[How I explore abdominal tuberculosis in children ?] / Comment j'explore une tuberculose abdominale chez l'enfant.

Tuberculosis (TB) is one of the top 10 causes of death worldwide. Abdominal TB is an uncommon presentation of TB and is challenging to diagnose due to its insidious onset. The most common forms in children are peritonitis and lymphadenitis. Diagnosis is based on radiological and histopathological findings. Specific PCR amplification confirms the diagnosis quicker than conventional cultures. The treatment includes a 6-month therapy and a close follow-up. This article describes the different methods allowing to confirm the diagnosis of abdominal TB.

La tuberculose (TB) fait partie du top 10 des maladies mortelles dans le monde. La TB abdominale est difficile à diagnostiquer car ses symptômes sont insidieux. Les formes les plus fréquentes chez l'enfant sont la TB péritonéale et la TB ganglionnaire. Le diagnostic repose sur l'anamnèse, l'imagerie, la culture microbiologique et l'histologie. La polymerase chain reaction (PCR) confirme le diagnostic plus rapidement que la culture. Le traitement consiste en une quadrithérapie de 2 mois, suivie d'une bithérapie de 4 mois. Cet article décrit les différentes méthodes d'exploration permettant d'étayer le diagnostic de TB abdominale.

Microreversibility and the statistics of currents in quantum transport.

For the statistics of currents in quantum transport, microreversibility is shown to provide a way to obtain the statistical cumulants at the order n+1 from the measurement of the cumulants at the order n or lower. This fundamental result is based on relations generalizing the fluctuation-dissipation theorem and the Onsager-Casimir reciprocal relations from linear toward nonlinear transport properties, as a consequence of the time-reversal symmetry of the underlying microscopic Hamiltonian dynamics. The method is demonstrated in detail in the case of multiterminal Aharonov-Bohm rings. Within the independent electron approximation, the cumulant generating function, which fully specifies the statistics of the nonequilibrium currents, is obtained from the scattering matrix of these circuits. The time-reversal symmetry relations are explicitly shown to express the cumulants at equilibrium up to the fourth order in terms of lower-order cumulants and their nonequilibrium responses in the presence of an external magnetic field.

A cost-effectiveness analysis of consolidation immunotherapy with durvalumab in stage III NSCLC responding to definitive radiochemotherapy in Switzerland.

BACKGROUND: Consolidation immunotherapy with the programmed death ligand 1 (PD-L1) inhibitor durvalumab improves survival in patients with stage III non-small-cell lung cancer responding to radiochemotherapy. The aim of this study was to assess the cost-effectiveness of durvalumab in Switzerland based on the most recent PACIFIC survival follow-up. MATERIALS AND METHODS: We constructed a Markov model based on the 3-year follow-up data of the PACIFIC trial and compared consolidation durvalumab with observation. We used published utility values and assessed costs for treatment strategies from the perspective of the Swiss health care payers. Cost-effectiveness was tested both in the intention-to-treat population of the PACIFIC trial unselected for PD-L1 tumor expression and in patients with PD-L1-expressing tumors (≥1%). RESULTS: In the unselected/PD-L1-positive patients, durvalumab showed an incremental effectiveness of 0.76/1.18 quality-adjusted life year (QALY) and incremental costs of Swiss Francs (CHF) 67 239/78 177, resulting in incremental cost-effectiveness ratios of CHF 88 703/66 131 per QALY gained, respectively. The most influential factors for the incremental cost-effectiveness ratio were the utility before first progression, costs for durvalumab, and the hazard ratio for overall survival under durvalumab versus observation. The cost-effectiveness of durvalumab was better than CHF 100 000 per QALY gained in 75% of the simulations in probabilistic sensitivity analysis. CONCLUSION: Assuming a willingness-to-pay threshold of CHF 100 000 per QALY gained, consolidation durvalumab is likely to be cost-effective both in patients with inoperable stage III non-small-cell lung cancer (NSCLC) unselected for PD-L1 status and in patients with PD-L1-expressing tumors in Switzerland.

[Focus on the endocannabinoid system and the reprotoxicity of marijuana in female users]. / Focus sur le système endocannabinoïde et la reprotoxicité du cannabis chez la femme à l'heure du débat sur sa dépénalisation en France.

Among recreative compounds, marijuana is the most used worldwide. Delta9THC binding on brain endocannabinoid receptors drives its psychotropic effects. The endocannabinoid system (ECS) is an endogenous neurohormonal system essential for homeostasis composed of ligands, metabolic enzymes and at least 2 receptors discovered to date. In female reproduction, the ECS regulates the hypothalamic-pituitary axis and many steps of the reproduction process, such as ovulation, tubal transportation and trophoblast implantation. Delta9THC can cross the placental barrier and bind to the fetal endocannabinoid system. In humans, fetal and obstetrical consequences of marijuana use during pregnancy are intrauterine growth restriction and preterm delivery. In the light of legalization projects currently reviewed in several western countries, further research should be conducted to improve knowledge on maternal, fetal and reprotoxic consequences of marijuana use during reproductive age and pregnancy.

Role of CO2 in low to medium enthalpy geothermal systems in the Central Betic Cordillera (Spain).

There is growing interest in geothermal energy, which is considered as an efficient energy solution to mitigate rising atmospheric CO2. Besides known high enthalpy geothermal systems, increasing attention is paid to low temperature geothermal systems, as they are suitable for local use. Although geothermal production seems to be an environmentally advantageous renewable energy, it might result in significant CO2 emissions. In this study, we investigate the relationship between temperature, fugacity of CO2 (fCO2), and mineral buffers in the reservoir conditions, taking the low- to medium- enthalpy thermal waters in the Central Betic Cordillera as case study. Using geochemical modeling, three main groups of waters have been identified depending on temperature, buffering mineral assemblage, and fCO2 in their reservoir. A group of waters with a reservoir temperature ranging from 70 to 90 °C and located in the intramountain sedimentary basins shows a fCO2 in depth ranging from ~6 × 10-2 and 6 × 10-1. The reservoir chemistry of this water group seems to be mainly controlled by carbonates and evaporites displaying a fCO2 variation between depth and surface (ΔfCO2) of 10-1. Another intermediate group of waters, located in an active extension zone, displays lower temperature (50-60 °C) and fCO2 in the reservoir (from 10-3 to 10-2). Finally, the third group of waters, located on the metamorphic complexes contacts, show the highest estimated temperatures (130-140 °C) and fCO2 in the reservoir (1 to 102). The two latter groups suggest increasing buffering effect of alumino-silicates, in addition to carbonates and quartz. Therefore, we evidenced a strong relationship between temperature and fCO2 in the reservoir as well as the potential mineral buffers. We discussed the potential of geothermal systems as clean energy source based on the estimation of the CO2 emissions generated by the investigated thermal systems for a practical case of household heating.

Trends in work-related mental disorders by sector in France.

BACKGROUND: Notifications of work-related mental disorders (WRMDs) are increasing while little data are available on trends by industrial sector. AIMS: To assess WRMD notifications and trends from 2001 to 2011 by industrial sector using data collected by the French National Network for Occupational Disease Vigilance and Prevention (RNV3P) network. METHODS: We calculated standardized notification ratios (SNRs) per sector. To analyse trends over time, we used odds ratios, analysed by logistic regression, including time as a discrete variable or as a continuous variable. RESULTS: We found higher than expected WRMD notifications in manufacturing; paper and book (SNR = 2.16; 95% CI [1.88-2.48]), chemical and pharmaceutical (SNR = 1.79; 95% CI [1.58-2.03]), textile and clothing (SNR = 1.27; 95% CI [1.04-1.54]). In the trade sectors, retail (SNR = 1.60; 95% CI [1.52-1.68]), motor vehicle and cycle trade and repair (SNR = 1.19; 95% CI [1.05-1.34]). In the services sector personal (SNR = 2.09; 95% CI [1.83-2.38]), information technology (SNR = 1.54; 95% CI [1.36-1.74]), financial and insurance (SNR = 1.42; 95% CI [1.31-1.53]), post and telecommunication (SNR = 1.44; 95% CI [1.30-1.60]), human health and social work (SNR = 1.29; 95% CI [1.24-1.34]). We found an increase in notifications in agriculture, post-telecommunication services and the human health/social work sectors and a decrease in chemical/pharmaceutical, metal, and paper and book manufacturing sectors (P < 0.05). CONCLUSIONS: These results reveal trends in notifications for WRMDs by industrial sector. This highlights the importance of monitoring trends in WRMDs in specific worker subsets, using specialized networks such as the RNV3P.

European Network of Trainees in Obstetrics and Gynaecology-ENTOG Exchange 2017: an experience report from Slovenia outlining the different trainee situations around Europe.

PURPOSE: The European Network of Trainees in Obstetrics and Gynaecology (ENTOG) is a non-profit, independent organisation that represents young trainees in obstetrics and gynaecology around Europe. At present, ENTOG has 32 member countries. The organisation was founded in 1997 and shall assure the exchange of experiences between young physicians all over Europe. The aim is to improve the quality of traineeship in all participating countries and consequently enhance the standards for women's healthcare. METHODS: This article reports about the experiences of trainees during the ENTOG Exchange 2017 in Slovenia and gives an overview of the trainee situations in different ENTOG member countries. RESULTS: The ENTOG exchange in Slovenia was a unique opportunity to get insights to the Slovenian medical system. Reflecting about their training situations, the participants found considerable differences in the training of young gynaecologists throughout Europe. CONCLUSIONS: Working on the ENTOG goal of raising the quality of training is still highly relevant. The ENTOG exchange is an excellent way to build a network among trainees and stimulate their commitment to improve women's healthcare in their home countries and beyond.

The dual impact of ecology and management on social incentives in marine common-pool resource systems.

Understanding how and when cooperative human behaviour forms in common-pool resource systems is critical to illuminating social-ecological systems and designing governance institutions that promote sustainable resource use. Before assessing the full complexity of social dynamics, it is essential to understand, concretely and mechanistically, how resource dynamics and human actions interact to create incentives and pay-offs for social behaviours. Here, we investigated how such incentives for information sharing are affected by spatial dynamics and management in a common-pool resource system. Using interviews with fishermen to inform an agent-based model, we reveal generic mechanisms through which, for a given ecological setting characterized by the spatial dynamics of the resource, the two 'human factors' of information sharing and management may heterogeneously impact various members of a group for whom theory would otherwise predict the same strategy. When users can deplete the resource, these interactions are further affected by the management approach. Finally, we discuss the implications of alternative motivations, such as equity among fishermen and consistency of the fleet's output. Our results indicate that resource spatial dynamics, form of management and level of depletion can interact to alter the sociality of people in common-pool resource systems, providing necessary insight for future study of strategic decision processes.

Blast Dynamics in a Dissipative Gas.

The blast caused by an intense explosion has been extensively studied in conservative fluids, where the Taylor-von Neumann-Sedov hydrodynamic solution is a prototypical example of self-similarity driven by conservation laws. In dissipative media, however, energy conservation is violated, yet a distinctive self-similar solution appears. It hinges on the decoupling of random and coherent motion permitted by a broad class of dissipative mechanisms. This enforces a peculiar layered structure in the shock, for which we derive the full hydrodynamic solution, validated by a microscopic approach based on molecular dynamics simulations. We predict and evidence a succession of temporal regimes, as well as a long-time corrugation instability, also self-similar, which disrupts the blast boundary. These generic results may apply from astrophysical systems to granular gases, and invite further cross-fertilization between microscopic and hydrodynamic approaches of shock waves.

Use of GIS in visualization of work-related health problems.

BACKGROUND: Occupational health and safety (OHS) information is often complex, diverse and unstructured and suffers from a lack of integration which usually precludes any systemic insight of the situation. AIMS: To analyse to what extent the use of geographical information systems (GISs) can help to integrate, analyse and present OHS data in a comprehensive and communicable way relevant for surveillance purposes. METHODS: We first developed a 'macro-approach' (from national to local level), mapping data related to economic activity (denominator of active workers displayed by activity sectors), as well as work-related ill-health (numerators of workers suffering from work-related ill-health). The latter data are composed of compensated occupational diseases on the one hand and work-related diseases investigated by specialized clinics on the other hand. Then, a 'micro-approach' was worked out, integrating at a plant level, using computer-aided drawing, occupational risks data and OHS surveillance data (e.g. use of medication and sickness absence data). RESULTS: At the macro-level, microelectronics companies and workers were mapped at different scales. For the first time, we were able to compare, up to the enterprise level, complementary data showing different pictures of work-related ill-health, allowing a better understanding of OH issues in this sector. At the micro-level, new information arose from the integration of risk assessment data and medical data. CONCLUSIONS: This work illustrates to what extent GIS is a promising tool in the OHS field, and discusses related challenges (technical, ethical, biases and interpretation) and research perspectives.

[Assessment of practices in postoperative analgesia in caesarean before and after implementation of an information program]. / Évaluation des pratiques de prise en charge analgésique en postopératoire de césarienne avant et après mesures d'amélioration.

OBJECTIVE: To assess the improvement of practices in postoperative analgesia after a cesarean section post implementation of a corrective program. STUDY DESIGN: Prospective impact study. PATIENTS AND METHODS: After obtaining ethics approval, we included all patients undergoing a cesarean section at Montpellier University Hospital during February 2011 (PRE group) and March 2012 (POST group). The patients were interviewed on the fourth day postpartum about pain management and related data was collected from the chart. From March 2011 to February 2012, training sessions were held for the paramedical and medical teams. RESULTS: Sixty patients were included in each group. The two groups were not significantly different. The mean overall numeric rating scale worst pain score between Day 0 and Day 4 in POST group was lower (5.5±2.5 vs. 6.5±2.4 p<0.01) and impairment during mobilization decreased significantly. Compliance with protocols improved in the POST group: the number of women receiving full analgesia regiment increased from 12% to 68% between PRE and POST period. CONCLUSION: After an awareness campaign of the paramedical and medical staff, we succeeded in improving significantly the routine use of analgesics regardless of their level. Nevertheless healthcare professionals still seem reluctant to administer opioids.

[Acute non-puerperal uterine inversion the third degree]. / Inversion utérine non puerpérale aiguë du 3(e) degré

The uterine inversion is a rare gynecologic complication. Usually, it is extremely serious obstetric complication exposing the young mother at the risk of postpartum haemorrhage. We report the case of a 57-year-old woman, hemodynamically unstable at admission, with an acute uterine inversion a complete fundic submucosal myoma. The surgical management was done by a double approach: laparoscopic and vaginal. Although rare and difficult diagnosis, the acute non-puerperal uterine inversion is a medical-surgical emergency caused by an intracavitary expansive process.

[Follow-up and counselling after pelvic inflammatory disease]. / Suivi et conseils après infections génitales hautes.

Pelvic inflammatory disease (PID) can be responsible for infertility and chronic pelvic pain. Treatment of acute PID is very important as it can reduce the risk of sequelae. However, follow-up, partner treatment and counselling are also useful to reduce the reinfection rate. Few weeks after PID, clinical evaluation as well as transvaginal and transabdominal sonography must be performed. The interest of systematic bacteriological tests is not proved. Hysterosalpingography and second-look laparoscopy should be considered only for women with infertility and severe infection. Use of condom is advisable in this population in order to prevent sexually transmitted diseases (STD) including HIV and to decrease rate of recurrence, associated to contraceptive pill, which is also a good option. In selected cases, intrauterine devices can be used in patients with history of PID if the infection is resolved and no significant risk factors for STD exist. Infertility and chronic pelvic pain are the most common sequelae in the population of young women with severe and recurrent infection. The risk of ectopic pregnancy is higher for these women and must be kept in mind. Counselling and risk-reduction interventions decreased significatively the rate of recurrence and sequelae in PID.

[Breast adenocarcinoma discovered by orbital metastases: a case report and review of the literature]. / Un adénocarcinome mammaire découvert par une métastase orbitaire : à propos d'un cas et revue de la littérature.

Ocular metastasis of breast cancer has become more frequent since therapy increases patients' survival. It is therefore important to recall this diagnosis. We report the case of a 73-year-old patient who had orbital metastases of an unknown breast cancer. The commonest clinical sign at diagnosis is exophthalmia. Prognosis is usually pejorative once diagnosis is performed. Standard treatment is radiotherapy and requires a multidisciplinary approach.

Debio 0507 primarily forms diaminocyclohexane-Pt-d(GpG) and -d(ApG) DNA adducts in HCT116 cells.

PURPOSE: To characterize the cellular action mechanism of Debio 0507, we compared the major DNA adducts formed by Debio 0507- and oxaliplatin-treated HCT116 human colon carcinoma cells by a combination of inductively coupled plasma mass spectrometry (ICP-MS) and ultraperformance liquid chromatography mass spectrometry (UPLC-MS/MS). METHODS: HCT116 cells were treated with IC(50) doses of Debio 0507 or oxaliplatin for 3 days. Total cellular Pt-DNA adducts were determined by ICP-MS. The DNA was digested, and the major Pt-DNA adducts formed by both drugs were characterized by UPLC/MS/MS essentially as described previously for cisplatin (Baskerville-Abraham et al. in Chem Res Toxicol 22:905-912, 2009). RESULTS: The Pt level/deoxynucleotide was 7.4/10(4) for DNA from Debio 0507-treated cells and 5.5/10(4) for oxaliplatin-treated cells following a 3-day treatment at the IC(50) for each drug. UPLC-MS/MS in the positive ion mode confirmed the major Pt-DNA adducts formed by both drugs were dach-Pt-d(GpG) (904.2 m/z â†’ 610 m/z and 904.2 m/z â†’ 459 m/z) and dach-Pt-d(ApG) (888.2 m/z â†’ 594 m/z and 888.2 m/z â†’ 459 m/z). CONCLUSIONS: These data show that the major DNA adducts formed by Debio 0507 are the dach-Pt-d(GpG) and dach-Pt-d(ApG) adducts and at equitoxic doses Debio 0507 and oxaliplatin form similar levels of dach-Pt-d(GpG) and dach-Pt-d(ApG) adducts. This suggests that the action mechanisms of Debio 0507 and oxaliplatin are similar at a cellular level.

Evidence for epistasis between hemoglobin C and immune genes in human P. falciparum malaria: a family study in Burkina Faso.

Hemoglobin C (HbC) has been recently associated with protection against Plasmodium falciparum malaria. It is thought that HbC influences the development of immune responses against malaria, suggesting that the variation at the HbC locus (rs33930165) may interact with polymorphic sites in immune genes. We investigated, in 198 individuals belonging to 34 families living in Burkina Faso, statistical interactions between HbC and 11 polymorphisms within interleukin-4 (IL4), IL12B, NCR3, tumor necrosis factor (TNF) and lymphotoxin-α (LTA), which have been previously associated with malaria-related phenotypes. We searched for multilocus interactions by using the pedigree-based generalized multifactor dimensionality reduction approach. We detected 29 multilocus interactions for mild malaria, maximum parasitemia or asymptomatic parasitemia after correcting for multiple tests. All the single-nucleotide polymorphisms studied are included in several multilocus models. Nevertheless, most of the significant multilocus models included IL12B 3' untranslated region, IL12Bpro or LTA+80, suggesting that those polymorphisms play a particular role in the interactions detected. Moreover, we identified six multilocus models involving NCR3 that encodes the activating natural killer (NK) receptor NKp30, suggesting an interaction between HbC and genes involved in the activation of NK cells. More generally, our findings suggest an interaction between HbC and genes influencing the activation of effector cells for phenotypes related to mild malaria.

[Early home abortion and immediate contraception with Evra® patch]. / IVG précoce à domicile et contraception immédiate post-IVG par le patch Evra®.

AIM: To propose a new home safe abortion protocol and effective immediate contraception. PATIENTS AND METHODS: Four hundred women undergoing home safe abortion with RU 486. Hundred accepted to start contraception with Evra® patch. RESULTS: Concerning home abortion, the failure rate of the protocol was only 3% (12 cases). Concerning contraception, the continuation rate was 50% (50 cases). CONCLUSION: Early home abortion is a promising method to propose an immediate contraception. The Evra® patch is well accepted and appears to be a first line contraceptive choice.

[A case of malignant hyperthermia arising five hours after the beginning of anaesthesia with sevoflurane and after five uneventful surgical procedures]. / Crise d'hyperthermie maligne de l'anesthésie après cinq heures d'anesthésie avec le sévoflurane et plusieurs anesthésies antérieures avec halogénés.

We report a case of per anaesthesia malignant hyperthermia (MH) arisen in a 16-year-old young man presenting antecedents of five anaesthesia with use of halogenated agents without complication and having started a typical crisis of MH after five hours of anaesthesia with sevoflurane and with recurrence of the crisis after 14 hours in ICU. The association in the same clinical case of these three peculiarities of the crisis of MH already described separately in the international literature allows us to insist on their importance, with the French-speaking anaesthesiologists community.

Efficacy and safety of initial combination therapy with amlodipine/valsartan compared with amlodipine monotherapy in black patients with stage 2 hypertension: the EX-STAND study.

The strategy of initiating hypertension treatment with combination versus single-drug therapy was formally tested in a prospective, double-blind, parallel-group trial in blacks with stage 2 hypertension (mean sitting systolic BP (MSSBP) >or=160 and <200 mm Hg). Participants were randomized equally to amlodipine/valsartan (A/V) (n=286) or amlodipine (A) monotherapy (n=286). After 2 weeks, there was forced titration of A/V 5/160 mg to A/V 10/160 mg and of A 5 to A 10 mg followed by 10 additional weeks of treatment. If SBP was >or=130 mm Hg at week 4, the protocol allowed optional titration of A/V to the 10/320 mg dose and, at week 8, hydrochlorothiazide 12.5 mg was optionally added to both A/V and A if SBP >or=130 mm Hg. Amlodipine/valsartan at week 8 lowered MSSBP last observation carried forward significantly>A (33.3 vs 26.6 mm Hg, P<0.0001). Lowering of MSSBP with A/V significantly exceeded that of A in several specified subgroups-the elderly (>or=65 years), isolated systolic hypertension, and those with body mass index (BMI) >or=30 kg/m(2). More patients treated with A/V than A achieved BP control (<140/90 mm Hg) both at weeks 8 (49.8 vs 30.2%; P<0.0001) and 12 (57.2 vs 35.9%; P<0.0001). Both treatment regimens were well tolerated. In conclusion, the strategy of initiating combination antihypertensive drug therapy in blacks with stage 2 hypertension with amlodipine /valsartan achieves greater and quicker reductions in BP as well as significantly higher BP control rates than starting treatment with amlodipine monotherapy.