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While salarin C (SalaC) is a potent marine cytotoxin, Kashman demonstrated that congeners which had undergone Wasserman rearrangement exhibit little to no cytotoxicity. Given that thiazoles are known to undergo Wasserman rearrangement at a significantly reduced rate, we hypothesized that a thiazole-containing SalaC would exhibit greater stability without significantly altering the macrocyclic conformation. Herein, we describe the synthesis of a simplified, thiazole-containing macrocycle which demonstrates significantly improved stability under identical aerobic conditions.

Resume Objectifs La decouverte de pheochromocytome ou de paragangliome secretant au cours d’une grossesse est une situation rare et grave, engageant le pronostic maternofœtal. L’objectif de cette serie de cas est de discuter la prise en charge optimale de ces patientes pendant la grossesse. Methodes Il s’agit d’une etude retrospective des cas de pheochromocytome (n = 2) ou de paragangliome (n = 2) pris en charge au cours d’une grossesse au sein du Centre Hospitalier Universitaire (CHU) de Lille (France) entre 2013 et 2020. Resultats Nous rapportons quatre cas de patientes dont le diagnostic de pheochromocytome ou paragangliome a ete realise pendant la grossesse, a respectivement 4, 28, 31 et 34 semaines d’amenorrhee (SA). Leurs grossesses etaient marquees par un tableau brutal d’hypertension arterielle (HTA) parfois associe a des cephalees, des sueurs et des palpitations. Les patientes ont toutes accouche par cesarienne apres une preparation medicale par inhibiteurs calciques, avec une bonne issue. L’exerese de la tumeur s’est deroulee a distance de l’accouchement pour chaque patiente. Conclusions La strategie therapeutique repose sur un traitement medical par inhibiteurs calciques ou alphabloquants et un traitement curatif lie a l’âge gestationnel. La prise en charge multidisciplinaire ainsi que le diagnostic precoce permettent d’ameliorer le pronostic maternofœtal. La voie d’accouchement privilegiee est la cesarienne, mais peut se discuter. L’exerese se fera idealement a distance de l’accouchement. L’analyse de ces cas a permis l’elaboration d’un protocole de suivi et de prise en charge des patientes atteintes d’un pheochromocytome ou paragangliome lors de leur grossesse.

Objective To describe EEG patterns of critical Coronavirus Disease 2019 (COVID-19) patients with suspicion of encephalopathy and test their association with clinical outcome. Methods EEG after discontinuation of sedation in all patients, and somesthesic evoked potentials and brainstem auditive evoked potentials when EEG did not show reactivity, were performed. Clinical outcome was assessed at day 7 and 14 after neurophysiological explorations. Results 33 patients were included for analysis. We found slowed background activity in 85% of cases, unreactive activity in 42% of cases, low-voltage activity in 21% of cases and rhythmic or periodic delta waves in 61% of cases. EEG epileptic events were never recorded. Clinical outcome at day 14 was associated with unreactive background activity and tended to be associated with rhythmic or periodic delta waves and with low-voltage activity. Results of multimodal evoked potentials were in favor of a preservation of central nervous system somatosensory and auditory functions. Conclusions Among critical COVID-19 patients with abnormal arousal at discontinuation of sedation, EEG patterns consistent with encephalopathy are found and are predictive for short term clinical outcome. Significance The abnormal EEG with presence of periodic discharges and lack of reactivity could be related to encephalopathy linked to COVID-19.

Intensive care unit (ICU)-acquired weakness (ICU-AW) is defined as clinically detected weakness in critically ill patients in whom there is no plausible etiology other than critical illness. Using electrophysiological methods, patients with ICU-AW are classified in three subcategories: critical illness polyneuropathy, critical illness myopathy and critical illness neuromyopathy. ICU-AW is a frequent complication occurring in critical ill patients. Risk factors include illness severity and organ failure, age, hyperglycemia, parenteral nutrition, drugs and immobility. Due to short- and long-term complications, ICU-AW results in longer hospital stay and increased mortality. Its management is essentially preventive avoiding modifiable risk factors, especially duration of sedation and immobilization that should be as short as possible. Pharmacological approaches have been studied but none have proven efficacy. In the present review, we propose practical questions that the clinician should ask in case of acquired weakness during ICU stay: when to suspect ICU-AW, what risk factors should be identified, how to diagnose ICU-AW, what is the prognosis and how can recovery be improved?

Additional file 3. Table S2 : Results for all specialties.

Additional file 2. Table S1 : Responses by specialty.

International audience; Objective: Previous studies have unveiled a relationship between the severity of coronavirus disease 2019 (COVID-19) pneumonia and obesity. The aims of this multicenter retrospective cohort study were to disentangle the association of BMI and associated metabolic risk factors (diabetes, hypertension, hyperlipidemia, and current smoking status) in critically ill patients with COVID-19.Methods: Patients admitted to intensive care units for COVID-19 in 21 centers (in Europe, Israel, and the United States) were enrolled in this study between February 19, 2020, and May 19, 2020. Primary and secondary outcomes were the need for invasive mechanical ventilation (IMV) and 28-day mortality, respectively.Results: A total of 1,461 patients were enrolled; the median (interquartile range) age was 64 years (40.9-72.0); 73.2% of patients were male; the median BMI was 28.1 kg/m2 (25.4-32.3); a total of 1,080 patients (73.9%) required IMV; and the 28-day mortality estimate was 36.1% (95% CI: 33.0-39.5). An adjusted mixed logistic regression model showed a significant linear relationship between BMI and IMV: odds ratio = 1.27 (95% CI: 1.12-1.45) per 5 kg/m2 . An adjusted Cox proportional hazards regression model showed a significant association between BMI and mortality, which was increased only in obesity class III (≥40; hazard ratio = 1.68 [95% CI: 1.06-2.64]).Conclusions: In critically ill COVID-19 patients, a linear association between BMI and the need for IMV, independent of other metabolic risk factors, and a nonlinear association between BMI and mortality risk were observed.

Additional file 1. Survey: Career aspirations among specialty residents (in English).

The diagnosis of a pheochromocytoma or paraganglioma secreting during pregnancy is a rare and serious situation, involving maternal-fetal prognosis. The purpose of this case series is to discuss the management of these patients.This is a retrospective study of cases of pheochromocytoma (n=2) or paraganglioma (n=2) managed during pregnancy between 2013 and 2020 in one center (Lille, France).We report four cases of patients with a diagnosis of pheochromocytoma or paraganglioma during pregnancy, at respectively 4, 28, 31 and 34 weeks of amenorrhea (AS). Their pregnancies were affected by a sudden onset of hypertension sometimes associated with headaches, sweating, and palpitations. All patients delivered by Caesarean section after calcium channel blocker impregnation, with a good outcome. Tumor removal took place at a distance from delivery for each patient.The therapeutic strategy includes antihypertensive treatment with calcium channel blockers or alphablockers and surgical curative treatment linked to gestational age. Multidisciplinary management as well as early diagnosis can improve the maternal-fetal prognosis. The preferred way of delivery is Caesarean section, but vaginal delivery can also be considered. Removal should ideally take place at a distance from the birth. The analysis of these cases has led to the development of a protocol for monitoring and management of parturients with diagnosis of pheochromocytoma or paraganglioma during pregnancy.

International audience; Objective :The study aimed to evaluate the impact of the single nucleotide polymorphism (SNP) rs7903146 on the transcription factor 7-like 2 (TCF7L2) gene in stress-related hyperglycaemia (SRH), defined as blood glucose ≥ 11 mmol/L in at least two blood samples during the first 3 days in the intensive care unit (ICU), and on 28-day and 1-year mortality, and incidence of type 2 diabetes (T2D) at 6 months and 1 year in patients hospitalized in the ICU. Methods :This prospective observational (non-interventional) multicentre READIAB study, carried out during 2012–2016 in six French ICUs, involved adult patients admitted to ICUs for at least two organ failures; patients admitted for < 48 h were excluded. During the 3-day ICU observational period, genetic testing, blood glucose values and insulin treatment were recorded.Main results :The association of rs7903146 with SRH was assessed using logistic regression models. Cox proportional hazards regression models assessed the associations between rs7903146 and mortality and between SRH and mortality, both at 28 days and 1 year. A total of 991 of the 1000 enrolled patients were included in the READIAB–G4 cohort, but 242 (24.4%) had preexisting diabetes and were excluded from the analyses. SRH occurred within the first 3 days in the ICU for one-third of the non-diabetes patients. The association between the rs7903146 polymorphism and SRH did not reach significance (P = 0.078): OR(per one T copy): 1.24, 95% CI: 0.98–1.58. A significant association was found between rs7903146 and 28-day mortality after adjusting for severity scores (P = 0.026), but was no longer significant at 1 year (P = 0.61). At 28 days, mortality was increased in patients with SRH (HR: 2.09, 95% CI: 1.43–3.06; P < 0.001), and remained significant at 1 year after adjusting for severity scores (HR: 1.73, 95% CI: 1.32–2.28; P < 0.001). On admission, non-diabetes patients with SRH had a higher incidence of T2D at 6 months vs. those without SRH (16.0% vs. 7.6%, RR: 2.11, 95% CI: 1.07–4.20; P = 0.030). At 1 year, these figures were 13.4% vs. 9.2%, RR: 1.45, 95% CI: 0.71–2.96; P = 0.31). Moreover, the rs7903146 polymorphism was not significantly associated with T2D development at either 6 months (P = 0.72) or 1 year (P = 0.64).Conclusion :This study failed to demonstrate any significant association between rs7903146 and SRH. Nevertheless, the issue remains an important challenge, as SRH may be associated with increased rates of both mortality and T2D development.

L’hyperammoniémie est un trouble métabolique induit par un excès d’ammoniac plasmatique. La toxicité nerveuse de l’ammoniac peut entraîner une encéphalopathie d’aggravation rapide, avec risque de décès par oedème cérébral irréversible. En Réanimation adulte, lorsque l’hyperammoniémie n’est pas en lien avec une insuffisance hépatocellulaire aiguë, d’autres causes plus rares doivent être recherchées, incluant un déficit enzymatique du cycle de l’urée (urea cycle disorder [UCD]) de révélation tardive. C’est le bilan métabolique qui permettra de distinguer une hyperammoniémie primitive, par déficit enzymatique du cycle de l’urée, d’une hyperammoniémie secondaire. Nous rapportons les cas de deux patients pris en charge en Réanimation adulte pour encéphalopathie hyperammoniémique majeure révélatrice d’un déficit du cycle de l’urée dans un cas (acidurie argininosuccinique) et secondaire aux localisations hépatiques d’une tumeur dans l’autre cas. Nous souhaitons rappeler ici la démarche rigoureuse pour parvenir au diagnostic ainsi que la prise en charge thérapeutique spécifique de ces situations.

Introduction : Les recours aux services d'urgences pédiatriques se multiplient, mais une partie d'entre eux sont médicalement inappropriés. Pour comprendre, au-delà des déterminants connus comme la démographie médicale ou l'attraction du plateau technique, la genèse de ces recours inadéquats et les logiques internes des parents concernés, une enquête a été menée en Pays de la Loire. Méthode : Qualitative par entretiens semi-directifs, à Nantes et à La Roche-sur-Yon, auprès de parents ayant conduit leur enfant aux urgences et qui, après examen clinique, n'a eu besoin ni de soin ni d'investigation technique. Les entretiens étaient centrés sur le récit de l'épisode ayant motivé la décision de recours et sur le contexte familial de cette décision. Une analyse thématique puis conceptuelle a tenté d'aboutir à une typologie de recours. Résultats : Les thèmes récurrents permettant d'interpréter ces recours concernaient : 1) le niveau d'inquiétude lié au caractère inhabituel ou inexplicable des premiers symptômes ; 2) la grande confiance accordée aux services d'urgences, effaçant tous les inconvénients possibles ; 3) une perception contrastée ou une méconnaissance du réseau de soins primaires freinant son usage non programmé. Des thèmes discordants concernant le contexte familial ont permis d'isoler trois modalités de recours inappropriés : recours par effacement parental et délégation de responsabilité de la part de parents se positionnant comme profanes incompétents, recours par confrontation de compétence avec revendication de reconnaissance de l'expertise parentale, recours par recherche de complémentarité de compétence avec les médecins. Conclusion : Certains recours inappropriés peuvent cacher une demande implicite d'étayage urgent de la parentalité.

Previous studies unveiled a relation between COVID-19 severity and obesity. The aims of this multicenter retrospective cohort study were to disentangle the association of body mass index (BMI) and associated metabolic risk factors, with pneumonia outcomes in critically ill patients with COVID-19, and explore the impact of age and sex on this relationship. Participants were COVID-19 patients admitted in intensive care in 21 centers in Europe, Israel, and USA, between 02/19/2020 and 05/19/2020. The exposure of interest was BMI. The primary and secondary outcomes were the need for invasive mechanical ventilation (IMV), and 28-day mortality. The covariates were age, sex, and diabetes, hypertension, hyperlipidemia, and current smoking. We enrolled 1,461 patients (median age 64 years (Interquartile range (IQR), 40.9-72.0); 73.2% males; median BMI 28.1 kg/m2 (IQR, 25.4-32.3); 1,080 patients (73.9%) required IMV and the 28-day mortality rate was 36.1% (95% confidence intervals (CI), 33.0-39.5). Adjusted mixed logistic regression model showed a significant relation between BMI and IMV: odds ratio 1.27 (95% CI, 1.12-1.45) per 5 kg/m2 in the whole cohort, and 1.65 (95% CI, 0.97-2.79) per 5 kg/m2 in females under 50 years. Adjusted Cox proportional hazards regression model showed a significant association between BMI and mortality, which was only increased in obesity class III (≥40 kg/m2) (Hazard Ratio 1.68 (95% CI 1.06-2.64). In conclusion, we observed in critically ill COVID-19 patients, a linear association between BMI and the need for IMV, independent of other metabolic risk factors, and more pronounced in younger females, and a non-linear association between BMI and mortality risk. Trial Registration: ClinicalTrials.gov Identifier: NCT04391738 Funding Statement: No specific funding. Declaration of Interests:The authors declared no conflict of interest. Ethics Approval Statement: The study complied with standard operating procedures in place, in accordance with the European Data Protection Directive (95/46/EC) and, upon its entry into force, Regulation (EU) 2016/679 (also referred to as the General Data Protection Regulation (GDPR)), and French CNIL frameworks n° MR004 regarding the processing of personal data in clinical studies. The institutional review board from other centers in USA and Israel approved the retrospective case series as minimal-risk research using data collected for routine clinical practice and waived the requirement for informed consent.

Background The French health authorities recommend systematic screening for Chlamydia trachomatis (Ct) urogenital infections in dedicated sexual health centers (planning centers) for women under 25 years old and for women who have changed partners during the last year. The two main purposes of this study were to assess adherence to this recommendation in planning centers and to identify possible obstacles to this screening. Methods We conducted an observational prospective study from April to August 2013 in planning centers of Poitou-Charentes. Data on declarative screening practices and possible obstacles to Ct screening were collected qualitatively. Real center practices were also recorded to assess conformity with guidelines. Quantitative data were collected about real activities in each center. Screening percentage among women younger than 25 years and among those who had changed partners during the year was computed for each center. The main endpoint was percentage of centers that did not follow the recommendations. Declared practices were compared to observational practices using real practices data. Results Twelve out of 17 planning centers in the region participated. Six centers declared they performed systematic screening for Ct infection in women under 25 and 2 centers in women who had changed partners during the year. No center fully complied with the recommendations. Forty-three percent (601/1390) of women with standard screening criteria were screened and 52 % (102/197) of women without these criteria were screened. Depending on the center, declared practices could overestimate or underestimate the observed practices. The declared obstacles were lack of time, patient refusal, budget issues and no specific organization. Conclusion Poitou-Charentes planning centers screen for Ct infection in women younger than 25 years old and those who have changed partners during the last year depending on risk factors (unprotected sex, infected partner…). Which patients need this screening has to be clarified.

Resume Introduction La maladie de Castleman multicentrique (MCM) peut mimer une maladie de Still de l’adulte. Elle est exceptionnellement associee a une anasarque, une microangiopathie thrombotique et une dysautonomie. Observation Nous rapportons l’observation d’une femme de 32 ans qui presentait a la fois une oligo-anurie avec anasarque, une microangiopathie thrombotique et un tableau compatible avec une maladie de Still. L’evolution etait initialement favorable sous corticotherapie, immunoglobulines polyvalentes et plasmaphereses, avec cependant la persistance de poussees marquees par un syndrome dysautonomique severe et une corticodependance. Le diagnostic de maladie de Castleman de type mixte, HHV8 et VIH negative, etait porte 4 ans apres le debut des symptomes sur une biopsie ganglionnaire. L’evolution etait initialement favorable apres l’introduction de tocilizumab associe a la corticotherapie, puis le remplacement du tocilizumab par l’anakinra permettait un controle durable de la maladie. Conclusion Le tableau de notre patiente correspond partiellement a la description du syndrome TAFRO (Thrombocytopenia, Anasarca, myeloFibrosis, Renal dysfunction, Organomegaly) variant de MCM recemment decrit chez des patients japonais.

La mortalite maternelle en rapport avec une maladie cardiovasculaire est en augmentation. La grossesse s’accompagne demodifications physiologiques propices a la survenue de la decompensation d’une cardiopathie preexistante, mais peut egalement etre responsable de pathologies acquises de novo. La prise en charge de cardiopathies connues comme les cardiopathies congenitales est frequente, mais s’accompagne rarement d’un evenement grave. Au contraire, les pathologies survenant de novo sont moins frequentes mais responsables de la majorite des deces. Les principales causes de deces sont la mort subite, l’infarctus du myocarde, la dissection aortique et les cardiomyopathies acquises, en premier lieu desquelles la cardiomyopathie du peripartum. En l’absence d’une prise en charge adequate, ces pathologies peuvent avoir une evolution rapidement fatale. Leur reconnaissance precoce est donc primordiale, car elle conditionne leur pronostic. Au cours de la prise en charge d’une pathologie cardiovasculaire en reanimation, le pronostic maternel est toujours privilegie par rapport a celui du fœtus. La complexite des situations medicales et la dualite mere-enfant rendent indispensables la coordination multidisciplinaire.

Comparing assessments of incapacity to work in patients with subjective health complaints (SHC) by physicians from 5 different European countries.Cross-sectional study.General practitioners from Norway (n=56), Sweden (n=29), Denmark (n=41), France (n=46) and occupational and insurance physicians from the Netherlands (n=93) watched and assessed incapacity to work in nine video vignettes of patients with SHC. We subsequently analysed differences between assessments (whether or not there was incapacity to work) by country, with Norway as a reference, as well as differences between general practitioners from the four countries and occupational and insurance physicians using a generalised linear mixed model.Assessments of incapacity to work by physicians from the 5 countries were generally very similar. However, compared to Norwegian general practitioners, Swedish general practitioners (odds ratio (OR) of 0.43 with 95% confidence interval (CI) of 0.23-0.79) and Dutch occupational and insurance physicians (OR of 0.55 with 95% CI of 0.36-0.86) concluded less often that the patients in the videos were unable to work. There were no differences between general practitioners from the other 2 European countries and those from Norway. The Dutch occupational and insurance physicians also concluded less often that there was an incapacity to work compared to all general practitioners from the other 4 European countries (OR of 0.67 with 95% CI of 0.49-0.93).There are significant differences between assessments of incapacity to work in patients with SHC between countries and professional groups, but these differences are generally small. Potential explanations for these differences could be found in occupational and insurance medicine specialist training and in the existence of professional guidelines.

Resume Introduction La grande majorite des myopericardites aigues est d’origine virale ou indeterminee. Observation Nous rapportons le cas d’une jeune patiente ayant presente deux tableaux cliniques rapproches compatibles avec le diagnostic d’infarctus du myocarde a coronaires saines, mais pour lesquels le diagnostic final reposant sur l’imagerie cardiaque par resonance magnetique et le serodiagnostic est celui de myopericardite a Chlamydia trachomatis . Une antibiotherapie par levofloxacine a permis d’obtenir une disparition definitive des symptomes. Conclusion L’infection a Chlamydia trachomatis , plus souvent cause d’infections genitales, de grossesse extra-uterine ou d’infertilite, se manifeste rarement par une myopericardite aigue. Son identification permet un traitement specifique.

L’insuffisance renale aigue liee a la grossesse est une complication responsable d’une importante morbimortalite mais dont la frequence diminue. Cette defaillance resulte de multiples causes dont la preeclampsie (PE) et le HELLP (Hemolysis, elevated liver enzymes, low platelets) syndrome. La PE modifie l’adaptation physiologique renale lors de la grossesse, en detournant le role de facteurs angiogeniques dont le Vascular endothelial growth factor (VEGF), implique dans le remodelage vasculaire placentaire afin de permettre le bon developpement foetal. De recentes avancees ont permis de mettre en evidence un facteur circulant, le Soluble fms-like tyrosine kinase-1 (sFlT-1), bloquant l’action du VEGF en inhibant sa fixation sur son recepteur a la surface des cellules endotheliales. Il en resulte une ischemie placentaire, la cellule endotheliale glomerulaire en etant la premiere cible physiopathologique. Le diagnostic precoce de PE a pour but de limiter les sequelles en initiant un traitement rapide. Celui-ci repose sur l’association d’un traitement antihypertenseur pour controler la pression arterielle diastolique et d’un remplissage vasculaire. A l’heure actuelle, le seul traitement efficace, notamment en cas d’insuffisance renale aigue, reste l’interruption immediate de la grossesse pour permettre la reversion de l’endotheliopathie glomerulaire. Le suivi a long terme de femmes preeclamptiques a permis de definir cette pathologie comme un facteur de risque a la fois cardiovasculaire et renal, avec le risque de developper une nephropathie secondaire. Ainsi, la mise en evidence d’une proteinurie au cours de la grossesse necessite des explorations nephrologiques complementaires et un suivi a distance de l’accouchement.

Le syndrome de takotsubo est une entite clinique de decouverte recente mimant un syndrome coronarien aigu (SCA) en l’absence de lesions coronaires significatives associees. Il concerne surtout les femmes âgees exposees a un stress intense, le plus souvent de nature psychique. Sa physiopathologie reste incertaine et son traitement reste empirique. Le pronostic est souvent favorable en dehors de complications aigues imprevisibles.

Resume Le syndrome de Tako-tsubo ou ballonisation transitoire de l’apex du ventricule gauche (VG) est une entite de decouverte recente mimant un syndrome coronarien aigu (SCA) en l’absence de lesions coronaires significatives associees. Il concerne surtout les femmes âgees exposees a un stress intense. Sa physiopathologie precise est inconnue et son traitement reste empirique. Le pronostic est souvent favorable en dehors de complications aigues imprevisibles.

In 1987/88 a prospective study was undertaken of 750 patients with postoperative carcinoma of the breast but no evidence as yet of skeletal metastases. A thorough history regarding pain was taken with pre-set questions and an exact clinical examination conducted to reveal any skeletal pain. Subsequently whole-body skeletal scanning was performed, plus additional X-ray films, determination of tumour markers CA-15-3 and CEA, and further tests as indicated. Clinical and imaging results agreed in 649 patients. In 70 patients the clinical suspicion or questionable finding of metastases was not confirmed by radiology or a scan. Bone metastases would have been missed in only 14 patients (1.9%) without a skeletal scan. Eleven of these 14 patients were in high-risk groups (negative hormone receptor status; axillary lymph node metastases). Skeletal metastases were undiscovered in only three of the 750 patients (0.4%). It is thus sufficient to limit skeletal scans to high-risk groups, as long as a careful history of pain is taken and a thorough clinical examination conducted.

Resume Le HELLP syndrome associe une hemolyse, une elevation des enzymes hepatiques et une thrombopenie. Ce syndrome survient le plus souvent dans un contexte de dysgravidie et de preeclampsie. Le diagnostic et la prise en charge du HELLP syndrome font encore l'objet de controverses. Ainsi, afin d'ameliorer le pronostic fœtal sans majorer la morbidite maternelle, deux attitudes therapeutiques se discutent : interruption rapide de la grossesse avec risques de morbidite et mortalite fœtales lies a la prematurite ou traitement conservateur avec risques maternels, notamment a type de complications hemorragiques hepatiques et/ou cerebromeningees. La prise en charge therapeutique doit donc etre instauree apres evaluation de la balance benefices/risques pour la mere et l'enfant.

The French health authorities recommend systematic screening for Chlamydia trachomatis (Ct) urogenital infections in dedicated sexual health centers (planning centers) for women under 25 years old and for women who have changed partners during the last year. The two main purposes of this study were to assess adherence to this recommendation in planning centers and to identify possible obstacles to this screening.We conducted an observational prospective study from April to August 2013 in planning centers of Poitou-Charentes. Data on declarative screening practices and possible obstacles to Ct screening were collected qualitatively. Real center practices were also recorded to assess conformity with guidelines. Quantitative data were collected about real activities in each center. Screening percentage among women younger than 25 years and among those who had changed partners during the year was computed for each center. The main endpoint was percentage of centers that did not follow the recommendations. Declared practices were compared to observational practices using real practices data.Twelve out of 17 planning centers in the region participated. Six centers declared they performed systematic screening for Ct infection in women under 25 and 2 centers in women who had changed partners during the year. No center fully complied with the recommendations. Forty-three percent (601/1390) of women with standard screening criteria were screened and 52 % (102/197) of women without these criteria were screened. Depending on the center, declared practices could overestimate or underestimate the observed practices. The declared obstacles were lack of time, patient refusal, budget issues and no specific organization.Poitou-Charentes planning centers screen for Ct infection in women younger than 25 years old and those who have changed partners during the last year depending on risk factors (unprotected sex, infected partner…). Which patients need this screening has to be clarified.

The psychosocial rehabilitation and the quality of life of schizophrenics have constituted the main concern in the taking care of these patients since their return into our society. Thus, the emergence of atypical neuroleptics allows us to imagine very interesting and important perspectives concerning these 2 concepts. The adaptation to social and professional life, and the quality of life have been rarely compared according to the antipsychotic therapeutic used (classical neuroleptics or atypical neuroleptics). As many authors underline it, there are still very few studies undertaken concerning this subject because of the diverse methodological and ethical limitations implied. That is why we established a transversal study of the psychosocial adaptation and of the quality of life of 2 stabilized schizophrenic groups. These 2 different groups are: the NC group under classical neuroleptics on the one hand, and the NA group under atypical neuroleptics on the other hand. The main target of this study is to observe the influence of the atypical neuroleptics independently of the other factors. Three evaluation scales were used: the PANSS, the psychosocial skill scale (EAPS) of G. Darcourt and the French translation by P. Martin of the Functional Statut Questionnaire (FSQ), and a collection of the clinical and therapeutic socio-demographic data. Concerning the psychosocial capacities, the total results revealed one significant difference (p-value

We have developed a capacitance–voltage (C–V) and a current–voltage (I–V) quasistatic quantum model of ultrathin metal–oxide–semiconductor (MOS) structures based on the self-consistent solution of the Schrodinger and Poisson equations. The direct tunneling current takes into account the carrier distribution in energy subbands and uses the notions of corrected tunnel transparency and of impact frequency at the injecting electrode. These models are used to obtain the main physical parameters of n+-polysilicon/SiO2/〈100〉 p-Si MOS structures, with oxide thickness ranging from 1.2 to 3.5 nm. The extracted parameters are the oxide thickness (TOX), the substrate doping, both at the Si/SiO2 interface [NS(0)] and deep in the bulk [NS(∞)], and the polysilicon gate doping (NP) near the polysilicon/SiO2 interface. For this range of oxide thickness, the direct tunneling current strongly perturbs the C–V measurements, which must be corrected. Down to 1.5 nm oxide thickness, these parameters are obtained by C–V characte...

It has been shown recently that the low voltage gate current in ultrathin oxide metal–oxide–semiconductor devices is very sensitive to electrical stresses. Therefore it can be used as a reliability monitor when the oxide thickness becomes too small for traditional electrical measurements to be used. This paper presents a thorough study of the low voltage gate current variation for different uniformed or localized electrical stress conditions at or above room temperature, and for various oxide thicknesses ranging from 1.2 to 2.5 nm. As it has been proposed recently that this current could be due to electron tunneling through Si/SiO2 interface states, the results obtained in the thicker oxides for the gate current have been compared with the corresponding surface state density variations measured by charge pumping. It is shown that there is no clear relation between low voltage gate current increase after stress and that of surface state density, and that soft or hard oxide breakdown happens when the low vo...

Multicentric Castleman's disease can mimic adult-onset Still disease. It is exceptionally associated with anasarca, thrombotic microangiopathy and dysautonomia.We report a 32-year-old woman with an association of oligoanuria, anasarca, thrombotic microangiopathy with features compatible with adult-onset Still disease. The outcome was initially favorable with corticosteroids, immunoglobulins and plasmapheresis but with the persistence of relapses marked by severe autonomic syndrome and necessity of high dose corticosteroids. The diagnosis of mixed type Castleman's disease, HHV8 and HIV negative, was obtained four years after the onset of symptoms by a lymph node biopsy. The outcome was favorable after tocilizumab and corticosteroids but tocilizumab had to be switched to anakinra to ensure a proper and long-lasting control of the disease.Our patient partially fits the description of TAFRO syndrome (Thrombocytopenia, Anasarca, myeloFibrosis, Renal dysfunction, Organomegaly), a MCM rare variant, recently described in Japanese patients.

Resume Objectifs Rapporter la mise en place d’un programme de simulation pour l’apprentissage des examens mammaire et pelvien gynecologiques aux etudiants de deuxieme annee de medecine (DFGSM2) et evaluer la satisfaction des etudiants et des enseignants suite a cet enseignement. Patients et methodes Mise en place de la seance d’apprentissage aux gestes par groupes de cinq etudiants avec une evaluation prospective du programme d’apprentissage grâce a un questionnaire de satisfaction rempli par les etudiants et les enseignants a la fin de la seance d’enseignement. Resultats Le programme d’apprentissage comprenait une preparation en ligne a la seance, trois ateliers sur mannequins simples (examen mammaire, examen pelvien avec mise en place d’un speculum et frottis cervico-vaginal) et la projection d’un film. Au total, 419 (80,6 %) sur 520 etudiants en MED2 et 15 (50 %) sur 30 enseignants (13 chefs de clinique et 17 sages-femmes) ont repondu au questionnaire. L’appreciation globale de l’enseignement etait excellente pour 56,6 % des etudiants et bonne pour 43,2 % d’entre eux. Pour les enseignants, ces pourcentages etaient respectivement de 13,4 % et 86,6 %. En moyenne, 89,7 % des etudiants souhaitaient plus d’enseignements de ce type et tous les enseignants jugeaient ces formations utiles ou tres utiles pour les etudiants. Discussion et conclusion La mise en place de seances d’apprentissage par simulation des examens pelvien et mammaire destines a des etudiants en medecine de deuxieme annee avec l’utilisation de mannequins simples et de videos est associee a un haut degre de satisfaction chez les etudiants et chez les enseignants.

It is generally agreed that stress induced leakage current (SILC), in MOS devices, is due to electrons tunneling through stress-induced neutral traps and that SILC has a steady-state component. However, it was observed that SILC, created by positive or negative Fowler–Nordheim injection in 7 and 5 nm thick oxides, decays slowly but continuously when, after stress, the samples are positively or negatively biased at low voltage. The decay is irreversible as long as the gate voltage is less than 4 V. To explain the SILC decay, it has been proposed that some active traps in the tunneling process might possibly be deactivated. The present communication adds first complementary observations on this subject: it shows that the above phenomenon is observed in 3.8 and 3.5 nm thick oxides after a positive stress; that this phenomenon is stable as long as the temperature remains below the SILC annealing temperature threshold which is equal to 200°C; and that during the SILC decay the interface state density does not diminish and can even increase. This communication shows secondly that after a negative stress two SILC components exist in these thin oxides: one which has all the characteristics of the SILC induced by a positive stress and another which does not exist in thicker oxides, which does not decay when a low voltage is applied after stress and which is not annealed at 300°C.

We use a full quantum model of MOS (metal oxide semiconductor) structure to study the influence of a non-uniform doping profile of the substrate on the capacitance-voltage ( C − V ) behavior of the structure. For different “realistic” doping profiles, simulations are performed and compared to simulations with an uniform doping and to C − V measurements for samples with oxide thickness in the range [2−5 nm] [1]. In each case, we have extracted the oxide thickness that is found to be independent of the doping and the flat-band voltage which can be shifted up to 200 mV regarding the different profiles tested here. Moreover, below about 3 nm, the shape of the C − V simulation is more affected, which shows that the doping profile of the substrate has a great importance for an accurate C − V modeling of ultra-thin MOS structures.

In this paper, we present a full quantum model of metal oxide semiconductor capacitance based on a self-consistent resolution of Schrodinger and Poisson equations. The model is used in accumulation to extract the oxide thickness of N+ polycrystalline silicon–SiO2–P silicon capacitors in the range 2–5 nm. The extraction results are in agreement with reference ellipsometric measurements to

We present photometric ISO 60 and 170um measurements, complemented by some IRAS data at 60um, of a sample of 84 nearby main-sequence stars of spectral class A, F, G and K in order to determine the incidence of dust disks around such main-sequence stars. Of the stars younger than 400 Myr one in two has a disk; for the older stars this is true for only one in ten. We conclude that most stars arrive on the main sequence surrounded by a disk; this disk then decays in about 400 Myr. Because (i) the dust particles disappear and must be replenished on a much shorter time scale and (ii) the collision of planetesimals is a good source of new dust, we suggest that the rapid decay of the disks is caused by the destruction and escape of planetesimals. We suggest that the dissipation of the disk is related to the heavy bombardment phase in our Solar System. Whether all stars arrive on the main sequence surrounded by a disk cannot be established: some very young stars do not have a disk. And not all stars destroy their disk in a similar way: some stars as old as the Sun still have significant disks., Comment: 16 pages, 9 figures, Astron & Astrophys. in press