A hybrid optical-wireless network for decimetre-level terrestrial positioning.

Global navigation satellite systems (GNSS) are widely used for navigation and time distribution1-3, features that are indispensable for critical infrastructure such as mobile communication networks, as well as emerging technologies such as automated driving and sustainable energy grids3,4. Although GNSS can provide centimetre-level precision, GNSS receivers are prone to many-metre errors owing to multipath propagation and an obstructed view of the sky, which occur particularly in urban areas where accurate positioning is most needed1,5,6. Moreover, the vulnerabilities of GNSS, combined with the lack of a back-up system, pose a severe risk to GNSS-dependent technologies7. Here we demonstrate a terrestrial positioning system that is independent of GNSS and offers superior performance through a constellation of radio transmitters, connected and time-synchronized at the subnanosecond level through a fibre-optic Ethernet network8. Using optical and wireless transmission schemes similar to those encountered in mobile communication networks, and exploiting spectrally efficient virtual wideband signals, the detrimental effects of multipath propagation are mitigated9, thus enabling robust decimetre-level positioning and subnanosecond timing in a multipath-prone outdoor environment. This work provides a glimpse of a future in which telecommunication networks provide not only connectivity but also GNSS-independent timing and positioning services with unprecedented accuracy and reliability.

Electronic health record adopters: a typology based on patients' privacy concerns and perceived benefits.

OBJECTIVES: Patients' adoption of electronic health records (EHRs) varies substantially. Although some countries, such as Estonia and Denmark, are sufficiently advanced in terms of EHR generalisation, others, such as France, are figuring out how to implement and disseminate EHRs. These governments must respond to patients' disparities to achieve the expected performance for healthcare systems and improve the quality of care delivery. This study investigates patients' perceived benefits and privacy concerns related to EHRs to develop a typology of patients, identify the characteristics of different clusters and propose practical measures for public policy-makers. STUDY DESIGN: We conducted a cross-sectional study using online questionnaires. METHODS: An online quantitative survey was carried out in France. The final sample of EHR non-users (N = 1076) was fitted to be representative of the French population by age and gender, region and socioprofessional status. Hierarchical and non-hierarchical cluster analyses were performed. Several robustness check analyses were also performed. RESULTS: Cluster analyses identified four patient clusters: the worried, who show the highest mean privacy concern and risk levels related to health data disclosure; the ready adopters, who lack privacy concerns and risk and are the most motivated by EHR benefits; the concerned adopters, who express far fewer privacy concerns and perceive EHR benefits more favourably than the worried adopters; and the balanced adopters, who are relatively similar to the ready adopters in their EHR motives and are still concerned about their health data, suggesting a segment that is easier to convince. Comparing clusters regarding the intentions to create EHRs and willingness to disclose health data confirms that ready adopters, followed by balanced adopters, are more likely to create an EHR and disclose health data. The concerned adopters and, finally, the worried exhibit the lowest intentions for EHR creation and data disclosure. CONCLUSIONS: The results provide meaningful insights into patient profiles and expectations. The findings underscore the need to implement targeting policies for each cluster and design concrete solutions for improving EHR performance.

[Refractory Sweet syndrome complicated by monoclonal gammopathy of undetermined significance]. / Syndrome de Sweet récidivant compliqué de gammapathie monoclonale de signification indéterminée.

The association between Sweet syndrome and monoclonal gammopathy of undetermined significance (MGUS) is exceptional. We report the case of a 44 years-old woman in whom recurrent Sweet syndrome was complicated by monoclonal gammopathy of undetermined significance (MGUS) after 3 years of evolution.

L'association entre syndrome de Sweet et gammapathies monoclonales de signification indéterminée (MGUS) est exceptionnelle. Nous rapportons l'observation d'une patiente âgée de 44 ans chez qui un syndrome de Sweet d'évolution récurrente, s'est compliqué par l'apparition d'une gammapathie monoclonale de signification indéterminé après 3 ans d'évolution.

Evolution of sex chromosomes prior to speciation in the dioecious Phoenix species.

Understanding the driving forces and molecular processes underlying dioecy and sex chromosome evolution, leading from hermaphroditism to the occurrence of male and female individuals, is of considerable interest in fundamental and applied research. The genus Phoenix, belonging to the Arecaceae family, consists uniquely of dioecious species. Phylogenetic data suggest that the genus Phoenix has diverged from a hermaphroditic ancestor which is also shared with its closest relatives. We have investigated the cessation of recombination in the sex-determination region within the genus Phoenix as a whole by extending the analysis of P. dactylifera SSR sex-related loci to eight other species within the genus. Phylogenetic analysis of a date palm sex-linked PdMYB1 gene in these species has revealed that sex-linked alleles have not clustered in a species-dependent way but rather in X and Y-allele clusters. Our data show that sex chromosomes evolved from a common autosomal origin before the diversification of the extant dioecious species.

[Cryoglobulinemia in a Tunisian internal medicine department]. / Cryoglobulinémie : expérience dans un service de médecine interne tunisien.

AIM: Cryoglobulinemia is characterized by multiple organ involvement, mainly including the skin, liver, kidneys, and peripheral nerves. Our aim was to investigate the demographic, clinical, and serologic features, as well as survival in a group of 16 Tunisian patients with cryoglobulinemia. RESULTS: The study included 12 women and 4 men, and their mean age was 41 years. In all but two, the cryoglobulinemia was associated with another disease. These included lupus for 9, Sjögren syndrome for 2, and polyarteritis nodosa for one. They also included infectious diseases: 3 patients with hepatitis B virus infection, one with hepatitis C virus infection, one with parvovirus B19, and another with lymph node tuberculosis. Only one case of lymphoproliferative disease was noted. General symptoms were present in 81% of the patients, cutaneous vasculitis in 43%, peripheral vascular-Raynaud phenomenon in 37%, joint polyarthralgia or arthritis in 62%, renal involvement in 68%, neuropathy in 25%, lung involvement in 56%, gastrointestinal involvement in 37%, and finally cardiac involvement in 31%. In some cases it was difficult to determine if the clinical signs were attributable to cryoglobulinemia or the underlying pathology. The course was favorable under treatment for 5 patients, while 7 patients became sicker and 5 finally died. CONCLUSION: Cryoglobulinemia is underdiagnosed. Treatment depends on the severity of the lesions and the underlying disease.

[Lupus and pregnancy: study of 26 cases, an internal medicine department experience and review of the literature]. / Lupus et grossesse : expérience d'un service de médecine interne à propos de 26 cas et revue de la littérature.

OBJECTIVE: To study the maternal and fetal outcomes in women with systemic lupus erythematosus. PATIENTS AND METHODS: A retrospective study of 26 pregnancies in 15 systemic erythematosus patients diagnosed before or during pregnancy regarding to American College of Rheumatology criteria in a single reference center. RESULTS: The mean patient age was 31.52 years (24-39 years). The mean interval from the diagnosis of the systemic lupus erythematosus to pregnancy was 4.2 years. Eight pregnancies were planned. The flare rate of lupus during pregnancy was 31%, life birth rate was 65% and fetal loss rate was 35%. DISCUSSION AND CONCLUSION: As an increase in disease activity can occur during pregnancy and because of a higher rate of obstetrical complications in patients with lupus, it is important to carefully plan pregnancy. Pregnancy in lupus patients must be closely monitored by a multispeciality care of the patients.

[An unusual toothache!]. / Une douleur dentaire inhabituelle!

INTRODUCTION: Dental pain is a frequent reason for consulting. It may have non-odontogenic causes such as lesions of vascular, neurologic, muscular, or bone structures. The diagnosis and management of this acute or chronic pain syndrome may be difficult. We report a case of atypical dental pain leading to the diagnosis of a plasmocytic mandibular tumor revealing a multiple myeloma. CASE REPORT: A 50-year-old female patient consulted for dental pain during the 3 previous months. Bilateral mandibular swelling was noted during the clinical examination. Radiological examinations revealed a tumoral process associated with osteolytic lesions. The pathological examinations of biopsy samples revealed plasmocytic proliferation. A myelogram and immunoglobulin electrophoresis supported a diagnosis of multiple myeloma with kappa light chains. DISCUSSION: Discovering a mandibular tumor with lytic lesions is an indication for an etiological assessment and screening for a blood disease. A mandibular plasmacytoma may be isolated or present as a multiple myeloma, justifying a complete initial assessment. The bone localization of a plasmacytoma is a bad prognostic factor for survival for patients presenting with multiple myeloma.

[Late revelation of homocysteinuria: clinical, biological and progressive aspects]. / Homocystéinurie à révélation tardive : aspect clinique, biologique et évolutif.

UNLABELLED: Homocysteinuria is a metabolic disorder with defect in genes encoding for methionine metabolism enzymes. The clinical features consist in: ophthalmic, neurological, orthopedic and vascular manifestations. It is generally diagnosed in childhood. Vascular involvements characterize adult's forms. We report one case. OBSERVATION: A 26-year-old man, who has lentis ectopia and a recent epilepsy, was hospitalized for deep vein thrombosis. Regarding the marfanoid phenotype and the high level homocysteinemia (231 micromol/L), homocysteinuria was suspected. Amino acid chromatography and reduced CBS activity were used to confirm the diagnosis. Vitamin enriched diet with vitamin B6 and folates has reduced slightly the homocysteine level. CONCLUSION: Homocysteinuria must be diagnosed early since a simple vitamin supply could ameliorate prognosis and decrease complications.

[Pituitary and ovarian mass syndrome in primary hypothyroidism]. / Syndrome de masse hypophysaire et kystes ovariens dans un cas d'hypothyroïdie périphérique.

INTRODUCTION: Hyperprolactinemia and a pituitary mass syndrome can occur in patient with primary hypoyhroidism. In young women, hypothyroidism can be associated with ovarian cysts. EXEGESIS: We report a case of a 30 year-old women who was treated for an anemia. She had clinical and biological signs of primary hypothyroidism with hyperprolactinemia at the biology. Pituitary MRI showed a pituitary mass. The pelvic ultrasound examination and CT scan showed a right ovarian cyst. The subsequent thyroid hormone replacement was associated with a clinical, a biological and radiological resolution. It was a pituitary and ovarian mass syndrome secondary to primary hypothyroidism. CONCLUSION: The recognition of these associations may eliminate unnecessary surgery and lead to the choice of hormone replacement therapy.

[Dermatofibrosarcoma protuberans. About 18 cases]. / Le dermatofibrosarcome de Darier et Ferrand A propos de 18 observations.

Dermatofibrosarcoma protuberans (DFSP) is a rare mesenchyma skin tumor. It is characterized by a slow growth with a high rate of recurrence but limited potential for metastasis. We report the result of a retrospective study of 18 cases of DFSP collected over 16 years in the dermatology department of La Rabta Hospital. The mean age was 32 years with a sex ratio of 1.57. The site of predilection was the trunk (77.5%). Histological features were typical in all cases with positivity for CD34 in 14 cases. Treatment was surgical in 13 cases. DFSP is a tumor of intermediate malignancy, which can have aggressive course. This tumor is best treated with surgery in which large excision are necessary to reduce the risk of recurrence.