A cluster of meningococcal disease caused by rifampicin-resistant C meningococci in France, April 2012.

In April 2012, a cluster of two cases of meningococcal disease caused by rifampicin-resistant C meningococci was reported in the Champagne-Ardenne region, France. The two cases occurred in a student population living in the same town but studying at different schools. Bacteriological and epidemiological investigations of cases have shown that the isolates of both cases were non-differentiable.

Adult intensive-care patients with 2009 pandemic influenza A(H1N1) infection.

In France, the surveillance of hospitalized cases of pandemic influenza was implemented in July 2009 and restricted to intensive-care unit (ICU) patients in November. We described the characteristics of the 1065 adult patients admitted to ICUs and analysed risk factors for severe outcome (mechanical ventilation or death). Eighty-seven percent of cases were aged 15-64 years. The case-fatality ratio was 20%. The risk for severe outcome increased with age and obesity while this association was negative for chronic respiratory disease. Late antiviral therapy was associated with a severe outcome in ICU patients with risk factors (adjusted OR 2·0, 95% CI 1·4-3·0). This study confirms the considerable contribution of young adults to A(H1N1) 2009 mortality. It shows the role of obesity as an independent risk factor for severe disease, and of early antiviral therapy as a protective factor, at least in patients with risk factors.

[Winter surveillance of cold exposure effects on health among the homeless population in the Paris area: data from the Coordinated Health Surveillance of Emergency Department network (Organisation de la surveillance coordonnée des urgences [Oscour(®)])]. / Surveillance hivernale des effets du froid sur la santé des populations sans-domicile en région Île-de-France : utilisation des données du réseau d'Organisation de la surveillance coordonnée des urgences (Oscour(®)).

BACKGROUND: A program for helping homeless individuals in winter is implemented from November 1(st) to March 31(st) each year in France. Its aim is to prevent morbidity and mortality in this population during cold spells and periods of severe cold. A health surveillance system of the homeless population in the Paris area has been proposed to evaluate the effectiveness of the program and to alert decision-makers if an unusual increase in cold-weather effects is observed. The goal of this study was the creation of an indicator for the proposed surveillance system based on emergency department activity in the Paris area (Oscour(®) Network - Organisation de la surveillance coordonnée des urgences). METHODS: The winter 2007-2008 computer medical files of 11 emergency departments in the Paris area were examined to confirm diagnosis and ascertain patient-homelessness for each patient visit which was selected from the Oscour(®) database by the patient chief-complaint or diagnosis code referring to hypothermia or frostbites. The proposed indicator is based on the maximization of three criteria: the positive predictive value, the proportion of people identified as being homeless and the number of emergency department visits. A Shewhart control chart was applied to the indicator for the four winters between 2005 and 2009 in the Paris area. Values beyond the statistical threshold would indicate a need for an adjustment to the program strategy. RESULTS: Two hundred and sixteen medical files were analyzed. An indicator was created, "number of emergency department visits of 15 to 69-years-old persons with chief-complaint or diagnosis code referring to hypothermia". It had a positive predictive value estimated near 85 % and identified 61.7 % people as being homeless. In the winter of 2008-2009, the statistical threshold was reached in December during the first cold spell, and again at the beginning of January during a period of severe cold. CONCLUSION: Our results support the use of this health indicator, alongside social indicators, for optimizing the strategy for helping the homeless population during winter.

Measurement of the absolute gamma-ray emission intensities from the decay of 147Nd.

The 2011 Decay Data Evaluation Project (DDEP) evaluation for 147Nd includes recommended absolute emission intensities for the two main gamma-rays at 91.105 (2) keV and 531.016 (22) keV of 0.284 (18) and 0.127 (9) respectively, i.e. with uncertainties of 6.3% and 7.1%. These large uncertainties stem from inconsistencies in the published data and are unfit for modern purposes, since the production of 147Nd is used as an important neutron flux dosimeter. The LNE-LNHB has undertaken new absolute gamma-ray emission intensity measurements. The results of these measurements will be presented, along with a full uncertainty budget, and their effect on the recommended data uncertainties will be discussed.

Multi-elemental Nd, Sm, Eu, Gd isotope ratio measurements by stop-flow isotachophoresis coupled to MC-ICPMS.

In this study, a new analytical procedure based on isotachophoresis (ITP) coupled to a multi collector inductively coupled plasma mass spectrometer named Stop-Flow-ITP-MC-ICPMS is developed for exhaustive and high-precision multi-elemental isotopic characterization. We demonstrate that Stop-Flow-ITP makes it possible to stop the analytes migration several times for a duration compatible with the detector configuration changes without losing the separation performance. With this procedure, isotope ratio measurements of four lanthanides of interest for nuclear applications (Nd, Sm, Eu and Gd) were obtained with a reproducibility better than 0.4% in a single analysis with only 20ng of each element. A nebulization interface between ITP and MC-ICPMS composed of a dual inlet spray chamber and a multiple flow stream valve made it possible to perform isotopic reference standard injections for on-line mass bias correction by the sample standard bracketing approach. The flexibility of the Stop-Flow-ITP-MC-ICPMS procedure opens the way to online determination of isotope ratio measurements of multiple analytes present in a sample in a single analysis.

[Cases of imported cholera in France, summer 2005. A. Tarantola for the incident management teams]. / Cas de choléra d'importation en France, été 2005. A. Tarantola pour les groupes de gestion des incidents.

Cholera is a bacterial infection, which causes digestive symptoms and massive diarrhoea. It may lead to dehydration and death if appropriate medical management is not rapidly initiated. Most cases of infection by choleric vibrio, however, remain symptom-free or may mimic common gastroenteritis. A review of two cases of imported cholera in France in the summer of 2005 and the community- and hospital-based investigation, which they triggered, enabled the incident management teams to assess risks of transmission. There were no secondary cases among 58 hospital contacts and 15 family contacts of the cases. Clinicians will find a discussion of possible clinical presentations and the risk of secondary transmission, in the context of progressing epidemics in countries, which have maintained close ties with France.

[Lung cancer mortality among women in France. Trend analysis and projection between 1975 and 2014, with a bayesian age-cohort model]. / Mortalité par cancer du poumon chez les femmes françaises. Analyse de tendance et projection à l'aide d'un modèle âge-cohorte bayésien, de 1975 à 2014.

BACKGROUND: With 4,500 deaths in year 2000, female lung cancer mortality rates increased by 3% every year over the last two decades in France. This trend, not observed among males, is attributed to the regular increase of female smoking. In order to answer French Health decider's concerns, we estimated the future female lung cancer mortality rates and numbers of deaths for the next fifteen years, in France and its regions. METHODS: Analyses were based on numbers of female deaths from lung cancer observed between 1975 and 1999, and on past and future population estimates for 1975-2014, at national and regional levels. Mortality rates and numbers of deaths in France and its regions by 5-year periods and 5-year age groups were given in the 1975-1999 death certificate data base, and were projected for 2000-2014. The analysis used a bayesian approach of the age-cohort model with auto-regressive constraints on parameters. Estimated mortality rates were standardized on truncated 20-85 + world population. RESULTS: French female lung cancer mortality increased by 3% every year between 1975 and 1999. In period 1995-1999, truncated 20-85 + mortality rates, and number of deaths per year were respectively 11.4 per 100,000 and 4,000. Mortality rates increased in all regions but variations were maximum in Corsica (+ 314%) and minimum in Auvergne (+ 37%). For the whole of France, the estimated truncated 20-85 + standardized rate, was respectively, 14.1 and 22.5 per 100,000 in period 2000-04 and period 2010-14, which represents a 60% increase between these two time periods. At the regional level, the maximum variation was found in Languedoc-Roussillon (107%), the minimum in Nord-Pas-de-Calais (40%). CONCLUSIONS: The bayesian approach of the age-cohort model is increasingly used because it produces stable projections, without having to include other cancer parameters. Nevertheless, it would be interesting to extend this model by incorporating a tobacco consumption component, in order to assess scenarios based on consumption decreases.

[Colorectal cancer. Knowledge of the public and acceptability of early detection in non-hospital medical practice]. / Cancer colo-rectal. Connaissances du public et acceptabilité du dépistage précoce en pratique médicale non hospitalière.

Six general practitioners attached to a day-care center investigated the extent of their patient's knowledge concerning colorectal cancer and the degree of cooperation to be expected in a screening program. An eight-week information campaign was organized in the neighborhood from which 60 p. cent of their patients were drawn, along with free access to a guaiac test for people aged forty and over. Surveys conducted before the campaign and six months after, revealed how well- or ill-informed the local people were. Immediately after the campaign a screening program combining rectosigmoidoscopy with guaiac test was proposed to patients aged forty and over. Their level of cooperation was studied over a period of three years. Before the campaign 4.5 p. cent of those interviewed were afraid of contracting colorectal cancer, while 14.5 p. cent considered it to be frequent. After the campaign, 13.5 p. cent of people interviewed as opposed to 4.4 p. cent before (p less than 0.001) knew polyps to be precancerous lesions; 22.6 p. cent, as opposed to 2.4 p. cent before (p less than 0.001) mentioned the search for occult blood in the feces as a screening method. Their knowledge of endoscopy remained unchanged (mentioned by 15.5 p. cent of the people interviewed). During the campaign, 8.6 p. cent of people in the neighborhood of forty and upwards carried out a test. Seventy-five (2 p. cent) of the 3,860 people aged forty and over who consulted a general practitioner at least once during the three-year period following the campaign underwent the full screening program.(ABSTRACT TRUNCATED AT 250 WORDS)

[Uncertainty, expertise and decision making: the lessons from the Montchanin landfill]. / Incertitude, expertise et décision: les leçons de la décharge de Montchanin.

Three epidemiological studies were conducted at the urgent request of the administrative authority of the French department of Saône-et-Loire, in order to assess the health impact of volatile emissions from an industrial wastes dump situated in the vicinity of dwellings in the city of Montchanin, France (6,000 inhabitants). These studies were implemented in the context of deep concern within the local population. Two dealt with the diagnosed morbidity before (retrospective follow-up study), or after (case-control study) the closure of the site. The third one dealt with mortality, for several causes of death liable to be related to the gazes emitted by the landfill (SMR analysis). Due to the small size of the population, these studies had limited statistical power. Despite these uncertainties, the authors claim that the decision to close the site was based on sound health considerations and recommend that the site be cleaned up. This experience illustrates the usefulness and the limitations of field epidemiological evaluations of environmental nuisances.

[Generalized idiopathic epilepsy in older children and adolescents]. / Les épilepsies généralisées idiopathiques du grand enfant et de l'adolescent.

Generalized idiopathic epilepsies starting between 12 and 18 years of age are mostly represented by juvenile myoclonic epilepsy, juvenile absence epilepsy and grand-mal on awakening. The EEG and clinical description of the seizures, the different epileptic syndromes with their therapeutics, the prognosis and the familial forms with the molecular genetic aspects are studied. The importance of the history for the positive diagnosis is emphasized, in order to display the often overlooked myoclonies occurring in the morning. Differential diagnosis concerns mostly absences which are sometimes difficult to separate from frontal seizures, and in the case of first generalized tonico-clonic seizure, partial epilepsy which needs further investigations, and the exceptional progressive myoclonic epilepsy which begins the same way, but has a totally different prognosis. Psycho-social difficulties due to epilepsy and lack of therapeutic compliance are frequent. The therapeutic results are generally good but there is a high rate of relapse after medication withdrawal.

Photon emission intensities in the decay of 108mAg and 110mAg.

This study focuses on two radioisotopes of silver, (108m)Ag and (110m)Ag, characterized by a complex decay scheme. Each isotope has two disintegration modes, the isomeric transition leading to the daughter isotope ((108)Ag and (110)Ag, respectively) with a short half-life. The radioactive solution was obtained by neutron activation on silver powder enriched in (109)Ag. Gamma-spectrometry was carried out using a calibrated high purity germanium detector. The main relative photon emission intensities for both radionuclides were obtained and compared with previously published values.

Bk and Cf chromatographic separation and ²49Bk/²48Cm and ²49Cf/²48Cm elemental ratios determination by inductively coupled plasma quadrupole mass spectrometry.

The French Atomic Energy Commission has carried out several experiments for the study of minor-actinide transmutation processes in high intensity thermal neutron flux. In this context a Cm sample enriched in (248)Cm (∼97%) was irradiated in a thermal neutron flux at the High Flux Reactor (HFR) of the Laue-Langevin Institute (ILL). The precise and accurate determination of Cf isotope ratios and of (249)Bk/(248)Cm and (249)Cf/(248)Cm elemental ratios in the (248)Cm irradiated sample is crucial for the calculation of actinide neutron capture cross-sections. This work describes an analytical procedure for the separation and the isotope ratio measurement of Bk and Cf in the irradiated sample. The Bk and Cf separation is based on a lanthanides separation protocol previously developed by the laboratory. Well-defined retention times for Bk and Cf were obtained by coupling the Ionic Chromatography (IC) with an ICP-QMS. All conditions of element separation by IC and the different steps of the analytical protocol in order to obtain the isotopic and elemental ratios are presented. Relative uncertainties of Cf isotopic ratios range from 0.3% to 0.5% and the uncertainty of the (249)Bk/(248)Cm and (249)Cf/(248)Cm elemental ratios are respectively 6.1% and 3.2%. This level of uncertainty for both isotopic and elemental ratios is in perfect agreement with the requirement for transmutation studies.

Development of cadmium/silver/palladium separation by ion chromatography with quadrupole inductively coupled plasma mass spectrometry detection for off-line cadmium isotopic measurements.

A separation method was investigated to perform off-line cadmium isotopic measurements on a (109)Ag transmutation target. Ion chromatography (IC) with Q ICPMS detection (quadrupole inductively coupled plasma mass spectrometry detection) was chosen to separate cadmium from the isobarically interfering elements, silver and palladium, present in the sample. The optimization of chromatographic conditions was particularly studied. Several anion and cation columns (Dionex AG11(®), CS10(®) and CS12(®)) were compared with different mobile phases (HNO(3), HCl). The separation procedure was achieved with a carboxylate-functionalized cation exchange CS12 column using 0.5 M HNO(3) as eluent. The developed technique yielded satisfactory results in terms of separation factors (greater than 5) and provides an efficient solution to obtain rapidly purified cadmium fractions (decontamination factors higher 100,000 for silver and palladium) which can directly be analyzed by multi collection inductively coupled plasma mass spectrometry (MC ICPMS). By applying the proposed procedure, accurate and precise cadmium isotope ratios were determined for the irradiated (109)Ag transmutation target.

Determination of (93)Zr decay scheme and half-life.

This study describes a new determination of the decay scheme and half-life of (93)Zr. A pure (93)Zr solution was obtained after chemical separation from the dissolution of an irradiated zircaloy sample. The concentration of (93)Zr in the solution was measured by mass spectrometry, with an isotopic dilution technique. The activity of the solution was measured by liquid scintillation counting, using an efficiency tracing method. The measurement of the activity concentration of (93)Nb(m) by X-ray spectrometry, allowed the determination of the (93)Zr decay scheme and the calculation of the (93)Zr detection efficiency. This leads to the calculation of the decay probability of (93)Zr toward (93)Nb(m) of (0.73+/-0.06) and to a half-life of (93)Zr of (1.64+/-0.06)x10(6) years. These values are discussed in comparison with the evaluated values available in the literature.

Progressive facial hemiatrophy with multiple benign tumors and hamartomas.

We report the unusual association of Progressive Facial Hemiatrophy (Parry-Romberg syndrome) with multiple benign tumors (orbital neurinoma, mandibular odontogenous fibroma) and hamartomas. The neurological clinical features were infantile hemiplegia, mild mental retardation and focal seizures. Brain CT-scan and MRI showed porencephaly and cerebral calcifications ipsilateral to hemifacial atrophy. Immunological investigations proved negative. The etiology of the disease and the bridging of this case to phakomatoses are discussed.

[Electroencephalography, epilepsy and brain tumor]. / Electroencéphalographie, épilepsie et tumeur cérébrale.

The authors present a critical analysis of electroencephalographic (EEG) data recorded in children with supratentorial intracranial tumor. They emphasize the value of clinical and EEG presentation in the diagnosis of epileptogenic tumor in children and in the evolution of the children who underwent surgery.

[Visual seizures and benign epilepsy in children with paroxysmal occipital discharges]. / Crises visuelles et épilepsie bénigne de l'enfant à paroxysmes occipitaux.

The study of ocular symptoms during seizures and of electroencephalograms between seizures in 244 children affected by partial epilepsy has allowed the isolation of nine cases of benign epilepsy with occipital paroxysms. Ocular symptoms as well as other accompanying symptomatology are detailed. The diagnostic procedure should address secondary occipital epilepsy and migraine with ocular symptoms.

[Transitory EEG asymmetry at the start of quiet sleep in the newborn infant: 75 cases]. / Asymétrie EEG transitoire à l'entrée dans le sommeil calme chez le nouveau-né: étude sur 75 observations.

75 transient EEG asymmetries occurring during quiet sleep were studied. These asymmetries were obtained from 73 polygraphic recordings registered in 73 neonates. These infants represented 3.17% of all the neonates registered during the neonatal period in a department of neonatology (2297 neonates registered between July 1974 and July 1982). The pattern of these asymmetries was always identical, it consisted of a sudden flattening of the EEG activity occurring on one hemisphere followed on this hemisphere by an EEG activity which was more discontinuous and less mature than on the other hemisphere. These asymmetries were transient, lasting from 1 to 5 min. They occurred at the beginning of quiet sleep. The EEG activity before and after the asymmetry was almost always normal. The analysis of the clinical data showed that the infants who presented an EEG asymmetry during quiet sleep had a conceptional age ranging from 35 to 44 weeks, and that they were hospitalized for a minor illness which turned out to be a neurological disorder in only 2 cases. It showed that all the infants who were followed later, except one, developed normally. The physiological mechanism of these asymmetries is discussed and it is concluded that they are functional, probably enhanced by a sleep deprivation and not associated with a focal pathology.