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BACKGROUND Trastuzumab increases the incidence of cardiac events (CEs) in patients with breast cancer (BC). Dual blockade with pertuzumab (P) and trastuzumab (T) improves BC outcomes and is the standard of care for high-risk human epidermal growth factor receptor 2 (HER2)-positive early BC patients. We analyzed the cardiac safety of P and T in the phase III APHINITY trial. PATIENTS AND METHODS Left ventricular ejection fraction (LVEF) ≥ 55% was required at study entry. LVEF assessment was carried out every 3 months during treatment, every 6 months up to month 36, and yearly up to 10 years. Primary CE was defined as heart failure class III/IV and a significant decrease in LVEF (defined as ≥10% from baseline and to 65 years, body mass index ≥ 25 kg/m2, baseline LVEF between 55% and

Les audits effectués au Bénin ont révélé de part et d’autre de mauvaise gestion des ressources financières puisque la gestion axée sur les résultats affiche un signe négatif et entorse le développement durable. A cet effet, ce papier vise à apprécier l’effet de l’audit interne sur la gestion des ressources financières dans les administrations publiques au Bénin. Dans une démarche méthodologique à la fois qualitative et quantitative, nous avons enquêté les cadres avec un échantillon est constitué de 90 personnes prises dans 30 administrations publiques au Bénin. L’analyse des données a été faite par la régression, l’analyse bivarriée et les tests de khi-deux pour faire ressortir les liens qui existent entre les variables. Les résultats montrent que l’inefficacité du contrôle interne, le non fonctionnement de l’audit interne et la non application de la fonction d’audit interne ont une influence négative sur la gestion des ressources financières allouées aux administrations publiques au Bénin. Cette recherche va réguler le problème de l’inefficacité du dispositif d’audit interne, de malversations ou détournements persistants au sein de ces administrations du Bénin afin que son image de haut lieu de corruption et de gestion peu efficace soit corrigée.

Context The National Federation of State High School Associations previously implemented 2 lacrosse rule modifications: Rule 5.4 in the 2012–2013 academic year to heighten the penalty for a head or neck hit to the head, face, or neck (HFN) and Rule 5.3.5 in the 2013–2014 academic year to minimize body checking. Objective To determine if the rates of overall injury, HFN injuries, and concussions due to intentional contact (checking) differed for boys' high school lacrosse players after Rule 5.4 and 5.3.5 modifications were enacted. Design Descriptive epidemiology study. Setting Web-based online surveillance system. Patients or Other Participants Boys' high school lacrosse players during the 2008–2009 to 2016–2017 seasons whose teams involved athletic trainers participating in the High School Reporting Information Online sports injury-surveillance system. Intervention(s) Rule 5.4 in the 2012–2013 academic year increased the penalty for any intentional hits to the HFN, and Rule 5.3.5 in the 2013–2014 year eliminated body checking to a player in a defenseless position. Main Outcome Measure(s) Overall, HFN, and concussion injury rate ratios (IRRs) by checking mechanism; overall and checking-related injury ratios by competitions and practices. Results A decrease was shown in checking-related HFN injuries (IRR = 0.29, 95% CI = 0.13, 0.65) and checking-related concussions (IRR = 0.29, 95% CI = 0.12, 0.70) during practices in the seasons after both rule modifications were imposed, but no decreases occurred in any checking-related injuries during competitions. By injury mechanism, no decreases were evident after the Rule 5.4 modification. When both rule modifications (Rules 5.4 and 5.3.5) were enacted together, concussion rates due to delivering body checks (IRR = 0.51, 95% CI = 0.29, 0.91) and overall injury risk due to being body checked (IRR = 0.72, 95% CI = 0.53, 0.97) decreased. Conclusions When both Rule 5.4 and 5.3.5 modifications were in effect, concussion and overall injury risks decreased for the body checker and the player being body checked, respectively.

Cette recherche vise à apprécier l’effet de la crise sanitaire du Covid-19 sur l’endettement des Très Petites Entreprises agro-alimentaires au Bénin. L’échantillon de cette étude est constitué de 150 responsables de TPE agro-alimentaires installées au Bénin. Nous avons fait recours à une méthode qualitative complétée par la méthode quantitative basée sur la régression linéaire. Après le traitement des données, nous avons abouti à des résultats probants. Les résultats de notre étude montrent que l’endettement est statistiquement significatif au seuil de 0,01 (β=,497 ; P< ,000) et qu’il est négativement influencé par la crise sanitaire du Covid-19. De même, la relation entre la crise sanitaire du covid-19 et l’endettement des TPE est modérée par l’âge des TPE agro-alimentaires au Bénin (β = -0,019 ; t = -2,14 et p < 0,05). Les TPE agro-alimentaires n’ont pas honoré à leurs engagements auprès des institutions financières et sont quasiment en faillite. De ce fait, des apports managériaux ont été soulignés pour surmonter les dettes des TPE agro-alimentaires en contexte de crise sanitaire.

In Human immunodeficiency virus infected (HIV+) patients, deregulation of regulatory T (Treg) cells can be deleterious for the development of an efficient anti-HIV specific immune response with an inappropriate immune activation despite anti-retroviral therapy (ART). In addition, infection and ART have the potential to cause hematological and biochemical abnormalities that can lead to the discontinuation of ART. The aim of this study was to assess hematological, biochemical and immunological abnormalities in HIV+ patients’ naive to ART and 6 months after ART initiation. In a cross-sectional study, 11 HIV+ patients and 09 healthy individuals (control group) were voluntarily recruited. At inclusion, blood samples were taken before administration of ART. All hematological, biochemical, immunological parameters and viral load were measured and assessed at inclusion (M0) and three and/or six months later (M3, M6). Higher level of white blood cells and CD4+ T lymphocytes (p = 0.032, 0.038 respectively) were observed in HIV+ patients. ART also had significantly effect on the level of red blood cells (p = 0.04) and Hb (p = 0.015). The inflammatory markers, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) that were significantly increased by HIV infection, tended to decrease for ESR and revert to levels similar to those of control for CRP. Analysis of CD4+CD25+ cells and CD4+Foxp3+CD25+ showed significantly elevated levels of activated form of all CD4+ cells and Treg cells. Interestingly, six months after initiation of ART, the average percentage of CD4+CD25+ was not significantly different from control group (p = 0.382). Our study provides information about the evolution of the activated form of all CD4 cells and Treg cells and points out the necessity to monitor hematological and biochemical parameters in order to detect and prevent toxicity, improve the quality of life and reduce the risk of mortality.

International audience; The current French national guidelines were elaborated by a working group consisting of experts in the field of pediatric endocrinology, rheumatology, hepatogastroenterology, nephrology, and pneumology. A systematic search was undertaken of the literature published between 2008 and 2018 and indexed in PubMed. The recommendations developed were then validated by an external evaluation group comprising representatives from the various highly specialized fields in pediatrics, representatives of the societies and groups supporting the development of the guidelines, and representatives of different healthcare professions. The objective of these guidelines was to detail the current optimal management of children at risk of secondary bone fragility

Anorexia nervosa (AN) is a serious mental illness. It is frequently accompanied by a history of childhood maltreatment (CM) that may constitute a specific ecophenotype in patients with eating disorders necessitating special assessment and management. This retrospective study tested whether in patients with AN, CM-related chronic stress may manifest through low-grade inflammation reflected by an increase in white blood cell ratios (neutrophil-to-lymphocyte ratio, NLR, platelet-to-lymphocyte ratio, and monocyte-to-lymphocyte ratio).Participants (N = 206) were enrolled at an eating disorder daycare unit in Montpellier, France, from March 2013 and January 2020. CM was assessed using the childhood trauma questionnaire (CTQ). The Eating Disorder Examination Questionnaire (EDE-Q) and the MINI were used to assess AN severity and the other clinical characteristics, respectively.NLR was higher in patients with AN and history of CM (p = 0.029) and in patients with AN and history of emotional abuse (p = 0.021), compared with patients with AN without history of CM. In multivariate analysis, emotional abuse (β = 0.17; p = 0.027) contributed significantly to NLR variability.In patients with AN, NLR is a low-grade inflammation marker that is influenced by various sociodemographic, clinical and biological factors. It is more directly affected by some CM types, especially emotional abuse, than by the presence/absence of CM history. Future studies should focus on mediators between CM and increased inflammation, such as interoceptive awareness, emotional dysregulation, food addiction, and stress sensitization.III. Evidence obtained from well-designed cohort or case-control analytic studies.

BackgroundMusculoskeletal Ultrasonography (US) is a suitable tool for the clinical assessment in juvenile idiopathic arthritis (JIA). Recently US definitions for normal components of pediatric joints and synovitis have been developed by the OMERACT US working group. Currently this group is working on development and validation of US definition for tenosynovitis as it is also an essential prerequisite for the reliable use of this technology in the pediatric age group.ObjectivesTo produce consensus-based definitions for US tenosynovitis in JIA through a Delphi process.MethodsWe undertook a Delphi process on US-defined tenosynovitis in children that consisted of two steps. As a prior systematic literature review showed that US anatomy of the tendons is similar to adults, a Delphi questionnaire was written based on the consensual definitions developed for and used in adults with rheumatoid arthritis [1, 2]. The Delphi questionnaire was sent to rheumatologists and pediatricians who perform pediatric US examination, asking them to rate their level of agreement with each statement of US-defined tenosynovitis. Group agreement was considered if ≥80% of responders scored an item as either 4 or 5.In the second step, the definitions were validated on 88 standardized US images displaying various degrees of tenosynovitis obtained from JIA patients at various ages. Tendons often involved in JIA were selected (foot and ankle tendons, hand and wrist tendons, bicep tendon.). US images of both normal and tenosynovitis elementary lesions were collected by the 18 experts participating in the OMERACT US task force on pediatric tenosynovitis. An agreement ≥70% was considered mandatory for accepting the definition as applicable in the rated image.ResultsThe response rate was 75% (28 out of 37) from the first Delphi questionnaire. Strong group agreement (≥86%) was obtained for the US definitions tested. The response rate was 88.9% (16 out of 18) from the Web-exercise after four rounds. The final definitions were validated on still images for all tendons, except for the biceps tenosynovitis in the age group 2-4 years (the definitions of elementary lesions and the global definition of tenosynovitis) as no image was available for this location and age group. Despite not reaching group agreement after the second and the third round for the US-defined normal finger pulley in children aged 8 years and younger (roughly 68% and 69% respectively), it reached a score of 99.8% after the fourth round.ConclusionUS definitions of tenosynovitis and its elementary components covering a wide pediatric age range were successfully developed through a Delphi questionnaire and validated in a web-based still images exercise. These results provide the basis for the standardized US assessment of tenosynovitis in clinical practice.References[1]Ultrasound in the assessment of tenosynovitis in juvenile idiopathic arthritis: systematic literature review. Collado P on behalf of the OMERACT Ultrasound Task Force. DOI: 10.1136/annrheumdis-2019-eular.3493[2]Reliability of a consensus-based ultrasound score for tenosynovitis in rheumatoid arthritis. Naredo E on behalf of the OMERACT Ultrasound Task Force. Ann Rheum Dis 2013;72:1328AcknowledgementsAG Bruyn, L Terslev, S Jousse-Joulin, A Rodriguez, M Steiner, E Inarejos, P Bøyesen, K Misaki, A Iagnocco, B Marston, T Cazenave, P Mandl, A Bruns.Disclosure of InterestsNone declared

BackgroundThe COVID-19 pandemic has raised concerns about its psychological effects. Sleep disturbances, anxiety and/or depressive symptoms, post-traumatic stress symptoms have been reported in general population. Patients with chronic rheumatism, systemic autoimmune disease or auto-inflammatory disease, due to immunosuppression, are at risk of severe forms of infection. Currently, there is little information on psychological impact of the pandemic on the mental health of these more vulnerable patients.ObjectivesTo compare psychological assessment between patients with chronic rheumatic, autoimmune and/or autoinflammatory diseases who presented with COVID-19 infection between March and September 2020, first wave of French pandemic, and patients with same diseases who did not presented with infection to date.MethodsThe MentCOVRMD study was a multicenter descriptive study. Cases were patients with chronic rheumatic, autoimmune and/or autoinflammatory diseases from the French RMD cohort who presented COVID-19 infection between March and September 2020. Controls were patients with same diseases who did not develop infection. The study is registered in Clinical Trials under number 2020-A02058-31.For participants, following criteria were collected: demographics (age, gender, smoking status); psychological assessment questionnaires: Insomnia Severity Index (ISI); Post-traumatic stress disorder (PTSD) checklist; Patient Health Questionnaire (PHQ9) Depression; Generalized Anxiety Disorder (GAD7) Anxiety; Patient Health Questionnaire-15 (PHQ-15) and Somatic Symptom Disorder (SSD)-12.ResultsBetween February and December 2021, 60 cases (46 (76.7%) women), median age 52.0 (39.0; 63.0) were included, of which 15 (25%) had been hospitalized during infection, and 169 controls (148 (87.6%) women), median age of 52.0 (38.0; 63.0). There were more smokers in the group of cases 12 (20%) than controls 14 (9.1%) (p=0.028) as well as more cases on ARA2 treatment (8 (13.3%)) than controls (7 (4.5%)) (p=0.035) with no statistically significant difference in others comorbidities or treatments.There was no statistically difference concerning the ISI scores between cases (11.83 ± 7.31) of which 60% had sleep disorders and controls (11.64 ± 6.82) of which 70.4% had sleep disorders. There was no statistically significant difference in PTSD scores of 15.5 (5.0 to 28.0) for cases and 18.0 (8.0 to 35.0) for controls, of which respectively 12 (20%) had values indicating possible PTSD for cases and 50 (29.6%) for controls. There was no statistically significant difference in PHQ-9 scores (5.5 (1.5 to 11.0)) of which 50% had depressive symptoms and controls (6.0 (2.0 to 11.0)) of which 54.5% had symptoms. There was no statistically significant difference in GAD-7 scores (3.5 (0.0 to 8.0)) of which 40% had anxiety symptoms and controls (4.0 (0.0 to 8.0)) of which 43.2% had symptoms. There was no statistically significant difference in PHQ-15 scores (11.4 ± 6.7), 85% of whom reported presence of symptoms, and controls (10.9 ± 6.2), 82.3% of whom reported symptoms. There was no statistically significant difference in SSD scores between cases (17.7 ± 10.9) and controls (18.4 ± 10.9).There was a statistically significant difference in reported VAS scores of pain related to inflammatory rheumatism in cases with a median of 4.5 (3.0 to 6. 0) compared to controls with a median of 4.0 (1.0 to 6.0) (p=0.011).There was no statistically significant difference in any of the psychological assessment scores between the inpatient and outpatient COVID cases.ConclusionThere was no statistically significant difference between COVID cases and controls in the evaluation of these psychological parameters. Prevalence of all these variables were high in the whole study population, testifying to the need to manage these psychological aspects for patients with chronic rheumatisms, autoimmune and/or autoinflammatory diseases.Disclosure of InterestsNone declared

Management of anorexia nervosa is difficult and few treatments have shown their effectiveness, justifying the exploration of new therapeutic approaches. Available evidence suggests an interest of psychoeducational groups in a significant number of psychiatric disorders. In patients suffering from anorexia, to date there are few groups or interventions available. We aimed to assess the feasibility and acceptability of a psycho-educational program promoting information about the disease and presenting techniques that can help to cope with anorexia and the functional impact it causes. The exploratory secondary objectives were to evaluate if such a group is associated with clinical improvement.Twenty-seven patients suffering from anorexia nervosa, in three groups, received eight weekly interventions in addition to their usual care. The study was open-label and non-randomized. Patients were assessed three times (baseline, at the end of the group and three months later). The assessments were both qualitative (Eating Disorder Examination questionnaire, The Anorexia Nervosa Stage of Change Questionnaire, the Eating Disorders Quality of Life questionnaire, Work and Social Adjustment Scale) and qualitative.Seventy-eight percent of participants attended more than 75 % of the sessions. Seventy percent of participants found the group useful, and 95 % said it helped them improve their knowledge of the disease and its consequences. The average BMI of participants changed significantly with an average increase of 2.5kg between baseline and the three month assessment. There was an improvement of the eating disorders features in EDE-Q for the total score and for all subscores. The improvement in the total score was significant at the end of the group sessions, while the improvement in the sub scores became significant at three months. There was also a significant mood improvement at the end of the group. Finally, there was a significant improvement in daily functioning with a decrease in Work and Social Adjustment Scale scores and an improvement in quality of life. On qualitative assessment, patients were satisfied with the care proposal. They were able to appreciate the support and sharing of experience provided by the group formula. Most of them reported changes in their daily lives, either in their relationship to care and illness, or in their relationships with their loved ones, their leisure/work, their mood or their eating behavior.Both qualitative and quantitative results suggest that this group psychoeducation program is feasible and well accepted by patients in addition to usual management. Although the methodology does not allow any conclusions, the clinical improvements observed during the group are encouraging with regard to the safety of this type of intervention and its possible effectiveness and argue for a controlled study.

A prototype rod-net for a fabric formwork system is described, including the fabrication, control of the geometry via turnbuckles, and the measurement of nodal co- ordinates via an image-based theodolite system. Such a net and fabric formwork system consists of a network of tie elements, either discrete or continuous, forming the main falsework structure, onto which is placed a fabric membrane acting as the flexible formwork for the pouring of wet concrete for the forming of a concrete shell. The fabrication of the plastic and steel net components of the prototype is described in detail, including the arrangement of the nodes, rods and boundary conditions. A control system was developed to determine the necessary adjustments at the boundary elements to move the rod-net to a target geometry to eliminate deviations that may arise from fabrication and construction tolerances. This control system showed that with minimal adjustments the rod-net could be directed effectively, resulting in deviations from the target surface reduced from up to 3–9mm to below 1–2mm for a 3D rod-net of approximate dimension 2.5 m × 4.5 m × 2.0 m. Additionally, the algorithm provided a more symmetric distribution of deviations around the target. The control system was coupled with 3D point-cloud measurements of markers placed on and around the rod-net by using a motorised image-assisted theodolite and specialised software for spherical and circular targets. This semi-automated process proved to be both efficient and accurate for determining the spatial co-ordinates of the markers and hence the node locations., Automation in Construction, 96, ISSN:0926-5805

Introduction La population pediatrique est sous-representee dans la pandemie actuelle, en termes de nombre de cas et de severite. De surcroit le risque evolutif de l’infection au SARS-CoV-2 dans cette population, en cas de maladies inflammatoires sous traitements immuno-modulateurs, est peu connu. Cette population de jeunes patients immuno-deprimes est consideree comme une population a risque de formes severes de COVID-19. L’objectif de notre etude est d’evaluer le degre de severite et l’issue de l’infection a SARS-CoV-2 chez les patients atteints de RMD (avec une arthrite juvenile idiopathique, une maladie auto-inflammatoire, une vascularite ou une maladie auto-immune systemique) exposes a des traitements immuno-modulateurs, au travers d’une cohorte prospective francaise. Patients et methodes Cette etude ancillaire, multicentrique, observationnelle, descriptive et prospective, de cohorte nationale francaise a inclus de jeunes patients, suivis dans les centres de pediatrie et de rhumatologie pediatrique francais, presentant une maladie inflammatoire associee a une infection COVID diagnostiquee par PCR (reaction en chaine par polymerase), serologie, scanner ou par une clinique fortement evocatrice. Les donnees demographiques, cliniques et therapeutiques, les comorbidites, de ces jeunes patients ainsi que des donnees sur l’infection par le SARS-CoV-2, l’issue et l’impact sur l’activite de la maladie inflammatoire (RMD) ont ete documentes par un questionnaire SARS-CoV-2 specifique mis en œuvre par la FAI2R. Resultats D’avril 2020 a juin 2021, des donnees ont ete recueillies aupres de 95 patients âges de 13,1 ± 4,4 ans, de predominance feminine (62,1 %), atteints de RMD : une arthrite juvenile idiopathique 44 (46,3 %), maladie auto-inflammatoire 6 (6,3 %), vascularite 1(1,1 %) et maladie systemique auto-immune 37 (39 %), avec un diagnostic hautement suspecte/confirme de COVID-19. 33 patients (34,7 %) ont recu des DMARDS, 35 (36,84 %) des bioDMARD,10 (10,6 %) des glucocorticoides systemiques et 11(11,7 %) des AINS. Quatre vingt onze patients (95,8 %) avaient une forme benigne et 4 patients (4,2 %) une forme moderee. Vingt quatre patients (25,3 %) ayant au moins une comorbidite (dont 22 (24,2 %) avaient une forme benigne). Aucun cas d’hospitalisation en soins intensifs ni de detresse respiratoire n’a ete releve. L’evolution etait benigne sans sequelles a 21 jours et sans retentissement sur l’activite de la maladie. Conclusion Dans notre cohorte French RMD Covid pediatrique, il n’y a pas d’augmentation de la severite de l’infection COVID chez les patients ayant une maladie inflammatoire lies a leur maladie ou a leur traitement immunosuppresseur. L’evolution est benigne sans signes de severite ni sequelles et sans retentissement sur l’activite de la maladie.

An increasing number of studies are using landscape genomics to investigate local adaptation in wild and domestic populations. The implementation of this approach requires the sampling phase to consider the complexity of environmental settings and the burden of logistic constraints. These important aspects are often underestimated in the literature dedicated to sampling strategies.In this study, we computed simulated genomic datasets to run against actual environmental data in order to trial landscape genomics experiments under distinct sampling strategies. These strategies differed by design approach (to enhance environmental and/or geographic representativeness at study sites), number of sampling locations and sample sizes. We then evaluated how these elements affected statistical performances (power and false discoveries) under two antithetical demographic scenarios.Our results highlight the importance of selecting an appropriate sample size, which should be modified based on the demographic characteristics of the studied population. For species with limited dispersal, sample sizes above 200 units are generally sufficient to detect most adaptive signals, while in random mating populations this threshold should be increased to 400 units. Furthermore, we describe a design approach that maximizes both environmental and geographical representativeness of sampling sites and show how it systematically outperforms random or regular sampling schemes. Finally, we show that although having more sampling locations (between 40 and 50 sites) increase statistical power and reduce false discovery rate, similar results can be achieved with a moderate number of sites (20 sites). Overall, this study provides valuable guidelines for optimizing sampling strategies for landscape genomics experiments.

This study aimed to evaluate the effects of diet supplementation with monensin and saponins alone or combined with essential oils (EOs) on the nutrient intake and apparent digestibility, rumen fermentation parameters, microbial population, nitrogen balance, ruminal microbial protein synthesis, blood metabolites, and milk composition, yield and fatty acid profile of mid- to late-lactating Jersey cows. Eight ruminally cannulated lactating Jersey cows (average 17.6 ± 5.5 kg/day of milk yield and 100.5 ± 26.6 days of milk (mean ± SD)) were distributed in a replicated 4 × 4 Latin square design with 21-day periods (last seven days for sampling). Treatment sequences were randomly designated to cows and consisted of: (1) CON - Control, no feed additive; (2) SAP - 16 g/cow/day of a supplement based on whole-seed fenugreek powder (variety Fenucold) standardized to diosgenin, one of the major steroidal sapogenins of fenugreek (2000 mg/kg); (3) SAPEO - SAP supplement combined with a blend of natural EOs with major components of carvacrol (2500 mg/kg), cinnamaldehyde (5600 mg/kg) and limonene (3000 mg/kg); and (4) MON - Monensin, inclusion of monensin sodium in the diet at 24 mg/kg DM. Cows fed CON showed higher dry matter, organic matter, crude protein and ether extract intakes than animals fed MON, whereas higher neutral detergent fibre intake was observed in animals fed SAPEO than those fed MON (P

L’usage et les troubles lies a l’usage de substances (TUS) sont la regle dans le trouble bipolaire (TB). Ils pejorent le pronostic du TB en aggravant les decompensations thymiques, en diminuant la reponse au traitement usuel et, surtout, en augmentant la mortalite toutes causes. L’epidemiologie descriptive des comorbidites addictives du TB est desormais mieux connue [1] , [2] , mais on connait mal l’influence de l’apparition ou de la remission des TUS sur l’evolution du TB, qui presente de probables specificites pronostiques par substance et selon la sequence d’installation [3] . Nous nous focaliserons sur la comorbidite entre TB et troubles lies a l’usage d’alcool (TUA), qui aggravent la polarite depressive du TB, le risque de cancer et, probablement, de suicide. Ces TUA concernent 20 % des 2945 participants de la cohorte du reseau national des centres experts du trouble bipolaire de la fondation Fondamental dont les donnees anonymisees sont disponibles. Les participants, diagnostiques TB1 (52 %) ou TB2 (48 %) (nous avons exclu les TB-NOS pour notre projet), sont a 61 % des femmes et leur âge moyen est de 41 ± 13 ans. Les âges de debut des TUA, contrairement a tabac et cannabis, ont une distribution multimodale tres etalee permettant l’etude de trois sous-groupes d’interet par des modeles multivaries stratifies sur le genre TUA precedant largement le TB, TUA et TB relativement concomitants, et TUA debutant largement apres le TB. Notre hypothese est que ces groupes ne montrent pas (1) la meme evolution du TB evaluee retrospectivement par le taux annuel d’episodes thymiques, le nombre de comorbidites addictives et le fonctionnement a l’inclusion (Romain ICICK) et (2) influencent differemment les symptomes anxieux et thymiques ainsi que le traitement medicamenteux du TB evalues prospectivement a un an (Ludovic SAMALIN). Pour conclure, Isabelle Biseul presentera une lecture critique des donnees de la litterature concernant les possibilites therapeutiques pour les patients avec TB + TUA, en interrogeant notamment leurs benefices sur l’usage d’alcool, l’humeur, ou les deux. Puis elle decrira les resultats encourageants d’un programme de therapie cognitive de groupe specifique developpe dans un centre expert parisien [4] . Ces presentations fourniront a l’auditoire une base solide pour discuter la prise en charge integree et personnalisee des individus souffrant d’une comorbidite TB + TUA, situation deletere et particulierement frequente.

Les troubles des conduites alimentaires, anorexie mentale, boulimie, hyperphagie boulimique et autres troubles sont des affections difficiles a caracteriser et evaluer, car ils affectent de nombreux secteurs de la vie du sujet. L’evaluation necessite d’aborder les dimensions psychiatriques, nutritionnelles et somatiques des troubles et leurs consequences en termes d’adaptation sociale doivent etre prises en compte. De ces evaluations decouleront les soins mis en œuvre. En France cette evaluation varie d’une equipe a une autre. Elle est le plus souvent exclusivement clinique (non structuree). Or cette evaluation est indispensable a la construction d’un projet de soins individualise. Dans d’autres pays (Suede et Quebec) les professionnels specialises dans les TCA ont developpe une evaluation commune, qui est transmise au patient. J Clarke presentera ces experiences et le projet porte par la FFAB de developper un tel projet. Au-dela de l’evaluation, soigner les personnes souffrant de TCA necessite le developpement d’une filiere de soin et de bonnes pratiques. En collaboration avec la HAS, la FFAB a developpe des recommandations de bonnes pratiques pour la prise en charge des TCA. Il a ete developpe une fiche pour gerer les urgences relatives aux TCA. Bien souvent a la faveur d’une crise liee a des complications somatiques ou des manifestations psychiatriques, les patients souffrant de TCA se presentent aux urgences. La clinique des complications de ces troubles reste mal connue et genere de ce fait des erreurs ou des reponses inadequates. M Hanachi dresse ici le tableau des situations d’urgence rencontrees dans les TCA et les conduites a tenir. Enfin, les TCA sont des affections difficiles a traiter et potentiellement tres graves. Afin d’en eviter les complications il est necessaire de developper des approches plus efficaces. La therapie multifamiliale pour les personnes souffrant de TCA est une technique developpee initialement en Grande Bretagne. Cette technique s’appuie sur les ressources et la collaboration des familles prises en charge afin de construire des soins ambulatoires pour les personnes souffrant de formes severe d’AM. Cette approche originale a essaime partout en Europe, aux Etats-Unis et en Australie. Son implementation en France a l’initiative de S Cook-Darzens se poursuit dans des contextes varies (enfants, adolescents, adultes). S Criquillion presente ici les experimentations francaise en cours en France.

Les patients souffrant de trouble bipolaire (TB) ont un risque augmente de souffrir egalement d’un trouble lie a l’usage d’alcool (AUD), qui pejore le pronostic du TB en augmentant notamment les symptomes depressifs et le risque suicidaire. La physiopathologie de cette comorbidite reste mal connue, meme si TB et AUD partagent certains facteurs de risque, notamment temperamentaux et environnementaux precoces. Le developpement de cette comorbidite pourrait avoir des consequences majeures sur la trajectoire des patients concernes, aussi bien en fonction de la sequence d’apparition des troubles que de leur delai de survenue respective. Les donnees de la litterature indiquent que la sequence « AUD puis TB » est associee a un âge plus eleve, a d’autres comorbidites addictives, au genre masculin et a la presence de troubles anxieux comorbides. Cependant, les donnees existantes n’ont pas evalue l’influence potentielle du delai d’apparition des deux troubles, ce que nous avons etudie au moyen d’analyses de survie appropriees chez 2515 patients diagnostiques TB-I ou TB-II dans les centres experts de la fondation Fondamental. Nous avons analyse les caracteristiques associees (i) a la presence d’un AUD et a sa sequence d’apparition avec le TB au moyen d’une regression multinomiale puis (ii) au delai de survenue entre les deux par un modele de survie. Nous avons confirme certaines caracteristiques associees a la presence d’un AUD : comorbidites addictives, troubles anxieux, debut maniaque du TB, genre masculin et augmentation de la prevalence des tentatives de suicide. Nous avons surtout pu mettre en avant : (i) que les trajectoires cliniques des patients comorbides sont surtout liees a l’âge de debut du TB, qui est toujours plus tardif en cas de sequence « AUD puis TB » comparee a « TB puis AUD », ces patients ayant ainsi des scores plus eleves de depression, (ii) : que ces resultats ont une portee methodologique et clinique importante concernant le reperage des comorbidites addictives chez les patients souffrant de TB et sur les priorites a donner dans le soin des patients souffrant de telles comorbidites.

Les antecedents de traumas precoces sont un important facteur de risque de troubles de trouble des conduite alimentaires (TCA). Ils sont presque quatre fois plus frequents en population souffrant de TCA qu’en population generale. Ils sont independants des comorbidites psychiatriques frequemment retrouve dans les TCA. Ces traumas souvent associes a des presentations cliniques complexes (incluant une apparition plus precoce), plus severes, et avec un retentissement fonctionnel plus important. Il existe une relation dose effet entre la presence des differents traumas (sexuel, emotionnel…) et la severite des troubles. Des antecedents de traumatismes et d’abus durant l’enfance ces trauma sont egalement associes a une moindre reponse aux prises en charge. Les patients souffrant de TCA avec trauma precoce semblent presenter des caracteristiques specifiques et differentes des patients sans histoire d’abus. Ainsi d’un point de vu neurobiologique les patients souffrant d’un TCA avec trauma ont une signature epigenetique, et un fonctionnement neuroendocrinien specifique. Ils presentent egalement une activite cerebrale differentes dans des regions connues pour etre implique dans les TCA. D’un point de vu clinique, si chez des patients sans histoire de trauma les obsessions corporelles et alimentaires sous-tendent la maladie, celle si semble plutot sous tendu par des dysregulations emotionnelles chez les patients avec histoire de trauma. Les patients souffrant d’un TCA avec histoire de trauma precoce pourraient representer un sous type de patient specifique chez qui des prises en charges specifiques en adjonction a celles usuellement proposes dans les TCA sont necessaires. Les therapies de troisiemes vagues semblent notamment particulierement utiles dans ce sous-groupe specifique de patients.

Summary For most organisms, early life-history stages are the most sensitive to environmental stress and so transgenerational phenotypic plasticity, whereby the parental environment and offspring environment interact to alter the phenotype of the offspring, is viewed as key to promoting persistence in the face of environmental change. While there has been long-standing interest in the role of transgenerational plasticity via the maternal line (traditionally the field of maternal effects), increasingly it appears that paternal effects can also play a role. Despite the emerging role of paternal effects in studies of global change, key knowledge gaps remain: first, whether paternal effects act to increase or decrease offspring performance remains largely unexplored; second, the relative roles of maternal and paternal effects are rarely disentangled; and third, the role of environmental variation, a key determinant of the benefits of transgenerational plasticity, has not been explored with regard to paternal effects. Here, we explore all three issues using the marine tubeworm Galeolaria caespitosa, an important habitat-forming species in southern Australia. We found that both paternal and maternal experiences affected key stages of offspring performance (fertilization and larval development) and, surprisingly, paternal effects were often stronger than maternal effects. Furthermore, we found that paternal effects often reduced offspring performance, especially when environments varied compared with when environments were stable. Our results suggest that, while transgenerational plasticity may play an important role in modifying the impacts of global change, these effects are not uniformly positive. Importantly, paternal effects can be as strong, or stronger, than maternal effects and environmental variability strongly alters the impacts of paternal effects.

Background Uveitis in children is rare. Intensive interactions between ophthalmologists and paediatric rheumatologists are needed in order to choose the best therapeutic strategies for severe uveitis attacks. Objectives Describe a cohort of 74 patients with paediatric uveitis. Methods Retrospective analysis of children followed for uveitis before 18, by one paediatric rheumatologist (SGC) for systemic treatments9 management and members of 3 ophthalmologic departments specialized in uveitis care in children (AR, CT, ML and BB) in Paris, during the 2006–16 period. Results There were 74 paediatric uveitis, 42 anterior (57%, group1), 16 intermediate (21%, gr2), 7 posterior (9%, gr3) and 9 pan-uveitis (12%, gr4). Gender was equal in gr2–4, but there were more females in gr1. At presentation, mean ages were 8.6±4.1, 9.8±3.9, 9.1±3.6 and 10±4.2 years old. Mean follow-up was 3.7±3.7 years. JIA was the leading cause of gr1 uveitis (45%); gr2–3 uveitis were idiopathic in 81% and 86%, respectively. In gr4, etiologies were found in 7 out of 9 patients (Behcet-3, JIA-2, BBS-1, TINU-1). Conclusions Paediatric uveitis induce a very high-level burden in children, even when anterior and sometimes despite optimal therapeutic management in tertiary care centers. Their early recognition and tight control in specialized units are absolutely required in order to decrease the level of definitive complications. Disclosure of Interest None declared

Background Ultrasound (US) was found to have face and content validity for detecting synovitis in juvenile idiopathic arthritis (JIA) with higher sensitivity than clinical examination. In order to test validity and improve the applicability of US in JIA, the OMERACT US pediatric subtask force recently published preliminary definitions for the sonographic features of synovitis in children. Objectives Aim of this study was to confirm and improve B-mode and color power/Doppler (PD) US definitions for synovial components and grading in children, by using an image and patient based exercise. Methods The definitions were confirmed and modified in a multi-step process. In the 1st step, definitions were developed in multi-round Delphi web based consensus process were ≥80% of participants would need to reach ≥80% of agreement on a Likert scale from 1–5 (1 strongly disagree, 2 disagree, 3 neutral, 4 agree, 5 strongly agree). In the 2nd step, in a face to face meeting, a subgroup of these experts revised the definitions for final wording and performed intra- and inter-observer reliability exercise study in JIA patients as the final 3rd phase of the process. The definitions were tested in four joints (wrist, 2nd MCP, knee and ankle) of JIA patients divided in four age groups following standardized image acquisition and machine setting protocol. Statistics program R (version 3.3.0) was used for the statistical analyses. For intra-rater agreement Cohen kappa and for inter-rater agreement prevalence and bias adjusted kappa (PABAK) were calculated if needed. Results Reliability exercise included 20 JIA patients (distributed in equal numbers by age groups), 14 observers, 4 joints/observer, 3 observers/joint, 360 intra- and 360 inter-observer tests. A 0–3 semi-quantitative B-mode and color power/Doppler US definitions for synovial components and grading, were agreed (presented in Figure 1). Conclusions The proposed synovitis grading for children showed to be reliable why the next step should be to test sensitivity to change in order to possibly be used as an outcome tool in JIA. Disclosure of Interest None declared

Disease due to non-tuberculous mycobacteria (NTM) is common in fish. Current recommendations focus on outbreak management by depopulating entire fish stocks and disinfecting tanks. Treatment is not advocated. Treatment may be appropriate, however, where individual, valuable fish are concerned. ZSL London Zoo managed an outbreak of mycobacteriosis in a valuable group of imported F1 captive-bred Australian lungfish (Neoceratodus fosteri) by depopulation, isolation, extensive testing and daily oral antibiotic treatment. Four species of Mycobacterium (M. marinum, M. fortuitum, M. chelonae and M. peregrinum) were involved in this outbreak, each with unique antibiotic sensitivities. Triple therapy with rifampicin, doxycycline and enrofloxacin for 8 months was the most effective antibiotic combination, resulting in full disease resolution. No side effects were noted and, more than 18 months post-treatment, no recurrence had occurred. This is the first report of mycobacterial disease in lungfish and the first report of a polymycobacterial outbreak in fish involving these four species of Mycobacterium. This report demonstrates the value of extensive isolation and identification. Also, as therapies currently advised in standard texts did not reflect the antibiotic sensitivity of the NTM found in the fish reported here, we recommend that antibiotic treatment should always be based on sensitivity testing.