Impact des nouvelles recommandations du traitement médicamenteux de l ostéoporose post-ménopausique (Étude rétrospective des patientes vues en consultation Ostéoporose au CHU de Rouen entre 2006 et 2012)

L ostéoporose est une maladie généralisée du squelette responsable d une fragilité osseuse exagérée et donc d un risque élevé de fracture. Le diagnostic et le traitement de l ostéoporose font encore défaut à ce jour puisqu on estime que seuls 20% des patients en bénéficient après une fracture. Les nouvelles recommandations du traitement médicamenteux ont été éditées en 2012 sous l égide de la SFR, du GRIO et de différentes sociétés savantes, remplaçant les dernières recommandations de la HAS de 2006. Le but de notre étude est d évaluer l impact des nouvelles recommandations du traitement médicamenteux de l ostéoporose post-ménopausique dans le cadre d une pratique quotidienne au sein d une consultation ostéoporose . Matériel et méthodes - Nous avons réalisé une étude observationnelle, rétrospective, monocentrique, au sein d une consultation ostéoporose réalisée au sein du service de Rhumatologie du CHU de Rouen. Nous avons sélectionné les patientes ménopausées, sans ostéoporose secondaire, vues en consultation entre Janvier 2006 et Décembre 2011. Les données épidémiologiques et cliniques des patientes ont été recueillies, permettant de justifier l indication d un traitement de l ostéoporose pour chaque patientes avec les recommandations 2006 et 2012. Résultats 231 patientes ont été incluses, 85 dans le groupe non fracturé , 47 dans le groupe fracture non sévère et 99 dans le groupe fracture sévère . 187 patientes (80,1%) avaient une indication au traitement médicamenteux avec les recommandations 2006 contre 173 (75,9%) avec les recommandations 2012. Pour 26 patientes (11,3%) il existe une discordance dans l indication au traitement avec les deux recommandations. Pour 24 de ces 26 patientes (92,3%), la discordance est liée au calcul du score FRAX®. Conclusion - Les nouvelles recommandations du traitement de l ostéoporose postménopausique ont un faible impact sur l indication au traitement de l ostéoporose postménoapusique. Le score FRAX® confirme son rôle majeur lorsque son calcul est indiqué, entraînant une diminution des indications au traitement avec les recommandations de 2012 par rapport à celles de 2006.ROUEN-BU Médecine-Pharmacie (765402102) / SudocSudocFranceF

Intérêt de l évaluation systématique de la micro-architecture osseuse par technique BMA en complément de la densitométrie osseuse dans une population de patients fracturés

L ostéoporose est une maladie diffuse du squelette associant baisse de la densité minérale osseuse et altérations microarchitecturales. L ostéodensitométrie, examen de référence pour le diagnostic d ostéoporose n évalue pas spécifiquement ces altérations. De nouveaux outils d imagerie sont développés afin de les étudier de manière non invasive, parmi lesquels le BMA , technique basée sur l analyse fractale. Matériel et méthodes : 77 patients fracturés ont répondu à un questionnaire évaluant les facteurs de risques d ostéoporose et bénéficié d une ostéodensitométrie au rachis lombaire, col fémoral et avant-bras et d une mesure de la microarchitecture osseuse par BMA (D3A Medical Systems) au col fémoral et à l avant-bras. Résultats : Nous retrouvons un lien entre paramètres densitométriques et microarchitecturaux aux deux sites de mesure, avec une corrélation négative au col fémoral. Il existe une corrélation positive entre paramètres densitométriques au col fémoral et microarchitecturaux à l avant-bras. Nous retrouvons une corrélation entre les trois paramètres microarchitecturaux sur un même site, mais pas entre paramètres de deux sites différents. Nous mettons en évidence une corrélation positive entre paramètres densitométriques aux deux sites et paramètres morphologiques, et négative entre ceux-ci et les paramètres microarchitecturaux au col fémoral. Enfin, nous ne retrouvons pas de corrélation entre paramètres microarchitecturaux au col fémoral et score FRAX. Conclusion : L évaluation de la microarchitecture osseuse par BMA à deux sites de mesure permet d apporter des informations complémentaires à l ostéodensitométrie, notamment chez des patients en surpoids ou obèses pour lesquels les paramètres densitométriques seuls ne reflètent souvent pas complétement le risque fracturaire.ROUEN-BU Médecine-Pharmacie (765402102) / SudocSudocFranceF

A Cluster-based and On-demand routing algorithm for Large-Scale Multi-hop Wireless Sensor Networks

International audienceReducing the energy consumption and improving the robustness of a Wireless Sensor Network (WSN) are the main requirements for many industrial and research applications. The sensors usually use a routing protocol in order to deliver the sensing data to a Base Station (BS) which may be far away from the monitoring area. Many algorithms proposed in the literature compute the routing process by clustering the network and by designing new election mechanisms in which the cluster-heads are chosen taking account of the remaining energy, the communication cost and the density of nodes. However, they do not consider the connectivity to the BS, and assume that all the nodes or only few prefixed nodes are able to directly communicate with it. We believe that this assumption is not suitable for many applications of WSN and to tackle this problem we propose CESAR, a multi-hop and energy-efficient routing protocol for large-scale WSN which includes a new cluster-head selection mechanism aware of the battery level and the connectivity to the BS. Furthermore, our solution employs an innovative hybrid approach to combine both clustering and on-demand techniques in order to provide an adaptive behavior for different dynamic topologies. Simulation results show that our solution outperforms in terms of energy consumption and data delivery other known routing algorithms in the literature

Gene profiling in white blood cells predicts infliximab responsiveness in rheumatoid arthritis

As indicators of responsiveness to a tumour necrosis factor (TNF)α blocking agent (infliximab) are lacking in rheumatoid arthritis, we have used gene profiling in peripheral blood mononuclear cells to predict a good versus poor response to infliximab. Thirty three patients with very active disease (Disease Activity Score 28 >5.1) that resisted weekly methotrexate therapy were given infliximab at baseline, weeks 2 and 6, and every 8th week thereafter. The patients were categorized as responders if a change of Disease Activity Score 28 = 1.2 was obtained at 3 months. Mononuclear cell RNAs were collected at baseline and at three months from responders and non-responders. The baseline RNAs were hybridised to a microarray of 10,000 non-redundant human cDNAs. In 6 responders and 7 non-responders, 41 mRNAs identified by microarray analysis were expressed as a function of the response to treatment and an unsupervised hierarchical clustering perfectly separated these responders from non-responders. The informativeness of 20 of these 41 transcripts, as measured by qRT-PCR, was re-assessed in 20 other patients. The combined levels of these 20 transcripts properly classified 16 out of 20 patients in a leave-one-out procedure, with a sensitivity of 90% and a specificity of 70%, whereas a set of only 8 transcripts properly classified 18/20 patients. Trends for changes in various transcript levels at three months tightly correlated with treatment responsiveness and a down-regulation of specific transcript levels was observed in non-responders only. Our gene profiling obtained by a non-invasive procedure should now be used to predict the likely responders to an infliximab/methotrexate combination

Association between the TNFRII 196R allele and diagnosis of rheumatoid arthritis

Tumour necrosis factor (TNF)-α plays a key role in the pathogenesis of rheumatoid arthritis (RA). It binds to two receptors, namely TNF receptor (TNFR)I and TNFRII. Several studies have suggested an association between TNFRII 196R/R genotype and RA. The objective of the present study was to evaluate the predictive value of the TNFRII 196R allele for RA diagnosis and prognosis in a cohort of patients with very early arthritis. We followed up a total of 278 patients recruited from the community, who had swelling of at least two joints that had persisted for longer than 4 weeks but had been evolving for less than 6 months, and who had not received disease-modifying antirheumatic drugs or steroid therapy. At 2 years, patients were classified according to the American College of Rheumatology criteria. All patients were genotyped with respect to TNFRII 196M/R polymorphism. Radiographs of hands and feet (read according to the modified Sharp method) and the Health Assessment Questionnaire were used to quantify structural and functional severity. The cohort of 278 patients was found to include 156 and 122 RA and non-RA patients, respectively. The TNFRII 196R allele was found to be associated with RA (P = 0.002). However, progression of radiographic severity and Health Assessment Questionnaire scores over 1 year did not differ between carriers of the 196R allele and noncarriers. Our findings suggest that the TNFRII 196R allele may be associated with RA diagnosis but that it does not predict early radiographic progression or functional severity in patients with very early, unclassified arthritis

How can ski resorts get smart? Transdisciplinary approaches to sustainable winter tourism in the European Alps

Climate change and the call for reduction of greenhouse gas emissions, the efficient use of (renewable) energy, and more resilient winter tourism regions, forces ski resorts across the European Alps to look for \u201csmart\u201d approaches to transition towards a sustainable, low-carbon economy. Drawing on the smart-city concept and considering the different historical developments of Alpine resorts, the Smart Altitude Decision-Making Toolkit was developed using a combination of an energy audit tool, a WebGIS, and collaborative and innovative living labs installed in Les Orres (France), Madonna di Campiglio (Italy), Krvavec (Slovenia), and Verbier (Switzerland). This step-by-step Decision-Making Toolkit enables ski resorts to get feedback on their energy demand, an overview of the locally available sources of renewable energy, and insights regarding their potential for improving their energy efficiency by low-carbon interventions. The Decision-Making Toolkit is suitable for knowledge transfer between stakeholders within living labs and moreover provides the flexibility for tailor-made low-carbon strategies adapting to the unique assets and situatedness of ski resorts

Fexinidazole – A New Oral Nitroimidazole Drug Candidate Entering Clinical Development for the Treatment of Sleeping Sickness

This article describes the preclinical profile of fexinidazole, a new drug candidate with the potential to become a novel, oral, safe and effective short-course treatment for curing both stage 1 and 2 human African trypanosomiasis and replace the old and highly problematic treatment modalities available today. Fexinidazole is orally available and rapidly metabolized in two metabolites having equivalent biological activity to the parent and contributing significantly to the in vivo efficacy in animal models of both stage 1 and 2 HAT. Animal toxicology studies indicate that fexinidazole has an excellent safety profile, with no particular issues identified. Fexinidazole is a 5-nitroimidazole and, whilst it is Ames-positive, it is devoid of any genetic toxicity in mammalian cells and therefore does not pose a genotoxic risk for use in man. Fexinidazole, which was rediscovered through a process of compound mining, is the first new drug candidate for stage 2 HAT having entered clinical trials in thirty years, and has the potential to revolutionize therapy of this fatal disease at a cost that is acceptable in the endemic regions

A Panorama on Multiscale Geometric Representations, Intertwining Spatial, Directional and Frequency Selectivity

The richness of natural images makes the quest for optimal representations in image processing and computer vision challenging. The latter observation has not prevented the design of image representations, which trade off between efficiency and complexity, while achieving accurate rendering of smooth regions as well as reproducing faithful contours and textures. The most recent ones, proposed in the past decade, share an hybrid heritage highlighting the multiscale and oriented nature of edges and patterns in images. This paper presents a panorama of the aforementioned literature on decompositions in multiscale, multi-orientation bases or dictionaries. They typically exhibit redundancy to improve sparsity in the transformed domain and sometimes its invariance with respect to simple geometric deformations (translation, rotation). Oriented multiscale dictionaries extend traditional wavelet processing and may offer rotation invariance. Highly redundant dictionaries require specific algorithms to simplify the search for an efficient (sparse) representation. We also discuss the extension of multiscale geometric decompositions to non-Euclidean domains such as the sphere or arbitrary meshed surfaces. The etymology of panorama suggests an overview, based on a choice of partially overlapping "pictures". We hope that this paper will contribute to the appreciation and apprehension of a stream of current research directions in image understanding.Comment: 65 pages, 33 figures, 303 reference

Robust estimation of bacterial cell count from optical density

Optical density (OD) is widely used to estimate the density of cells in liquid culture, but cannot be compared between instruments without a standardized calibration protocol and is challenging to relate to actual cell count. We address this with an interlaboratory study comparing three simple, low-cost, and highly accessible OD calibration protocols across 244 laboratories, applied to eight strains of constitutive GFP-expressing E. coli. Based on our results, we recommend calibrating OD to estimated cell count using serial dilution of silica microspheres, which produces highly precise calibration (95.5% of residuals <1.2-fold), is easily assessed for quality control, also assesses instrument effective linear range, and can be combined with fluorescence calibration to obtain units of Molecules of Equivalent Fluorescein (MEFL) per cell, allowing direct comparison and data fusion with flow cytometry measurements: in our study, fluorescence per cell measurements showed only a 1.07-fold mean difference between plate reader and flow cytometry data

Silver Diamine Fluoride as a non-restorative treatment for caries Online survey, systemic review and meta-analysis

Introdução: A cárie dentária é uma doença infeciosa que resulta na destruição do esmalte e da dentina. O Fluoreto de Diamina de Prata (SDF) é uma opção de tratamento não restauradora para parar lesões de cárie. Objetivo: Determinar a eficácia do SDF como tratamento não invasivo para parar as lesões de cárie e, em segundo lugar, avaliar o mecanismo de ação do SDF, indicações, contraindicações, seguridade, vantagens e desvantagens. Questionar os Médicos Dentistas Franceses e Portugueses sobre o conhecimento e a utilização do SDF através de um inquérito online. Materiais e Metodologia: 459 artigos publicados nas bases de dados PUBMED e EBSCO foram recolhidos. 28 artigos que cumpriam os critérios de inclusão e exclusão foram incluídos para análise qualitativa. O inquérito online foi divulgado durante 14 dias através da plataforma Google Forms. Foi efetuada uma meta-análise com 6 estudos para calcular a diferença média entre os protocolos de intervenção e controlo, com um modelo de efeitos aleatórios (α=.05). Resultados: O SDF para efetivamente a cárie dentária, diminuindo a desmineralização do tecido duro do dente. 38% de concentração de SDF é mais eficaz do que 30%, e muito mais se comparada com placebo. Além disso, uma aplicação bianual tem uma melhor taxa de paragem da cárie do que uma aplicação anual. A partir de um inquérito online, este produto não é muito utilizado, exceto em odontopediatria. Uma minoria de faculdades combina cursos teóricos e práticos sobre SDF. Conclusão: O SDF é um produto eficaz para parar lesões cariosas em pacientes que não toleram tratamento invasivo devido às suas propriedades remineralizantes, bactericidas, e inibidoras de enzimas degradantes do colagénio. Recomenda-se a aplicação de SDF 38% duas vezes por ano.Introduction: Dental caries is an infectious disease destroying enamel and dentin. Silver Diamine Fluoride (SDF) is a nonrestorative treatment option to arrest caries lesions. Objective: Determine the SDF’s efficiency as a non-invasive treatment to stop caries lesions and secondarily evaluate the SDF’s action mechanism, indications, contraindications, safety, and advantages and disadvantages. Quiz the knowledge and use of SDF by French and Portuguese dentists through an online survey. Materials and Methodology: 459 articles published in the PUBMED and EBSCO databases were collected. 28 articles that met the inclusion and exclusion criteria were included for de qualitative analysis. An online survey was disseminated for 14 days throw the Google Forms platform. A meta-analysis analyzed 6 studies to calculate the mean difference between the intervention and control protocols with a random-effects model (α=.05). Results: SDF effectively stops dental caries by decreasing the demineralization of the tooth's hard tissue. 38% concentration of SDF is more effective than 30%, and much more if compared to placebo. Furthermore, a biannual application has a better caries arrest rate than an annual application. Based on the online survey, this product is not much used, except in pediatrics. A minority of faculties combine theoretical and practical courses about SDF. Conclusion: SDF is an effective product for stopping cavities in patients who cannot tolerate invasive treatment due to its remineralization, bactericidal, and collagen degrading enzyme inhibiting properties. It is recommended to apply SDF 38% twice a year