Revealing crystalline domains in a mollusc shell single-crystalline prism.

Biomineralization integrates complex processes leading to an extraordinary diversity of calcareous biomineral crystalline architectures, in intriguing contrast with the consistent presence of a sub-micrometric granular structure. Hence, gaining access to the crystalline architecture at the mesoscale, that is, over a few granules, is key to building realistic biomineralization scenarios. Here we provide the nanoscale spatial arrangement of the crystalline structure within the 'single-crystalline' prisms of the prismatic layer of a Pinctada margaritifera shell, exploiting three-dimensional X-ray Bragg ptychography microscopy. We reveal the details of the mesocrystalline organization, evidencing a crystalline coherence extending over a few granules. We additionally prove the existence of larger iso-oriented crystalline domains, slightly misoriented with respect to each other, around one unique rotation axis, and whose shapes are correlated with iso-strain domains. The highlighted mesocrystalline properties support recent biomineralization models involving partial fusion of oriented nanoparticle assembly and/or liquid droplet precursors.

Charge density waves tuned by biaxial tensile stress.

The precise arrangement and nature of atoms drive electronic phase transitions in condensed matter. To explore this tenuous link, we developed a true biaxial mechanical deformation device working at cryogenic temperatures, compatible with x-ray diffraction and transport measurements, well adapted to layered samples. Here we show that a slight deformation of TbTe3 can have a dramatic influence on its Charge Density Wave (CDW), with an orientational transition from c to a driven by the a/c parameter, a tiny coexistence region near a = c, and without space group change. The CDW transition temperature Tc displays a linear dependence with a / c - 1 while the gap saturates out of the coexistence region. This behaviour is well accounted for within a tight-binding model. Our results question the relationship between gap and Tc in RTe3 systems. This method opens a new route towards the study of coexisting or competing electronic orders in condensed matter.

Adherence in severe asthma.

Adherence in asthma is an important cause for concern. Although nearly 50% of asthma patients are considered poorly adherent to therapeutic advices, adherence is still difficult to assess, understand and improve despite major medical consequences. In this review, we revisited the literature of the last 10 years related to adherence in severe asthma. The concepts have changed and "compliance" is usually replaced by "adherence". Assessment of adherence is addressing ethical issues, but provides important insight into difficult-to-treat asthma. Different tools have been used but none is routinely recommended. Health-related outcomes (poor control, exacerbations, hospitalizations, lung function decline), which are clearly associated with severe asthma, are often worsened by non-adherence with consequences also on patient related outcomes (quality of life). The potential behaviour associated with non-adherence and all other related factors including easy-to-recognize psychological traits can help for patient's future management. Therapeutic educational interventions have been recognized with a scientifically proven efficiency even though evolution and improvements are needed. A multidisciplinary approach is required in severe asthma. Therapeutic adherence for a given patient is always a prerequisite to any other aspects when addressing severe asthma phenotypes. Severe asthma should be considered only in those who still experienced poor asthma outcomes despite optimal adherence. At a glance, poor adherence and severe asthma should be considered antinomic. Better understanding of the causes and customised management are potential future directions.

A candidate gene study of antiepileptic drug tolerability and efficacy identifies an association of CYP2C9 variants with phenytoin toxicity.

BACKGROUND AND PURPOSE: It is widely acknowledged that individual response to antiepileptic drugs (AEDs) is influenced by genetic factors. However, most of the underlying genes and genetic variants remain unidentified to date. The purpose of this study is to examine the role of common variants in a number of candidate genes in the response to commonly prescribed AEDs. METHODS: We recruited 495 patients with epilepsy. Patients were classified according to their response to several AEDs. We genotyped 104 polymorphisms in 17 candidate genes for AED response. We looked for statistically significant associations between these polymorphisms and well-defined AED response phenotypes. RESULTS: We identified significant associations of CYP2C9 variant alleles with presence of phenytoin (PHT) adverse drug reactions (ADRs) and of GSTM1 copy number variation with the presence of carbamazepine ADRs. The latter association could not be confirmed in a replication study. CONCLUSIONS: Our study is the first comprehensive candidate gene association study in epilepsy pharmacogenetics. Our results confirm the role of CYP2C9 variants in PHT toxicity. No other definite associations were identified. Large-scale efforts are needed to unravel the genetic determinants of AED response.

Neurodevelopmental outcome following prenatal diagnosis of an isolated anomaly of the corpus callosum.

OBJECTIVES: To assess the ability of prenatal ultrasound and magnetic resonance imaging (MRI) to diagnose isolated anomalies of the corpus callosum (ACC) and to further document the long-term prognosis following diagnosis. METHODS: This was a prospective case-control study carried out between 1999 and 2004. Diagnosis was made by a combination of ultrasound and MRI. All infants were examined by a neuropediatrician and parents consented to answer questionnaires (CDI, Ireton's Child Developmental Inventory) in 22 cases, which were matched with 44 control infants. The CDI was used to assess neurodevelopmental outcome in cases and controls. Mean DQ-CDI (development quotient calculated from CDI) values and frequencies of abnormal results were compared between groups, and a meta-analysis of previous studies was performed. RESULTS: The diagnosis of ACC was made prenatally and confirmed postnatally in 175 cases. The diagnosis was thought to be isolated ACC in 88/175 (50%) cases. Sixty of these 88 cases (68%) underwent termination of pregnancy and one died in utero. Twenty-seven were liveborn, of which 26 were followed up for a median of 50 (range, 30-74) months. Additional anomalies were diagnosed postnatally in four (15%) of these 26 neonates. The control group was significantly better (P < 0.05) compared with the cases diagnosed prenatally with isolated ACC with respect to gross motor, fine motor, language comprehension, numbers and general development, and it was marginally better for letters (P = 0.066). Seven of 26 (27%) (95% CI, 13-46%) infants with ACC over the age of 30 months had neurodevelopmental delay, compared with only one case with borderline developmental delay among the 44 controls (P = 0.006). CONCLUSION: Prenatal diagnosis of ACC by a combination of ultrasound and MRI is reliable. However, the isolated nature of the anomaly could only be assessed in 85% of our cases. Since counseling is provided at the time of prenatal diagnosis, our population of isolated ACC included the cases that were missed prenatally as being ACC with associated anomalies. A meta-analysis of nine studies suggests that the development of children diagnosed prenatally with isolated ACC is normal in up to 70% (CI 95%, 56-83%) of cases. This means that the prospective risk of neurodevelopmental delay for a fetus with ACC described as isolated prenatally is 27%, compared with 15% for an infant whose diagnosis of isolated ACC is confirmed postnatally.

5(S),15(S)-dihydroxyeicosatetraenoic acid and lipoxin generation in human polymorphonuclear cells: dual specificity of 5-lipoxygenase towards endogenous and exogenous precursors.

5-Lipoxygenase activation of human blood polymorphonuclear cells (PMN) from asthmatic patients (asthmatics) was studied to investigate whether differences may exist with healthy subjects (controls). The respective cell capacities to produce lipoxins (LXs), leukotrienes, and 5(S), 15(S)-dihydroxyeicosatetraenoic acid [5(S),15(S)-diHETE] were compared under in vitro stimulation by ionophore A23187, with or without exogenous 15(S)-hydroxyeicosatetraenoic acid [15(S)-diHETE]. Eicosanoids were analyzed by elution with an isocratic reverse-phase high performance liquid chromatography system, and their profiles, detected by simultaneous monitoring at 302, 280, and 246 nm, were evaluated on the basis of chromatographic behavior: UV spectral characteristics and coelution with synthetic standards. In the presence of exogenous 15(S)-HETE, human PMN were able to produce LXs and 5(S),15(S)-diHETE, PMN from asthmatics were able to produce 5(S), 5(S),15(S)-diHETE, and LXs from endogenous sources, whereas in the same experimental conditions, no detectable amounts of these compounds were released by PMN from controls. The levels of 5(S),15(S)-diHETE, and LXs biosynthesized from endogenous arachidonic acid were highly correlated. Two different LX patterns were observed involving two possible metabolic pathways: (a) via the intermediate 5,6-epoxytetraene alone for LXs generation from exogenous 15(S)-HETE; and (b) via 5,6- and/or 14,15-epoxytetraenes leading to the formation of an enzyme-bound delocalized carbocation for LXs generation from endogenous arachidonate, respectively. The enhanced 5-lipoxygenase activation of blood PMN from asthmatics and the metabolism of exogenous 15(S)-HETE may reflect a priming induced by various mediators released from environmental cells, and could be considered as a model of transcellular signalization between PMN and endothelial cells.

Time trends in prevalence and severity of childhood asthma and allergies from 1995 to 2002 in France.

OBJECTIVE: To assess time trends in symptoms of asthma, allergic rhinitis and atopic eczema among adolescents in Languedoc Roussillon, France. METHODS: Two cross-sectional surveys were conducted 7 years apart using the same protocol. School-based samples of 3383 participants in the 1995 survey and 1642 participants in the 2002 survey respectively were recruited. RESULTS: There was a tendency towards stagnation in current symptoms of asthma, rhinoconjunctivitis and eczema. Indices related to lifetime diagnosis of asthma, hay fever and eczema increased. For all the conditions, indices of severity also showed a decrease in the 7-year study period. CONCLUSIONS: Our study shows that symptoms of asthma, allergic rhinitis and eczema were stable, supporting the effectiveness of national asthma prevention and management guidelines for such diseases. The increase in indices related to lifetime diagnosis could be the result of increased public and professional awareness of the diseases and changes in diagnostic labelling in recent years.

[Respiratory consequences of inhalation of adulterated cannabis]. / Conséquences respiratoires de l'inhalation d'herbe de cannabis frelatée.

Cannabis is widely smoked in Europe and its increasing use is becoming a major public health problem. Adulterating cannabis with glass beads or sand is a new trick used by dealers to increase the weight and boost profits. These recent practices are not without danger. We report two cases of respiratory symptoms related to the use of this kind of adulterated cannabis. The first case is a 33 year-old patient admitted for an acute inhalation pneumonitis secondary to smoking cannabis adulterated with grit sand. The CT scan showed patchy ground-glass opacities, mainly in the upper lobes. A broncho-alveolar lavage, examined under polarized light, revealed birefringent intracellular particles, identified as silica, in alveolar macrophages. Spontaneously clinical and radiological improvements were observed after stopping the use of contaminated cannabis. The second patient, who smoked cannabis mixed with glass beads, described epistaxis, mouth ulcers, sore throats and cough. CT scan and BAL were normal. Adulteration of cannabis with microscopic glass beads, alone or mixed with sand, is a recent and widespread practice in Europe. These anecdotal reports prompted the French Department of Health to advise cannabis smokers of the harmfulness of these contaminants.

[Outcome of fetuses with malformations discovered before 14 weeks. Where the discovery is revealed by echography during the first trimester, is it responsible for the voluntary termination of the pregnancy? Comparison before and after July 2001]. / Devenir des foetus présentant une ou plusieurs malformations découvertes avant 14 SA. Ou la découverte d'une malformation à l'échographie du premier trimestre est-elle responsable d'interruption volontaire de grossesse? Comparaison avant/après juillet 2001.

OBJECTIVES: The aims of this study were to review detection of fetal malformations during the first trimester and to study pregnancy and infant outcomes. We wanted to check if the lengthening of the legal delay for volontary termination of pregnancy changes the outcome of the pregnancy, in cases outside of the legal requirements. MATERIALS AND METHODS: This study was overseen by the french college of fetal echography (CFEF). All the cases of abnormality detected before 14 weeks' gestational age, excluding the isolated increased nuchal translucency, were extracted from the total population examined, and details were entered into the database of the French College of Fetal Echography. All case records were then analyzed. We compared two populations: before and after July 2001. RESULTS: We observed 336 fetuses with malformation(s), 108 before July 2001 and 208 after that date. One percent (0.5-1.6) of scans performed between 10 and 14 weeks revealed fetal abnormalities apart from isolated increased nuchal translucency. Of the 336 cases retained for investigation, 109 increased nuchal translucency or hygroma associated with other malformation(s), 103 central nervous system anomalies, 85 malformations of the thoracoabdominal wall, 81 limb abnormalities, 41 had renal malformations, 28 spinal abnormalities, 21 had heart malformations, 16 involved biometric abnormalities, 12 involved abnormalities of the appendages, and 11 facial abnormalities. Medical termination of pregnancy was performed in 75% of cases. Death in utero occurred in 9% of cases, 12% of infants were born alive. In 3.9% of cases, an abortion was performed. There were no differences between both populations before and after July 2001. CONCLUSION: Excluding isolated increased nuchal translucency or hygroma, malformation before 14 weeks' gestational age was detected in 1% of fetuses. The most common malformations detected in the first trimester were non-isolated increased nuchal translucency and malformations of the thoracoabdominal wall and the brain. The prognosis for fetuses with malformations detected during the first trimester was very poor as only 12% of these infants were born alive, some of them with severe malformations. In our study, and given its limitations, there were no differences between the number of voluntary terminations performed before and after July 2001.

[The decrease in asthma-related mortality in France]. / Diminution de la mortalité par asthme en France.

INTRODUCTION: Asthma-related morbidity, mortality and socio- economic cost represent significant public health problems. Despite efficient therapies, in 1999 asthma still killed around 2000 people in France. METHODS: This study investigated the changes in asthma-related mortality in metropolitan France between 1980 and 2005 and examined its regional disparities. Annual age- and gender-specific mortality rates for asthma were calculated, as well as age-standardized rates. The change in asthma-related mortality was estimated by the annual average rate of change fitted using a log-linear regression model. Lastly, regional disparities were mapped. RESULTS: After having levelled off between 1990 and 1995, asthma- related mortality significantly decreased. From 2000 onwards the drop was more rapid in men than in women. The observed decrease was significant only in people aged more than 35 years. Moreover, regional disparities could be seen. CONCLUSIONS: The decline of asthma-related mortality that started in 1986 continued until 2005. Potential explanations could be better patient care due to consensus, including the use of inhaled corticosteroids and therapeutic education, and improvement in the recording of deaths.

[Inhaled corticosteroids in asthma: a medico-economic analysis of clinical trials]. / Les corticoïdes inhalés dans l'asthme: analyse médico-économique des essais cliniques.

BACKGROUND: Asthma is a chronic disease with a heavy economic burden in terms of public health on account of its clinical impact and consequences on quality of life and costs. Its management is based on pharmacological measures with inhaled corticosteroids playing a large role. The objective of this study was to undertake an analysis of the published literature of medico-economic trials of the use of inhaled corticosteroids. METHODS: A review of the literature from 1990 to 2007 was undertaken with separate analyses of studies of inhaled steroids alone and those looking at combined preparations. RESULTS: The costs of asthma vary greatly depending on the clinical management. Analysis of the published clinical trials showed that the addition of inhaled steroids increased the total cost. When efficacy is taken into account the economic results are acceptable for developed societies. The use of inhaled steroids as maintenance therapy, or maintenance and symptomatic therapy, was always cost effective. CONCLUSION: These results are based on data from clinical trials. They need to be confirmed by large scale observational studies using validated criteria of effectiveness.

[Asthma control level in asthmatic children followed in general practice medicine in France: results of ER'ASTHME study]. / Niveau de contrôle de l'asthme chez l'enfant en médecine générale en France: résultats de l'étude ER'ASTHME.

UNLABELLED: Little information is available on asthma control level in children in France in general practice medicine although such control is 1 of the essential goals of treatment. The ER'Asthme survey has been set up to assess asthma control among asthmatic patients visiting their general practitioner and to determine the clinical and therapeutic associated factors. METHODS: Cross-sectional ancillary study carried out in 1410 asthmatic children aged 6 to 14 years old (B/G 65/35%), with asthma diagnosed at least 12 months earlier and visiting spontaneously their GP. It collected data on self-assessed health status, asthma control (assessed by 3-level composite score based on the Canadian consensus criteria as adapted by Anaes: optimal, acceptable and unacceptable), and compliance (PMAQ3w questionnaire) during the last 4 weeks. RESULTS: Children (or their parents) answered the question about their asthma control as follow: 62% "excellent" or "fine", 31% "not very good" and 7% "poor". GPs, however, assessed asthma control as optimal in 27% of children, acceptable in 7% and unacceptable in 66%. Eighty-four per cent of children had taken a maintenance treatment. Only 57% of patients reported complete compliance with their maintenance treatment (60% in 6-12 years old vs 52% in 13-14 years old, P=0.0089). Asthma control level was significantly associated to the asthma severity (P=0.0063), type of maintenance treatment (P<0.0001) and to treatment compliance (P=0.0005). CONCLUSION: Asthmatic children aged 6 to 14 years old (or their parents) overestimate their asthma control, which remains inadequate. Severity of asthma, compliance level and the type of maintenance treatment influence the level of asthma control.

[Assessment of quality of care in asthma]. / Evaluation de la qualité des soins dans l'asthme.

INTRODUCTION: Asthma is a chronic airways disease characterised by variable and reversible airflow obstruction. It is highly prevalent and incurs high costs, inducing a particular consideration from health authorities (an Asthma Plan has already been published and is part of the new public heath law). BACKGROUND: In order to assess the appropriateness of care delivered, it is important to take into account several parameters: mortality, acute asthma management, hospitalisations, costs, and other parameters such as DALY. It is also important to consider occupational asthma. All the terms (variable, reversible, chronic) that allow identification of asthma explain the difficulties in producing an efficient management strategy and good quality care. PERSPECTIVES: Public heath policy has to address the availability of these different management strategies. Medical doctors and all other health professionals need to adapt themselves to the needs of patients and their disease. Finally, patients have to be involved in the management of their own disease. Their active involvement will make it possible to significantly improve the quality of care. CONCLUSION: During the past 20 years, significant improvements have been achieved in basic and clinical science but more data are needed to improve the practical management of asthmatic patients.

[The contribution of cognitive-behavioural therapies to smoking cessation]. / Apport des thérapies cognitivo-comportementales dans le sevrage tabagique.

INTRODUCTION: Behavioural therapies have been developed on the basis of Pavlov's and Skinner's learning theories. They have recently benefited from advances in the understanding of information handling and the organisation of perceptions of experience. It is for these two reasons that these treatments are called cognitive behaviour therapies (CBT). They have now achieved an important role in the treatment of addictions including tobacco smoking. Currently CBT's are seen as promising because they rely on cognitive restructuring combined with learning of new behaviour while following a process appropriate to the changing dynamic of the smoker. BACKGROUND: They have recently been recognised as of grade A effectiveness by the French Institute of Medical Research and may be recommended to all smokers whose primary intention is to stop. The establishment of a collaborative rapport and a therapeutic attitude are essential. They may be used during the three stages of cessation: preparation, stopping, and the prevention of relapse. A personalised functional analysis provides the patient with a management program using behavioural and, above all, cognitive techniques. The ideal is to combine a pharmacological and an optimised cognitive-behavioural approach. VIEWPOINT: The management of smoking patients has advanced with the understanding of a very complex problem, often associated with anxiety-depressive co-morbidities and other addictions. Tobacco specialists, psychiatrists, cognitive-behavioural therapists and addiction therapists must work together in the future, particularly in respect of research protocols. CONCLUSIONS: Cognitive-behavioural therapy is a useful technique in the personalisation and optimisation of management of the patient, particularly in the prevention of relapse. However, the evaluation of CBT is difficult methodologically and there are few studies evaluating CBT alone. On the other hand, CBT is effective, particularly where there are anxiety or depressive co-morbidities or other addictions that are found more and more frequently during consultations for tobacco smoking.

Phenotypic heterogeneity studied by immunohistochemistry and aneuploidy in non-small cell lung cancers.

Non-small cell lung cancers (non-SCLC) differ from small cell lung cancers (SCLC) by many clinical features and prognosis. However, recent studies suggest that lung cancer heterogeneity frequently leads to the association of SCLC and non-SCLC in the same tumor. This phenotypic heterogeneity can be analyzed by immunohistochemistry using monoclonal antibodies (Mab) raised against differentiation related antigens. It may have clinical relevance inasmuch as the diversification of malignant cells is a well-known factor of tumor progression and may be due to chromosomal instability because inappropriate gene expression leads to the formation of antigens unrelated to cell lineage. Chromosomal instability in cancer leads to aneuploidy detectable by cell DNA content analysis. In a prospective study, we analyzed, in parallel, the expression of neuroendocrine related antigens by immunohistochemistry and the cell DNA content in frozen specimens from 40 patients who underwent complete surgical resection of primary non-SCLC in an attempt (a) to characterize the phenotypic heterogeneity and (b) to determine whether this heterogeneity is correlated with aneuploidy and clinical staging. Three Mabs were used in association as a marker of neuroendocrine antigen expression (S-L 11.14, MOC-1, and NE-25); reactivity of these Mabs in 9 SCLC and 3 lung carcinoid tissue sections was used as positive control. All SCLC and 2 of 3 lung carcinoids tested were homogeneously positive with Mabs S-L 11.14, MOC-1, and NE-25; 13 of 40 non-SCLC were homogeneously positive and 11 additional specimens focally positive with Mabs S-L 11.14, MOC-1, and NE-25. The frequency of this abnormal phenotype was significantly higher in poorly differentiated squamous cell carcinomas (chi 2 10.08; P less than 0.005), in clinical stage III non-SCLC (chi 2 5.93; P less than 0.02), and in tumors involving mediastinal lymph nodes (chi 2 5; P less than 0.03). The percentage of cells in the modal DNA of G0-G1 phase was significantly lower in non-SCLC homogeneously positive with Mabs S-L 11.14, MOC-1, and NE-25 [27.4 +/- 10.3% (SD)] in comparison with non-SCLC negative with these same Mabs [56.8 +/- 21.3%; P less than 0.01, Mann-Whitney U test]. We conclude that (a) mixed SCLC-non-SCLC differentiation is frequent and can be assessed by immunohistochemistry, (b) neuroendocrine differentiation in non-SCLC is mainly observed in poorly differentiated tumors and in advanced clinical stages, and that (c) this heterotopic phenotype is correlated with aneuploidy and has clinical implications.

Effect of endurance training on lung function: a one year study.

OBJECTIVE: To identify in a follow up study airway changes occurring during the course of a sport season in healthy endurance athletes training in a Mediterranean region. METHODS: Respiratory pattern and function were analysed in 13 healthy endurance trained athletes, either during a maximal exercise test, or at rest and during recovery through respiratory manoeuvres (spirometry and closing volume tests). The exercise test was conducted on three different occasions: during basic endurance training and then during the precompetition and competitive periods. RESULTS: During the competitive period, a slight but non-clinically significant decrease was found in forced vital capacity (-3.5%, p = 0.0001) and an increase in slope of phase III (+25%, p = 0.0029), both at rest and after exercise. No concomitant reduction in expiratory flow rates was noticed. During maximal exercise there was a tachypnoeic shift over the course of the year (mean (SEM) breathing frequency and tidal volume were respectively 50 (2) cycles/min and 3.13 (0.09) litres during basic endurance training v 55 (3) cycles/min and 2.98 (0.10) litres during the competitive period; p < 0.05). CONCLUSIONS: This study does not provide significant evidence of lung function impairment in healthy Mediterranean athletes after one year of endurance training.

[Asthma control in general practice: a cross-sectional survey of 16,580 patients]. / ER'Asthme, contrôle de l'asthme chez 16580 patients suivis en médecine générale.

INTRODUCTION: Little information is available about asthma control in patients followed by general practitioners care in France, although such control is one of the essential aims of their treatment. OBJECTIVES: The ER'Asthme survey sought to assess asthma control among patients visiting their general practitioner (GP) and to determine the factors associated with it. METHODS: This cross-sectional included patients with asthma diagnosed at least 12 months earlier, aged more than 6 years, and followed by a GP. It collected data on self-assessed health status, asthma control (assessed by a 3-level composite score based on the Canadian consensus criteria as adapted by ANAES: optimal, acceptable and unacceptable), and compliance. RESULTS: The study included 16,580 patients; 85% were older than 20 years, and 54% were male. Patients answered the question about their asthma control as follows: 53% "excellent" or "fine", 39% "not very good" and 8% "poor". GPs, however, assessed asthma control as optimal in 21% of patients, acceptable in 7% and unacceptable in 72%. Concordance between these two assessments was thus poor: Kappa coefficient 34.5% (95% CI [33.5%; 35.5%]). Only 59% of patients reported complete compliance with their maintenance treatment. Factors associated with optimal control were: use of fixed combination therapy (inhaled corticosteroid+long-acting beta-agonist) (OR: 3.7; 95%CI [3.5; 4.2]) normal BMI (OR: 2.4; 95%CI [2.0; 2.9]), non-smoker status (OR: 2.4; 95%CI [2.1; 2.8]), age<50 (OR: 2.3; 95%CI [2.1; 2.6]) and good compliance (OR: 1.6; 95%CI [1.5; 1.8]). CONCLUSION: Patients with asthma overestimate their asthma control, which often remains inadequate. Maintenance treatment with a fixed combination, BMI, smoking, age and compliance all influence the level of asthma control.

[Economic burden of COPD: the SCOPE study]. / Impact economique de la BPCO en France: etude SCOPE.

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is a major health problem. Few data about COPD economic burden are available. METHODS: SCOPE was an observational economical retrospective and prospective study conducted in France in 2001, by 114 general practitioners (GPs) and 57 lung specialists. The aim was to describe the burden of COPD patients and to estimate the annual cost according to severity stages. Health resource utilization was collected by questionnaires over a 12-month period for 285 patients. RESULTS: It was a cost-of-illness analysis. COPD patients followed by a lung specialist were more severe than patients followed by a GP and had a higher level of medical resource consumption. The COPD disease and its complications explained 66% of the total cost. The main cost drivers were inpatient care (35%, or 1509,9 euros/year/patient) and prescription medications (31%, or 1340,6 euros/year/patient). The direct total cost varied according to COPD severity on account of inpatient care and respiratory assistance. DISCUSSION: This study confirmed the economic burden of COPD in France. Actions allowed to slow down the disease's evolution and to anticipate the exacerbation could reduce the cost.

Strain in a silicon-on-insulator nanostructure revealed by 3D x-ray Bragg ptychography.

Progresses in the design of well-defined electronic band structure and dedicated functionalities rely on the high control of complex architectural device nano-scaled structures. This includes the challenging accurate description of strain fields in crystalline structures, which requires non invasive and three-dimensional (3D) imaging methods. Here, we demonstrate in details how x-ray Bragg ptychography can be used to quantify in 3D a displacement field in a lithographically patterned silicon-on-insulator structure. The image of the crystalline properties, which results from the phase retrieval of a coherent intensity data set, is obtained from a well-controlled optimized process, for which all steps are detailed. These results confirm the promising perspectives of 3D Bragg ptychography for the investigation of complex nano-structured crystals in material science.

Phosphoinositide breakdown and superoxide anion release in formyl-peptide-stimulated human alveolar macrophages. Comparison between quiescent and activated cells.

Human alveolar macrophages (AMs) from allergic asthmatics (AAs) showed continuous Li+-sensitive production of IP1, indicating that the cells were continuously activated. Furthermore, whereas the accumulation of IP1, IP2 and IP3 rapidly increased by as much as 125-175% in chemotactic-factor-stimulated AMs from healthy subjects, stimulation of cells from AAs increased these inositol phosphates only slightly. This moderate production could be due to a permanent state of activation leading to a depleted pool of polyphosphoinositides, corroborating the greater capacity of these cells to generate superoxide anion after stimulation by a chemoattractant. The activation state could be due to the action of priming agents, which are known to be released into the inflammatory sites.