Characteristics of uveitis presenting for the first time in the elderly: analysis of 91 patients in a tertiary center.

International audiencePURPOSE: To describe uveitis clinical characteristics in the elderly. METHODS: Retrospective review of 91 patients at the age of 60 or more years at the authors' uveitis tertiary center over a 7-year period. RESULTS: Uveitis in the elderly accounted for 30.1% of this population. Uveitis localization was anterior in 22.0% of patients, intermediate in 8.8%, posterior in 20.9%, while 41.7% patients presented with panuveitis. Sarcoidosis (37.4%) and idiopathic uveitis (36.3%) accounted for the majority of cases, whereas other diagnostic entities accounted for 26.3%. Panuveitis (41.7%) and sarcoidosis (37.4%) were detected at a significantly higher frequency than in the younger population. Contrarily, ankylosing spondylitis and established ophthalmological entities (pars planitis, Birdshot chorioretinopathy, Fuchs heterochromic cyclitis) were more common in patients younger than 60 years old. CONCLUSION: In the authors' experience, sarcoidosis is the leading cause of uveitis in the elderly. Idiopathic uveitis and other specific entities account for less than two-thirds of cases

Ocean crust accretion along a high-temperature detachment fault in the Oman ophiolite: A structural and petrological study of the Bahla massif

International audienceThe Bahla massif exposes the lower crustal section of the Oman ophiolite located close to the thrust front of the Semail nappe. It is affected by intense faulting previously attributed to tectonic events that dismembered a classical ophiolitic sequence during or after the obduction. Here we show that most of this complexity is primary, inherited from syn-accretion tectonics. The crustal section is exposed in a 15 by 8 km tectonic enclave surrounded by mantle peridotite. Its northern boundary corresponds to a major, steeply dipping normal fault striking WNW-ESE, at low angle to the paleo-ridge axis. Movement along this fault was accommodated by intense plastic deformation of the crustal cumulates and adjacent mantle peridotites at temperature conditions ≥900 °C. The thickness of the deformed zone reaches several hundred meters. The flattening of the cumulate layering away from the fault is correlated to a decrease in the deformation intensity. Undeformed olivine-gabbro dykes cross-cut this “tectonic Moho” indicating that the tilting occurred before the end of the igneous activity. To the southwest, the crustal enclave is bounded by a NW-SE trending transtentional shear zone that was active in the amphibolite to greenschist facies and was intensely injected by syn- to post-kinematic gabbronorite and tonalite/trondhjemite dykes and plugs. The age of one felsic sample (95.214 ± 0.032 Ma, high-precision Usingle bondPb zircon dating) is within error of the age of intrusive felsic intrusions into the mantle and lowermost axial crust from the length of the Oman ophiolite, which slightly post-dates the mean crystallization age of the Semail crust (V1 magmatism; 96.1–95.6 Ma). Other contacts are low temperature features including cataclastic faults, serpentine‑carbonate breccias and flat-lying décollements.Parent melts of the Bahla crustal cumulates were more siliceous and hydrous, i.e. more andesitic, than typical mid-ocean ridge basalt (MORB) as deduced from the frequent occurrence of early crystallizing orthopyroxene (opx) and late crystallizing amphibole. Some facies such as cumulate harzburgite and opx-troctolite have not been documented elsewhere in the Oman ophiolite and may be specific to the tectonic context in which the frontal massifs accreted. The chemical composition of the lower crustal cumulates can be accounted for by the hybridization in various proportions between MORB and a primitive andesite from a depleted source whose origin can be looked for in melts from a nascent subduction zone or from high temperature hydrothermal processes.The structure of the Bahla lower crustal section is reminiscent of the plutonic growth faults documented along present-day slow-spreading centres in both mid-ocean ridge and back arc settings. The distinctive characteristics of the Moho and lower crustal section in the Bahla massif are tentatively related to their position at the leading edge of the ophiolite, i.e. closer to the Arabian continental margin at the time of accretion than the massifs from the internal part of the ophiolite that have a more continuous and less deformed lower crust. It indicates that the style of crustal accretion may have changed during the opening of the oceanic basin from which the Oman ophiolite issue

Biocomposites from poly(3-hydroxybutyrate-co-3-hydroxyvalerate) and lignocellulosic fillers: Processes stored in data warehouse structured by an ontology

International audienceDue to the rising amount of plastic waste generated each year, multiple questions are emerging about their harmful long-term effects on the environment, the ecosystems and human health. One possible strategy to mitigate these issues is to substitute conventional plastics by materials fully biodegradable in natural conditions, such as poly(3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBV). In order to decrease the overall cost and environmental impact of PHBV-based materials while modulating their technical performance, PHBV can be combined with lignocellulosic fillers. In this article, a total of 88 formulations of PHBV-based biocomposites has been collected, distributed over 5 interdisciplinary projects involving computer scientists, data scientists and biomass processing experts for food and bio-based material production. Available data concern the technical process descriptions, including the description of each step and the different observations measured. These data are stored in a knowledge base that can be queried on the Web

Is there a role for a handheld gamma camera (TReCam) in the SNOLL breast cancer procedure?

International audienceACKGROUND: Sentinel node and occult lesion localization (SNOLL) calls for a combination of two specific procedures: intraoperative detection of sentinel lymph node (SLN) and radio-guided occult lesion localization (ROLL). The safety and benefits of radio-guided localization in the surgical treatment of non-palpable breast cancer have been confirmed. The aim of this study was to evaluate the potential role for an intra-operative handheld tumor resection gamma camera (TReCam) in SNOLL procedures.METHODS: Fifteen patients were enrolled. The SNOLL procedure was performed in all patients with conventional lymphoscintigraphy (LS). TReCam was used to obtain nuclear imaging in the operating theater. Concordance between LS and TReCam images, duration of use and assessment of difficulties in data acquisition with TReCam were reported.RESULTS: Concordance for tumor localization between single-detector gamma probe and TReCam was excellent (15/15). The number of radioactive SLNs visualized between LS and TReCam was equivalent in 53.3% of cases (8/15). TReCam was considered to be very easy-to-use (12/15) or easy-to-use (3/15). Average duration of acquisition with TReCam was 4 minutes and 45 seconds for the SLN procedure, and 2 minutes and 10 seconds for lumpectomy.CONCLUSIONS: This study suggests that TReCam is easy-to-use and does not increase operative time. Its exact role in radio-guided surgery needs to be clearly defined in a larger study. However, its usefulness and benefits in radio-guided breast surgery seem to be promising

Projet Innov-Care : ruptures des parcours de soins des personnes en situation de handicap mental ou visuel

International audienceNotre projet Innov-Care a pour objectif de comprendre les parcours (et les ruptures) de soins de personnes en situation de handicap mental et visuel et d'en identifier les ruptures. Des entretiens semi-directifs et des focus group ont été réalisés auprès de personnes en situation de handicap et des professionnels du secteur médico-social. Nous avons pu alors proposer des modèles de parcours de soins et repérer la nature des freins et les obstacles rencontrés par les personnes en situation de handicap (mental et visuel). Ces modèles ont mis en exergue notamment une difficulté majeure, rencontrée par tous les acteurs, concernant l'accès à l'information et à l'échange entre acteurs et ce indépendamment du parcours de soin (consultation chez un généraliste, gynécologue, dentiste, etc.) et de la situation de handicap. Nous discuterons nos résultats en termes de freins et de ruptures et en mettant en évidence les points communs entre nos deux populations et les spécificités de chacune d'entre elles

Outcomes in Patients With COVID-19 With Acute Encephalopathy and Coma: An International Prospective Study

International audienceBackground and ObjectivesTo report the prevalence of acute encephalopathy and outcomes in patients with severe coronavirus disease 2019 (COVID-19) and to identify determinants of 90-day outcomes.MethodsData from adults with severe COVID-19 and acute encephalopathy were prospectively collected for patients requiring intensive care unit management in 31 university or university-affiliated intensive care units in 6 countries (France, United States, Colombia, Spain, Mexico, and Brazil) between March and September of 2020. Acute encephalopathy was defined, as recently recommended, as subsyndromal delirium or delirium or as a comatose state in case of severely decreased level of consciousness. Logistic multivariable regression was performed to identify factors associated with 90-day outcomes. A Glasgow Outcome Scale-Extended (GOS-E) score of 1-4 was considered a poor outcome (indicating death, vegetative state, or severe disability).ResultsOf 4,060 patients admitted with COVID-19, 374 (9.2%) experienced acute encephalopathy at or before the intensive care unit (ICU) admission. A total of 199/345 (57.7%) patients had a poor outcome at 90-day follow-up as evaluated by the GOS-E (29 patients were lost to follow-up). On multivariable analysis, age older than 70 years (odds ratio [OR] 4.01, 95% CI 2.25-7.15), presumed fatal comorbidity (OR 3.98, 95% CI 1.68-9.44), Glasgow coma scale score <9 before/at ICU admission (OR 2.20, 95% CI 1.22-3.98), vasopressor/inotrope support during ICU stay (OR 3.91, 95% CI 1.97-7.76), renal replacement therapy during ICU stay (OR 2.31, 95% CI 1.21-4.50), and CNS ischemic or hemorrhagic complications as acute encephalopathy etiology (OR 3.22, 95% CI 1.41-7.82) were independently associated with higher odds of poor 90-day outcome. Status epilepticus, posterior reversible encephalopathy syndrome, and reversible cerebral vasoconstriction syndrome were associated with lower odds of poor 90-day outcome (OR 0.15, 95% CI 0.03-0.83).DiscussionIn this observational study, we found a low prevalence of acute encephalopathy at ICU admission in patients with COVID-19. More than half of patients with COVID-19 presenting with acute encephalopathy had poor outcomes as evaluated by GOS-E. Determinants of poor 90-day outcome were dominated by older age, comorbidities, degree of impairment of consciousness before/at ICU admission, association with other organ failures, and acute encephalopathy etiology.Trial Registration InformationThe study is registered with ClinicalTrials.gov, number NCT04320472