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One of the major goals of vaccination is to prepare the body to rapidly secrete specific Abs during an infection. Assessment of the vaccine quality is often difficult to perform, as simple measurements like Ab titer only partly correlate with protection. Similarly, these simple measurements are not always sensitive to changes in the preceding immunization scheme. Therefore, we introduce in this paper a new, to our knowledge, method to assay the quality of immunization schemes for mice: shortly after a recall with pure Ag, we analyze the frequencies of IgG-secreting cells (IgG-SCs) in the spleen, as well as for each cells, the Ag affinity of the secreted Abs. We observed that after recall, appearance of the IgG-SCs within the spleen of immunized mice was fast (

Introduction: the electrocardiogram has many indications in general practice. The aim of our study is to assess the ability of general practitioners in France to recognize electrocardiographic abnormalities. Methods: we conducted a descriptive, quantitative study, using a questionnaire, open to all physicians registered as generalists and practicing in France in 2018. General information was requested and then 16 ECG were presented. Results: 227 physicians in 51 departments responded. Physicians' activity patterns were divided into three groups: 77 (34%) physicians practiced exclusively in private practice. 95 (42%) made home visits. 55 (24%) had a hospital activity. There is no difference in level when comparing the 3 groups with each other (p = 0.097). 67.6% of the diagnoses were found. The number of ECGs performed per year and the estimated level are correlated with the scores (p = 0.02 and p

Introduction: lung cancer is a major public health problem due to a very significant frequency, a bad prognosis and the hospitalisations and emergency consultations it often requires. Aims: depicting the perceptions of specialists, general practitioners (GP) and patients of the role of GP in lung cancer. Comparing these perceptions to the role of the GP described in the French state health plan regarding cancer care. Method: multicentric and observational qualitative study using semi-guided individual interviews conducted between June 2016 and September 2017. The recruitment was done from 3 oncology centres in Ile de France. In total, 8 specialists, 8 GP and 11 patients were interviewed until data saturation. Interviews were analysed thematically and cross-analysed. Results: all the three actors agreed the GP has a principal role at the beginning of the care, and after the cessation of the active treatments. However, due to a number of reasons, GP’s role became less central during the treatment period itself. All the actors expected a better collaboration and transmission of information between them. Discussion: unlike the position of the French sate health plan about cancer care, GP is not the principal actor during all stages of lung cancer care. The decline of GP’s role during active treatments can lead to a lack of care continuity. Possible solutions to increase collaboration and information between GP and hospital teams could be direct numbers to rich specialists, email, or digital tools and therefore allow to a better care and quality of life for patients.; Introduction : devant sa fréquence, son pronostic sombre et la fréquence des hospitalisations et consultations urgentes qu’il entraine, le cancer du poumon est une préoccupation de santé publique. Objectifs : faire un état des lieux du rôle du généraliste dans la prise en charge du patient atteint de cancer bronchique du point de vue des trois acteurs de la prise en charge : le spécialiste, le généraliste et le patient. Voir si ce rôle coïncide avec celui qui est attribué dans le contexte de lutte contre le cancer en France. Méthodes : étude qualitative multicentrique, observationnelle en entretiens individuels semi-dirigés, réalisée entre juin 2016 et septembre 2017. Le recrutement s’est fait sur 3 centres d’oncologie thoracique d’Ile de France : 8 spécialistes, 8 généralistes et 11 patients ont été interviewés jusqu’à saturation des données. Une analyse thématique puis croisée des entretiens a été réalisée. Résultats : pour tous les acteurs, le généraliste a un rôle majeur au début de la prise en charge et après l’arrêt des traitements. Il est cependant mis à l’écart lors des traitements actifs. Les attentes de chacun s’organisent autour d’une meilleure collaboration ville-hôpital ainsi qu’une meilleure transmission d’information. Discussion : contrairement au Plan cancer, le rôle du généraliste n’est pas central durant toute la prise en charge. Sa mise à l’écart lors des traitements actifs entraîne des difficultés de continuité des soins. Des numéros directs, une messagerie sécurisée ou une application numérique pourraient permettre d’améliorer la collaboration entre l’hôpital et les généralistes afin d’améliorer la prise en charge et la qualité de vie des patients.

Objective: Hy-Result® software is designed to help patients to comply with the home blood pressure measurement (HBPM) protocol and self-interpret their results. We compare in a daily routine care setting, the classification generated by Hy-Result® with the physician’s clinical evaluation. Design and method: the algorithm combines BP readings with patient’s characteristics. According to the ESH guidelines, BP readings and automatically generated text messages are made available to the patient in a report. The primary assessment criterion was whether classification of the BP status generated by the software concurred with the physician’s classification following a consultation (n=195 patients) (gold standard). Results: in the 58 untreated patients, the agreement between classification of the BP status generated by the software and the physician’s classification was 87.9%. In the 137 treated patients, the agreement was 91.9%. The kappa-test applied for all the patients was 0.81[95%CI:0.73–0.89]. After correction of errors identified in the algorithm during the study, agreement was 95.4% (? 0.9[95%CI:0.84–0.97]). For 100% of the patients with comorbidities (n=46), specific text messages were generated indicating that a physician might recommend a target BP lower than 135/85 mmHg. Specific text messages were also generated for 100% of the patients for whom global cardiovascular risks greatly exceeded norms relating to BMI, tobacco and/or alcohol consumption. Remaining discrepancies were more attributable to physician than software. Conclusion: classification by Hy-Result® software is at least as accurate as that of a specialist in current practice. Hy-Result® is the first validated software for self-interpretation of HBPM results taking into account both the recommended thresholds for normal values and patient characteristics.; Objectif : le logiciel Hy-Result® est destiné à améliorer la pratique de l’automesure tensionnelle (AMT) et l’auto-interprétation des résultats. Nous avons comparé en aveugle la classification du statut tensionnel du patient par le logiciel Hy-Result® par rapport à celle du médecin spécialiste de l’HTA au cours d’une consultation médicale. Méthode : après recueil des résultats d’automesure et des antécédents du patient, une courbe ainsi que des messages de prévention cardiovasculaire sont générés automatiquement par le logiciel. L’objectif principal de l’étude est la mesure de la concordance en aveugle entre la classification du statut tensionnel des 195 patients par le logiciel Hy-Result® versus la classification par le médecin en consultation (Gold-Standard). Résultats : chez les 58 patients non traités, la concordance entre la classification du statut tensionnel générée par le logiciel et la classification du médecin était de 87,9%. Chez les 137 patients traités, la concordance était de 91,9%. Le test kappa appliqué à tous les patients était de 0,81 [IC95%:0,73-0,89]. Après correction des erreurs identifiées dans l'algorithme au cours de l'étude, la concordance a augmenté à 95,4% (?=0,9 [IC 95%: 0,84-0,97]). Pour 100 % des patients atteints de comorbidités (n=46), des messages textes ont été générés indiquant qu'un médecin pourrait recommander une TA cible inférieure à 135/85 mmHg. Des messages textes ont également été générés pour 100% des patients pour lesquels les valeurs dépassaient largement les normes relatives à l'IMC, au tabac et/ou à la consommation d'alcool. Les divergences restantes étaient attribuables à des erreurs du médecin plutôt qu’au logiciel. Conclusion : la classification par le logiciel Hy-Result® est au moins aussi pertinente que celle d'un médecin spécialiste de l’HTA en pratique courante. Hy-Result® est le premier logiciel en accès libre, validé pour l'auto-interprétation des résultats d’automesure prenant compte à la fois des seuils cibles selon les recommandations européennes et des caractéristiques du patient.

Introduction: delayed prescriptions are part of the actual evolution of medicine toward the notion of shared medical decision making. In France, unlike what is happening in other countries, this practice is not subject to national recommendations, even though this practice is used by some general practitioners. The aim of this study is to assess the experience of general practitioners regarding delayed prescriptions, and to understand the feelings of their patients. Material and Method: prospective and quantitative study. Doctors were included in the study after an initial contact by phone (they were then split into two groups: doctors who stated they were delivering delayed prescriptions, and doctors who stated they didn’t). The doctors included their patients. Data collection was conducted via an online or email questionnaire. Statistical analysis was performed using the R software. Results: 36 general practitioners (28 YES and 8 NO) and 53 patients were included in the study, which took place between September, 10th 2015 and April, 10th 2016, in Lorraine (France). Delayed prescriptions were mainly delivered for infectious diseases. Nearly a prescription out of four did not include antibiotics. The delayed nature of the prescription has been respected by 92% of patients. Patients who wanted to be part of the medical decision-making were even more satisfied with it. Conclusion: delayed prescriptions are used by some general practitioners in various fields. They form part of a therapeutic education approach with patients who want to be involved in medical decisions. The existence of a legal framework would limit the risks associated to this practice.; Introduction : les prescriptions différées font partie de l’évolution actuelle de la médecine vers la notion de "Décision Médicale Partagée". Contrairement à d’autres pays, cette pratique ne fait pas l’objet de recommandations nationales, alors qu’elle est utilisée par certains médecins généralistes. L’objectif de ce travail était d’évaluer l’expérience des médecins généralistes concernant les prescriptions différées et de comprendre le ressenti de leurs patients. Matériel et Méthode : étude prospective quantitative. Les médecins étaient inclus après contact téléphonique (deux groupes étaient constitués, selon qu’ils disaient faire ou non des prescriptions différées). Les médecins incluaient leurs patients. Les données étaient recueillies par des questionnaires en ligne ou par courrier. L’analyse statistique a été réalisée via le logiciel R. Résultats : 36 médecins généralistes (28 OUI et 8 NON) et 53 patients ont été inclus, entre le 10 septembre 2015 et le 10 avril 2016, en Lorraine. Les pathologies infectieuses étaient les principales pourvoyeuses de prescriptions différées. Près d’une ordonnance sur quatre ne comportait pas d’antibiothérapie. Le caractère différé de la prescription a été respecté par 92% des patients. Ils étaient d’autant plus satisfaits lorsqu’ils étaient demandeurs de participer aux prises de décisions médicales. Conclusion : les prescriptions différées sont utilisées par certains médecins généralistes dans différents domaines. Elles s’intègrent dans une démarche d’éducation thérapeutique auprès de patients qui souhaitent s’impliquer dans les décisions médicales. L’existence d’un cadre légal permettrait de limiter les risques inhérents à la pratique.

International audience; Methionyl-adenylate, the mixed carboxylic-phosphoric acid anhydride synthesized by methionyl-tRNA synthetase (MetRS) is capable of reacting with this synthetase or other proteins, by forming an isopeptide bond with the epsilon-NH2 group of lysyl residues. It is proposed that the mechanism for the in vitro methionylation of MetRS might be accounted for by the in situ covalent reaction of methionyl-adenylate with lysine side chains surrounding the active center of the enzyme, as well as by exchange of the label between donor and acceptor proteins. Following the incorporation of 7.0 +/- 0.5 mol of methionine per mol of a monomeric truncated methionyl-tRNA synthetase species, the enzymic activities of [P-32]PP1-ATP isotopic exchange and tRNA(Met) aminoacylation were lowered by 75% and more than 90%, respectively. The addition of tRNA(Met) protected the enzyme against inactivation and methionine incorporation. Matrix-assisted laser desorption-ionization mass spectrometry designated lysines-114, -132, -142 (or -147), -270, -282. -335, -362, -402, -439, -465, and -547 of truncated methionyl-tRNA synthetase as the target residues for covalent binding of methionine. These lysyl residues are distributed at the surface of the enzyme between three regions [114-150], [270-362], and [402-465], all of which were previously shown to be involved in catalysis or to be located in the binding sites of the three substrates, methionine, ATP, and tRNA.

INTRODUCTION: Pain assessment is a crucial step in the management of patients with rheumatic diseases. Among validated pain scores, the visual analog scale (VAS) score is the most widely used, in both clinical practice and therapeutic trials. OBJECTIVE: To determine the VAS pain score decrease that constitutes meaningful pain relief, with the goal of evaluating treatment effects. METHODS: We included patients with acute pain caused by non-malignant rheumatic conditions. Pain duration of less than 1month and a baseline VAS score greater than 50/100mm were required. Twice daily, patients evaluated pain intensity using the VAS and pain relief using a five-category verbal rating scale (VRS) where 0 indicated no pain relief and 4 excellent relief. RESULTS: Fifty patients were included. VAS score changes correlated linearly with VRS score changes (r=0.7 and P

International audience; A cascading system of hierarchical, artificial neural networks (named PRED-CLASS) is presented for the generalized classification of proteins into four distinct classes-transmembrane, fibrous, globular, and mixed-from information solely encoded in their amino acid sequences. The architecture of the individual component networks is kept very simple, reducing the number of free parameters (network synaptic weights) for faster training, improved generalization, and the avoidance of data overfitting. Capturing information from as few as 50 protein sequences spread among the four target classes (6 transmembrane, 10 fibrous, 13 globular, and 17 mixed), PRED-CLASS was able to obtain 371 correct predictions out of a set of 387 proteins (success rate approximately 96%) unambiguously assigned into one of the target classes. The application of PRED-CLASS to several test sets and complete proteomes of several organisms demonstrates that such a method could serve as a valuable tool in the annotation of genomic open reading frames with no functional assignment or as a preliminary step in fold recognition and ab initio structure prediction methods. Detailed results obtained for various data sets and completed genomes, along with a web sever running the PRED-CLASS algorithm, can be accessed over the World Wide Web at http://o2.biol.uoa.gr/PRED-CLASS.

International audience; We evaluated a dog owner, participation-based, bait delivery system for the oral immunization of dogs against rabies. In a field study in a semirural area of northern Tunisia, dog owners were asked to come to temporary bait delivery sites. A total of 314 baits were given to 178 dog owners in four sites. The experimental baits used consisted of a freeze-dried core unit containing sulfadimethoxine (SDM) as a biological marker and an aromatized paraffin envelope. No vaccine was used. Preliminary tests had shown that by using a rapid commercial card test, positive SDM serum levels were detected in more than 95% of dogs up to two days after bait ingestion. During the two days following bait delivery, we visited more than 95% of all households in the study area and took blood samples from as many owned dogs as possible. Unconsumed baits were recovered and human contacts with the bait matrix were recorded. The campaign required 7.6 person-min per bait and 13.5 person-min per dog owner for providing baits, gloves, and instructions. The estimated average cost effectiveness ratio per dog accepting a bait was 1.7 US dollars. From the indications given by the dog owners and the results of the SDM test, it was concluded that 85-90% of the owned dogs in the study area had consumed a bait at least partially. Of 314 baits delivered, 78.7% were fully consumed by dogs and 4.1% were recovered during the household survey. The remaining baits (17.2%) that were not recovered were either not consumed or only partially consumed by the target dogs (3.7 baits per 100 inhabitants). These baits probably remained within the highly populated areas and were potentially accessible to other domestic animals and other nontarget species, including humans. Twenty-five unprotected human contacts with baits were recorded (1.7% of all inhabitants). Our study has demonstrated the potential of dog owner based bait delivery. This technique is simple and efficient, particularly if the human population is accustomed to mass immunization in defined centers. Before applying this method on a large scale with live vaccine loaded baits, further studies should focus on minimizing the number of human contacts with the vaccine bait, systematizing contact identification and establishing structures in ensuring proper treatment if exposure to vaccine should occur.

SummaryBackground: Plasma D-Dimer analysis, using ELISA assays, has demonstrated in previous studies a high sensitivity, suggesting its utility in excluding deep venous thrombosis (DVT). Aim: To assess the performance of a new rapid plasma D-Dimer ELISA measurement in suspected DVT patients with recent clinical signs, not exceeding one week. Methods: A prospective study of patients admitted for a suspected recent DVT. Contrast venography or compression ultrasonography were performed within 24 h of admission. A new membrane based ELISA technique, which uses an immunofiltration and two complementary monoclonal antibodies was tested. Results were expressed as positive or negative. A standard plasma D-Dimer ELISA measurement was also performed. D-Dimer performances were assessed at the end of the study. Results: 265/448 patients had a proven DVT (72 distal, 193 proximal). The sensitivity of the instantaneous method in the diagnosis of overall DVT is 92 ± 3.4% (95% Cl), and specificity is 36.6 ± 6.9%. Positive predictive value is 67.7 ± 4.8% and negative predictive value is 76.1 ± 8.9%. Sensitivity and negative predictive values reach 97.9 and 94.3% in the diagnosis of proximal DVT, but only 76.3 and 79.7% in the diagnosis of distal DVT. Similar results are observed with the standard ELISA method. Conclusion: This new rapid plasma D-Dimer measurement appears highly sensitive, and could substitute the older ELISA methods. Both methods provide lower sensitivity in the case of a distal DVT location.

Dans le domaine des psychothérapies psychodynamiques, la recherche évaluative selon les principes del'Evidence-Based Medicine n'a produit à ce jour que peu d'études randomisées contrôlées (RCT). Ce faibleniveau de preuve pourrait être lié à une certaine inadéquation des RCT dans ce contexte, plutôt qu'à une faibleefficacité des thérapies. En effet, la réalisation de RCT dans ce domaine pose des difficultés méthodologiques, etla généralisabilité des résultats obtenus reste limitée.D'autres types d'études paraissent plus pertinentes pour l'évaluation des thérapies psychodynamiques. Lesétudes observationnelles permettent une évaluation multidimensionnelle en conditions de pratique réelle, ainsiqu'une mesure des processus thérapeutiques et des mécanismes de changement. La mise en oeuvre des étudesobservationnelles dans le cadre de réseaux de pratique clinique permet d'établir un continuum entre recherche etpratique clinique. Les résultats sont alors issus de la pratique clinique, et directement transposables à celle-ci.Différents exemples d'études évaluatives portant sur les thérapies psychodynamiques montrent l'intérêt d'uneapproche observationnelle intégrative. Cette approche associe des mesures qualitatives et quantitatives, dansdes conditions de pratique réelle, avec une durée de suivi de plusieurs années.Au-delà du débat opposant psychanalyse et évaluation, les thérapies psychodynamiques apparaissent ainsicomme un domaine privilégié pour le développement de méthodes alternatives aux RCT dans la rechercheévaluative, permettant de passer du paradigme d'une Evidence-Based Medicine à celui d'une Medicine-BasedEvidence.

A novel thermophilic, anaerobic and organotrophic bacterium, designated strain MC3T, was isolated from a coastal thermal spring on Île Saint-Paul in the Southern Indian Ocean. Cells of strain MC3T were motile rods, 0.8–1.0 μm wide and 1.0–2.4 μm long during exponential phase and up to 7.0 μm long during stationary phase. Strain MC3T was an anaerobic organotroph able to use diverse organic compounds. It was also able to reduce sulfur to sulfide. Growth was observed at temperatures ranging from 45 to 70 °C (optimum at 60 °C), between pH 5.5 and 7.5 (optimum at pH 6) and from 8 to 46 g NaCl l−1 (optimum at 26 g l−1). The total G+C content of the genomic DNA was 26.2 mol%. Phylogenetic analysis based on 16S rRNA gene sequence comparisons indicated that strain MC3T was affiliated with the genus Marinitoga within the order Thermotogales. It shared 94.4–95.7 % 16S rRNA gene sequence similarity with strains of other Marinitoga species; Marinitoga hydrogenitolerans was found to be the most closely related organism. Based on the data from the phylogenetic analysis and the physiological properties of the novel isolate, strain MC3T should be classified as a representative of a novel species, for which the name Marinitoga litoralis sp. nov. is proposed; the type strain is MC3T (=DSM 21709T =JCM 15581T).

International audience; New MR imaging protocols enable visualization of brain structures. However, for dedicated clinical applications such as targeting deep brain stimulation (DBS), a more accurate localization requires the use of atlases. We developed a three-dimensional digitized mono-subject anatomical template of the human brain based on 3-T magnetic resonance images (MRI). By averaging 15 registered T1 image acquisitions, we have shown that the final image corresponds to an optimal image, limited by the performance of the 3-T MR machine. We compared different preprocessing workflows for template construction. With the optimal strategy, along with validated existing processing methods, one T1 template and one T1-T2 mixing template were created in order to improve visualization of spatially complex deep structures. Reduction of voxel size to 0.25 mm(3) was also advantageous to observe fine structures and white matter/gray matter intensity crossings. Results demonstrated that such a template also improved inter-patient registration for population comparison in DBS. These MR templates are made freely available to our community (http://www.vmip.org/mritemplate) to serve as a reference for neuroimage processing methods.

International audience; UNLABELLED: WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT: Several comparative measures (ratios, differences, or the number needed to treat) are used to express the effect of a drug or another intervention. These measures can vary in the way they are affected by the background risk measured from the reference group. WHAT THIS STUDY ADDS: This paper reviews the formulation, interpretation and limitations of measures of effect. We describe a little-known parameter, the attained effect or clinical result ratio, a positive reformulation of the relative risk difference, and suggest how available parameters can be best used to summarize results of studies of the effect of drugs. AIMS Measures to compare two drugs are often affected by the background risk in the reference group; a ceiling effect results when the background risk is small. We review measures of the effect of drugs, including a special formulation of the relative risk difference, the attained effect or clinical result ratio, that addresses background risk and ceiling effect. METHODS: Existing measures are the risk and odds ratios, the absolute and relative risk differences, and the number needed to treat. The attained effect is defined as the observed gain in success (the difference of proportion of success between the two interventions), divided by the maximum attainable gain, the maximum proportion of success one can expect. We illustrate the relationship between these measures with published results of two meta-analyses. RESULTS: In studies of the effectiveness of cell salvage, the baseline risk ranged between 8 and 95%. This variability affected the risk difference and number needed to treat, while the attained effect, with a ceiling residual risk of 2%, showed that the gain in success was half the maximum attainable gain. In studies of the effectiveness of therapy in patients infected by the human immunodeficiency virus, where the baseline risk was less variable, and there was no ceiling effect, the maximum attained effect indicated that the gain could be much smaller. CONCLUSION: The attained effect, interpreted as the proportion of effectiveness that remains to gain for future interventions, can usefully complete the number needed to treat as a clinically informative effect measure.

International audience; UNLABELLED: WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT: Several comparative measures (ratios, differences, or the number needed to treat) are used to express the effect of a drug or another intervention. These measures can vary in the way they are affected by the background risk measured from the reference group. WHAT THIS STUDY ADDS: This paper reviews the formulation, interpretation and limitations of measures of effect. We describe a little-known parameter, the attained effect or clinical result ratio, a positive reformulation of the relative risk difference, and suggest how available parameters can be best used to summarize results of studies of the effect of drugs. AIMS Measures to compare two drugs are often affected by the background risk in the reference group; a ceiling effect results when the background risk is small. We review measures of the effect of drugs, including a special formulation of the relative risk difference, the attained effect or clinical result ratio, that addresses background risk and ceiling effect. METHODS: Existing measures are the risk and odds ratios, the absolute and relative risk differences, and the number needed to treat. The attained effect is defined as the observed gain in success (the difference of proportion of success between the two interventions), divided by the maximum attainable gain, the maximum proportion of success one can expect. We illustrate the relationship between these measures with published results of two meta-analyses. RESULTS: In studies of the effectiveness of cell salvage, the baseline risk ranged between 8 and 95%. This variability affected the risk difference and number needed to treat, while the attained effect, with a ceiling residual risk of 2%, showed that the gain in success was half the maximum attainable gain. In studies of the effectiveness of therapy in patients infected by the human immunodeficiency virus, where the baseline risk was less variable, and there was no ceiling effect, the maximum attained effect indicated that the gain could be much smaller. CONCLUSION: The attained effect, interpreted as the proportion of effectiveness that remains to gain for future interventions, can usefully complete the number needed to treat as a clinically informative effect measure.

From 1989 to 1996, 533 eligible patients with stage IIIB/IV Hodgkin lymphoma (HL) were randomly assigned to receive 6 cycles of hybrid MOPP/ABV (mechlorethamine, vincristine, procarbazine, prednisone/Adriamycin [doxorubicin], bleomycin, vinblastine; n = 266) or ABVPP (doxorubicin, bleomycin, vinblastine, procarbazine, prednisone; n = 267). Patients in complete remission (CR) or partial response of at least 75% after 6 cycles received 2 cycles of consolidation chemotherapy (CT) (n = 208) or subtotal nodal irradiation (RT) (n = 210). A better survival probability was observed after ABVPP alone: the 10-year overall survival (OS) estimates were 90% for ABVPP×8, 78% for MOPP/ABV×8, 82% for MOPP/ABV with RT, and 77% for ABVPP×6 with RT (P = .03); and the 10-year disease-free survival (DFS) estimates were 70%, 76%, 79%, and 76%, respectively (P = .09). The 10-year DFS estimates for patients treated with consolidation CT or RT were 73% and 78% (P = .07), and OS estimates were 84% and 79%, respectively (P = .29). These results showed that RT was not superior to consolidation CT after a doxorubicin-induced CR in patients with advanced HL. An analysis of competing risks identified age more than 45 years as a significant risk factor for death, relapse, and second cancers. Prospective evaluation of late adverse events may improve the management of patients with HL.

International audience; Conventional tests for antibody to Hepatitis C virus (HCV) and HCV RNA require considerable time before results are available, remain very expensive and are not adapted to many sub-Saharan African countries where HCV is endemic. The aim of this study was to evaluate the accuracy of an algorithm consisting of two HCV rapid tests to diagnose and predict HCV viremia in patients in Cameroon. Three hundred and twenty nine plasma samples were screened by two HCV rapid tests (ImmunoComb II HCV, PBS Orgenics and Hexagon HCV, Human). Previous evaluation of these samples for HCV antibodies (anti-HCV) by conventional third generation ELISA, considered as a reference test, indicated that 168 were anti-HCV negative and 161 positive. Among the 161 anti-HCV positive plasma, 114 (71%) were HCV RNA-positive by RT-PCR assay. The ImmunoComb II HCV test provided the more sensitive detection of anti-HCV (sensitivity: 99.4% with a 95% CI = 96-100%). Surprisingly, the second HCV rapid test, Hexagon HCV, showed a high capacity to identify non-viremic subjects amongst anti-HCV positive cases (93.6% [95% CI: 82-99%]). These results suggest an algorithm using ImmunoComb II HCV as a first test to screen anti-HCV positive subjects, and Hexagon HCV as a second test to discriminate between viremic and non-viremic HCV seropositive subjects.

International audience; BACKGROUND: The Pall third-generation enhanced bacterial detection system (eBDS) was recently approved for detection of bacterial contamination in leukoreduced platelets (PLTs). The method is based on the measurement of the oxygen content as a marker for bacteria. eBDS incorporates major modifications including removal of the sample-set filter, modification of the culture medium, and incubation with agitation of the sample pouch. STUDY DESIGN AND METHODS: Ten whole blood-derived random-donor PLT units collected on Day 1 after donation and 10 single-donor apheresis PLT units were spiked with low levels of bacteria in three different blood transfusion centers. Inoculation was performed at a final concentration of 5 to 50 colony-forming units per mL with reference strains of five organisms involved in severe transfusion-associated infections. PLT units were stored at 22 degrees C for 24 hours before sampling. Six sample sets were then sterile-connected to each unit and placed on a horizontal agitator at 35 degrees C for 18 or 24 hours of incubation. RESULTS: No false-positive results were obtained, indicating a 100 percent specificity of the assay. Of 126 spiked sample pouches tested, 61 of 63 (96.82%) and 63 of 63 (100%) were detected positive after 18 or 24 hours of incubation, respectively. In the two missed cases that failed to detect Bacillus cereus, the measured oxygen was slightly above the detection threshold but was markedly different from the negative samples. CONCLUSION: The eBDS method allows definitive testing of PLTs as soon as 42 hours after collection and offers an alternative culture method to the BacT/ALERT system.

International audience; OBJECTIVE: Since 1992, 7 European neurophysiologists have participated in the ESTEEM project concerned with improvements in electrodiagnostic medicine. This study assesses whether the collaboration that includes peer review medical audit has influenced the involved physicians' electrodiagnostic criteria for polyneuropathy (PNP) diagnosing and classification. METHODS: Two sets of each physician's PNP examinations performed early and late in the study were examined for changes in (1) number of studies with abnormal electrophysiological findings required for diagnosing PNP, and (2) agreement between the classifications given by the individual physicians and the peer review group. RESULTS: The average number of abnormal motor nerve segments per patient increased from 4.6 to 6.4 during the study. Although most individual changes were minor, the second set of examinations showed an increased homogeneity among the physicians in the number of abnormal motor nerve segments and abnormal F wave studies, and a tendency towards increased homogeneity in the number of abnormal sensory nerve segments. There was also an increased agreement on pathophysiological PNP classification in the second set of examinations compared to the first set. CONCLUSIONS: The participation in the ESTEEM project seems to have impacted the physicians' clinical routine, possibly as they have accustomed themselves to apply criteria more strictly. SIGNIFICANCE: This study support that international collaboration is a useful step towards improvements in electrodiagnostic medicine.

International audience

International audience; Chemosensitivity of N-methyl-N-nitrosourea-induced rat mammary tumours treated with 5-fluorouracil at a dose of 100 mg kg(-1) i.p. was assessed by using diffusion-weighted 1H-MRS to measure the average diffusion coefficient (ADC) of water in the tumour tissue. ADC measurements prior to any therapy correlated positively with necrotic fraction. Tumours with low initial ADC (< 0.95 x 10(9) m2 s(-1)) showed an increase in ADC 7 days after treatment, whereas tumours with a high initial ADC (> 1.2 x 10(9) m2 s(-1)) showed a decrease. All tumours decreased significantly in volume (P < 0.05) 2, 5 and 7 days after treatment. At day 7 post-treatment, tumours with a high pre-treatment ADC started to regrow. The initial ADC value, as well as changes after treatment predict tumour chemosensitivity, which could be clinically relevant.

International audience; This paper aims to retrieve and evaluate the quality of the Internet sites providing information on cardiovascular risk. We searched web pages related to risk prediction using six search engines. Sites proposing a cardiovascular risk prediction were selected for evaluation. The quality of each site was checked against criteria testing the validity, type and potential usefulness of information for physicians or patients. Search engines retrieved about 50 10(6) web pages. Eight sites were included. Only 2 of them provided calculation of cardiovascular risk based on Framingham equation. The others proposed algorithms, guidelines, or general information on cardiovascular health. Most sites lacked details to ensure quality of information. Present search engines are inefficient to retrieve precise and valid information. Facing the inflation of medical information, a systematic approach to validate the quality of a site is mandatory. Application of Evidence Based Medicine concepts gives a solution for evaluation of internet-based medical information.

International audience; Analysis of the nature of calculi provides a valuable mean for the diffential diagnosis of urinary lithiasis. In this work, we report a comparative study of the nature of 31 calculi performed by infra red and the classical chemical techniques.; L'analyse du calcul est un élément fondamental pour orienter le diagnostique étiologique de la lithiase. Les auteurs comparent à travers une série de 31 calculs les résultats obtenus par l'analyse infra rouge à ceux de la méthode chimique classique. Les résultats montrent que la technique chimique donne sur le plan analytique des faux positifs pour la struvite, la whewellite et des faux négatifs pour la weddellite, le phosphate amorphe de calcium carbonaté, la whitlockite, les protéines, l'urate d'ammonium et l'acide urique. Sur le plan clinique 83,9% des cas sont en discordance avec l'analyse infra rouge. La méthode chimique est donc une méthode non fiable et inadaptée à l'étude des calculs urinaires.

International audience; Previous studies have suggested the utility of D-Dimer ELISA assays in eliminating a diagnosis of pulmonary embolism (PE). Our objectives were to evaluate the performance of a new, rapid, quantitative, and automated Liatest D-Dimer Assay in patients with suspected PE. Three hundred eighty-six consecutive patients referred to our institution between March 1992 and December 1996 for clinically suspected PE, with recent clinical signs not exceeding 1 wk, were included in this study. Diagnosis of PE was based on clinical evaluation, radionuclide lung imaging, lower limb examination, and, when required, pulmonary angiography. D-Dimer performances, for both Liatest D-Dimer and standard D-Dimer ELISA (Asserachrom DDi), assays, were assessed at the end of the study. Among the 386 patients tested, 146 (37.8%) were classified as PE-positive. Liatest D-Dimer assay had a 100% sensitivity (95% confidence interval, 97 to 100%) and a negative predictive value of 100% (95% confidence interval, 94 to 100%). A normal result, below the cutoff of 500 ng/ml, occurred in 83 of the 386 (21%) patients. There was a strong agreement between Liatest D-Dimer and Asserachrom DDi analyses. These findings suggest that this rapid, quantitative, and automated D-Dimer assay provides a useful diagnostic tool for the clinician with regard to exclusion of PE.

International audience; The diagnostic value of coronary angiography, a widespread method of detection of transplant coronary artery disease, was studied in 17 cardiac transplant patients with reference to histological examination. In the 6 coronary segments studied, the only significant but weak correlation that was found was for the distal left anterior descending artery: the correlations were not statistically significant in the other 5 segments. Coronary angiography underestimated lesions and false negative results were frequently reported (66 and 27% respectively). The limitations of coronary angiography may be explained by the technical artefacts related to both methods of evaluation and the anatomically diffuse and distal nature of transplant coronary artery atherosclerosis. A more reliable diagnostic method would seem to be required in view of the clinical importance of this pathology.

International audience; Toxoplasmosis is a serious opportunistic infection in patients with acquired immunodeficiency syndrome (AIDS). The lung is a major site of infection after the central nervous system. The aim of the study was to assess the polymerase chain reaction (PCR) and cell culture for the detection of Toxoplasma gondii. One hundred and thirty two human immunodeficiency virus (HIV)-infected patients with respiratory manifestations, who underwent fibreoptic bronchoalveolar lavage, were investigated. Detection of Toxoplasma gondii was compared using three techniques: Giemsa staining; polymerase chain reaction with specific primers derived from the P30 gene; and culture on the MRC5 cell line. Toxoplasma gondii was detected in the same four samples by all three techniques. We conclude that PCR adds little to conventional (and cheaper) tools already used to diagnose pulmonary toxoplasmosis.

International audience; A reverse transcriptase polymerase chain reaction (RT-PCR) was used to detect a human cytomegalovirus (HCMV) late mRNA in peripheral blood leukocytes (PBL) of 102 human immunodeficiency virus-infected individuals. The clinical value of this new technique for the diagnosis of acute HCMV disease was evaluated in comparison with viral culture and direct amplification of viral DNA (PCR). The sensitivity of the RT-PCR was slightly lower than that of the two other methods, but its specificity was 94%, compared to 55 and 32% for culture and PCR, respectively. Transcription of this late mRNA is linked to viral replication, and its detection in PBL confirms that these cells can support a complete viral cycle. The relationship between complete replicative cycles and HCMV disease makes RT-PCR a useful clinical tool.

International audience; The usefulness of the ID32 Staph System and a method based on rRNA gene restriction site polymorphism was evaluated by the study of 42 staphylococcal clinical isolates phenotypically difficult to identify. The ID32 Staph micromethod and the genomic method are adapted for recognition of 27 and 31 staphylococcal taxa, respectively. The genomic method is based on a Dice analysis of the hybridization patterns obtained by cutting the cellular DNA either with EcoRI or with HindIII and by probing with pBA2, containing the Bacillus subtilis gene encoding 16S rRNA, labeled either with [alpha-32P]dCTP or with acetylaminofluorene. This study showed that the nonradioactive labeling provided a better resolution of the hybridizing bands than radioactive labeling. Of the 42 isolates selected, only 22 could be assigned to a staphylococcal species by the ID32 Staph System, whereas 35 could be identified by the genomic method. This latter method also enabled the screening of three unclassified isolates having hybridization patterns more closely related to each other than to any of the 31 staphylococcal taxa investigated. These three isolates could belong to a staphylococcal taxon not yet described.

International audience; Temperature measurement using magnetic resonance imaging (MRI) of water self-diffusion is investigated. Diffusion images and derived temperatures are obtained in polyacrylamide gel phantom. The temperatures measured from MRI are compared with those from temperature probes to verify their accuracy. In general, the difference between temperatures determined from MRI diffusion images over 0.3 cm3 regions of interest and from temperature probes were 0.2 degrees C. It is concluded that current MRI technology allows noninvasive temperature tomography that is comparable with invasive thermometry with respect to temperature accuracy, has spatial and time resolutions that would be useful in hyperthermic oncology.

International audience; An indirect immunofluorescence monoclonal antibody assay was found to have higher sensitivity than usual stains for the detection of Pneumocystis carinii, particularly in bronchoalveolar lavage fluids in which there are only a few parasites, as in HIV-patients or in HIV+ patients with prophylaxis or treatment. For patients without any therapy, when different stains give conflicting results, decisions on therapeutic approaches to be used should consider the patient's clinical and biological status. Prospective studies are necessary to evaluate the predictive value of low parasitism in asymptomatic immunosuppressed patients.

International audience; Selective amplification of a 187-bp fragment within the DT6 sequence using the AV6 and AV7 primers for Mycobacterium avium and of a 666-bp fragment within the DT1 sequence of Mycobacterium intracellulare using the IN38 and IN41 primers was performed for 69 clinical isolates identified as M. avium complex by conventional methods. The results were compared in parallel with results with commercial M. avium and M. intracellulare probes. A positive response to either of the two PCRs or M. avium-M. intracellulare AccuProbes constituted positive detection as M. avium complex; this cumulative detection limit was 94.2% for PCR, compared with 90% for AccuProbe. Concordance, on the other hand, was considered an identical species identification using either DT1 PCR and the M. intracellulare probe or DT6 and DT1 PCRs are inexpensive and at least equally sensitive, in-house options to the AccuProbe system for species identification of M. avium and M. intracellulare.