebutate d’ingenol (MI) en gel est indique dans le traitement des keratoses actiniques (KA) de l’adulte. In vitro, il a ete montre que le MI etait capable d’induire l’apoptose de cellules de melanome. L’objectif de ce travail etait d’evaluer l’efficacite et la tolerance du MI dans le traitement du melanome de Dubreuilh in situ de la face (MDIS). Patients et methodes Etude ouverte, prospective (juin 2016 a novembre 2017) de phase 2 ( NCT02723721 ), multicentrique (8 centres), concue selon un plan de Simon optimal a 2 etapes avec analyse intermediaire (au terme de l’inclusion des 11 premiers patients [pts]) et le cas echeant une seconde etape (poursuite de l’etude jusqu’a 26 pts si 7/11 etaient repondeurs). L’objectif principal etait d’evaluer l’efficacite, en termes de remission complete (RC), d’1 ou 2 cycles (pour les pts n’ayant pas repondu au 1er) de MI 150 μg/g (3 jrs consecutifs) chez des pts presentant un MDIS de la face. Le critere de jugement principal etait la RC, clinique et histologique du MDIS a 2 mois de la fin d’un cycle. En cas d’echec du 1er cycle, un second etait realise et la RC reevaluee a 4,5 mois. La RC etait definie comme l’absence de lesion visible cliniquement (lumiere de Wood et dermoscopie) et confirmee histologiquement (analyse centralisee). Parmi les objectifs secondaires il y avait la tolerance du MI par le recueil des evenements indesirables (EI classes en grades selon les criteres de l’OMS) jusqu’a 15 jours apres l’application du MI. L’intensite des effets secondaires locaux a court terme etait evaluee a l’aide du « Local Skin Response score » (LSR). Resultats Onze patients ont ete inclus d’âge median 73 ans (62 a 96). L’etude a ete interrompue au terme de la 1re etape car seulement 2 des 11 premiers pts ont obtenu une RC. Pour l’un de ces 2 patients une rechute (toujours MDIS), est survenue 9 mois apres la fin du traitement. Le second est toujours en RC a M15, apres avoir recu 1 cycle ( Tableau 1 ). Sur les 55 EI lies au MI, la majorite etait de grades 3–4 (78 % EI vs 22 % Discussion Le MI a ete peu efficace dans le traitement du MDIS de la face a la concentration de 150 μg/g 3 jours consecutifs. Une concentration plus elevee (500 μg/g) aurait pu etre choisie pour cette etude, mais aurait probablement induit des effets indesirables trop importants, au vu du profil de tolerance mediocre a 150 μg/g. Conclusion Le MI ne peut pas etre considere comme une alternative therapeutique a la chirurgie dans la prise en charge du MDIS de la face a la concentration utilisee pour les KA du visage (150 μg/g, tous les jours pendant 3 jours consecutifs).

Summary Background The 308-nm excimer laser and 308-nm excimer lamp have both been shown to be effective in treating vitiligo but a direct comparison has never been performed. Objectives To test the equivalence of these two devices for treating nonsegmental vitiligo. Patients and methods A randomized monocentric study was undertaken. One lesion was treated with the 308-nm excimer laser and its counterpart with the 308-nm excimer lamp. Lesions were treated twice weekly with the same dose on both sides for a total of 24 sessions. The evaluation was done by two independent physicians blinded to the treatment on direct light and ultraviolet light photos. Results Twenty patients were included: 17 completed the study and 104 lesions were treated. The two treatments showed similar results in terms of efficacy for a repigmentation of at least 50% (P = 0·006). The lamp induced more erythema than the laser. Conclusions The 308-nm excimer lamp and laser showed a similar efficacy in treating vitiligo. For the same fluence, the lamp induced more erythema suggesting photobiological differences between the two devices.

Objective: To compare the efficacy on pain relief and function of one, two or three injections of intra-articular hyaluronic acid in symptomatic osteoarthritis (OA) of the carpometacarpal joint of the thumb (CMCJ). Methods: Among subjects with symptomatic OA of the CMCJ of the thumb referred to the Rheumatology Department of Nice, patients free of any joint injection in last 6 months with pain visual analogue score (VAS) >40 and with Kellgren and Lawrence score between 2 and 4 were included. Each subject was randomly allocated to receive, at weekly intervals, 1 (group 1) or 2 (group 2) or 3 injections (group 3) of 1 ml Sodium Hyaluronidate (Sinovial). Injections were given under imaging control. Sociodemographic characteristics, VAS and functionality (Dreiser Functional Index) were assessed at baseline, at one month and at three months. An intention to treat analysis was performed. Results: Forty two subjects were enrolled in the study. Their mean age was 64.8 (8.0) years, and 90.5% were women. Baseline pain VAS, and mean Dreiser functional index were respectively 57.7 (17.1) and 12.5 (5.8). A repeated measure analysis of variance (ANOVA) model was used to compare the time-course profile of the three treatment groups for VAS and Dreiser index. Due to statistically significant groups-time interaction the analyses were conducted at each evaluation time. No difference was found for VAS at 1 month (p ¼ 0.075) and 3 months (p ¼ 0.382). Intra group differences between baseline and three months was significant in groups 2 and 3 (p ¼ 0.012 and p ¼ 0.002). Conclusion: No significant differences were found between each group over the study period for pain relief and function. But the intra groups analysis results show that intra-articular sodium hyaluronidate injections into the carpometacarpal joint of the thumb in osteoarthritis can be efficacious on pain and fuctionality. What is now needed is a controlled placebo randomised study with larger samples and longer term follow up of the achieved effects. 2007 Elsevier Masson SAS. All rights reserved.

Resume Introduction Le laser a colorant pulse (LCP) est une methode seduisante pour traiter les verrues. Cependant, les donnees concernant son efficacite reposent essentiellement sur des cas cliniques ou des series ouvertes avec des resultats tres variables d’une etude a l’autre. L’objectif de cette etude etait de comparer l’efficacite et la tolerance du laser a colorant pulse par rapport a un placebo dans le traitement d’un groupe homogene de malades ayant des verrues palmo-plantaires. Methodes Il s’agissait d’une etude prospective controlee contre placebo, randomisee, en simple insu menee de decembre 2004 a juillet 2005 chez des malades venant consulter dans le service de dermatologie du CHU de Nice pour des verrues palmo-plantaires. Les parametres de traitement par le laser a colorant pulse a 595 nm etaient : diametre du spot de 5 mm, duree d’impulsion de 0,45 ms, fluence de 9 J/cm 2 avec une repetition de cinq coups a une frequence de 1 Hz. Des impulsions de refroidissement (systeme integre a la machine) par spray de cryogene etaient utilisees avec une duree de 40 ms et un debit de 50 avant chaque tir laser. Chez les malades du groupe placebo, seules les impulsions de refroidissement etaient utilisees. Pour les verrues plantaires (dans les deux groupes) un decapage manuel au bistouri de l’hyperkeratose etait effectue avant chaque seance. Au maximum, trois seances, espacees de 3 semaines chacune, etaient realisees. Le type et le nombre de verrues etaient comptabilises et reportes sur un schema avant le debut du traitement, lors de chaque seance et 5 semaines apres la derniere seance. La tolerance globale du traitement etait evaluee sur une echelle visuelle analogique allant de 0 (intolerable) a 10 (tolerance parfaite). Resultats Dix-neuf malades ont ete retenus dans le groupe laser et 16 dans le groupe placebo. Soixante-quatre pour cent (48/75) des verrues du groupe laser ont totalement disparu versus 13 p. 100 (4/30) dans le groupe placebo (p Discussion Le laser a colorant pulse apparait comme un traitement efficace des verrues palmo-plantaires mais son efficacite semble equivalente a celle des traitements conventionnels (cryotherapie ou preparation a base d’acide salicylique). Sa tolerance est excellente et constitue l’un des principaux interets de cette technique. L’absence de superiorite prouvee, en terme d’efficacite, par rapport aux traitements conventionnels et son cout eleve incitent a utiliser le laser a colorant pulse comme un traitement de deuxieme intention chez des malades desireux de ne pas etre genes dans leur activite professionnelle.

Background: The adverse effects of isotretinoin have been well documented, but dental side effects over the course of treatment have never been studied. Objectives: To prospectively document the oral side effects experienced by a group of patients taking isotretinoin and to compare the changes in oral health and salivary parameters with a control group. Methods: A cohort study was conducted within the dermatology department at the University Hospital in collaboration with two private dermatology practices in Nice, France. Patients were treated at a dose of 0.5 mg/kg/day. The control group was made up of students from the University of Nice-Sophia-Antipolis. The salivary flow, the buffer capacity of saliva, the number of pathogen bacteria and the DMFT index (number of decayed, missing and filled teeth) were assessed at each visit. Results: Eighteen patients and 99 controls were available for evaluation. None of the oral parameters varied with time in the control group, whereas the DMFT significantly increased in the treated group (3.07 ± 3.85 vs. 3.41 ± 4.36; p < 0.036). The salivary flow gradually decreased with time (p < 0.004), but the patients recovered their baseline salivary flow 2 months after the end of the treatment. Conclusions: This study clearly showed that patients treated with isotretinoin experienced oral side effects.

Background As CD4/CD8 ratio inversion has been associated with non-AIDS morbidity and mortality, predictors of ratio normalization after cART need to be studied. Here, we aimed to investigate the association of antiretroviral regimens with CD4/CD8 ratio normalization within an observational cohort. Methods We selected, from a French cohort at the Nice University Hospital, HIV-1 positive treatment-naive patients who initiated cART between 2000 and 2011 with a CD4/CD8 ratio 1) in the first year was assessed using multivariate logistic regression models. Specific association with INSTI-containing regimens was examined. Results 567 patients were included in the analyses; the median CD4/CD8 ratio was 0.36. Respectively, 52.9%, 29.6% and 10.4% initiated a PI-based, NNRTI-based or NRTI-based cART regimens. About 8% of the population started an INSTI-containing regimen. 62 (10.9%) patients achieved a CD4/CD8 ratio ≥1 (N group). cART regimen was not associated with normalization when coded as PI-, NNRTI- or NRTI-based regimen. However, when considering INSTI-containing regimens alone, there was a strong association with normalization [OR, 7.67 (2.54–23.2)]. Conclusions Our findings suggest an association between initiation of an INSTI-containing regimen and CD4/CD8 ratio normalization at one year in naïve patients. Should it be confirmed in a larger population, it would be another argument for their use as first-line regimen as it is recommended in the recent update of the “Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents”.

Background and Objectives To determine the true efficacy of the 308-nm excimer laser for the treatment of vitiligo, while taking into account confounding factors such as anatomic site of treatment, age, sex, skin type, MED, and duration of evolution of the vitiligo. Study Design/Materials and Methods Thirty-five patients with vitiligo were included. Each lesion was treated twice a week by the 308-nm excimer laser for a maximum of 24 sessions. Efficacy was blindly evaluated by two independent physicians. Results Repigmentation was noted in 46 plaques/52 (88.5%). Repigmentation rate (75%) was obtained in 14 (26.9%). In “UV sensitive” areas (face, neck, trunk), 8/14 lesions (57.1%) had a repigmentation rate, 75% versus 6/38 (15.8%) in “UV resistant” areas (bony prominences and extremities) (P = 0.031). No relationship could be established between response to the treatment and the following variables: age, sex, skin type, MED, and duration of evolution of the vitiligo (respectively, P = 1, 0.666, 0.566, 0.628, 0.521). Conclusions An aesthetically reasonable result is achieved essentially in “UV sensitive” areas, thus appearing to be the appropriate places of choice for this treatment. Lasers Surg. Med. 35:152–156, 2004. © 2004 Wiley-Liss, Inc.

Background: The 940-nm diode laser has been shown to be an effective treatment for leg veins. Objective: We sought to evaluate the effectiveness of the 940-nm diode laser on leg veins, depending on the size and morphologic aspect of the treated vessels. Methods: A total of 60 patients (mean age: 44.4 years, Fitzpatrick skin types I-IV) underwent up to 3 treatment sessions at 4-week intervals using the 940-nm diode laser. Treatment parameters were: vessels 2 ; 0.4 to 0.8 mm in diameter, 1-mm spot, pulse duration of 30 milliseconds, fluence 306 J/cm 2 ; and 0.8 to 1.4 mm in diameter, 1.5-mm spot, pulse duration of 70 milliseconds, fluence 317 J/cm 2 . Repetition rate was 2.5 Hz. Success rate was evaluated through double-blind observation. Results: Only 13.33% of patients with telangiectases less than 0.4 mm in diameter had a percentage of vessel clearance superior to 75%. However, 88.24% of patients with vessels between 0.8 and 1.44 mm in diameter obtained more than 75% vessel clearance. Conclusion: The treatment of leg veins by the 940-nm diode laser strongly depends on the size of the target vessel. Better results were obtained with 0.8- to 1.4-mm leg venulectases. (J Am Acad Dermatol 2003;48:768-74.)

International audience

Introduction Les donnees recentes sur la physiopathologie du vitiligo soulignent l’importance de la voie de l’IFNg et des chimiokines CXCL9 et CXCL10. Les anticorps anti-CXCL10 ont donne des resultats encourageants dans des modeles murins de vitiligo. Les statines protegent les melanocytes humains du stress oxydatif et diminuent le nombre de lymphocytes T autoreactifs dans la peau. Il a egalement ete montre que l’atorvastatine peut diminuer le taux plasmatique de CXCL10 dans la maladie de Crohn. Le but de notre etude etait d’evaluer l’efficacite d’un traitement par atorvastatine associe a une phototherapie UVB vs phototherapie UVB seule dans le vitiligo evolutif. Materiel et methodes Cette etude interventionnelle, prospective, en simple insu, bicentrique a ete realisee au CHU de Nice et au National Skin Center de Singapour. Les patients atteints de vitiligos evolutifs non segmentaires (definis par des bords flous en lumiere de Wood et/ou une depigmentation en confetti) ont ete randomises (randomisation equilibree, centralisee et stratifiee sur le centre) en deux groupes : phototherapie UVB-TL01 avec atorvastatine 80 mg par jour ou phototherapie UVB-TL01 pendant 6 mois. Les patients etaient suivis a 1 mois, 3 mois et 6 mois avec examen clinique, photographies et prise de sang. Le critere de jugement principal etait l’evolution du Vitiligo Area Scoring Index (VASI) entre j0 et m6 evalue par 3 dermatologues independants sur photographies en insu du traitement. Les criteres secondaires etaient les scores VETF, VES, PGA, DLQI. Resultats Trente patients (16 a Nice, 14 a Singapour) ont ete inclus, 15 dans le groupe A et 15 dans le groupe B. En ITT, l’evolution moyenne dans le groupe UVB+ atorvastatine etait de −2,95 ± 1,39 (−5,81 a −0,09) ; p = 0,0434 et de −4,38 ± 1,44 ; (−7,35 a −1,42), p = 0,0054, dans le groupe UVB seul. La difference d’evolution moyenne entre les 2 groupes etait de 1,43 (−2,76 a 5,62). Cette difference n’est pas significative ( p = 0,49, Ancova ajustee sur le centre et la valeur du score VASI a j0). L’analyse en perprotocole ne montre egalement pas de difference entre les 2 groupes. Discussion Dans les 2 groupes, le traitement a permis de diminuer significativement le score de severite du vitiligo et de stopper l’evolutivite. Cependant, la combinaison atorvastatine-UVB n’a pas montre de superiorite par rapport aux UVB seuls. Cela est concordant avec une etude recente ayant evalue la symvastatine 80 mg en monotherapie vs placebo dans des vitiligos souvent non evolutifs. Il est possible qu’aux doses utilisees l’action sur CXCL10 soit trop modeste pour impacter significativement l’evolution du vitiligo. Conclusion L’association de l’atorvastatine a la phototherapie UVB n’a pas montre de superiorite par rapport a la phototherapie pour re-pigmenter des vitiligos tres evolutifs. Ces resultats confirment cependant l’interet de la phototherapie dans ce sous-groupe de patients tres actifs.

Objective To estimate the prevalence of ultrasonographic enthesitis in psoriasis patients with or without musculoskeletal symptoms and to investigate their evolution under systemic treatments given for the cutaneous symptoms. Patients and methods Prospective bi-centre (rheumatology and dermatology) study over 6 months, including psoriasis pts requiring systemic treatment, with or without musculoskeletal symptoms and/or psoriatic arthritis (PsA). Clinical assessment (M0 and M6) included: BASDAI, HAQ, SPARCC, PASI and nail disease. US assessment (M0 and M6) with Grey Scale and PD of 10 entheses was performed by one trained rheumatologist blinded to clinical and biological data, scoring morphological, structural lesions and PD signal. Results Complete data were obtained on 340 entheses in 34 patients. Twenty-two were asymptomatic (PsO) and 12 symptomatic (PsA). They received conventional treatment and/or biologics. At baseline US abnormalities were found in 97.1% total population and in 86.4% PsO patients. 95/340 enthesitis were observed, 57/220 in PsO vs 38/120 in PsA (P = 0.258). Neither group had PD signal. Presence of 24/90 enthesitis in patients with nail disease vs 33/130 without (P = 0.831). At M6 Twenty-three patients were assessed. US morphological (thickness and hypoechogenicity) abnormalities were improved in PsO (n = 13) (P = 0.021) and PsA patients (n = 10) (P = 0.164) with a significant decrease of BASDAI, HAQ, SPARCC. Conclusion We observed a high frequency of US enthesitis in psoriasis patients, with or without musculoskeletal symptoms, requiring systemic treatment. At 6 months, US morphological abnormalities were likely to improve. Further studies would be interesting to validate our data and to assess their potential impact on PsA development.

Pulmonary rehabilitation (PR) for patients undergoing lung resection for cancer remains controversial. We studied the effects of PR, its impact on quality of life and the level of anxiety and depression.In 2011 and 2012, PR was offered to all patients referred to our institution after lung resection for cancer. Patients were evaluated between admission and discharge by a 6 minutes walking test (6MWD), a Visual Analogue Pain Intensity Scale, a quality of life questionnaire (EORTC QLQ C30) and by the Hospital Anxiety and Depression Scale (HAD). The same questionnaires were mailed 6 months after completing PR.Between early 2011 and late 2012, 133 patients were admitted to our institution following lung resection for cancer. Of these, 59 (44%) patients completed PR and returned their questionnaires 6 months after discharge. During PR of these 59 patients, the mean quality of life score increased from 56.3 to 65.9 (P0.05), the median anxiety score decreased from 5.5 to 4 (P0.05) and that of depression from 3 to 2 (P0.05). At 6 months post-discharge, the mean quality of life score remained stable at 66.3 (P=0.8), the median anxiety score reverted to 6 (P0.05) and the median depression score reverted to 4.5 (P0.05).This observational study during PR, showed that quality of life and the levels of anxiety and depression were improved at the end of the course. After returning home, the average quality of life score remained stable but the level of anxiety and depression increased.

International audience; : Introduction: Oxytocin (OT), a neurohypophysial hormone regulated by estrogen and leptin, may play a role in bone metabolism in humans as suggested by animal studies. This study assess the relationship between OT and bone status in a large population of post menopausal women. Subjects and methods: Subjects were included in the Osteoporosis and Ultrasound study (OPUS), a 6-yr prospective study in a population-based cohort. Final visit data were used for this cross-sectional study. OT, leptin and estradiol serum levels were measured in 1097 post-menopausal women and compared with bone mineral density (BMD), fractures and the bone turnover markers (BTM) procollagen type 1 N-terminal propeptide (PINP), bone alkaline phosphatase (bone ALP) and C-telopeptide of type 1 collagen (CTX). Results: Median age was 70.8 years, 16% were osteoporotic, 48% osteopenic, and 29% had at least one fracture. OT serum level was related to spine (r=+0.12, p=0.0002) and total hip BMD (r=+0.21, p

Elastography is a novel imaging technology that shows promise in the identification of anatomic structures. The widespread use of ultrasound for screening testicular tumors in patients with cancer risk factors highlights unclassified testicular micronodules. We investigated the ability of elastography to accurately diagnose testicular nodules.Patients with clinical testicular nodules were assigned to undergo elastography in a prospective study. The imaging was carried out by a single radiologist using a static elastography unit with a 9-14MHz frequency linear transducer, to identify hardness score, loss of architecture of testicular parenchyma, and surrounding effect. When orchidectomy was required, the corresponding specimens were subjected to hematoxylin and eosin staining for histologic correlation.We imaged 34 testicular lesions: 26/34 (76%) malignant tumors and 8/34 (24%) non-tumor lesion including 4 hematomas, 3 orchitis and 1 ischemia. Se, Sp, PPV and NPV of hardness in elastography in differentiating between malignant and benign tissue was found to be 96.2%, 37.5%, 83%, and 75%, respectively. Further, for recognizing cancer, the loss of architecture of the testicular parenchyma detecting in elastography was 92.3%, 75%, 92.3%, and 75%, respectively, and the surrounding effect was 84.6%, 87.5%, 95.6% and 63.6%, respectively.Elastography may be a promising tool at diagnosing testicular tumor when the loss of architecture and the surrounding effect were present. Further studies are needed to evaluate whether the utility of elastography is worth pursuing to identify of unclassified testicular micronodules.3.

Infiltrative gliomas (IG), including astrocytomas, oligodendrogliomas, and glioblastomas, are the most common primary brain tumors in humans.1 IG display a poor prognosis, especially glioblastomas, which represent the most aggressive subtype.1 The tumors of this group are characterized by a pattern of infiltrative growth into the surrounding normal brain,2 making complete surgical excision very difficult. Recurrence or progression after surgery almost always occurs despite adjuvant treatment with radiotherapy and/or chemotherapy.1 Morphological patterns of IG are often heterogeneous, and the diagnosis may be challenging for pathologists.2 Glial tumor cells may also be difficult to distinguish from reactive cells on the basis of morphology alone. Reactive astrocytes may become very large and may even display pleomorphic nuclei resembling neoplastic tumor cells.3 The differential diagnosis between IG and gliosis can thus be difficult, especially in small biopsy samples.4 IG can also be difficult to differentiate from benign and/or curable noninfiltrative glial tumors, including pilocytic astrocytomas, gangliogliomas, and dysembryoplastic neuroepithelial tumors,1,2 and from demyelinating disease.5 It is therefore very important for pathologists to develop histological markers to identify infiltrating glioma cells. To date, no ideal marker has been identified for this purpose. In practice, the most useful markers are MIB1/Ki676,7 and p53,8,9 but these lack sensitivity and specificity.10 More recently, the mutated R132H form of isocitrate dehydrogenase 1 (IDH1), which can be specifically detected by immunohistochemistry,11,12 has been shown to be a good marker of grade II and grade III gliomas and of secondary glioblastomas.13–15 However IDH1 (R132H) is rare in primary glioblastomas16 and is not useful for the diagnosis of this subtype, which represents the most common IG. A marker specific for infiltrating cells, which are characteristic of IG regardless of grade or histological subtype, would be of value. Recently, we showed that the EGFR immunolabelling pattern can discriminate low-grade glioma from gliosis.17 The criterion that characterized low-grade gliomas was strong EGFR immunostaining in cells with a high nuclear to cytoplasmic ratio. EGFR overexpression is frequent in gliomas. In 40% of glioblastomas, EGFR overexpression is secondary to gene amplification and is often associated with expression of EGFRvIII, a constitutively activated mutated variant.18 Conversely, EGFR amplification is rare in low-grade gliomas,18–21 although protein overexpression has been detected with a frequency ranging from 11.5% to 100% of cases in the literature.19,20,22–24 The mechanism of this overexpression in low-grade IG remains unknown. Several ligands, including EGF and TGFα, may activate EGFR. The activation of EGFR is involved in several processes, including cell survival, differentiation, proliferation, and migration.25 Because EGFR has been shown to influence cell migration during the development of the central nervous system26–28 and in gliomas,29–31 we postulated that EGFR could be a marker of migrating cells, specific for IG. The aim of the present study was to assess whether elevated EGFR expression in cells with a high nuclear to cytoplasmic ratio, as we previously observed in low-grade glioma,17 may be a valuable criterion to discriminate infiltrative gliomas of any grade or histological subtype from noninfiltrative glial lesions. We also sought to further characterize these strongly EGFR-positive cells.

Background and study aims: Uncovered self-expanding metal stents offer effective relief for colonic obstruction. The aim of this study was to determine the effectiveness of fully covered self-expanding metal stents (FCSEMSs) in the treatment of benign colonic strictures. Patients and methods: All patients presenting with a symptomatic benign colonic stricture (occlusion or subocclusion) during a 6-year study period were treated with FCSEMSs. The stents were placed and removed 4 – 6 weeks later at one of 10 endoscopy centers. The efficacy of the stent (clinical and radiological signs of colonic decompression within 48 hours), technical success, stent retrieval, safety, and recurrence of symptoms were evaluated during follow-up. Univariate and multivariate analyses were performed to identify variables associated with clinical success, stent migration, and symptom recurrence. Results: The study included 43 patients (24 men, 19 women; mean age 67.6 ± 10.4) with occlusive (n = 18) or subocclusive symptoms (n = 25) due to anastomotic (n = 40), post-ischemic (n = 2), or post-radiation (n = 1) strictures. Insertion was successful in all patients. Clinical success was obtained in 35 patients (81 %). Migration was observed in 27 patients (63 %). The median duration of stenting was 21 days (95 %CI 17.8 – 35.4 days). Multivariate analysis showed that stents more than 20 mm wide migrated significantly less often. Recurrence of obstructive symptoms was observed in 23 patients (53 %), irrespective of migration. No predictive factors for recurrence or clinical efficacy were found. Conclusions: FCSEMSs for treatment of symptomatic benign colonic strictures are safe and effective, despite a high rate of spontaneous migration.

Cystinosis is a rare autosomal recessive disease characterized by cystine crystal accumulation leading to multiorgan dysfunctions and caused by mu- tation in CTNS. CTNS encodes cystinosin, a cystine/H symporter that exports cystine out of the lysosomes. Patients with cystinosis frequently exhibit blond hair and fair complexion, suggesting an alteration in mela- nogenesis. However, the pigmentation singularities of these patients have not been studied, and the role of cystinosin in melanogenesis has remained unknown. In our study, a clinical evaluation of 27 patients with cystinosis showed that 44% had a cutaneous pigmenta- tion dilution compared to their relatives. Analysis of the hair melanin content in these patients by HPLC dem- onstrated a 50% decrease in eumelanin (4360 vs. 9360 ng/mg), and a 2-fold increase in pheomelanin (53 vs. 20 ng/mg), the yellow/red pigments. Cystinosin-deficient mice also showed a 4-fold increase in hair pheomelanin content. In vitro studies showed that cystinosin was located at melanosomes. CTNS silencing led to a 75% reduction of melanin synthesis that was caused by a degradation of tyrosinase by lysosomal proteases. Our results objectify the pigmentation defect in patients with cystinosis. We also identify the role of CTNS in melanogenesis and add a new gene to the list of the genes involved in the control of skin and hair pigmen- tation.—Chiaverini, C., Sillard, L., Flori, E., Ito, S., Briganti, S., Wakamatsu, K., Fontas, E., Berard, E., Cailliez, M., Cochat, P., Foulard, M., Guest, G., Niau- det, P., Picardo, M., Bernard, F.-X., Antignac, C., Ortonne, J. P., Ballotti, R. Cystinosin is a melanosomal protein that regulates melanin synthesis. FASEB J. 26, 000 - 000 (2012). www.fasebj.org

The treatment of vitiligo remains unsatisfactory.To assess in patients with vitiligo the effect of a laser dermabrasion in addition to the association of topical steroids and ultraviolet (UV) B in difficult-to-treat areas.This was a single-centre prospective randomized trial including patients with nonsegmental vitiligo who had at least two symmetrical lesions located on bony prominences and/or extremities. An erbium laser-assisted dermabrasion was first performed on one side (randomly assigned). After 48 h, hydrocortisone 17-butyrate cream applied daily for three periods of 3weeks followed by a 1-week steroid-free interval and narrowband UVB treatment was performed on both sides twice weekly for 12weeks. The evaluation was performed on standardized pictures by two physicians blinded to the type of treatment received. The criterion of success was a repigmentation of at least 50%, 1month after the end of the treatment.Eighteen patients were included (24 paired lesions treated). Two patients dropped out for personal reasons. Almost 50% of lesions achieved at least 50% repigmentation in the dermabrasion side while only 4·2% did so with topical steroids and UVB alone (P10(-4) ). Side-effects were delayed healing, pain and two hypertrophic scars. The tolerance and patient satisfaction were 4·2 and 4/10 for the laser-treated side and 8·4 and 3/10 in the UVB+ steroids alone group, respectively.Laser dermabrasion significantly improves the repigmentation rate in vitiligo lesions. Despite a high rate of repigmentation in such difficult-to-treat areas the high rate of side-effects and the poor tolerance strongly limit its use in current practice.

Since many years, caesarean section rate has increased in France. The purpose of the study was to compare the different French obstetrical attitudes after a prior caesarean section.This retrospective study was performed between March 2008 and February 2010. We collected the answers of a majority of maternity centres contacted with an anonymous questionnaire sent by postal, electronic, fax mails.Of the 194 maternity centres which have responded, there were 37 university hospitals and 312 obstetricians: 75.6% of them worked in public sector and 19.2% in private one. The use of a protocol is registered for 29.6% of questioned obstetricians (only 14% in private sector, P=0.002). Pelvimetry is consistently proposed by 44.4% of them. A trial of labour in case of breech presentation is proposed by 20% of questioned obstetricians, with twin pregnancies by 23.7%, with two prior low-transverse caesarean delivery by 12%, most in university hospitals, level III, with more than 1500 births per year. Induction of labour is allowed by 73.9% of questioned obstetricians, by ocytocics as a majority. Induction by Prostine(®) is underwent by 14.5% of them (24.6% in academic centres, P=0.01), by Propess(®) by 19.2% of them (30% in university hospitals, P=0.008).These findings showed that the management of delivery after caesarean section is associated with statistically significant differences in France. These informations are relevant for counselling French obstetrical practices.

Introduction Le vitiligo est une maladie ayant un impact important sur la qualite de vie. La redepigmentation apres un traitement efficace est un phenomene frequent avec un taux de rechutes a un an evalue a plus de 40 %. A ce jour, il n’existe aucun traitement d’entretien dans le vitiligo qui pourrait prevenir ces rechutes. Notre objectif etait d’evaluer l’efficacite d’un traitement d’entretien par tacrolimus topique a raison de 2 fois par semaine dans la prevention des rechutes chez des patients atteints de vitiligo ayant obtenu une repigmentation superieure a 75 % suite a un traitement. Patients et methodes Nous avons realise une etude prospective bicentrique comparative randomisee contre placebo. Cette etude a ete effectuee dans les services de dermatologie du CHU de Nice et du CHU de Bordeaux, et s’est deroulee de decembre 2011 a octobre 2013. Les patients devaient appliquer la pommade 2 fois par semaine pendant 24 semaines. L’evaluation etait faite en insu du traitement administre sur comparaison des photographies avant et apres 24 semaines de traitement par 2 evaluateurs independants. Le critere d’evaluation principal etait le pourcentage de lesions sans nouvelle depigmentation a 6 mois. Resultats Trente-cinq patients avec 67 plaques de vitiligo ont ete inclus. Il n’y avait pas de difference significative dans la saison d’inclusion entre les 2 groupes ( p = 0,98), ni dans l’evolutivite du vitiligo ( p = 0,25). En analyse per-protocole, 46 % des lesions sous placebo ont depigmente contre 9 % des lesions dans le groupe Protopic ® 0,1 % ( p = 0,001 %). En analyse en intention de traiter avec recherche du biais maximal, 43 % des lesions sous placebo ont depigmente contre 17 % dans le groupe Protopic ® 0,1 % ( p = 0,03). La tolerance du traitement a ete bonne dans les 2 groupes. Discussion Cette etude montre que le tacrolimus topique utilise en traitement proactif a raison de 2 applications par semaine permet de diminuer de facon significative les rechutes sur des plaques de vitiligo ayant precedemment repigmente. Au-dela de la demonstration de la possibilite de reduire les rechutes dans cette pathologie ayant un impact important sur la qualite de vie, ces resultats ont des repercussions tres pratiques pour la prise en charge des patients. Le tacrolimus pommade pourrait etre ainsi propose en prevention secondaire chez des patients ayant deja eu des rechutes apres un episode de repigmentation. Conclusion Le tacrolimus a 0,1 % en application bihebdomadaire est le premier traitement preventif des rechutes dans le vitiligo tout en restant peu contraignant pour les patients.

The 308-nm excimer laser and 308-nm excimer lamp have both been shown to be effective in treating vitiligo but a direct comparison has never been performed.To test the equivalence of these two devices for treating nonsegmental vitiligo.A randomized monocentric study was undertaken. One lesion was treated with the 308-nm excimer laser and its counterpart with the 308-nm excimer lamp. Lesions were treated twice weekly with the same dose on both sides for a total of 24 sessions. The evaluation was done by two independent physicians blinded to the treatment on direct light and ultraviolet light photos.Twenty patients were included: 17 completed the study and 104 lesions were treated. The two treatments showed similar results in terms of efficacy for a repigmentation of at least 50% (P = 0.006). The lamp induced more erythema than the laser.The 308-nm excimer lamp and laser showed a similar efficacy in treating vitiligo. For the same fluence, the lamp induced more erythema suggesting photobiological differences between the two devices.

Objectives To evaluate the efficacy of 1% pimecrolimus cream in treating oral erosive lichen planus and to assess its tolerance. Design Double-blind randomized trial with placebo control. Setting Outpatients of the Department of Dermatology, University Hospital of Nice, from December 21, 2004, to April 19, 2005. Patients Fourteen consecutive patients with oral erosive lichen planus confirmed by histological examination and with a clinical score superior to 3. Of the 14 patients, 2 did not meet the inclusion criteria and 12 were enrolled in the trial. Intervention The intervention was 1% pimecrolimus cream or its vehicle, which was applied on ulcerated lesions twice a day for 4 weeks. Main Outcome Measures The efficacy of the treatment was quantified using a 12-point clinical score. The blood level of pimecrolimus was analyzed on days 0 (baseline), 14, and 28. Results In the placebo group, the mean score was 4.67 on day 0 vs 3.33 on day 28 ( P = .22). In the pimecrolimus group, the mean score was 6.83 on day 0 vs 3.33 on day 28 ( P = .04). In the pimecrolimus group, blood concentrations of pimecrolimus were always above the threshold (mean value, 2.84 ng/mL; extreme values, 0-6.19 ng/mL). Pimecrolimus cream was well tolerated, and only transient burning sensations were reported by some subjects. Each of the patients in the pimecrolimus group whose condition improved subsequently relapsed when assessed 1 month after treatment. Conclusions The 1% pimecrolimus cream seems to be an effective and well-tolerated treatment for oral erosive lichen planus. The finding of systemic levels of pimecrolimus after mucosal applications necessitates long-term study because it seems that long-term application is required to maintain clinical improvement. Trial Registration clinicaltrials.gov Identifier:NCT00321750

Pulse dye laser (PDL) appears an attractive method to treat warts. However, data concerning the efficacy of this approach are based chiefly upon open clinical studies or case reports and results vary widely from one study to another. The purpose of this study was to compare the efficacy and safety of PDL with a placebo in the treatment of a homogeneous group of patients presenting palmoplantar warts.This was a randomized, prospective, placebo-controlled, single-blind study conducted between December 2004 and July 2005 in patients consulting for palmoplantar warts at the Dermatology Department of the University Teaching Hospital of Nice. The treatment settings used for the 595-nm PDL were as follows: spot diameter 5 mm, pulse duration 0.45 ms, fluence 9 J/cm2 with 5 passes at a frequency of 1 Hz. Cryogen spray cooling (system incorporated in the machine) was given at a rate of 50 spurts of 40 ms prior to each laser pulse. In patients in the placebo group, cooling pulses alone were given. For the plantar warts (in both groups), hyperkeratosis was removed manually with a scalpel before each session. A maximum of three sessions was administered at 3-week intervals. The type and number of warts was counted and recorded in a treatment schedule before the start of therapy, at each session and 5 weeks after the final session. The global safety of the treatment was evaluated using a visual analog scale between 0 (intolerable) and 10 (completely safe).Nineteen patients were included in the laser group and 16 were included in the placebo group. Sixty-four per cent (48/75) of warts in the laser group resolved completely compared with 13% (4/30) in the placebo group (p0.001). In the PDL group, 6 of 19 patients (31.5%) no longer had warts by the end of the study compared with 3 of 16 patients (18.75%) in the placebo group (p=0.46). The global safety score of the treatment as assessed by the patients themselves was 8.31 in the laser group and 9.81 in the placebo group.Pulse dye laser appears to be an effective treatment in palmoplantar warts but the efficacy of this method seems to be only equivalent to that of standard treatments (cryotherapy or salicylic acid preparations). Safety is excellent and constitutes one of the major advantages of this technique. The absence of any proven superiority over the standard treatments in terms of efficacy, coupled with the high costs involved, means that PDL should only be used second-line therapy in patients wishing to avoid constraints affecting their professional activity.

Background: Appropriate use of prebiotics and optimal combinations of probiotics and prebiotics (synbiotics) could allow significantly better results to be obtained in the treatment of atopic dermatitis (AD). Objective: To evaluate the efficiency of synbiotics when compared with prebiotics alone (control group) in the treatment of moderate and severe AD in children aged 2 years and over. Methods: Double-blind prospective randomized study performed on children aged at least 2 years presenting AD with a minimum SCORing Atopic Dermatitis (SCORAD) score of 15. A dose of 1.2 × 109 colony-forming units Lactobacillus rhamnosus Lcr35 plus prebiotic preparation or an identically appearing prebiotic preparation alone was given three times a day for 3 months. Patients’ diet and usual treatment for AD remained unchanged during the study period. Efficiency was evaluated using the SCORAD score. Use of topical drugs was noted. Results: A total of 48 patients were originally enrolled; nine did not complete the study. In synbiotic group, the mean values of the total SCORAD score was 39.1 before treatment vs 20.7 after 3 months of treatment (P