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International audience; Sandy beaches are the result of a dynamic interaction among physical conditions, biological processes and the anthropic impact (essentially linked to the natural resource direct or indirect exploitation). Monitoring the health state of coastal areas is a fundamental tool for land-use management. Moreover, integrated sedimentological studies with multidisciplinary methodologies are increasingly needed. This study aims to monitor the evolution of Torre Guaceto beach (Brindisi) over different seasons. The study area is part of a protected marine reserve characterised by a relatively slight human impact and a significant availability of previous data that allows us to observe the natural dynamic effects on the health state of the beach. The research was developed by adopting different techniques in order to investigate the foreshore and the shoreface sector of the beach. The geomorphological investigation, carried out with the terrestrial laser scanner and the optical total station, aimed to quantify the variations of sediment volume of the beach, while the sedimentological and petrographical analyses were conducted to define the sand textural and compositional characteristics throughout different sampling seasons; finally, Delft3d software was applied to analyse the effects of the dominant wave motion on the sedimentary dynamics.

Bone repair induced by stem cells and biomaterials may represent an alternative to autologous bone grafting. Here, we compared the efficiency of two biomaterials - biphasic calcium phosphate (BCP) and bioactive glass (BG) - when loaded with either adult bone marrow mesenchymal stem cells (BM-MSCs) or newborn nasal ecto-mesenchymal stem cells (NE-MSCs), the latter being collected for further repair of lip cleft-associated bone loss. Both cell types display the typical stem cell surface markers CD73+/CD90+/CD105+/nestin, and exhibit the MSC-associated osteogenic, chondrogenic and adipogenic multipotency. NE-MSCs produce less collagen and alkaline phosphatase than BM-MSCs. At the transcript level, NE-MSCs express more abundantly three genes coding for bone sialoprotein, osteocalcin and osteopontin, while BM-MSCs produce extra copies of RUNX2. BM-MSCs and NE-MSCs adhere and survive on BCP and BG. In vivo experiments reveal that bone formation is only observed with BM-MSCs transplanted on BCP biomaterial.

Resume Les traumatismes des nerfs peripheriques peuvent etre extremement invalidants et l’efficacite des traitements existants demeure tres insuffisante. La greffe de cellules souches apparait comme une alternative prometteuse. Notre equipe travaille sur les cellules souches olfactives, localisees dans la cavite nasale, appartenant au systeme nerveux peripherique et facilement accessibles chez tout individu vigile (sans alterer le sens de l’olfaction). Elles sont apparentees aux cellules souches mesenchymateuses de la moelle osseuse, presentent une activite mitogene elevee et detiennent un fort potentiel de differenciation vers des cellules neurales. Nous avons valide un nouveau procede de fabrication en grade clinique de ces cellules souches humaines isolees a partir d’une biopsie de 2 mm2. Recemment, nous avons montre, chez le rat, que la greffe de cellules souches olfactives, adjuvante a la chirurgie de reparation du nerf facial et du nerf peronier, ameliore la recuperation fonctionnelle et ce grâce aux pouvoirs immuno-modulateur et trophique des cellules transplantees. Aucune migration des cellules exogenes n’a ete observee, ce qui, couple a l’absence de proliferation des cellules greffees, indique un tres faible risque de tumoriginicite et de metastases. Suite a ces resultats concluant chez l’animal, nous allons lancer un essai clinique multicentrique de phase I/IIa. Les vesicules extracellulaires sont des nanoparticules produites par les cellules. Leur utilisation permettrait de conserver les benefices paracrines des cellules souches sans leurs inconvenients (immunocompatibilite ou culture longue). Nous avons valide leur extraction et sommes en train de tester leur efficacite in vitro et chez le rat dans la regeneration nerveuse peripherique.

Resume Introduction La secheresse oculaire est une pathologie plurifactorielle de la surface oculaire dont la frequence elevee, le retentissement significatif sur la qualite de vie et sur la vision, ainsi que le cout financier, en font un veritable probleme de sante publique. Si le traitement des formes minimes a moderees est generalement simple et efficace, celui des formes severes est souvent decevant. L’utilisation de collyres a base de serum autologue (CSA) represente une alternative therapeutique envisageable pour les cas les plus severes. L’objectif de notre etude est d’evaluer l’efficacite du traitement par CSA a long-terme chez des patients presentant des syndromes secs isoles refractaires aux traitements conventionnels ou secondaires a d’autres pathologies generales telles que le syndrome de Gougerot-Sjogren et la maladie du greffon contre l’hote (GVH), ou a des pathologies oculaires telles que les keratites neurotrophiques, les brulures chimiques et les pemphigoides cicatricielles oculaires. Patients et methodes Il s’agit d’une etude observationnelle retrospective monocentrique menee sur 47 patients, soit 83 yeux traites par collyre de serum autologue a l’Assistance Publique-Hopitaux de Marseille entre avril 2014 et avril 2017 pour syndrome sec oculaire severe isole ou secondaire. Les symptomes subjectifs des patients (score ocular surface disease index [OSDI]), leur degre de satisfaction ainsi que les effets secondaires ont ete recueillis a l’aide de questionnaires. Le break up time (BUT) et le score de Schirmer ont ete notes. Une evaluation clinique fondee sur un test de coloration corneenne a la fluoresceine (score Oxford) est realisee avant le traitement par CSA a P0 puis selon 5 periodicites : P1 (entre 1 et 3 mois), P2 (3 et 9 mois), P3 (9 a 15 mois) et P4 (15 mois a 24 mois), P5 (> 24 mois). Resultats Sur les 83 yeux traites, l’âge moyen etait de 54,39 ans ± 21,56 dont 20 hommes (42,55 %) et 27 femmes (57,44 %), les indications de traitement comprenaient principalement 25,53 % de GVH, 21,27 % de syndromes secs oculaires severes primitifs et 19,14 % de syndrome de Goujerot-Sjogren primaire. Le suivi moyen a ete de 9,82 mois ± 15,50. La variation du score OSDI entre P0 et P1 montre une diminution de 19,32 points ± 29,37 (p Discussion Des analyses biologiques complementaires sur la composition des CSA sont en cours afin de mettre en evidence des facteurs predictifs d’efficacite. Ainsi, les patients non repondeurs au traitement par CSA pourraient repondre aux collyres de serum allogenique, fabriques a partir de sang peripherique preleve chez un donneur sain a partir de sang de cordon. Conclusion Sur cette premiere serie de 83 yeux traites par CSA, une efficacite clinique a ete notee chez la majorite des patients. Aucune complication infectieuse n’a ete rapportee et le taux de satisfaction a ete tres eleve.

Le consortium TOURNESOL, regroupant 11 equipes de chercheurs et de cliniciens de trois villes (Marseille, Montpellier et Rouen) et finance par la Fondation de l’Avenir, a pour mission de mener deux essais cliniques destines a reparer des nerfs peripheriques leses–nerfs facials et des membres – grâce a des greffes autologues de cellules souches nasales. Pourquoi la therapie cellulaire ? Environ 100 000 operations de reparation nerveuse sont realisees chaque annee aux Etats-Unis et en Europe. Elles representent 2,8 % des traumatismes et sont le plus souvent responsables d’une perte de fonction voire d’invalidite. Malgre des progres dans le delai de prise en charge et dans la qualite du geste technique chirurgical, il n’y a eu aucun progres majeur depuis une vingtaine d’annees. Une approche de therapie cellulaire pourrait limiter l’inflammation et ameliorer la croissance axonale. Pourquoi les cellules souches olfactives nasales ? Chez le mammifere adulte, y compris chez l’homme, la muqueuse olfactive est le seul tissu nerveux capable d’auto-renouvellement. La plasticite de ce tissu est en partie assuree par des cellules souches qui sont multipotentes. Comme demontre par plusieurs membres du consortium, elles peuvent donner naissance a des cellules neurales (neurones, astrocytes, oligodendrocytes, cellules de Schwann). Leur potentiel therapeutique a ete teste avec succes dans differents modeles animaux de paraplegie, de la maladie de Parkinson, de surdite et d’amnesie. Que disent les etudes menees chez le rat par le consortium. Deux etudes, menees en parallele sur le nerf facial et le nerf peronier ont permis de montrer que la greffe de cellules souches olfactives : ameliore la recuperation fonctionnelle de la mobilite faciale ; diminue les syncinesies œil-bouche ; accroit les capacites locomotrices ; ameliore le seuil tetanique, le temps de contraction et le taux de relaxation musculaire Les cellules souches olfactives, medicament de therapie innovante, agree par l’ANSM. Avant de mener les essais cliniques, il a ete necessaire de cultiver les cellules souches dans un laboratoire de therapie cellulaire, dans des conditions repondant aux normes europeennes. Les essais cliniques multicentriques porteront sur une premiere serie de 10 patients avec des lesions negligees des nerfs collateraux et de la branche sensitive du nerf radial avec une perte de substance. La periode d’evaluation post-greffe s’etalera sur 12 mois. La chirurgie regenerative va representer une revolution dans la reparation des membres. Et les nerfs peripheriques devraient en beneficier.

Emulsified fat injection showed its interest in aesthetic facial surgery. The adipose tissue harvested is mechanically emulsified and filtered. The suspension obtained is injected into the dermis through small diameter needles (27 to 30 gauges). The objective of our study was to evaluate the biological composition of emulsified fat and its clinical effectiveness in the treatment of peri-oral wrinkles in 4 patients aged 50 to 59 years.Each patient received an intradermal injection of emulsified fat in the peri-oral wrinkles prepared from abdominal fat under local anesthesia. The cell viability, stromal vascular fraction (FVS) composition in emulsified fat and the adipocyte differentiation capacity of mesenchymal stem cells (MSC) were studied. The clinical results were evaluated by standardized photographs, 3D microphotography, confocal microscopy, and self-evaluation of patient satisfaction over a period of 4 months.The biological study of the emulsified fat found a lysis of all the adipocytes. The mean number of FVS cells was 126,330±2758 cells by cc of emulsified fat with preserved cell viability (85.1±6.84 %) and a good proportion of regeneratives cells (18.77±6.2 %). The clinical study found a tendency to decrease the volume of wrinkles on standardized photography and 3D microphotography no significative. Patients were satisfied with treatment with an average score of 7±1.15/10 to 4 months.Intradermal injection of emulsified fat seems to be an interesting treatment of face wrinkles. Our study has shown its safety, but additional studies seems necessary to confirm its clinical efficacy.

Dry eye disease is a multifactorial pathology of the ocular surface. The high incidence of this pathology, as well as its significant impact on quality of life and vision and its financial cost, makes it a real public health problem. While the treatment of mild cases is generally simple and effective, treatment of severe forms is often disappointing. The use of autologous serum tears (AST) represents a therapeutic alternative for the most severe cases. The purpose of our study is to evaluate the efficacy of long-term AST treatment in patients with severe dry eye disease refractory to conventional treatment or secondary to systemic diseases such as Sjögren's syndrome or Graft versus Host disease (GVH), or ocular pathologies such as neurotrophic keratitis, chemical burns and ocular cicatricial pemphigoid.This is a monocentric retrospective observational study conducted on 47 patients, with 83 eyes treated with autologous serum eye drops for isolated or secondary dry eye disease at the Marseille Public Hospitals between April 2014 and April 2017. The patients' subjective symptoms (ocular surface disease index [OSDI] score), their degree of satisfaction and the side effects were collected using questionnaires. Tear Break Up Time (BUT) and Schirmer scores were noted. A clinical evaluation based on fluorescein staining (Oxford score) was carried out prior to treatment with AST at P0 followed by 5 periods: P1 (between 1 and 3 months), P2 (3 to 9 months), P3 (9 to 15 months), P4 (15 months to 24 months), and P5 (24 months).Out of the 83 eyes treated, the mean age was 54.39±21.56. There were 20 males (42.55 %) and 27 females (57.44 %); treatment indications consisted mainly of 25.53 % GVH, 21.27 % severe dry eye disease and 19.14 % Sjögren syndrome. The mean duration of follow-up was 9.82 months±15.50. The OSDI score decreased by 19.32 points±29.37 (P0.05) between P0 and P1 and by 23.06 points±18.41 (P0.05) between P0 and P4. The Oxford clinical score showed a significant decrease by the third month of treatment, between P0 and P2, by 1.32 points±1.76 (P0.05). The Schirmer test and the BUT also showed an improvement in dry eye symptoms over time with AST, significantly at P1 (P0.05).Complementary biological analyzes on the composition of AST are under way in order to identify predictive factors of effectiveness; patients not responding to AST treatment might respond to allogeneic serum from healthy donor cord blood.On this first series of 83 eyes treated with ASD, clinical efficacy was noted in most of the patients. No infectious complications were reported, and the satisfaction rate was very high.

Resume L’imagerie de microcirculation des cancers du sein repose sur l’etude du rehaussement tissulaire apres injection de produit de contraste. Les vitesses de rehaussement servent a deduire la perfusion et la permeabilite. L’amplitude des rehaussements reflete les volumes sanguins et interstitiels. Cette technique a beneficie des progres de l’IRM qui permettent l’acquisition de grands volumes, avec un bon compromis entre resolutions temporelle et spatiale. Les logiciels ont egalement evolue, permettant de calculer des cartographies de la microcirculation et d’en analyser l’heterogeneite. L’imagerie de la microcirculation renforce le caractere suspect et agressif d’une lesion, devant une augmentation de la permeabilite et une chute du volume interstitiel ; elle permet l’evaluation precoce des traitements neoadjuvants, en montrant la normalisation des parametres fonctionnels qui precede les modifications morphologiques.

Resume La biopsie pulmonaire transparietale guidee en imagerie permet de retrouver l’agent pathogene dans la moitie des infections fongiques et la plupart des infections bacteriennes (sensibilite = 55 %, specificite = 100 %). Les performances diminuent dans les condensations (50 % des infections) par rapport aux masses. Les complications, pneumothorax, hemorragies alveolaires et hemoptysies sont generalement benignes et necessitent rarement (

CT-guided transparietal lung biopsy in imaging makes it possible to find the pathogenic agent in half of all fungal infections and most bacterial infections (sensitivity=55%, specificity=100%). Performance is decreased in consolidations (50% of infections) compared to masses. Complications, pneumothorax, alveolar bleeding and hemoptysis are generally benign and rarely (

Experimentally induced sensorimotor conflicts can result in a loss of the feeling of control over a movement (sense of agency). These findings are typically interpreted in terms of a forward model in which the predicted sensory consequences of the movement are compared with the observed sensory consequences. In the present study we investigated whether a mismatch between movements and their observed sensory consequences does not only result in a reduced feeling of agency, but may affect motor perception as well. Visual feedback of participants’ finger movements was manipulated using virtual reality to be anatomically congruent or incongruent to the performed movement. Participants made a motor perception judgment (i.e. which finger did you move?) or a visual perceptual judgment (i.e. which finger did you see moving?). Subjective measures of agency and body ownership were also collected. Seeing movements that were visually incongruent to the performed movement resulted in a lower accuracy for motor perception judgments, but not visual perceptual judgments. This effect was modified by rotating the virtual hand (Exp.2), but not by passively induced movements (Exp.3). Hence, sensorimotor conflicts can modulate the perception of one’s motor actions, causing viewed “alien actions” to be felt as one’s own.

OBJECTIVE: To describe the level of functionality of President's Emergency Plan for AIDS Relief (PEPFAR)-supported HIV clinical services following the devastating earthquake that struck Haiti in January 2010. DESIGN: Available program-monitoring data from sites providing voluntary counseling and testing for HIV (VCT), antenatal care (ANC) and prevention of mother-to-child transmission (PMTCT) services, and antiretroviral treatment (ART) were described, comparing pre-earthquake and post-earthquake periods during October 2008 to May 2010. METHODS: Pre-earthquake HIV service baselines for VCT, PMTCT, and ART enrollment were defined as monthly mean total number of patients served over 15 months pre-earthquake. ART baseline was defined as total current patients by December 2009. Sites were categorized as high-earthquake or low-earthquake intensity based on location and instrumental shake intensity data. RESULTS: Pre-earthquake mean monthly baselines were 41 087 (VCT), 11 909 (HIV testing at ANC sites), 648 (ART enrollment), and 296 (PMTCT enrollment); baseline total current patients on ART was 24 863. Service provision in January and May 2010, reported as percentage of baseline, was 43 and 78.7% (VCT), 50.8 and 88.7% (HIV testing at ANC), 46 and 81% (PMTCT), and 41 and 82.7% (ART enrollment), respectively. Current patients on ART decreased to 97% of baseline in April, rising to 103.9% by May; the initial decline was restricted to high-earthquake intensity areas. CONCLUSION: Following the Haiti earthquake, there was a transient, marked decline in VCT and new ART patient enrollment, whereas follow-up of established ART patients remained impressively high. HIV treatment continuity should be reinforced in disaster preparedness and response strategies in HIV epidemic settings.

Resume Les biopsies abdominales ont connu ces dernieres annees un essor spectaculaire grâce aux progres des materiels de biopsie et des techniques de guidage (scanner et echographie), a une meilleure prise en charge des prelevements en anatomopathologie, et surtout a une meilleure maitrise des gestes interventionnels par les radiologues. Ainsi, de nombreuses lesions reputees difficiles d'acces ou dangereuses autrefois beneficient desormais de la technique de biopsie guidee. Lorsqu'une lesion semble difficile a aborder, plusieurs artifices techniques permettent de rendre la biopsie possible, et de la securiser. Le but de cette mise au point est de presenter l'etat de l'art des biopsies abdominales guidees, en insistant sur les methodes simples qui facilitent ces gestes. Les resultats attendus en fonction des organes cibles et des pathologies recherchees seront rappeles. Enfin, les contre-indications et les complications de ces ponctions guidees seront egalement presentees.

Resume L’IRM mammaire ne doit pas etre utilisee pour le diagnostic differentiel entre un cancer du sein inflammatoire (CSI) et une mastite aigue (MA) avant traitement. Lorsque les symptomes de mastite persistent apres dix a 15 jours de traitement medical bien conduit, une IRM peut etre realisee en complement de l’echographie, de la mammographie et des prelevements histologiques pour eliminer un CSI. Concernant le bilan d’extension, l’IRM serait utile pour rechercher une lesion controlaterale, la TEP-TDM pour connaitre l’extension metastatique a distance et dans certains centres pour savoir l’extension ganglionnaire locoregionale initiale qui guide les champs d’irradiation (l’atteinte ganglionnaire pouvant etre negativee apres chimiotherapie neoadjuvante). L’IRM et la TEP-TDM seraient interessantes pour depister precocement les patientes repondant mal a la chimiotherapie neoadjuvante afin de la modifier rapidement.

The number of biopsy requests continuously increases over the years. Similarly, lesions that are not amenable to CT-guided biopsy are exceptional due to improved imaging guidance and technical advances. The needle tract should preferably go through fat, which is less painful and safer. The biopsy should be painless with the use of local anesthetics complemented by intravenous sedation. Blunt introducers and hydrodissection techniques create access to lesions without injury to vessels, bowel loops and fascias. The biopsy samples should be processed in accordance with the suspected diagnosis.

Cell-derived microparticles are complex vesicular structures that can be shedded by activated or apoptotic endothelial cells. Cell-derived microparticles are composed of a phospholipid bilayer that exposes transmembrane proteins and receptors and encloses cytosolic components such as enzymes, transcription factors and mRNA derived from their parent cells. Thus, they behave as biological conveyors playing a key role in the tuning of vascular homeostasis. This review will address the potential of microparticles as efficient vectors of biological activities in pathologies. Based on the model of endothelial vesiculation, the first part of this review will develop the contribution of endothelial microparticles to coagulation inflammation and angiogenesis and their role in vascular disorders. The second part will be focused on the multifaceted impact of cell-derived microparticles present in blood products and its relevance to transfusion medicine.

Inflammatory response is a major component in physiopathology of preeclampsia and intra-uterine growth retardation. Endothelium is a main connection between placental ischemia and clinical manifestations during vascular pregnancy complications. In this review recent findings concerning inflammatory response and its links with endothelium are reported. Studies concerning isolated intra-uterine growth retardation confirm the hypothesis of a similar pathophysiology with an activation confined to utero-placental bed or at a lower level. Current information on oxidative stress, atherosclerosis, and apoptosis in vascular pregnancy complications are available in this review. These concepts offer innovative possibilities of treatment.

Systemic sclerosis is a disorder involving the connective tissue, arterioles and microvessels. It is characterized by skin and visceral fibrosis and ischemic phenomena. Currently, therapy is limited and no antifibrotic treatment has proven its efficacy. Beyond some severe organ lesions (pulmonary arterial hypertension, pulmonary fibrosis, scleroderma renal crisis), which only concern a minority of patients, the skin sclerosis of hands and face and the vasculopathy lead to physical and psychological disability in most patients. Thus, functional improvement of hand motion and face represents a priority for patient therapy. Due to its easy obtention by fat lipopaspirate and adipocytes survival, re injection of adipose tissue is a common therapy used in plastic surgery for its voluming effect. Identification and characterization of the adipose tissue-derived stroma vascular fraction, mainly including mesenchymal stem cells, have revolutionized the science showing that adipose tissue is a valuable source of multipotent stem cells, able to migrate to site of injury and to differentiate according to the receiver tissue's needs. Due to easy harvest by liposuction, its abundance in mesenchymal cells far higher that the bone marrow, and stroma vascular fraction's ability to differentiate and secrete growth angiogenic and antiapoptotic factors, the use of adipose tissue is becoming more attractive in regenerative medicine. We here present the interest of adipose tissue use in the treatment of the hands and face in scleroderma.

Microcirculation imaging in breast cancer involves studying tissue enhancement after contrast injection, which is used to calculate perfusion and permeability. The magnitude of enhancement reflects blood and interstitial volumes. This technique has benefitted from advances in MRI, which allow large volumes to be acquired with a good compromise between temporal and spatial resolution. Software has also advanced enabling microcirculation maps to be calculated and heterogeneity to be analyzed. If permeability is increased and interstitial volume is reduced, the microcirculation imaging suggests a suspicious aggressive lesion and can be used for early assessment of neoadjuvant therapies by demonstrating restoration of normal functional indices, which precede morphological changes.

A quelques kilometres du village de Boulc-en-Diois (Drome), le versant ouest de la montagne des Pinies s'affaisse depuis une cinquantaine d'annees. Ce mouvement de terrain, recent et toujours actif, est remarquable par son ampleur (une douzaine de millions de m3 de materiaux mobilises) et par la variete des phenomenes qui se sont developpes: glissement de panneaux rocheux, ecroulements, coulees visqueuses et coulees boueuses. Le site desertique a suscite surtout l'interet des scientifiques qui ont mis en place des techniques, dont certaines experimentales, de suivi de l'evolution depuis 1988. L'histoire de ce mouvement complexe a pu etre retracee. Elle permet notamment de mieux comprendre les mecanismes generaux qui le caracterisent dans un contexte geologique particulier, le fosse d'effondrement de Terre Rouge-Mondores. (A). (Titre en anglais: The "montagne des Pinies" landslide at the origin of the Boulc-en-Diois (Drome) flows).

The World Health Organization currently does not recommend the use of dried blood spot specimens for drug resistance testing in patients undergoing antiretroviral therapy (ART). Therefore, HIV-1 resistance testing using peripheral blood mononuclear cells (PBMCs) may be of value in resource-limited settings. We compared genotypic resistance profiles in plasma and PBMCs from patients failing ART in two cities of Honduras (Tegucigalpa and San Pedro Sula), a resource-limited country. One hundred patients failing ART were randomly selected from a longitudinal patient monitoring cohort. Plasma and PBMC samples without patient identifier were used for genotypic resistance testing. Sequence data were analyzed, resistance profiles were determined and compared using Stanford HIV Drug Resistance Database algorithm. Specimens with concordant resistance profiles between the two compartments were 88% (95% CI: 80.3% - 94.5 %). Nine specimens (12%, 95% CI: 6.5% - 21.3%) had discordant resistance profiles of clinical significance. Logistic regression analyses indicated that patients on triple therapy were 17.24 times more likely to have concordant drug resistance profile than those on non-triple therapies (OR=17.24, 95% CI: 3.48, 83.33), while patients with increasing number of regimens and years on ART have a decreased rate of concordance (OR = 0.59, 95% CI: 0.32, 1.09 and OR = 0.62, 95% CI: 0.43, 0.88), respectively, than those with less number of regimens and years on ART. Our results show high level of concordance between plasma and PBMC resistance profiles, indicating the possibility of using PBMCs for drug resistance testing in resources-limited settings.

The number of biopsy requests continuously increases over the years. Similarly, lesions that are not amenable to CT-guided biopsy are exceptional due to improved imaging guidance and technical advances. The needle tract should preferably go through fat, which is less painful and safer. The biopsy should be painless with the use of local anesthetics complemented by intravenous sedation. Blunt introducers and hydrodissection techniques create access to lesions without injury to vessels, bowel loops and fascias. The biopsy samples should be processed in accordance with the suspected diagnosis.

Cell-derived microparticles are complex vesicular structures that can be shedded by activated or apoptotic endothelial cells. Cell-derived microparticles are composed of a phospholipid bilayer that exposes transmembrane proteins and receptors and encloses cytosolic components such as enzymes, transcription factors and mRNA derived from their parent cells. Thus, they behave as biological conveyors playing a key role in the tuning of vascular homeostasis. This review will address the potential of microparticles as efficient vectors of biological activities in pathologies. Based on the model of endothelial vesiculation, the first part of this review will develop the contribution of endothelial microparticles to coagulation inflammation and angiogenesis and their role in vascular disorders. The second part will be focused on the multifaceted impact of cell-derived microparticles present in blood products and its relevance to transfusion medicine.

Exposure to deleterious processes of metabolic, infectious, autoimmune or mechanical origin, alters the endothelium which progresses towards a proinflammatory and procoagulant activation, senescence and apoptosis. This "response to injury" of the endothelium plays a key role in the initiation and progression of cardiovascular disorders. In the last 10 years, identification in peripheral blood of circulating endothelial cells (CEC) and endothelial-derived microparticles (EMP) reflecting endothelium damage has led to the development of new noninvasive methods for endothelium exploration. Indeed, these biomarkers were associated with most of the cardiovascular risk factors, were correlated with established parameters of endothelial dysfunction, and were indicative of a poor clinical outcome. Moreover, they behave as biological vectors able to disseminate deleterious signals in the vascular compartment. More recently, this concept has been enlarged by the discovery of a potent repair mechanism based on the recruitment of the circulating endothelial progenitors cells (EPC) from the bone marrow, able to regenerate injured endothelial cells. Cardiovascular risk factors alter EPC number and function. Because the damage/repair balance plays a critical role in the endothelium homeostasis, CEC, EMP and EPC could be combined in an endothelium phenotype that defines the "vascular competence" of each individual. In the future, progress in standardization of available methodologies to measure these emerging biomarkers is a crucial step to establish their clinical interest for assessment of vascular risk and monitoring of vascular-directed therapeutics.

This paper describes how the densely low-lying populated areas and sand beaches along the Mediterranean French coast are constantly threatened by extreme sea levels. In micro-tidal conditions, the long term hourly water level records available at Marseilles Endoume (1885–2003) has made possible the statistical analysis that is usually computed on continental hydrological parameters. Frequential analysis tools, applied to time series near to the million data, are implemented in order to provide a calculation method for the stochastic meteorological storm surge component to characterize coastal inundation and erosion risk. Surge probability distributions tested with an associated confidence interval (GEV, Jenkinson, Gamma) and extreme values of the data fitting (Maximum Annual and Peaks-Over-Threshold) are discussed with relative tests (stationarity, independence, homogeneity) in this paper. Surge stochastic results are compared with sea-levels of morphological significance correlated to coastal impact observations during storm events. The statistic methods and tools presented contribute to a better knowledge of intensity, frequency and duration of extreme sea levels associated with morphogenic storms and provide guidelines for coastal risk mitigation.

Unfavorable cardiac mechanics in children with hypoplastic left heart syndrome (HLHS) when compared with other single-ventricle defects may affect long-term morbidity and outcome. Using noninvasive phase contrast magnetic resonance imaging (PC MRI), we examined cardiac mechanics in children with HLHS and compared the results to other single-ventricle defects.Eighteen children with HLHS and 18 children with other single-ventricle defects were studied after the Fontan operation. Phase contrast MRI scans were obtained perpendicular to the ascending aorta, and flow was quantified using an in-house segmentation and reconstruction scheme. The total power output was determined using the modified Bernoulli equation along with cardiac output and systemic vascular resistance index.Compared with non-HLHS congenital heart defects, children with HLHS had significantly lower power output (1.40 +/- 0.39 versus 1.78 +/- 0.38 W/m2, p0.004) and cardiac index (3.15 +/- 0.97 versus 4.09 +/- 1.23 L x Min(-1) x m(-2), p0.009) with a concomitant higher systemic vascular resistance index (28.94 +/- 11.5 versus 22.7 +/- 8.53 WU, p0.03) despite generating similar systolic blood pressures (112.9 +/- 22.4 versus 115.2 +/- 23 mm Hg, p0.05).Minimally invasive measurements with PC MRI in children with HLHS showed significantly lower power output and cardiac index when compared with other single-ventricle physiologies. Abnormal aortic flow patterns may contribute to power loss and may have long-term survival and morbidity implications associated with the Fontan procedure. Elevated systemic vascular resistance index despite similar blood pressure opens avenues for therapeutic intervention for afterload reduction.

Children with orthotopic heart transplants (OHT) may die or require retransplantation due to chronic graft failure usually due to severe coronary allograft vasculopathy (CAV). Non-invasive detection of chronic transplant failure has been problematic due to lack of specific echocardiographic findings. Tissue Doppler Imaging (TDI) is a non-invasive ultrasound methodology, which measures myocardial contraction and relaxation velocities. The purposes of this study were to: 1. Determine quantitative changes of longitudinal TDI velocities characteristic to "pre-terminal" patients who subsequently either died or were listed for re-transplantation due to graft failure; 2. to define the time course of these changes, and 3. to show whether RV and LV velocities were equally effected.53 heart transplantation recipients were evaluated. Of these, 45 were "well" patients. They ranged in age at enrollment from 0.5 to 20.1 (mean 10.21) years, age at transplantation from 0.2 to 18 (mean 5.7) years. The time from transplantation to enrollment was 1 day to 14.9 (mean 4.5) years. There were 8 "pre-terminal" (test group) patients who died or were listed for re-transplantation within 9 months after TDI echo. These ranged in age from 2.6 to 17 (mean 11.6) years, age at transplant from 1 month to 15.9 (mean 8.1) years, and time from transplant to enrollment was 0.7 to 9.8 (mean 3.6) years. TDI was performed in the apical four-chamber view. Systolic (S, cm/s) and diastolic early (E, cm/s) and late (A, cm/s) velocity. Mitral and tricuspid annular TDI velocities were measured. Tricuspid regurgitation and LV ejection fraction were also compared.Pre-terminal patient's Left Ventricular Ejection Fraction began diverging from controls at 3 to 6 months prior to endpoint (p0.001). Tricuspid TDI S velocities of pre-terminal patients diverged by 2.0 cm/sec from controls (p0.002) 6 months prior to, and reduced further by 2.9 cm/sec 3 months prior to endpoint (p0.001). Tricuspid TDI E velocities diverged 3 to 6 months before endpoint, by 1.9 cm/sec (p0.02) and by 3.7 cm/sec 0-3 months prior to endpoint, (p0.001). Mitral S velocities diverged from controls by 1.5 cm/sec at 0 to 3 months before terminal endpoints (p = 0.002). Mitral E velocities were statistically similar at all time intervals (por = 0.15). Septal S velocities equaled controls 6 months (p = 0.92) and between 3 to 6 months (p = 0.83) but diverged by 1.6 cm/sec 0 to 3 months before terminal endpoints (p = 0.01). Septal E velocities equaled controls. Mortality Prediction: LVEF, tricuspid annulus systolic and diastolic velocities, and tricuspid regurgitation severity were significant in predicting mortality. Coronary angiography was performed in 26 patients, 5 had severe coronary artery disease and all were pre-terminal.The TDI data reported here show 3 to 6 months before the terminal graft failure, tricuspid, but not mitral, S and E TDI velocities, deteriorated to uniquely low levels not seen in other clinically well pediatric transplant recipients. Further RV deterioration occurred during the final 3 months before death and severely reduced left ventricular velocities then occurred. Small decreases in LVEF and progressive increases in the severity of tricuspid regurgitation were also detectable and predicted an increased likelihood of mortality. Seven of the 8 preterminal patients had angiograms 5 of which showed severe CAV. These data suggest that there is a critical "pre-terminal" window of time in which children demonstrate uniquely reduced right and subsequently left sided myocardial velocities at approximately 6 months prior to graft failure. The practice of annual catheterization and coronary angiography may not allow caregivers an opportunity to intervene early in the process of graft dysfunction. Therefore, a strategy of tissue Doppler echocardiography 2 or 3 times each year might be an appropriate regimen to survey for graft impairment.

Inflammatory response is a major component in physiopathology of preeclampsia and intra-uterine growth retardation. Endothelium is a main connection between placental ischemia and clinical manifestations during vascular pregnancy complications. In this review recent findings concerning inflammatory response and its links with endothelium are reported. Studies concerning isolated intra-uterine growth retardation confirm the hypothesis of a similar pathophysiology with an activation confined to utero-placental bed or at a lower level. Current information on oxidative stress, atherosclerosis, and apoptosis in vascular pregnancy complications are available in this review. These concepts offer innovative possibilities of treatment.

Breast MRI should not be used for differential diagnosis between inflammatory breast cancer and acute mastitis (AM) prior to treatment. When mastitis symptoms persist after 10 to 15 days of well-managed medical treatment, MRI may be performed in addition to an ultrasound examination, a mammogram and to taking histological samples, in order to eliminate inflammatory breast cancer (IBC). For staging, MRI would seem to be useful in looking for a contralateral lesion, PET-CT for finding information about remote metastases and in certain centres, for information about the initial extension to local/regional lymph nodes, which would guide the fields of irradiation (since patients can become lymph node negative after neoadjuvant chemotherapy). MRI and PET-CT seems to be useful for early detection of patients responding poorly to neoadjuvant chemotherapy so that the latter may be rapidly modified.

National audience; Les échanges d'eau sont contrôlés par un système de vannes et pertuis qui relient les étangs à la mer à travers la « Digue à la mer ». Sur la période 1994-2010, les volumes d'eau moyens échangés au niveau du pertuis de la Fourcade sont d'environ 11 millions de m 3 / an d'entrée marine et 20 millions de m 3 /an de sortie vers la mer. Malgré ce système, de grandes variations interannuelles se produisent. En effet, les flux restent dépendants des différences de niveau d'eau de part et d'autre, qui eux dépendent des facteurs environnementaux « internes » (apports d'eau par l'irrigation des rizières) et « externes » : les précipitations et le vent qui influencent le niveau d'eau des étangs, ainsi que les variations du niveau de la mer. Ces variations se produisent à court terme en fonction de la marée et des conditions météorologiques, avec notamment les phénomènes de surcotes marines, et à long terme en relation avec la remontée du niveau de la mer (1 à 7,5 mm/an-voir question 17 : « Changement climatique et surcotes marines, quel avenir pour les plages camarguaises ? »). Les relations entre les eaux souterraines et la mer Il existe une continuité des formations géologiques de part et d'autre du trait de côte permettant des échanges d'eau entre les eaux souterraines et la mer (fig. 1). Les différences de niveau entre la mer et les nappes régissent la direction et l'intensité des flux d'eau. Le bilan de ces flux se produit majoritairement en direction de la mer. Mais il existe néanmoins une intrusion saline, qui explique la salinité plus élevée des eaux de la nappe captive le long de la côte. L'augmentation progressive du niveau de la mer favorise l'intrusion de l'eau de mer dans les terres, ce qui entraînera à plus ou moins long terme une accentuation de la salinisation des eaux. L'eau partout présente en Camargue provient soit de la mer, soit des précipitations, soit de son fleuve. Depuis l'endiguement du Rhône, ce sont essentiellement les canaux d'irrigation et de drainage qui déterminent la distribution de l'eau du fleuve à travers son delta (photo 1). Les eaux continentales souterraines et en surface L'île de Camargue reçoit à la fois des eaux de pluie (470 millions de m 3 /an en moyenne) et des eaux d'irrigation issues du Rhône (296 et 362 millions de m 3 /an pour 1996 et 1993, Fondation Sansouire). En surface, le système lagunaire du Vaccarès est le réceptacle principal des flux hydriques de la zone (photo 2). Dans le sous-sol, on distingue deux types de nappes (fig. 1). Les sédiments récents du Rhône se trouvent sur une épaisseur variant de quelques mètres vers Arles jusqu'à environ 50 m vers le littoral et abritent des nappes plus ou moins connectées et de salinité très variable : douce, salée et même sursalée (jusqu'à 110 g/l, la mer étant à 38 g/l). Au-dessous, une formation de cailloutis grossiers abrite une nappe captive (séparée de la surface par une couche imperméable), dont la salinité augmente progressivement en direction de la mer depuis des eaux presque douces (≈2 g/l au nord) à des eaux de composition marine au sud. Les relations entre les eaux de surface et les eaux souterraines Les échanges d'eau entre la surface et le sous-sol sont complexes et se produisent soit par infiltration d'eau, soit par remontées artésiennes (sous pression). En fonction de l'occupation du sol, les eaux qui s'infiltrent proviennent de l'irrigation des rizières ou de la pluie dans les zones naturelles. Les remontées d'eau vers la surface se produisent quand la pression de l'eau souterraine le permet. On observe ce phénomène là où la topographie est légèrement plus basse, par exemple en bordure nord du Vaccarès où se trouve un forage artésien, mais il est le plus souvent invisible et difficile à quantifier. Ainsi, les étangs de Camargue, et de Vaccarès en particulier, reçoivent une quantité importante d'eau souterraine, estimée à environ un quart des apports de surface. Quelles relations entre la mer, les nappes souterraines et les eaux de surface dans le delta du Rhône ?

2 pages; National audience