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International audience; Introduction: Primary spontaneous pneumothorax (PSP) is the presence of air in the pleural space, occurring in the absence of trauma and known lung disease. Standardized expert guidelines on PSP are needed due to the variety of diagnostic methods, therapeutic strategies and medical and surgical disciplines involved in its management. Methods: Literature review, analysis of literature according to the GRADE (Grading of Recommendation Assessment, Development and Evaluation) methodology; proposals for guidelines rated by experts, patients, and organizers to reach a consensus. Only expert opinions with strong agreement were selected. Results: A large PSP is defined as presence of a visible rim along the entire axillary line between the lung margin and the chest wall and superior or equal to 2 cm at the hilum level on frontal chest x-ray. The therapeutic strategy depends on the clinical presentation: emergency needle aspiration for tension PSP; in the absence of signs of severity: conservative management (small PSP), needle aspiration or chest tube drainage (large PSP). Outpatient treatment is possible if a dedicated outpatient care system is previously organized. Indications, surgical procedures and perioperative analgesia are detailed. Associated measures, including smoking cessation, are described. Conclusion: These guidelines are a step towards PSP treatment and follow-up strategy optimization in France.; Introduction : Le pneumothorax spontané primaire (PSP) est un épanchement gazeux dans la cavité pleurale, survenant hors traumatisme et pathologie respiratoire connue. Des recommandations formalisées d'experts sur le sujet sont justifiées par les pluralités de moyens diagnostiques, stratégies thérapeutiques et disciplines médicochirurgicales intervenant dans leur prise en charge. Méthodes : Revue bibliographique, analyse de la littérature selon méthodologie GRADE (Grading of Recommendation Assessment, Development and Evaluation) ; propositions de recommandations cotées par experts, patients et organisateurs pour obtenir un consensus. Seuls les avis d'experts avec accord fort ont été retenus. Résultats : Un décollement sur toute la hauteur de la ligne axillaire et supérieur ou égal à 2 cm au niveau du hile à la radiographie thoracique de face définit la grande abondance. La stratégie thérapeutique dépend de la présentation clinique : exsufflation en urgence pour PSP suffocant ; en l'absence de signe de gravité : prise en charge conservatrice (faible abondance), exsufflation ou drainage (grande abondance). Le traitement ambulatoire est possible si organisation en amont de la filière. Les indications, procédures chirurgicales et l'analgésie périopératoire sont détaillées. Les mesures associées, notamment le sevrage tabagique, sont décrites. Conclusion : Ces recommandations sont une étape de l'optimisation des stratégies de traitement et de suivi des PSP en France.

International audience

Paddling technique and stroke kinematics are important performance factors in flatwater sprint kayaking and entail significant energetic demands and a high strength from the muscles of the trunk and upper limbs. The various distances completed (from 200 m to 1000 m) require the athletes to optimize their pacing strategy, to maximize power output distribution throughout the race. This study aimed to characterize paddling technique and stroke kinematics during two maximal sprints of different duration. Nine nationally-trained participants (2 females, age: 18 ± 3 years; BMI: 22.2 ± 2.0 Kg m−1) performed 40 s and 4 min sprints at maximal intensity on a kayak ergometer. The main findings demonstrated a significantly greater mean stroke power (237 ± 80 W vs. 170 ± 48 W; p < 0.013) and rate (131 ± 8 spm vs. 109 ± 7 spm; p < 0.001) during the 40 s sprint compared to the 4 min sprint. Athletes used an all-out strategy for the 40 s exercise and a parabolic-shape strategy during the 4 min exercise. Despite the different strategies implemented and the higher muscular activation during the 40 s sprint, no change in paddling technique and body coordination occurred during the sprints. The findings of the present study suggest that the athletes constructed a well-defined profile that was not affected by fatigue, despite a decrease in power output during the all-out strategy. In addition, they regulated their paddling kinematics during the longer exercises, with no change in paddling technique and body coordination.

Resume Cette etude a eu pour but de construire et valider un modele et une echelle d’autonomie adaptee aux transitions de carriere. Partant du constat que l’autonomie est une notion fondamentale dans un monde du travail caracterise par de nombreuses transitions, une serie d’items a d’abord ete produite par suite d’entretiens avec des experts et des salaries. Trois etudes quantitatives successives portant sur 336, 314 et 450 participants ont permis par des analyses d’items et methodes de condensation de reduire le nombre d’items et de construire un modele compose de 4 facteurs obliques et 14 items. Apres des analyses factorielles confirmatoires, les donnees s’ajustent bien a un modele en quatre facteurs et une etude de validite externe permet de relever des convergences fortes avec d’autres mesures de l’autonomie et de la variabilite interindividuelle dans le champ de l’orientation. La discussion synthetise l’interpretation qui peut etre donnee au modele, evoque les limites de la recherche et propose quelques implications theoriques et pratiques pour l’autonomie en transition de carriere.

Purpose: To characterize the acute effects of a long-duration adventure race on knee extensor (KE) fatigue and the knee functional ratio in adolescent athletes. Methods: Twenty trained male adolescents (aged 14–17 y) performed an adventure race of 68.5 km. Maximal voluntary isometric contraction (MVIC) KE and knee flexor torques were measured before and immediately after the race. Central and peripheral components of neuromuscular fatigue were quantified from the maximal voluntary activation level and the doublet peak torque (Tw100), respectively. The peak eccentric knee flexor torque to concentric KE torque ratio was also measured to determine functional ratio. Results: The race completion time was 05:38 (00:20) hours. Significant reductions in MVICKE (−14.7%, P KF (−17.0%, P P 100 remained unchanged. Peak eccentric knee flexor torque decreased 16.0% (P P Conclusion: The adventure race induced a moderate fatigue, which was mainly explained by central factors without significant peripheral fatigue. However, particular attention should be paid to the knee muscular imbalance incurred by the race, which could increase the risk of ligament injury in adolescent athletes.

Corticospinal excitability, and particularly the balance between cortical inhibitory and excitatory processes (assessed in a muscle using single and paired-pulse transcranial magnetic stimulation), are affected by neurodegenerative pathologies or following a stroke. This review describes how locomotor exercises may counterbalance these neuroplastic alterations, either when performed under its conventional form (e.g., walking or cycling) or when comprising eccentric (i.e., active lengthening) muscle contractions. Non-fatiguing conventional locomotor exercise decreases intracortical inhibition and/or increases intracortical facilitation. These modifications notably seem to be a consequence of neurotrophic factors (e.g., brain-derived neurotrophic factor) resulting from the hemodynamic solicitation. Furthermore, it can be inferred from non-invasive brain and peripheral stimulation studies that repeated activation of neural networks can endogenously shape neuroplasticity. Such mechanisms could also occur following eccentric exercises (lengthening of the muscle), during which motor-related cortical potential (electroencephalography) is of greater magnitude and lasts longer than during concentric exercises (i.e., muscle shortening). As single-joint eccentric exercise decreased short- and long-interval intracortical inhibition and increased intracortical facilitation, locomotor eccentric exercise (e.g., downhill walking or eccentric cycling) may be even more potent by adding hemodynamic-related neuroplastic processes to endogenous processes. Besides, eccentric exercise is especially useful to develop relatively high force levels at low cardiorespiratory and perceived intensities, which can be a training goal alongside the induction of neuroplastic changes. Even though indirect evidence let us think that locomotor eccentric exercise could shape neuroplasticity in ways relevant to neurorehabilitation, its efficacy remains speculative. We provide future research directions on the neuroplastic effects and underlying mechanisms of locomotor exercise.

Objective The objective of these guidelines is to define for women at low obstetric risk modalities that respect the physiology of delivery and guarantee the quality and safety of maternal and newborn care. Methods These guidelines were made by a consensus of experts based on an analysis of the scientific literature and the French and international recommendations available on the subject. Results It is recommended to conduct a complete initial examination of the woman in labor at admission (Consensus agreement). The labor will be monitored using a partogram that is a useful traceability tool (Consensus agreement). A transvaginal examination may be offered every two to four hours during the first stage of labor and every hour during the second stage of labor or before if the patient requests it, or in case of a warning sign. It is recommended that if anesthesia is required, epidural or spinal anesthesia should be used to prevent bronchial inhalation (grade A). The consumption of clear fluids is permitted throughout labor in patients with a low risk of general anesthesia (grade B). It is recommended to carry out a "low dose" epidural analgesia that respects the experience of delivery (grade A). It is recommended to maintain the epidural analgesia through a woman's self-administration pump (grade A). It is recommended to give the woman the choice of continuous (by cardiotocography) or discontinuous (by cardiotocography or intermittent auscultation) monitoring if the conditions of maternity organization and the permanent availability of staff allow it and, after having informed the woman of the benefits and risks of each technique (Consensus agreement). In the active phase of the first stage of labor, the dilation rate is considered abnormal if it is less than 1cm/4h between 5 and 7 cm or less than 1cm/2h above 7cm (level of Evidence 2). It is then recommended to propose an amniotomy if the membranes are intact or an oxytocin administration if the membranes are already ruptured, and the uterine contractions considered insufficient (Consensus agreement). It is recommended not to start expulsive efforts as soon as complete dilation is identified, but to let the presentation of the fetus drop (grade A). It is recommended to inform the gynecologist-obstetrician in case of nonprogression of the fetus after two hours of complete dilation with sufficient uterine dynamics (Consensus agreement). It is recommended not to use abdominal expression (grade B). It is recommended to carry out preventive administration of oxytocin at 5 or 10 IU to prevent PPH after vaginal delivery (grade A). In the case of placental retention, it is recommended to perform a manual removal of the placenta (grade A). In the absence of bleeding, it should be performed 30 minutes but not more than 60 minutes after delivery (Consensus agreement). It is recommended to assess at birth the breathing or screaming, and tone of the newborn to quickly determine if resuscitation is required (Consensus agreement). If the parameters are satisfactory (breathing present, screaming frankly, and normal tonicity), it is recommended to propose to the mother that she immediately place the newborn skin-to-skin with her mother if she wishes, with a monitoring protocol (grade B). Delayed cord clamping is recommended beyond the first 30 seconds in neonates, not requiring resuscitation (grade C). It is recommended that the first oral dose (2 mg) of vitamin K (Consensus agreement) be given systematically within two hours of birth. Conclusion These guidelines allow women at low obstetric risk to benefit from a better quality of care and optimal safety conditions while respecting the physiology of delivery.

International audience; iNTroducTioN: little is known about the biochemical consequences of endurance activities in adolescents. The present study aimed to examine the impact of a long-duration adventure race (>5 h) on hydration status, blood electrolytes and biomarkers of kidney function in adolescent athletes. MeThodS: Twenty male adolescents aged 14 to 17 y (mean±Sd; body mass: 59.7±9.1 kg and maximal o 2 uptake: 56.2±4.6 mL•kg-1 •min-1) volunteered to participate in a competitive adventure race of 68.5 km. Volunteers could drink ad libitum and fluid intake was monitored throughout the race. Blood samples were collected before, within 15 minutes after, and 24 hours after the race to monitor blood electrolytes (sodium, potassium, chloride), creatinine and blood urea nitrogen (BUN). Body mass and urine specific gravity (USG) were also measured across the same time points. reSulTS: The race was completed on average in 05:38±00:20 h:min under cold and rainy conditions (10-15 °c and 83-93% of relative humidity). fluid intake was 1.45±0.66 l and body mass decreased by 1.2% compared to before the race (p

This study examined the influence of knee extensors’ hip and knee angle on force production capacity and their neuromuscular and architectural consequences. Sixteen healthy men performed sub-maximal and maximal voluntary isometric contractions (MVIC) of knee extensors with four different combinations of the knee and hip angles. Muscle architecture, excitation-contraction coupling process, muscular activity, and corticospinal excitability were evaluated on the vastus lateralis (VL) and rectus femoris (RF) muscles. MVIC and evoked peak twitch (Pt) torques of knee extensors increased significantly (p

To provide national guidelines for the management of women with severe preeclampsia.A consensus committee of 26 experts was formed. A formal conflict of interest (COI) policy was developed at the onset of the process and enforced throughout. The entire guidelines process was conducted independently of any industrial funding. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) system to guide assessment of quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasized.The last SFAR and CNGOF guidelines on the management of women with severe preeclampsia was published in 2009. The literature is now sufficient for an update. The aim of this expert panel guidelines is to evaluate the impact of different aspects of the management of women with severe preeclampsia on maternal and neonatal morbidities separately. The experts studied questions within 7 domains. Each question was formulated according to the PICO (Patients Intervention Comparison Outcome) model and the evidence profiles were produced. An extensive literature review and recommendations were carried out and analyzed according to the GRADE® methodology.The SFAR/CNGOF experts panel provided 25 recommendations: 8 have a high level of evidence (GRADE 1±), 9 have a moderate level of evidence (GRADE 2±), and for 7 recommendations, the GRADE method could not be applied, resulting in expert opinions. No recommendation was provided for 3 questions. After one scoring round, strong agreement was reached between the experts for all the recommendations.There was strong agreement among experts who made 25 recommendations to improve practices for the management of women with severe preeclampsia.

This study examined the influence of knee extensors’ hip and knee angle on force production capacity and their neuromuscular and architectural consequences. Sixteen healthy men performed sub-maximal and maximal voluntary isometric contractions (MVIC) of knee extensors with four different combinations of the knee and hip angles. Muscle architecture, excitation-contraction coupling process, muscular activity, and corticospinal excitability were evaluated on the vastus lateralis (VL) and rectus femoris (RF) muscles. MVIC and evoked peak twitch (Pt) torques of knee extensors increased significantly (p

International audience; Purpose This study tested the hypothesis that prepubertal boys, but not untrained men, would exhibit a similar post-exercise parasympathetic reactivation as well-trained adult male endurance athletes. Methods Twelve prepubertal boys (12.3 +/- 1.6 years), 14 untrained men (21.8 +/- 2.2 years) and 16 well-trained adult male endurance athletes (24.5 +/- 4.8 years) completed an incremental maximal run field test on a track. Immediately after exercise completion, heart rate recovery (HRR) was assessed in the supine position for 5 min. Heart rate variability was analyzed in the time domain, and log-transformed values of the root mean square of successive differences in heart beats (Ln RMSSD30) were calculated over consecutive 30 s windows. Results Prepubertal children and well-trained adult endurance athletes showed significantly faster HRR than untrained adults from 30 s post-exercise until the end of recovery (p < 0.05). Ln RMSSD30 was significantly higher in prepubertal children and athletes than untrained adults over the post-exercise time interval 60-150 s (p < 0.05). No significant differences were observed for HRR and Ln RMSSD30 between prepubertal children and athletes. Conclusion Prepubertal children and well-trained adult endurance athletes exhibited comparable and faster HRR and parasympathetic reactivation than untrained adults following maximal exercise. This indirectly suggests that oxidative profile may be preserved by exercise training during growth and maturation to offset the decline in post-exercise HRR, parasympathetic reactivation and aspects of metabolic health.

Resume Objectif Determiner un seuil minimal de ressources humaines (sages-femmes, medecins gynecologues-obstetriciens, anesthesistes-reanimateurs, pediatres) pour assurer la securite et la qualite des activites non programmees en gynecologie-obstetrique. Materiel et methodes Consultation de la base de donnees MedLine, de la Cochrane Library et des recommandations des societes savantes. Reunions de membres representatifs dans differents modes d'exercice (universitaire, hospitalier, liberal) sous l'egide de et appartenant au College national des gynecologues et obstetriciens francais (CNGOF), a la Societe francaise d'anesthesie et de reanimation (SFAR), la Societe francaise de neonatalogie (SFN), la Societe francaise de medecine perinatale (SFMP), le College national des sages-femmes de France (CNSF), la Federation francaise des reseaux de soins en perinatalite (FFRSP), avec elaboration d'un texte relu par des experts exterieurs, en particulier par les membres des conseils d'administration de ces societes savantes et du Club d'anesthesie-reanimation en obstetrique (CARO). Resultats Differents seuils minimaux pour chaque categorie de soignants ont ete proposes en fonction du nombre de naissances/an. Ces seuils minimaux proposes peuvent etre modules a la hausse en fonction des types (niveau I, IIA, IIB ou III) ou de l'activite (existence d'un service d'accueil des urgences, activite maternofœtale et/ou chirurgicale de recours ou de reference) des centres. Du fait de pics d'activite et de la possibilite de concomitance non previsible d'actes medicaux urgents, il est necessaire que les organisations prevoient de pouvoir faire appel a des personnes-ressources. Le taux d'occupation des lits cible d'une maternite doit etre de 85 %. Conclusion Ces seuils minimaux proposes visent a aider les soignants assurant des soins non programmes en perinatalite et en gynecologie-obstetrique a faire valoir aupres des organismes institutionnels la pertinence des ressources humaines qui leur sont allouees pour en assurer la securite et la qualite.

With over 90% of convictions resulting from guilty pleas, it is of great importance to examine factors influencing the likelihood of plea acceptance. Prior research suggests individuals are risk-se...

Resume Objectif Determiner un seuil minimal de ressources humaines (sages-femmes, medecins gynecologues-obstetriciens, anesthesistes-reanimateurs, pediatres) pour assurer la securite et la qualite des activites non programmees en gynecologie-obstetrique. Materiel et methodes Consultation de la base de donnees MedLine, de la Cochrane Library et des recommandations des societes savantes. Reunions de membres representatifs dans differents modes d'exercice (universitaire, hospitalier, liberal) sous l'egide de et appartenant au College national des gynecologues et obstetriciens francais (CNGOF), a la Societe francaise d'anesthesie et de reanimation (SFAR), la Societe francaise de neonatalogie (SFN), la Societe francaise de medecine perinatale (SFMP), le College national des sages-femmes de France (CNSF), la Federation francaise des reseaux de soins en perinatalite (FFRSP), avec elaboration d'un texte relu par des experts exterieurs, en particulier par les membres des conseils d'administration de ces societes savantes et du Club d'anesthesie-reanimation en obstetrique (CARO). Resultats Differents seuils minimaux pour chaque categorie de soignants ont ete proposes en fonction du nombre de naissances/an. Ces seuils minimaux proposes peuvent etre modules a la hausse en fonction des types (niveau I, IIA, IIB ou III) ou de l'activite (existence d'un service d'accueil des urgences, activite maternofœtale et/ou chirurgicale de recours ou de reference) des centres. Du fait de pics d'activite et de la possibilite de concomitance non previsible d'actes medicaux urgents, il est necessaire que les organisations prevoient de pouvoir faire appel a des personnes-ressources. Le taux d'occupation des lits cible d'une maternite doit etre de 85 %. Conclusion Ces seuils minimaux proposes visent a aider les soignants assurant des soins non programmes en perinatalite et en gynecologie-obstetrique a faire valoir aupres des organismes institutionnels la pertinence des ressources humaines qui leur sont allouees pour en assurer la securite et la qualite.

Resume Objectif Determiner un seuil minimal de ressources humaines (sages-femmes, medecins gynecologues-obstetriciens, anesthesistes-reanimateurs, pediatres) pour assurer la securite et la qualite des activites non programmees en gynecologie-obstetrique. Materiel et methodes Consultation de la base de donnees MedLine, de la Cochrane Library et des recommandations des societes savantes. Reunions de membres representatifs dans differents modes d'exercice (universitaire, hospitalier, liberal) sous l'egide de et appartenant au College national des gynecologues et obstetriciens francais (CNGOF), a la Societe francaise d'anesthesie et de reanimation (SFAR), la Societe francaise de neonatalogie (SFN), la Societe francaise de medecine perinatale (SFMP), le College national des sages-femmes de France (CNSF), la Federation francaise des reseaux de soins en perinatalite (FFRSP), avec elaboration d'un texte relu par des experts exterieurs, en particulier par les membres des conseils d'administration de ces societes savantes et du Club d'anesthesie-reanimation en obstetrique (CARO). Resultats Differents seuils minimaux pour chaque categorie de soignants ont ete proposes en fonction du nombre de naissances/an. Ces seuils minimaux proposes peuvent etre modules a la hausse en fonction des types (niveau I, IIA, IIB ou III) ou de l'activite (existence d'un service d'accueil des urgences, activite maternofœtale et/ou chirurgicale de recours ou de reference) des centres. Du fait de pics d'activite et de la possibilite de concomitance non previsible d'actes medicaux urgents, il est necessaire que les organisations prevoient de pouvoir faire appel a des personnes-ressources. Le taux d'occupation des lits cible d'une maternite doit etre de 85 %. Conclusion Ces seuils minimaux proposes visent a aider les soignants assurant des soins non programmes en perinatalite et en gynecologie-obstetrique a faire valoir aupres des organismes institutionnels la pertinence des ressources humaines qui leur sont allouees pour en assurer la securite et la qualite.

Your muscles can contract in different ways: when you walk upstairs, the muscles at the fronts of your thighs shorten (concentric contraction), whereas when you walk downstairs, they lengthen (eccentric contraction). Concentric contractions require more oxygen and thus make you burn more calories. Eccentric contractions are easier but break parts of the muscle and make you feel sore for several days. If you repeat eccentric exercises, however, your muscles will probably get bigger and stronger than they would by repeating concentric contractions. Most physical activities (like running and jumping) include both concentric and eccentric phases. Scientists have designed tools to study each type of muscle contraction, such as eccentric cycling, which uses a bike on which you must resist the pedals as they are driven backward by an engine.

International audience; Objective: In addition to heredity, exposure to early-life adversity is an important predisposing risk factor of suicidal behaviour. Although the association between Childhood Trauma (CT) and suicide risk is well documented, interactions between CT and suicidal behaviour in Treatment-Resistant Depression (TRD) populations have received little coverage. This study aimed to evaluate i) association between CT and suicidal behaviour in a TRD population, and ii) the role of personality traits and impulsiveness as potential factors of mediation in these associations.Methods: Patients were recruited from a cohort of the French network of TRD expert centers. Depressive symptom severity, CT, suicidal behaviour, personality traits, and impulsiveness were assessed with the Montgomery-Åsberg Depression Rating Scale (MADRS), the Childhood Trauma Questionnaire (CTQ), the Columbia Suicide Severity Rating Scale (CSSRS), the Structured Clinical Interview for DSM-IV, the Big Five Inventory, and the Barratt Impulsivness Scale (BIS) respectively.Results: Among the 256 patients with a baseline CTQ, in relation to suicide risk for the current depressive episode, we found an association with the total CTQ scores mediated by the intensity of the current episode in a model adjusted for age and sex (total effect: β = 0.171; p = 0.011, direct effect: β = 0.135; p = 0.043; indirect effect: β = 0.036; p = 0.048). Focusing on CT subtypes, we detected an association between suicide risk and physical neglect in a model adjusted for age and sex (β = 0.301; p = 0.002), without any mediation by the intensity of the current episode. There was no mediation effect from personality traits nor impulsiveness. With regards to CSSRS to assess suicidal ideation, we did not find any association with the total CTQ score and CT subtype scores.Conclusion: We report a strong association between suicidal behaviour and CT (in particular childhood physical neglect) in a TRD population.

Lacustrine sediments in a poorly documented region regarding to lake sedimentation and paleo-environments (Bangladesh) were investigated using a multiproxy approach. Pukurpara Lake is located in eastern Bangladesh at an elevation of 360 m above sea level with a maximum water depth of 28 m. An age-depth model allowed us to investigate the changes in sedimentation that occurred since 850 CE. The high resolution multielement analyses by micro-X fluorescence scanning (μXRF) showed multiple variations over short increments. Variation in the abundance of elements with depth as well the ratios of the abundance of some elements (Fe/Ti and Zr/Rb) suggested both rapid and long-term changes in the origin of the material deposited, which, in turn, suggested changes in weather conditions. Principal Components Analysis (PCAs) mixing μXRF and Magnetic Susceptibility data allow identifying changes in geochemical redox processes between the Medieval Warm Period (MWP) and Little Ice Age (LIA). The drastic changes in the different proxies (magnetic susceptibility, diatom assemblages, fresh water/marine water diatom ratios, abundance of Fe and S, and the Fe/Ti ratio) were interpreted to be the result of climate change before and after the MWP-LIA transition period, the Little Ice Age period being relatively wet.

Corticospinal excitability and particularly the balance between cortical inhibitory and excitatory processes (assessed in a muscle using transcranial magnetic stimulation), are affected by neurodegenerative pathologies or following a stroke. Non-fatiguing conventional locomotor exercise, such as cycling or walking, decreases intracortical inhibition and/or increases intracortical facilitation. These modifications notably seem to be a consequence of neurotrophic factors (e.g., brain-derived neurotrophic factors) resulting from hemodynamic solicitation. Furthermore, it can be inferred from non-invasive brain and peripheral stimulation studies that repeated activation of neural networks can endogenously shape neuroplasticity. Such mechanisms could also occur following eccentric exercises (i.e., active lengthening of the muscle), during which motor-related cortical potential is of greater magnitude and lasts longer (assessed by electroencephalography) than during concentric exercises (i.e., muscle shortening). As single-joint eccentric exercise decreased short- and long-interval intracortical inhibition and increased intracortical facilitation (assessed by paired-pulse transcranial magnetic stimulation immediately after), locomotor eccentric exercise may be even more potent by adding hemodynamic-related neuroplastic processes to endogenous processes. Besides, eccentric exercise is especially useful to develop relatively high force levels at low cardiorespiratory and perceived intensity, which can be a training goal in addition to inducing neuroplastic changes. Further studies are required to understand how neuroplasticity is 1) acutely influenced by locomotor exercise characteristics (e.g., intensity, duration), 2) modulated by an exercise-based rehabilitation program, 3) related to functional cognitive and motor outcomes relevant to pathological population.

International audience; Purpose To examine corticospinal excitability and neuromuscular function following the completion of eccentric (ECC) or concentric (CON) maximal exercises of same mechanical work. Methods Ten males (29.9 +/- 11.8 years) performed maximal isokinetic knee extensor contractions in four experimental sessions. The two first sessions (one in ECC and one in CON) ended with a dynamic peak torque loss of 20%. The work completed in each contraction type was then achieved in the other contraction type. Neuromuscular function- maximal voluntary isometric contraction (MVIC), voluntary activation level (VAL), potentiated doublet (Dt), M-wave- and corticospinal excitability- motor evoked potential (MEP) amplitude and silent period (SP)-were assessed in the vastus lateralis (VL) and rectus femoris (RF) muscles at 20% MVIC before and immediately after exercise. Results To lose 20% of dynamic peak torque subjects performed 1.8 times more work in ECC than CON (P = 0.03), inducing a non-different decline in MVIC (P = 0.15). VAL dropped after the ECC sessions only (- 8.5 +/- 6.7%; all P < 0.027). Only, the CON session featuring the greatest work affected Dt amplitude (- 9.4 +/- 23.8%; P = 0.047). In both muscles, MEP amplitude decreased (all P < 0.001) and MEP SP stayed constant (all P > 0.45), irrespective of contraction type (all P > 0.15). Conclusion Same-work maximal ECC and CON exercises induced similar fatigue level but from different origins (preferentially central for ECC vs peripheral for CON). Yet, net corticospinal excitability did not depend on contraction type.

Today by the e-health and the telemedicine, many people are more and more interested by the improvement of disease knowledge on cardiovascular diseases and associated risk factors, personalized self management support follow-up and e-Health monitoring. MGEN is a not-for-profit complementary health insurance gave itself the ways to use the new digital tools in health. MGEN developed an original and personalized program VIVOPTIM for the primary prevention of the cardiovascular risks for their members. The VIVOPTIM Pilot program is based upon digital services and was experimented by November 2015 to December, 2017 with 8000 members of the MGEN, from 30 to 70 years old and resident in two French areas (Occitanie and Bourgogne Franche-Comte). The assessment of the experiment VIVOPTIM e -health program was positive for the personalized cardiovascular support and for their health. Therefore, the MGEN generalized the VIVOPTIM program of cardiovascular prevention, to the whole France on July 11th, 2018.

Introduction 18F-fluorodeoxyglucose PET/CT (FDG-PET/CT) is an imaging modality routinely used in oncology, hematology, as well as in infectious and inflammatory diseases. Frequently, patients and their accompanying persons may be apprehensive concerning risks of radiation exposure after performing this examination, particularly when it concerns nearby young adolescents or pregnant women. Our objective was to clearly explain about radiation protection instructions for patients after performing whole-body FDG-PET/CT based on the Equivalent Dose Rate (EDR) estimation at our nuclear medicine department. Methods We measured the dosage rates from 14 patients after undergoing whole-body FDG-PET/CT performed on two different PET/CT systems, with and without Time-of-Flight technology (TOF), in the Pitie Salpetriere–Charles Foix Hospital Group. The patients explored, using the TOF PET/CT system (group 1, n = 7), had a FDG injected dose (FDG-ID) of 3.7 MBq/kg whereas those explored using the non-TOF PET/CT system (group 2, n = 7) had a FDG-ID of 5 MBq/kg. Measurements of the EDR at 0.8 m (EDR-0.8 m) from the sternum were obtained immediately after PET/CT completion. Results Patients did not differ in terms of body mass index, mean ± SD 27.2 ± 7.1 kg/m2 and 27.9 ± 8.1 kg/m2, for group 1 and 2 respectively. The median administrated activity was not significantly different between the two groups: 263 MBq [187–362] for group 1 and 377 MBq [228–608] for group 2. The median delay of EDR-0.8 m measurement after FDG-injection was lower for group 1 (85 min [70–118]) (P = 0.03). The median of EDR-0.8 m did not differ between the 2 groups, 27 μSv/h [22–42] and 34 μSv/h [28–82] for group 1 and 2 respectively as well as the EDR-8 m normalized to the FDG-ID, 0.13 μSv/h/MBq [0.07–0.15] and 0.08 μSv//h/MBq [0.06–0.15], for group 1 and 2 respectively. Conclusion The present study confirmed the low values of EDR from patients after whole-body FDG-PET/CT. This suggests that patients and their accompanying persons can be reassured about potential risks of radiation exposure after this examination and that cautionary advice is unnecessary at our Hospital Group.

Background Osteosarcoma (OSA) should be differentiated from other less frequent primary bone neoplasms, metastatic disease, and tumor-like lesions, as treatment and prognosis can vary accordingly. Hence, a preoperative histologic diagnosis is generally preferred. This requires collection of multiple biopsies under general anesthesia, with possible complications, including pathological fractures. Fine-needle aspiration cytology would allow an earlier diagnosis with a significant reduction of discomfort and morbidity. Hypothesis/Objectives The aim of this study was to compare the accuracy of cytological and histologic biopsies in the diagnosis of canine osteodestructive lesions. Animals Sixty-eight dogs with bone lesions. Methods Retrospective study. Accuracy was assessed by comparing the former diagnosis with the final histologic diagnosis on surgical or post-mortem samples or, in the case of non-neoplastic lesions, with follow-up information. Results The study included 50 primary malignant bone tumors (40 OSAs, 5 chondrosarcomas, 2 fibrosarcomas, and 3 poorly differentiated sarcomas), 6 carcinoma metastases, and 12 non-neoplastic lesions. Accuracy was 83% for cytology (sensitivity, 83.3%; specificity, 80%) and 82.1% for histology (sensitivity, 72.2%; specificity, 100%). Tumor type was correctly identified cytologically and histologically in 50 and 55.5% of cases, respectively. Conclusions and Clinical Importance The accuracy of cytology was similar to histology, even in the determination of tumor type. In no case was a benign lesion diagnosed as malignant on cytology. This is the most important error to prevent, as treatment for malignant bone tumors includes aggressive surgery. Being a reliable diagnostic method, cytology should be further considered to aid decisions in the preoperative setting of canine bone lesions.

Introduction Au cours de l’epidemie de COVID-19, un nombre inhabituel de cas d’engelures a ete rapporte en Europe. L’hypothese d’un lien entre ces engelures et la COVID a ete rapidement avancee. Cependant, aucune etude prospective explorant de facon approfondie ces cas d’engelure n’a ete realisee. Materiel et methodes Cette etude prospective monocentrique a ete realisee dans les unites COVID du CHU de Nice. Tous les patients consecutifs avec engelures vus entre le 26 mars et le 17 avril 2020 etaient inclus. Une evaluation multidisciplinaire etait realisee comprenant examen dermatologique, biopsie cutanee, explorations vasculaires, bilan biologique, PCR et serologie COVID-19. Un suivi des patients etait organise. ClinicalTrials.gov identifier : NCT04344119 . Resultats Quarante patients ont ete inclus (âge median 22 ans ; 12 a 67 ans) dont 21 femmes. Tous les patients presentaient un tableau clinique similaire d’engelures, parfois bulleuses ou necrotiques, interessant les orteils ou les mains et dans certains cas les chevilles et les talons. Un acrosyndrome etait present dans 47,5 % des cas. La notion de contact avec une personne ayant presente des symptomes grippaux ou la presence de signes infectieux chez le patient dans 6 semaines precedentes etait notee chez respectivement 60 % et 32 % des cas. Chez 2 familles, 2 personnes avaient eu des engelures de facon concomitante. La PCR SARS-CoV-2 etait negative chez tous les patients. La serologie COVID-19 etait positive chez 12 patients (IgA+ n = 7, IgG+ n = 3, IgM+ et IgG+ n = 1, IgG+ et IgA+ n = 1). Les D-dimeres etaient superieurs a 215 ng/mL dans 61,5 % des cas. Les biopsies realisees chez 19 patients montraient une image histologique compatible avec des lesions de lupus engelure/interferonopathie de type I associees a un epaississement des veinules par hyperplasie des cellules musculaires sous endotheliales correspondant a des pericytes. L’evaluation in vitro de la reponse interferon α etait significativement plus elevee chez les patients avec engelures par rapport aux patients avec des formes moderees a severes de COVID-19 (p Discussion Cette etude conforte l’hypothese d’un lien entre les cas d’engelures et le virus SARS-CoV-2. Elle suggere que les manifestations dermatologiques observees sont la consequence d’une reaction immune, de type interferonopathie reactionnelle de type 1, induite par l’infection et d’une microvasculopathie impliquant les pericytes.

Introduction L’amelioration des prescriptions d’antibiotiques (ATB) en ville est primordiale, 70 % de celles-ci sont faites par les medecins liberaux (ML). La mise en place d’un antibiogramme cible en ville est evoquee depuis plusieurs annees. Il existe des experimentations, mais jusqu’a present, il n’a ete mis en place de facon generalisee dans aucune region. Ce deploiement peut difficilement etre fait sans information des parties prenantes, en particulier les ML. Objectif (1) Mise en place d’un antibiogramme cible pour les ECBU realisees en ville dans notre region. (2) Formation/information des professionnels liberaux autour des bonnes pratiques de gestion des infections urinaires. Materiels et methodes Mise en place d’un groupe pluri-professionnel comprenant les URPS ML, biologistes, IDE, sages-femmes, pharmacien, ainsi que le CPias. Realisation d’outils de formation/information : eventail a l’attention des prescripteurs, eventail a l’attention des preleveurs, affiche et film d’animation pour les usagers (a partir des dernieres recommandations de la SPILF). Dans le meme temps, l’URPS biologistes a demande aux LABM de ville de travailler a la mise en place d’un antibiogramme cible pour les ECBU mettant en evidence un E. coli chez les femmes. Evaluation de la campagne avant et apres la mise en place : – evolution de la consommation des antibiotiques (convention signee avec l’assurance maladie). Prescriptions chez les femmes de mai a octobre sur 2017–2019, variable permettant de reperer les prescriptions faites 2 j avant ou apres un ECBU ; – evolution de la resistance de E. coli via la mission PRIMO des CPias (MedQual-Ville). Resultats Lancement de la campagne PACA debut 2019. Envoie des outils aux 6200 medecins liberaux de la region. Cinq formations faites avec 144 professionnels formes (medecins, biologistes, IDE). Mise en place d’un antibiogramme cible dans la plupart des LABM de la region avec : amoxicilline, pivmecillinam, fosfomycine, furanes, trimetoprime + sulfamides. L’analyse des donnees de consommation des ATB montre : – chaque annee il y a environ 300 000 femmes traitees par antibiotique sur les 6 mois ; – les ATB delivres pour IU representent 13 % (38 202/291 875) des prescriptions d’ATB ; – en 2017–2018 : ¼ des prescriptions pour IU sont des FQ (9 % pour les autres indications) ; – en 2019 on a une diminution important avec 16 % (6132/38 202) de prescription de FQ dans les IU vs 24 % (9394/41 234) en 2018. Parallelement on note une augmentation du pivmecillinam et de la fosfomycine. Pas d’analyse des resistances bacteriennes aux antibiotiques pour le moment. Conclusion L’infection urinaire est une problematique frequente, l’ECBU est l’examen bacteriologique le plus demande en ville. Il y a souvent une mauvaise indication ou une mauvaise realisation des ECBU ce qui entraine un traitement antibiotique pas toujours adapte aux recommandations et en particulier une utilisation importante de FQ. Cette utilisation baisse en 2019 dans notre region. L’evaluation de la campagne va continuer jusqu’en 2021 pour confirmer cette tendance et analyser l’impact sur les resistances de E. coli.

International audience; Locomotor exercise may induce corticospinal excitability and/or cortical inhibition change in the knee extensors. This study investigated whether the mode of muscle contraction involved during a locomotor exercise modulates corticospinal and intracortical responsiveness. Eleven subjects performed two 45-min treadmill walking exercises in an uphill (+ 15%) or a downhill (− 15%) condition matched for speed. Maximal voluntary isometric torque (MVIC), voluntary activation level (VAL), doublet (Dt) twitch torque, and M-wave area of the knee extensors were assessed before and after exercise. At the same time-points, motor-evoked potential (MEP), cortical silent period (CSP), and short-interval cortical inhibition (SICI) were recorded in the vastus lateralis (VL) and rectus femoris (RF) muscles. After exercise, uphill and downhill conditions induced a similar loss in MVIC torque (− 9%; p

International audience; INTRODUCTION: To determine a minimum threshold of medical staffing needs (obstetricians-gynecologists, anesthesiologists-resuscitation specialists, nurse-anesthetists, pediatricians, and midwives) to ensure the safety and quality of care for unscheduled obstetrics-gynecology activity. MATERIALS AND METHODS: Face to face meetings of French healthcare professionals involved in perinatal care in different types of practices (academic hospital, community hospital or private practice) who belong to French perinatal societies: French National College of Gynecologists-Obstetricians (CNGOF), the French Society of Anesthesia and Resuscitation Specialists (SFAR), the French Society of Neonatology (SFN), the French Society of Perinatal Medicine (SFMP), the National College of French Midwives (CNSF), and the French Federation of Perinatal Care Networks (FFRSP). RESULTS: Different minimum thresholds for each category of care provider were proposed according to the number of births/year in the facility. These minimum thresholds can be modulated upwards as a function of the level of care (Level 1, 2 or 3 for perinatal centers), existence of an emergency department, and responsibilities as a referral center for maternal-fetal and/or surgical care. For example, an obstetrics-gynecology department handling 3000-4500 births per year without serving as a referral center must have an obstetrician-gynecologist, an anesthesiologist-resuscitation specialist, a nurse-anesthetist, and a pediatrician onsite specifically to provide care for unscheduled obstetrics-gynecology needs and a second obstetrician-gynecologist available within a time compatible with security requirements 24/7; the number of midwives always present (24/7) onsite and dedicated to unscheduled care is 5.1 for 3000 births and 7.2 for 4500 births. A maternity unit's occupancy rate must not exceed 85 %. CONCLUSION: The minimum thresholds proposed here are intended to improve the safety and quality of care of women who require unscheduled care in obstetrics-gynecology or during the perinatal period.

Image Correspondence; International audience

Introduction L’utilisation de la ceftazidime en hemodialyse chronique (HDC) pour le traitement des infections a BGN est une injection de 1 g a 2 g, realisee en fin de chaque seance car 50 % de la dose injectee est epuree. L’objectif de cette etude est d’affiner les modalites d’utilisation de la ceftazidime en HDC. Description Etude prospective observationnelle monocentrique incluant consecutivement tous les patients hemodialyses chroniques recevant de la ceftazidime pour un sepsis a BGN sans defaillance hemodynamique. Methodes La dose injectee de ceftazidime etait 1 g ou 2 g 10 minutes avant la restitution, et le taux residuel (T0) mesure au debut de la seance suivante, pendant 4 seances consecutives d’HDC. La duree interseance et la variation du volume de distribution (Watson) ont ete mesures. L’objectif pharmacocinetique etait un residuel > 4 fois la CMI du germe. Les resultats sont exprimes en mediane [IQR : 25–75]. Resultats Vingt-cinq patients (18 H/7 F) ont ete inclus, âges de 72 [65–77] ans. La nephropathie causale etait majoritairement diabetique et/ou vasculaire (80 %). L’anciennete en dialyse etait de 4 [1,5–6,1] ans. Quinze patients ont recu 1 g de ceftazidime, 10 ont recu 2 g. Le site infecte etait principalement l’os (40 %), et l’infection non documentee dans 44 % des cas. L’evolution des T0 est resumee dans le Tableau 1 . En cas d’infection documentee, 1 patient a presente un T0 non efficace. En situation probabiliste ou polymicrobienne, 3 patients atteignent la cible. En analyse univariee, le T0 est negativement correle a la duree interseance (R2 = 0,29 ; p = 0,05) pour les patients ayant recu 2 g, mais pas a l’augmentation du volume de distribution (R2 = 0,19 ; p = NS). Aucun T0 n’etait superieur au seuil toxique (80 mg/L). Aucun evenement indesirable attribuable a l’antibiotherapie n’a ete observe. Conclusion La ceftazidime injectee a la dose de 2 g a la fin de chaque seance permet d’atteindre la cible therapeutique, sans depasser le seuil toxique ni accumulation. Le delai interseance semble influencer le T0.

Heart failure (HF) patients often experience poor self-care, inadequate support, and increased mortality risk. Patients and family caregivers (“care partners”) have primary roles in self-care, providing support, and future-care planning. Practice guidelines recommend early and active partner involvement, but few interventions exist which effectively prepare partners to engage in these activities. The iPad-enhanced Shared Care Intervention for Partners (iSCIP), improves self-care and future planning based on patient values and preferences. Care partners use the iSCIP app to access self-care materials, manipulate values and preferences, and develop a care plan. This study assessed iSCIP feasibility, acceptability, and usability, and examined its effects on outcomes using a one-group experimental design with 10 sets of care partners. All participants completed 6 sessions, supporting feasibility. Mean program satisfaction scores were 4.8 for patients and 4.9 for caregivers (5 = “very satisfied”). Mean usability scores were 3.2 for patients and 3.3 for caregivers, indicating they were “not sure” or “somewhat agreed” that the app was easy to use. The iSCIP had a strong effect on patients’ self-care management (d = 0.81), with moderate effects for self-care confidence (d = 0.68), self-care maintenance (d = 0.56), and emotional support (d = 0.30). For caregivers, the iSCIP had moderate effects on emotional (d = 0.64) and informational (d = 0.48) support, with smaller effects on self-care confidence (d = 0.21). This study adds to the growing evidence of the acceptability of partner level interventions that address self-care in chronic conditions, care values and preferences, and future-care planning.

To determine a minimum threshold of human resources (midwives, obstetricians and gynecologists, anesthesiology and intensive care units, pediatricians) to ensure the safety and quality of unplanned activities in Obstetrics and Gynecology.Consultation of the MedLine database, the Cochrane Library and the recommendations of authorities. Meetings of representative members in different modes of practice (university, hospital, liberal) under the aegis of and belonging to the French College of Obstetricians and Gynecologists (CNGOF), the French Society of Anesthesia and Resuscitation (SFAR), the French Society of Neonatalogy (SFN), the French Society of Perinatal Medicine (SFMP), the French College of Midwives (CNSF), the French Federation of Perinatal Care Networks (FFRSP) with elaboration of a re-read text by external experts, in particular by the members of the Boards of Directors of these authorities and of Club of Anesthesiology-Intensive Care Medicine in Obstetrics (CARO).Different minimum thresholds for each category of caregivers were proposed based on the number of births/year. These proposed minimum thresholds can be modulated upwards according to the types (level I, IIA, IIB or III) or the activity (existence of an emergency reception service, maternal-fetal and/or surgical activity of resort or referral). Due to peak activity and the possibility of unpredictable concomitance of urgent medical procedures, it is necessary that organizations plan to use resource persons. The occupancy rate of the target beds of a maternity ward must be 85%.These proposed minimum thresholds are intended to help caregivers providing non-scheduled perinatal as well as Obstetrics and Gynecology care to make the most of the human resources allocated to institutional bodies to ensure their safety and quality.

Background Recent advanced applications of the functional electrical stimulation (FES) mostly used closed-loop control strategies based on mathematical models to improve the performance of the FES systems. In most of them, the pulse amplitude was used as an input control. However, in controlling the muscle force, the most popular force model developed by Ding et al. does not take into account the pulse amplitude effect. The purpose of this study was to include the pulse amplitude in the existing Ding et al. model based on the recruitment curve function. Methods Quadriceps femoris muscles of eight healthy subjects were tested. Forces responses to stimulation trains with different pulse amplitudes (30–100 mA) and frequencies (20–80 Hz) were recorded and analyzed. Then, specific model parameter values were identified by fitting the measured forces for one train (50 Hz, 100 mA). The obtained model parameters were then used to identify the recruitment curve parameter values by fitting the force responses for different pulse amplitudes at the same frequency train. Finally, the extended model was used to predict force responses for a range of stimulation pulse amplitudes and frequencies. Results The experimental results indicated that our adapted model accurately predicts the force-pulse amplitude relationship with an excellent agreement between measured and predicted forces ( R 2 =0.998, RMSE = 6.6 N). Conclusions This model could be used to predict the pulse amplitude effect and to design control strategies for controlling the muscle force in order to obtain precise movements during FES sessions using intensity modulation.

Today by the e-health and the telemedicine, many people are more and more interested by the improvement of disease knowledge on cardiovascular diseases and associated risk factors, personalized self management support follow-up and e-Health monitoring. MGEN is a not-for-profit complementary health insurance gave itself the ways to use the new digital tools in health. MGEN developed an original and personalized program VIVOPTIM for the primary prevention of the cardiovascular risks for their members. The VIVOPTIM Pilot program is based upon digital services and was experimented by November 2015 to December, 2017 with 8000 members of the MGEN, from 30 to 70 years old and resident in two French areas (Occitanie and Bourgogne Franche-Comté). The assessment of the experiment VIVOPTIM e -health program was positive for the personalized cardiovascular support and for their health. Therefore, the MGEN generalized the VIVOPTIM program of cardiovascular prevention, to the whole France on July 11th, 2018.

International audience; PURPOSE: To describe the neuromuscular and perceptual responses to incline, decline or level treadmill exercise.METHODS: Fifteen healthy subjects performed on separate days 45min treadmill exercise at 75% heart rate reserve in a level (+1% slope), incline (+15%) or decline condition (-15%). Neuromuscular function of the knee extensors (KE) was assessed before and after exercise. Perception of effort, muscle pain and pleasure were measured during the exercise. Muscle pain was also reported up to 96h after exercise.RESULTS: At the same heart rate, the decline exercise was performed at a higher velocity. This higher velocity was associated with a higher perceived effort and muscle pain, as well as lower pleasure. Maximal isometric KE peak torque and maximal voluntary activation similarly decreased in the three conditions (~15±12 and ~4±4%). M-wave amplitude of the vastus medialis muscle decreased in the three conditions (~-12±13%). M-wave amplitude of the rectus femoris muscle decreased only after the decline exercise (-12±16%). Peak twitch torque of the electrically evoked contractions was reduced after incline and decline exercises for both 10 and 100Hz doublets (-8±9 and -17±18%). The Dt10/Dt100 ratio was reduced only after decline exercise (-24±19%).CONCLUSION: At the same moderate intensity, decline exercise induced a greater level of muscle fatigue associated with a higher perceived effort and muscle pain than incline and level exercise. Exercise intensity should be carefully monitored during decline locomotion for training or rehabilitation purposes.

Introduction Dans le traitement du melanome metastatique, la sensibilite aux inhibiteurs du gene BRAF de mutations rares est parfois inconnue. Nous rapportons la premiere description d’une sensibilite aux BRAFi d’un melanome metastatique ayant la mutation pV600K601 delinsE, combinant la deletion de la valine (V) en position 600, de la lysine (K) en position 601, et l’insertion d’un acide aspartique (E). Observations Un homme de 46 ans etait pris en charge pour un melanome metastatique ganglionnaire inguino-iliaque, hepatique et cutane. Un sequencage Sanger etait realise sur la tumeur primitive et la metastase cutanee, permettant de caracteriser une mutation pV600_K601delinsE ( Fig. 1 ). La sensibilite aux BRAFi etant « non connue », le patient etait traite par ipilimumab nivolumab puis nivolumab. A M6, il presentait une reponse complete de la tumeur primitive, une reponse partielle hepatique et une progression des cibles ganglionnaires. L’immunotherapie etait maintenue, avec une stabilite des lesions hepatiques mais une progression ganglionnaire confirmee a M9 et M12 ( Fig. 2A ). L’immunotherapie etait relayee par une therapie ciblee (dafrafenib/trametinib). A S4, la TEP TDM objectivait une diminution du metabolisme et des dimensions des adenopathies ( Fig. 2B ). A M6, il existait une reponse complete hepatique et ganglionnaire iliaque, mais la persistance de l’adenopathie inguinale ( Fig. 2C ) que nous avons traitee par chirurgie. L’histologie montrait la persistance de cellules tumorales et la biologie moleculaire trouvait la mutation pV600_K601 delinsE du gene BRAF. A 6 mois de cette exerese le patient maintenait une reponse metabolique complete. Discussion Nous avons evalue la sensibilite de cette mutation aux therapies ciblees apres echec de l’immunotherapie. La cinetique rapide de reponse apres l’introduction des BRAFi/MEKi etait en faveur d’une reponse specifique a la therapie ciblee. La mutation pV600K601delinsE n’a jamais ete decrite a notre connaissance dans le melanome, mais rapportee dans les cancers papillaires de la thyroide. L’insertion d’un acide aspartique (E) apres deletion de la valine et de la lysine en position 600 et 601 est susceptible d’entrainer les memes consequences qu’une mutation V600E « classique » sur l’activite kinase de BRAF. Une mutation proche (pV600_K601delinsD) a ete rapportee chez un patient ayant un melanome metastatique sensible aux BRAFi. L’acide aspartique (E) et l’acide glutamique (D) etant similaires dans leurs proprietes biochimiques, il etait probable que le profil de reponse de notre patient soit similaire a celui decrit dans la litterature. Conclusion Nous rapportons la premiere description d’un melanome porteur de la mutation BRAF V600K601 delinsE avec une sensibilite a l’inhibiteur de BRAF.