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.

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.

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.

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.

[Early detection of COPD in primary care: which tools?]. / Sujets à risque de BPCO en médecine générale: comment favoriser la réalisation de spirométries et la détection précoce de l'obstruction bronchique?

INTRODUCTION: The early diagnosis of COPD in general practice is not satisfactory. OBJECTIVES: To evaluate the impact of different diagnostic tools (Piko-6, Software) in general practice (GP). METHODS: A multicentre, randomised, controlled study in GP assessing the effect of the tested strategies on the rate of referrals for spirometry and the rate of detection of airflow obstruction. RESULTS: One thousand one hundred and three patients (55 years old, 60% males, 31 years of smoking habits) were included by 248 GP. The rates of referal to a pneumologist were significantly higher in the Software (50% of patients), and Piko/Software (47%) groups than in the Control (22%) and Piko groups (28%). A high proportion (44%) of lung function tests recommended by the GP were not performed, often because of patient refusal. The confirmation rates were lower in the Software and Piko/Software groups (47% and 43%, respectively) compared with the Piko and Control groups (68% and 79%, respectively). Concordance between PFT and Piko-6 for the diagnosis of airflow obstruction was poor (about 50%). CONCLUSIONS: The use of software in association or not with the Piko-6 was useful for GPs to identify patients to refer for further lung function testing, but did not improve the confirmation of the obstructive syndrome, mainly due to reluctance of patients to go on to have further lung function tests. The use of a diagnostic tool (software and/or mini-spirometry) does however seem to improve early COPD detection.

Three-dimensional high-resolution quantitative microscopy of extended crystals.

Hard X-ray lens-less microscopy raises hopes for a non-invasive quantitative imaging, capable of achieving the extreme resolving power demands of nanoscience. However, a limit imposed by the partial coherence of third generation synchrotron sources restricts the sample size to the micrometer range. Recently, X-ray ptychography has been demonstrated as a solution for arbitrarily extending the field of view without degrading the resolution. Here we show that ptychography, applied in the Bragg geometry, opens new perspectives for crystalline imaging. The spatial dependence of the three-dimensional Bragg peak intensity is mapped and the entire data subsequently inverted with a Bragg-adapted phase retrieval ptychographical algorithm. We report on the image obtained from an extended crystalline sample, nanostructured from a silicon-on-insulator substrate. The possibility to retrieve, without transverse size restriction, the highly resolved three-dimensional density and displacement field will allow for the unprecedented investigation of a wide variety of crystalline materials, ranging from life science to microelectronics.

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.

[Phenotype of asthmatic patients according to a score derived from the Asthma Control Test]. / Phénotype des patients asthmatiques selon le score dérivé de l'Asthma Control Test.

UNLABELLED: Today the control of asthma is a key element of national and international guidelines. The ER'Asthma survey, created in 2003, measured the control of asthma and its determinants in a primary care population. The aim of the current analysis of the ER'Asthma database was to characterize the phenotype of asthmatic patients according to three levels of control by using a score derived from the Asthma Control Test (ACT). METHOD: An ancillary descriptive analysis of a cross-sectional epidemiological survey of 15,534 asthmatic patients. A score derived from the ACT was calculated for each patient by using an algorithm applied to five questions from the ER'Asthma questionnaire and similar to those of the ACT. The analysis looked for association between the patients' characteristics and the different levels of control. RESULTS: The uncontrolled patients were more likely to be obese, smokers, older, treated by a single drug, non-compliant and to have a poorer quality of life. CONCLUSION: The use of a validated three-level score has confirmed the phenotypes of poorly controlled patients. ACT not only evaluates asthma control but could also be the starting point of a discussion with the patients on the correction of modifiable risk-factors and the necessary compliance with treatment.

The decrease in asthma-related mortality in France.

BACKGROUND: Asthma-related morbidity, mortality and socioeconomic 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 over 35. In 2005, there were 1129 deaths due to asthma. Moreover, regional disparities could be seen. CONCLUSIONS: The decline of asthma-related mortality that started in 1986 continued until 2005. Possible explanations could be better patient care, including the use of inhaled corticosteroids and therapeutic education, and improvement in the recording of deaths.

[Evaluation of professional practice in the management of COPD at Montpellier University Hospital]. / Evaluation des pratiques professionnelles pour la prise en charge de la BPCO au CHU de Montpellier.

INTRODUCTION: Chronic obstructive pulmonary disease (COPD), because of its severity and prevalence, is an important target for the evaluation of professional practices. We present the results of an evaluation at Montpellier University Hospital in 2006 (number of admissions 4800/yr). RESULTS: One hundred and twenty-one observations were retrieved, 8% of the total where COPD was recorded as the principal diagnosis (Median age: 66 years; male: 67%). Eighty-eight per cent of the patients had undergone thoracic radiography and 50.8% had had lung function testing. Body mass index was recorded for 89.9% of the patients and the annual number of exacerbations in 14.9%. Information on smoking cessation was given to only 41.9% of the patients, pulmonary rehabilitation was considered in 14.5% and bronchodilators and/or inhaled corticoids were prescribed for 47.8%. Patients admitted under the care of a respiratory team were significantly more likely to have received information on the means of smoking cessation: 75% vs. 35% (p: 0.0004), lung function testing: 73% vs. 38% (p: 0.0005) and been offered pulmonary rehabilitaion: 35% vs. 5% (p<0.0001). CONCLUSION: There is considerable room for improvement in the care of COPD within the hospital in order for it to conform to national and international guidelines. Specialist respiratory care is more adherent with guidelines than non-specialist care.

[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.

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.

[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.

[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.

[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.