Identifying main drivers and testing control strategies for CCHFV spread.

Crimean Congo Haemorrhagic Fever (CCHF) is an emerging zoonotic disease. The causative agent is a virus (CCHFV), mainly transmitted by ticks of the species Hyalomma marginatum in Eastern Europe and Turkey. In order to test potential scenarios for the control of pathogen spread, the basic reproduction number (R0) for CCHF was calculated. This calculation was based on a population dynamics model and parameter values from the literature for pathogen transmission. The tick population dynamics model takes into account the major processes involved and gives estimates for tick survival from one stage to the other and number of feeding ticks. It also considers the influence of abiotic (meteorological variables) and biotic factors (host densities) on model outputs, which were compared with data collected in Central Anatolia (Turkey). R0 computation was thereafter used to test control strategies and especially the effect of acaricide treatment. Simulation results indicate that such treatments could have valuable effects provided that the acaricide is applied regularly throughout the spring and summer, and over several years. Furthermore, a sensitivity analysis to abiotic and biotic factors showed that, even though temperature has a strong impact on model outputs, host (mainly hare) densities also play a role. The kind of model we have developed provides insight into the ability of different strategies to prevent and control disease spread and has proved its relevance when associated with field trials.

On the anomalous magnetic behavior and the multiferroic properties in BiMn2O5.

Sealed-tube synthesis of BiMn2O5 materials and their physical properties have rationally been reinvestigated depending on the reactants. The aim of the study was to characterize its potential multiferroic properties and to investigate the anomalous magnetic properties in relation to the expected ferroelectric properties. Rietveld refinement of the room temperature X-ray diffraction data shows the stability of the crystallographic structure with a Mn(3+)/Mn(4+) ratio far from 1 because of bismuth and oxygen deficiencies despite the sealed-tube synthesis. Our detailed magnetic susceptibility and specific heat data analysis unambiguously support an intrinsic anomalous magnetic behavior in relation to the establishment of a magnetic short-range ordering far from the Néel temperature. Around room temperature, oxygen vacancies are responsible for supporting the dielectric loss peak measured, and, interestingly, the so-called T*, which was underlined in relation to an anomalous phonon shift (García-Flores, A. F.; et al. Phys. Rev. B 2006, 73, 104411), is not a characteristic temperature in relation to the multiferroic properties because no ferroelectric transition was detected.

An accurate, repeatable, and well characterized measurement of laser damage density of optical materials.

Known for more than 40 years, laser damage phenomena have not been measured reproducibly up to now. Laser resistance of optical components is decreased by the presence of material defects, the distribution of which can initiate a distribution of damage sites. A raster scan test procedure has been used for several years in order to determine laser damage density of large aperture UV fused silica optics. This procedure was improved in terms of accuracy and repeatability. We describe the equipment, test procedure, and data analysis to perform this damage test of large aperture optics with small beams. The originality of the refined procedure is that a shot to shot correlation is performed between the damage occurrence and the corresponding fluence by recording beam parameters of hundreds of thousands of shots during the test at 10 Hz. We characterize the distribution of damaging defects by the fluence at which they cause damage. Because tests are realized with small Gaussian beams (about 1 mm at 1e), beam overlap and beam shape are two key parameters which have to be taken into account in order to determine damage density. After complete data analysis and treatment, we reached a repeatable metrology of laser damage performance. The measurement is destructive for the sample. However, the consideration of error bars on defect distributions in a series of parts allows us to compare data with other installations. This will permit to look for reproducibility, a necessary condition in order to test theoretical predictions.

[Retraining between months 4 and 6 after anterior cruciate ligament reconstruction with hamstring graft: comparison between cycling and running with an untrained operated subject group]. / Réentraînement à l'effort entre le quatrième et le sixième mois après ligamentoplastie de genou au DIDT: comparaison de la pratique de la bicyclette et de la pratique du footing avec un groupe témoin non réentraîné.

OBJECTIVE: To study the effect of cycling or running retraining between 4 and 6 months after patients underwent anterior cruciate ligament reconstruction with hamstring grafting (Semitendinosus-Gracilis) compared with that in patients who had the same surgery but were untrained. METHOD: Patients who had undergone surgery for an anterior cruciate ligament reconstruction by the same surgeon who used hamstring grafting were included if they were free of knee pain 4 months after the surgery. After giving consent, patients were randomized to receive controlled retraining (cycling or running 3 times a week) or not. The effect of retraining was measured by the evolution of the knee isokinetic peak torque at 60 degrees/s and 180 degrees/s 6 months after surgery. RESULTS: Fifteen patients were retrained with cycling (GI), 17 with running (GII) and 15 patients did not retrain (GIII). Before retraining, the 3 groups had the same peak torque deficit, measured at an angular speed of 60 degrees/s and 180 degrees/s, for knee extensors (GI: 33+/-11% and 27+/-8%; GII: 30+/-13% and 24+/-10%; GIII: 31+/-15% and 24+/-13%, respectively) and knee flexors (GI: 26+/-11% and 20+/-13%; GII: 20+/-14% and 17+/-13%; GIII: 19+/-15% and 14+/-15%, respectively). After retraining, progress measured at 60 degrees /s of knee extensors and flexors on the operated knees was 18+/-9% and 16+/-10% for GI, 16+/-9% and 11+/-11% for GII and 12+/-15% and 8+/-12 for GIII, respectively. Progress measured at 180 degrees /s followed the same evolution. After comparison of the 3 groups, any significant difference was put in relief according to the type of retraining. CONCLUSION: Retraining after anterior cruciate ligament reconstruction is necessary for patients to practice their previous sport. In our study, aerobic cycling or running between 4 and 6 months after surgery did not improve peak torque in the operated knee extensors and flexors. However, these 2 types of retraining are well-tolerated.

[Consequences of pain on isokinetic performance after anterior cruciate ligament reconstruction using a semitendinosus and gracilis autograft]. / Conséquences des douleurs à l'effort sur les performances isocinétiques après ligamentoplastie du genou aux tendons ischio-jambiers: étude longitudinale.

PURPOSE OF THE STUDY: The purpose of this study was to investigate isokinetic performance of the knee twelve months after ligamentoplasty of the anterior cruciate ligament using four-strand hamstring autografts. We wanted to ascertain the effect of exercise-induced postoperative pain. MATERIAL AND METHODS: Between January 2001 and January 2003, at total of 75 patients underwent arthroscopic hamstring ligamentoplasty performed by the same surgeon. Isokinetic measurements were obtained at 4, 6, and 12 months postoperatively. At four months, four subpopulations were identified depending on the presence or not of exercise-induced pain. RESULTS: Fifty-two patients were pain free, seven presented exercise-induced posterior pain, nine exercise-induced anterior pain and seven diffuse pain with more than 5 degrees limitation of extension and 10 degrees for flexion. Isokinetic measurements at an angular speed of 60 degrees /s performed at the fourth postoperative month were compared with the pain-free population and demonstrated a significant flexion deficit in patients with exercise induced posterior pain (32% vs 18%, p = 0.04), significant extension deficit in patients with exercise-induced anterior pain (45% vs 30%, p = 0.02), and significant deficit in extension (58% vs 30%, p = 0.001) and flexion (39% vs 18%, p = 0.01) in patients with diffuse pain and limited joint motion. Certain deficits persisted one year after surgery. Patients did not achieve their prior level in contact pivot sports if they presented exercise-induced anterior pain. The population with diffuse pain and limited joint motion only resumed line sports. DISCUSSION: It is not easy to ascertain the origin of knee pain after ligamentoplasty. Posterior pain at the harvesting site occurs after hamstring reconstruction (defective regeneration or incomplete disinsertion with muscle retraction). The hamstring technique can also lead to anterior pain involving all the structures of the extension system. Diffuse pain with limited joint motion is related to "minor" reflex dystrophy. CONCLUSION: A mean 10% extensor and flexor isokinetic deficit can be expected one year after four-strand hamstring ligamentoplasty. Isokinetic tests performed four months postoperatively in patients with exercise-induced pain can provide objective evidence of difficult recovery. Posterior exercise-induced pain is associated with a flexion deficit of more than 30%. Anterior pain with exercise is associated with 45% deficit in extension. Diffuse pain with limited joint motion is associated with more than 40% in flexion and more than 55% in extension. These quantitative results enable the surgeon to inform the patient concerning potential sports level after repair since recovery will be longer with greater deficit.

[Detraining and retraining after injury in a high-level cyclist]. / Désentraînement et réentraînement du cycliste de haut niveau immobilisé par blessure.

OBJECTIVE: To define retraining after injury in a high-level cyclist by taking into account the consequences of detraining. METHOD: From three clinical cases and from the analysis of the consequences of detraining, three principles of retraining were determined. RESULTS: 1. The high-level cyclist is not protected and loses cycling capacity after four weeks of inactivity. The delay in recovery is longer the higher the adaptations. 2. Recovery of cycling capacity is based on bicycle exercises that are greater in intensity than quantity, taking into account delays in injury consolidation. 3. Retraining requires appreciating the individual physiological level by evaluating force and endurance before envisaging the resumption of training and competition. CONCLUSION: The injury of a high-level cyclist is at the origin of detraining, which has been evaluated so that sports rehabilitation may enable the cyclist to find a previous state without relapse, complication or overtraining.

[Efficacy of uvulopalatopharyngoplasty (UPPP) and modifications in sleep structure in the sleep apnea syndrome (SAS)]. / Efficacité de l'uvulopalatopharyngoplastie (UPPP) et modifications de la structure du sommeil dans le syndrome d'apnée du sommeil (SAS).

Thirty-four patients (32 male, 2 female; mean age 53 +/- 7 years) with confirmed sleep apnea syndrome (SAS) were studied before and after uvulopalatopharyngoplasty (UPPP). Clinical symptoms were tiredness, excessive daytime sleepiness and snoring. All patients were overweight. Patients underwent a thorough physical and oropharyngeal examination and polysomnography before and 3 months after surgery. On the basis of post-operative results, patients are divided into 3 groups: --group 1: 16 cured patients: apnea index (A.I./h) 38 +/- 17 before and 4.4 +/- 4 apneas/h sleep after surgery. Improved nocturnal hypoxemia: mean minimum oxyhemoglobin saturation (SAO2) before and after UPPP in NREM sleep 83 +/- 4% v. 90 +/- 4% in REM sleep 76 +/- 11% v. 85 +/- 7%. Uninterrupted sleep is restored; --group 2: 8 improved patients: A.I./h of 64 +/- 11 before and 20 +/- 6 after UPPP: improved nocturnal hypoxemia: mean minimum SAO2 in NREM sleep 74 +/- 10% before and 86 +/- 6% after UPPP: in REM sleep 59 +/- 9% before and 79 +/- 6% after UPPP, lower amount and percentage of fragmented sleep; --group 3: 10 non-improved patients: A.I./h unchanged 55 +/- 22% before and 50 +/- 20% after UPPP. Persistent nocturnal hypoxemia: mean minimum SAO2 in NREM sleep 76 +/- 13 before and 81 +/- 12% after UPPP: in REM sleep 63 +/- 16% before and 65 +/- 24% after UPPP. Sleep remains fragmented. In this last group patients are more overweight and all suffer from severe SAS with greater nocturnal oxyhemoglobin desaturation. Surgical treatment by UPPP is shown to be effective for 70% of our patients. Better results are obtained when SAS is less severe and overweight less important.

[Ergospirometry after repair of Fallot's tetralogy]. / Ergospirométrie après réparation de la tétralogie de Fallot.

Ergospirometry was performed in 19 children and adolescents operated for tetralogy of Fallot (TOF) to assess their exercise capacity compared to an active non sportive control group. The test was carried out on a treadmill with measurement of oxygen consumption cycle by cycle throughout exercise. In comparison with the control group, the patients had: a working capacity which was normal or reduced by 30 to 40 p. 100; a decrease d'oxygen consumption (-30 to 40 p. 100) throughout exercise and at maximal effort: this corresponds to a lower stroke volume secondary to the absence of physical activity during childhood and/or residual cardiac lesions; abnormal chronotropism: the test was stopped at a lower heart rate corresponding to a fall in oxygen uptake during exercise, or to an increase in the systolic ejection period probably due to right ventricular dysfunction or to the patient reaching maximal ventilation; decreased maximal ventilation capacity due to a lower tidal volume and a higher respiratory rate. This type of ventilation increases to role of the dead space and may be related to progressive "pulmonary dysfunction" or secondary to residual cardiac lesions. These different parameters cannot be assessed by simple ergospirometry: the test must be coupled with an evaluation of ventilatory function on effort in order to control and evaluate the long term functional results and the aptitude of these patients to regular physical activity.

[Correlations between effort tolerance and the severity of coronary disease. Influence of myocardial lesions]. / Corrélations entre la performance physique des coronariens à l'effort et la sévérité de la maladie coronarienne. Influence des lésions myocardiques.

The influence of coronary and myocardial lesions, defining the severity of the coronary artery disease on effort tolerance was studied in 51 patients. The appearances of the coronary arteriography and ventriculography were compared with the parameters of exercise tolerance: electrocardiographic changes, maximal charge (Cw), total work (TW), maximal systolic arterial pressure (SAP), maximal heart rate, percentage of the theoretical maximal heart rate, double product, exercise capacity index (CEI). The results showed that exercise tolerance (Cw, TW, ECI) and the exercise SAP are mainly affected by the myocardial lesions: patients with very reduced left ventricular ejection fractions and double or triple artery disease have very low indices: average Cw of 60 watts, TW less than 20,000 joules, ECI approximately 50. The SAP only rises slightly. On the other hand, patients with normal or subnormal ejection fractions have much higher indices whatever the state of their coronary arteries; Cw over 80 watts, TW over 30,000 joules, ECI over 80. In addition, major left ventricular dysfunction is associated with ST segment elevation during exercise.

[Long-term evaluation, physical and sports activities after correction of Fallot's tetralogy]. / Evaluation à long terme et activités physiques et sportives après corrections de tétralogie de Fallot.

The aim of this study was to assess the result of surgical repair of Fallot's tetralogy (FT) and to advise physical and sporting activities. Thirty-two patients (20 boys and 12 girls) underwent correction of FT either before 4 years of age (14 cases) or after (18 cases). The patients were assessed on average 7.5 years postoperatively (range 4 to 13 years). All but one were class I of the NYHA classification. Radiological cardiomegaly was observed in 3 cases (CTI greater than 0.55). Sinus rhythm was present in all cases: 27 out of 30 had complete right bundle branch block without bifascicular block. Holter monitoring was performed in 22 cases: occasional monomorphic VES (1 to 15/hour) were observed in 7 cases. Frequent polymorphic VES were observed during exercise in one adult. Echocardiography and cardiac catheterization revealed pulmonary regurgitation and right ventricular dilatation in over half the cases, with an infundibular aneurysm in 2 cases and a residual pressure gradient of 55 and 66 mmHg in 2 other cases requiring reoperation. Left ventricular function was satisfactory in all cases. Treadmill exercise testing was performed in 28 patients. However, for statistical analysis 12 boys aged 7 to 15 years were compared with 11 controls of the same age. There was a significant decrease in maximal O2 consumption, of CO2 excretion, of ventilation, of heart rate, of work developed and total work in the operated patients. Clinical assessment and complementary investigations are essential 5 to 10 years after correction of FT to detect latent abnormalities and to better advise patients on physical and sporting activities.

[Consequences and prediction of hamstring muscle injury with concentric and eccentric isokinetic parameters in elite soccer players]. / Conséquences et prédiction des lésions musculaires des ischiojambiers à partir des paramètres isocinétiques concentriques et excentriques du joueur de football professionnel.

OBJECTIVE: To know if isokinetic parameters identify previous hamstring (H) injury and predict a new muscle injury in high-level soccer player. METHOD: Concentric (con) and eccentric (ecc) isokinetic torque was measured at the angular speed of 60 degrees /s in 28 elite soccer players (23 years +/- 3.3; 74 kg +/- 7.5; 178 cm +/- 6.5). First, 11 players, victims of 15 moderate or major hamstring injuries in the preceding 2 years, were compared with 17 players without previous hamstring injury. Comparisons were carried out from isokinetic knee flexors-extensors ratios [Hcon/Qcon and Hecc/Qcon] and bilateral knee flexors ratios [Hcon/Hcon and Hecc/Hecc]. Secondly, all the population was followed during 12 months and the isokinetic muscular profile of players who presented a recurrence or a new hamstring muscle injury was analysed. RESULTS: A concentric ratio hamstring-to-quadriceps lower than 0.6 and a hamstring asymmetry of more than 10% do not allow to identify previous hamstring injury. On the other hand, the mixed ratio eccentric hamstring-to-concentric quadriceps lower than 0.6 represents the best indicator (probability: 77.5%). The rate of recurrence is 30% (three cases of 10) and the rate of new hamstring muscle injury is 31% (five cases of 16) (P > 0.05). One of the five injured soccer players presented a concentric ratio hamstring-to-quadriceps lower than 0.6 and no player presented a mixed ratio lower than 0.6. However, four of the five injured players presented a concentric and an eccentric asymmetry. But, it is the strongest side, which presented a new hamstring muscle injury. CONCLUSION: The mixed ratio eccentric hamstring-to-concentric quadriceps lower than 0.6 identify a previous hamstring injury despite the resumption of competitive soccer. However, this ratio and the others isokinetic studied parameters do not predict a recurrence or a new hamstring muscle injury.

[Blood pressure profile in effort and recuperation in the sportsman]. / Profil tensionnel d'effort et de récupération chez le sportif.

105 male sportsmen, children, adolescents, adults and veterans, performed a standardized stress test, seated on an ergometric bicycle. The HR/BP ratio was studied during effort and during 6 minutes of recuperation. The level of effort achieved was excellent in each age group, reflecting the value of regular physical training: 187 W in the 13--15 year olds, 274 W in the 16--18 year olds and 20--30 years olds and an excellent level of 206 W in the 60 year old veterans. The stress blood pressure profile in children and adolescent sportsmen is identical for superior performance to that seen in the young sedentary subject. Starting in the 16--18 year old group, we find a blood pressure profile comparable to that seen in other sportsmen. Adult and veteran sportsmen have a blood pressure profile similar to sedentary adults, for superior performance. The 6 minute recovery period allows us to examine: the change in the HR which remains higher than rest values (= 100) independent of age, and the maximal HR attained, as well as the return to normal of the blood pressure figures, which always returned to their initial value, whatever value was obtained on maximal effort. A pathological blood pressure profile is defined as an abnormal elevation during effort and an absence of normalization during the 6 minute recovery period.

[Is it possible to propose the abolition of crutches according to the gait speed in patients with total knee arthroplasty?]. / Peut-on proposer la suppression des cannes anglaises en fonction de la vitesse de marche chez les patients porteurs d'une prothèse totale de genou ?

OBJECTIVE: To determine the stop of crutches to walk in patients with total knee arthroplasty from the test of maximal gait speed. METHOD: 46 patients (73.6 +/- 4.6 years) carried out the maximal gait speed test on a 10-meter track, with two crutches, at the 3rd week after a total knee arthroplasty surgery for gonarthrosis. Two groups were separated according to the need of crutches to walk. Various threshold values of maximal gait speed were then determined (ROC curve) to know if this parameter could define the stop of crutches to walk (Predictive value). RESULTS: Patients able to stop crutches (n = 27) walk faster, than the patients who still need crutches (n = 19), (0.86 +/- 0.17 m/s vs 0.65 +/- 0.14 m/s; p < 0.01). According to the ROC curve, two speeds were chosen: 1.11 m/s (9 s) and 0.55 m/s (18 s). A gait speed superior or equal to 1.11 m/s presents a positive predictive value of 86% to authorize to stop crutches. Below 0.55 m/s, the positive predictive value is 83% to keep crutches. Between these two speeds, the test of maximal gait speed does not help the clinician to decide to stop crutches. CONCLUSION: The test of maximal gait speed brings a help to decide to stop crutches only for speeds superior to 1.11 m/s.

[Sports, bones and hormones. Multiple interactions]. / Sport, os, hormones. De multiples interactions.

Classically, sports activities are thought to have a beneficial effect on bone tissues. Actually, there are many interactions between sports activities and bone tissue and in certain cases complex hormone disorders may develop. Recent progress in the evaluation of bone structure (absorptiometry) and better understanding of the neuroendocrine functions have improved our knowledge of these interactions and helped provide answers as to the true effect of sports, and particular high-level training, on bone tissue. Mechanical stimulation of bone increases the level of both cortical and cancellous bone formation. The mechanical effect is localized in areas under particular constraint such as the lower limbs in runners and the upper predominant limb in tennis players. Inversely, hypoestrogenism, similar to anorexia nervosa, has been observed to be the cause of general bone loss and increased risk of osteoporosis in certain high level athletes. When these two opposing phenomena occur simultaneously, there is generally an overall loss of cancellous bone mass while bones submitted to major mechanical stress may be relatively protected. Amenorrhoea, particularly in long distance runners, generally occurs when training exceeds 30 km per week. Menarche may be delayed by 1 or 2 years when training begins early and dismenorrhoea is seen in 50% or more of the athletes. Amenorrhoea results from a central disorder due to insufficient pulsatile secretion of luteo-releasing hormone and subsequent hypogonadism. The role of beta-endorphins or catelestrogens on hypothalamic receptors has been suggested as the underlying mechanism. These different observations help provide answers to the different problems raised when providing counselling and care for high level athletes.

[Poor tolerance of exertion during sports and bronchial hyperreactivity]. / Mauvaise tolérance à l'effort chez le sportif et hyperréactivité bronchique.

135 sportsmen and women, 55 girls, 80 boys, aged from 7 to 30 years, from various sports, who complained of bad tolerance of exertion were examined with an exercise test and isocapnic spontaneous hyperventilation. 61, about 45%, during a hyperventilation test had a fall of V.E.M.S. greater than or equal to 20%, showing bronchial hyperreactivity. After three tests, this fall index was greater than or equal to 50%. 68% of the positive responses were seen in boys and 2/3 of the subjects with a positive response were atopics. No other argument could be maintained from the questioning or clinical history to predict the positive or negative character of the hyperventilation (age, sporting level, symptoms, previous asthma or asthmatic, allergy). H.S.V.I. of the chests of a sporting population that complains of exertion intolerance, therefore allows verification of an H.R.B. assessment of its severity and to follow evolution after treatment.

[An oneiroid experience during severe acute polyradiculoneuritis]. / Expérience d'un vécu oniroïde au cours des polyradiculonévrites aiguës graves.

This study is to present a psychopathological analysis of complex hallucinatory symptoms--without consciousness breaking up in confusional state--occurring in patients with acute Guillain-Barré's syndrome diagnosis requiring neurological intensive care. Finally the patients experience an unitary and closed situation "close to dream without being dream". This experience is corresponding to the semeiology of the "oneiroid experience" (Mayer-Gross, 1924). The "oneiroid experience" appears to be of syndromic nature independent of any etiological and/or nosological classification. But its conceptualization does probably need widening: the oneiroid world appears to be a creation of a primitive function which inserts us in the world before any science or verification.