Caractéristiques et origines principales des épisodes de pollution hivernaux aux PM10 en France

National audienceThis paper aims at gaining an insight into the PM10 daily threshold (50 micro g/m3) exceedances measured by French regional air quality monitoring networks for the last four years. As almost three quarter of these exceedances happens to occur between November and April, we focus here on such winter (broadly speaking) pollution episodes. The deployment of monitoring devices allowing for a proper account of semi-volatile material within PM10 was achieved concomitantly to the development particulate pollution episodes largely influenced by ammonium nitrate (which is semi-volatile) in March-April 2007. Since then, such pollution events are frequently observed at this period of the year, notably due to stable meteorological conditions favoring the condensation of semi-volatile material into the particulate phase along with the resumption of manure spreading, which constitutes a major source of ammonium nitrate gaseous precursors (at least at some points of the year). Such pollution events, which are also related to combustion emissions (among which mobile sources) are typically preceded, from November to February, by frequent daily threshold exceedances with potentially significant influences of biomass burning (e.g. residential wood burning). The winter period is also impacted by long range transport episodes, corresponding notably to increases of ammonium sulfate relative abundances within PM10. Moreover, as traffic sites are generally the first ones showing PM10 exceedances due the increment of direct emissions and resuspension processes, mobile sources are also considered as a major target for action plans. Finally, it is underlined that the occurrence of daily threshold exceedances is highly influenced by meteorological conditions, so that the yearly number of these exceedances shows well-marked inter-annual variations, with 2009 and 2011 (and 2012, but not shown here) being significantly more polluted than 2008 and 2010. The on-going development of efficient forecasting systems still suffer lacks of detailed emission inventories and strong knowledge on the physical and chemical transformation processes of particles and their gaseous precursors within the boundary layer.Cette synthèse dresse une analyse non exhaustive des dépassements du seuil réglementaire journalier de 50 micro g/m3 pour les PM10 mesurés au niveau national par les Associations Agréées de Surveillance de la Qualité de l'Air (AASQA) au cours des quatre dernières années. Près des trois quarts de ces dépassements étant observés entre fin novembre et début avril, nous nous intéressons plus particulièrement ici à ces épisodes hivernaux (au sens large). La mise en oeuvre de techniques analytiques permettant une prise en compte correcte des espèces semi-volatiles dans la composition des PM10 a coïncidé en mars-avril 2007 à la survenue de nombreux dépassements de seuil journalier s'accompagnant d'importants niveaux de nitrate d'ammonium (composé semi-volatil). Ce type d'épisode est régulièrement observé à cette période. Il s'explique notamment par la conjonction de conditions atmosphériques stables et propices à la condensation en phase particulaire des espèces labiles, et de la reprise des épandages agricoles, constituant une source majeure, au moins ponctuellement, de précurseurs gazeux azotés du nitrate d'ammonium. Ce type d'épisode, mettant également en cause les émissions anthropiques de combustion (dont les transports), est typiquement précédé entre novembre et février de fréquents dépassements pour lesquels le rôle des combustions de biomasse (incluant notamment le chauffage au bois individuel) peut être important. La période hivernale est également marquée par l'occurrence de phénomènes de transport longue distance se caractérisant par une augmentation des contributions du sulfate d'ammonium. Les sites de proximité automobile étant généralement les premiers concernés par les dépassements du seuil journalier en raison du surplus de concentrations provenant des émissions à l'échappement et des phénomènes de remise en suspension, le transport routier est également considéré comme un levier incontournable pour le respect des valeurs limites. Enfin, il est souligné que l'occurrence des différents types d'épisodes de dépassements dépend fortement des conditions météorologiques, de sorte qu'on observe une forte variabilité interannuelle du nombre de dépassements hivernaux ? : 2009 et 2011 (et 2012) étant significativement plus impactées que 2008 et 2010. Une bonne prévision de ces épisodes passe encore par l'affinage des cadastres d'émission et une meilleure compréhension du devenir dans l'atmosphère des émissions primaires (gazeuses et particulaires)

Caractéristiques et origines principales des épisodes de pollution hivernaux aux PM10 en France

National audienceThis paper aims at gaining an insight into the PM10 daily threshold (50 micro g/m3) exceedances measured by French regional air quality monitoring networks for the last four years. As almost three quarter of these exceedances happens to occur between November and April, we focus here on such winter (broadly speaking) pollution episodes. The deployment of monitoring devices allowing for a proper account of semi-volatile material within PM10 was achieved concomitantly to the development particulate pollution episodes largely influenced by ammonium nitrate (which is semi-volatile) in March-April 2007. Since then, such pollution events are frequently observed at this period of the year, notably due to stable meteorological conditions favoring the condensation of semi-volatile material into the particulate phase along with the resumption of manure spreading, which constitutes a major source of ammonium nitrate gaseous precursors (at least at some points of the year). Such pollution events, which are also related to combustion emissions (among which mobile sources) are typically preceded, from November to February, by frequent daily threshold exceedances with potentially significant influences of biomass burning (e.g. residential wood burning). The winter period is also impacted by long range transport episodes, corresponding notably to increases of ammonium sulfate relative abundances within PM10. Moreover, as traffic sites are generally the first ones showing PM10 exceedances due the increment of direct emissions and resuspension processes, mobile sources are also considered as a major target for action plans. Finally, it is underlined that the occurrence of daily threshold exceedances is highly influenced by meteorological conditions, so that the yearly number of these exceedances shows well-marked inter-annual variations, with 2009 and 2011 (and 2012, but not shown here) being significantly more polluted than 2008 and 2010. The on-going development of efficient forecasting systems still suffer lacks of detailed emission inventories and strong knowledge on the physical and chemical transformation processes of particles and their gaseous precursors within the boundary layer.Cette synthèse dresse une analyse non exhaustive des dépassements du seuil réglementaire journalier de 50 micro g/m3 pour les PM10 mesurés au niveau national par les Associations Agréées de Surveillance de la Qualité de l'Air (AASQA) au cours des quatre dernières années. Près des trois quarts de ces dépassements étant observés entre fin novembre et début avril, nous nous intéressons plus particulièrement ici à ces épisodes hivernaux (au sens large). La mise en oeuvre de techniques analytiques permettant une prise en compte correcte des espèces semi-volatiles dans la composition des PM10 a coïncidé en mars-avril 2007 à la survenue de nombreux dépassements de seuil journalier s'accompagnant d'importants niveaux de nitrate d'ammonium (composé semi-volatil). Ce type d'épisode est régulièrement observé à cette période. Il s'explique notamment par la conjonction de conditions atmosphériques stables et propices à la condensation en phase particulaire des espèces labiles, et de la reprise des épandages agricoles, constituant une source majeure, au moins ponctuellement, de précurseurs gazeux azotés du nitrate d'ammonium. Ce type d'épisode, mettant également en cause les émissions anthropiques de combustion (dont les transports), est typiquement précédé entre novembre et février de fréquents dépassements pour lesquels le rôle des combustions de biomasse (incluant notamment le chauffage au bois individuel) peut être important. La période hivernale est également marquée par l'occurrence de phénomènes de transport longue distance se caractérisant par une augmentation des contributions du sulfate d'ammonium. Les sites de proximité automobile étant généralement les premiers concernés par les dépassements du seuil journalier en raison du surplus de concentrations provenant des émissions à l'échappement et des phénomènes de remise en suspension, le transport routier est également considéré comme un levier incontournable pour le respect des valeurs limites. Enfin, il est souligné que l'occurrence des différents types d'épisodes de dépassements dépend fortement des conditions météorologiques, de sorte qu'on observe une forte variabilité interannuelle du nombre de dépassements hivernaux ? : 2009 et 2011 (et 2012) étant significativement plus impactées que 2008 et 2010. Une bonne prévision de ces épisodes passe encore par l'affinage des cadastres d'émission et une meilleure compréhension du devenir dans l'atmosphère des émissions primaires (gazeuses et particulaires)

Past African dust inputs in the western Mediterranean area controlled by the complex interaction between the Intertropical Convergence Zone, the North Atlantic Oscillation, and total solar irradiance

International audienceNorth Africa is the largest source of mineral dust on Earth, which has multiple impacts on the climate system; however, our understanding of decadal to centennial changes in African dust emissions over the last few millenniums is limited. Here, we present a high-resolution multiproxy analysis of sediment core from high-elevation Lake Bastani, on the island of Corsica, to reconstruct past African dust inputs to the western Mediterranean area over the last 3150 cal BP. Clay mineralogy with palygorskite and a clay ratio associated with geochemical data allow us to determine that terrigenous fluxes are almost exclusively related to atmospheric dust deposition from the western Sahara and Sahel areas over this period. High-resolution geochemical contents provide a reliable proxy for Saharan dust inputs with long-term (millennial) to short-term (centennial) variations. Millennial variations have been correlated with the long-term southward migration of the Intertropical Convergence Zone (ITCZ), with an increase in dust input since 1070 cal BP. This correlation suggests a strong link with the ITCZ and could reflect the increased availability of dust sources to be mobilized with an increase in wind and a decrease in precipitation over western and North Africa. For centennial to decadal variations, wavelet analyses show that since 1070 cal BP, the North Atlantic Oscillation (NAO) has been the main climatic forcing, with an increase in Saharan dust input during the positive phase, as suggested by previous studies over the last decades. However, when the ITCZ is in a northern position, before 1070 cal BP, wavelet analyses indicate that total solar irradiance (TSI) is the main forcing factor, with an increase in African dust input during low TSI. With climate reanalysis over the instrumental era, during low TSI we observe a significant negative anomaly in pressure over Africa, which is known to increase the dust transport. These two climatic forcing factors (NAO, TSI) modulate Saharan dust inputs to the Mediterranean area at a centennial timescale through changes in wind and transport pathways

2023 French recommendations for diagnosing and managing prepatellar and olecranon septic bursitis

International audienceSeptic bursitis (SB) is a common condition accounting for one third of all cases of inflammatory bursitis. It is often related to professional activities. Management is heterogeneous and either ambulatory or hospital-based, with no recommendations available. This article presents recommendations for managing patients with septic bursitis gathered by 18 rheumatologists from the French Society for Rheumatology work group on bone and joint infections, 1 infectious diseases specialist, 2 orthopedic surgeons, 1 general practitioner and 1 emergency physician. This group used a literature review and expert opinions to establish 3 general principles and 11 recommendations for managing olecranon and prepatellar SB. The French Health authority (Haute Autorité de Santé, HAS) methodology was used for these recommendations. Designed for rheumatologists, general practitioners, emergency physicians and orthopedic surgeons, they focus on the use of biological tests and imaging in both outpatient and inpatient management. Antibiotic treatment options (drugs and duration) are proposed for both treatment modalities. Finally, surgical indications, non-drug treatments and prevention are covered by specific recommendations

In inflammatory myopathies, dropped head/bent spine syndrome is associated with scleromyositis: an international case–control study

Background Some myopathies can lead to dropped head or bent spine syndrome (DH/BS). The significance of this symptom has not been studied in inflammatory myopathies (IM).Objectives To assess the significance of DH/BS in patients with IM.Methods Practitioners from five IM networks were invited to report patients with IM suffering from DH/BS (without other known cause than IM). IM patients without DH/BS, randomly selected in each participating centre, were included as controls at a ratio of 2 to 1.Results 49 DH/BS-IM patients (DH: 57.1%, BS: 42.9%) were compared with 98 control-IM patients. DH/BS-IM patients were older (65 years vs 53 years, p<0.0001) and the diagnosis of IM was delayed (6 months vs 3 months, p=0.009). Weakness prevailing in the upper limbs (42.9% vs 15.3%), dysphagia (57.1% vs 25.5%), muscle atrophy (65.3% vs 34.7%), weight loss (61.2% vs 23.5%) and loss of the ability to walk (24.5% vs 5.1%) were hallmarks of DH/BS-IM (p≤0.0005), for which the patients more frequently received intravenous immunoglobulins (65.3% vs 34.7%, p=0.0004). Moreover, DH/BS-IM patients frequently featured signs and/or complications of systemic sclerosis (SSc), fulfilling the American College of Rheumatology/European Alliance of Associations for Rheumatology criteria for this disease in 40.8% of the cases (vs 5.1%, p<0.0001). Distribution of the myopathy, its severity and its association with SSc were independently associated with DH/BS (p<0.05). Mortality was higher in the DH/BS-IM patients and loss of walking ability was independently associated with survival (p<0.05).Conclusion In IM patients, DH/BS is a marker of severity and is associated with SSc (scleromyositis)

Impact of Coronary Lesion Stability on the Benefit of Emergent Percutaneous Coronary Intervention After Sudden Cardiac Arrest

International audienceBackground: Conflicting data exist regarding the benefit of urgent coronary angiogram and percutaneous coronary intervention (PCI) after sudden cardiac arrest, particularly in the absence of ST-segment elevation. We hypothesized that the type of lesions treated (stable versus unstable) influences the benefit derived from PCI. Methods: Data were taken between May 2011 and 2014 from a prospective registry enrolling all sudden cardiac arrest in Paris and suburbs (6.7 million inhabitants). Patients undergoing emergent coronary angiogram were included. Decision to perform PCI was left to the discretion of local teams. We assessed the impact of emergent PCI on survival at discharge according to whether the treated lesion was angiographically unstable or stable, and we investigated the predictive factors for unstable coronary lesions. Results: Among 9265 sudden cardiac arrests occurring during the study period, 1078 underwent emergent coronary angiogram (median age: 59.6 years, 78.3% males): 463 (42.9%) had an unstable lesion, 253 (23.5%) only stable lesions, and 362 (33.6%) no significant lesions. Emergent PCI was performed in 478 patients (91.4% of unstable and 21.7% of stable lesions). At discharge, PCI of unstable lesions was associated with twice-higher survival rate compared with untreated unstable lesions (47.9% versus 25.6%, P =0.013), while stable lesions PCI did not improve survival (25.5% versus 26.3%, P =1.00). After adjustment, PCI of unstable coronary lesions was independently associated with improved survival (odds ratio, 2.09 [95% CI, 1.42–3.09], P <0.001), contrary to PCI of stable lesions (odds ratio, 0.92 [95% CI. 0.44–1.87], P =0.824). Angina, initial shockable rhythm, ST-segment elevation, and absence of known coronary artery disease were independent predictors of unstable lesions. Conclusions: Emergent PCI of unstable lesions is associated with improved survival after sudden cardiac arrest, contrary to PCI of stable lesions. Accordingly, early PCI should only be performed in patients with unstable lesions. Four factors (chest pain, ST-elevation, absence of coronary artery disease history, and shockable initial rhythm) could help identify patients with unstable lesions who would, therefore, benefit from emergent coronary angiogram

Characterisation of a high-risk profile for maternal thrombotic and severe haemorrhagic complications in pregnant women with antiphospholipid syndrome in France (GR2): a multicentre, prospective, observational study

International audienceBackgroundProspective data about the risks of thrombotic and severe haemorrhagic complications during pregnancy and post partum are unavailable for women with antiphospholipid syndrome. We aimed to assess thrombotic and haemorrhagic events in a prospective cohort of pregnant women with antiphospholipid syndrome.MethodsThis multicentre, prospective, observational study was done at 76 centres in France. To be eligible for this study, women had to have diagnosis of antiphospholipid syndrome; have conceived before April 17, 2020; have an ongoing pregnancy that had reached 12 weeks of gestation; and be included in the study before 18 weeks of gestation. Exclusion criteria were active systemic lupus erythematosus nephropathy, or a multifetal pregnancy. Severe haemorrhage was defined as the need for red blood cell transfusion or maternal intensive care unit admission because of bleeding or invasive procedures, defined as interventional radiology or surgery, to control bleeding. The GR2 study is registered with ClinicalTrials.gov, NCT02450396.FindingsBetween May 26, 2014, and April 17, 2020, 168 pregnancies in 27 centres met the inclusion criteria for the study. 89 (53%) of 168 women had a history of thrombosis. The median term at inclusion was 8 weeks gestation. 16 (10%) of 168 women (95%CI 5–15) had a thrombotic (six [4%] women; 95% CI 1–8) or severe haemorrhagic event (12 [7%] women; 95% CI 4–12). There were no deaths during the study. The main risk factors for thrombotic events were lupus anticoagulant positivity at inclusion (six [100%] of six women with thrombosis vs 78 [51%] of 152 of those with no thrombosis; p=0·030) and placental insufficiency (four [67%] of six women vs 28 [17%] of 162 women; p=0·013). The main risk factors for severe haemorrhagic events were pre-existing maternal hypertension (four [33%] of 12 women vs 11 [7%] of 156 women; p=0·014), lupus anticoagulant positivity at inclusion (12 [100%] of 12 women vs 72 [49%] of 146 women; p<0·0001) and during antiphospholipid history (12 [100%] of 12 women vs 104 [67%] of 156 women; p=0·019), triple antiphospholipid antibody positivity (eight [67%] of 12 women vs 36 [24%] of 147 women; p=0·0040), placental insufficiency (five [42%] of 12 women vs 27 [17%] of 156 women; p=0·038), and preterm delivery at 34 weeks or earlier (five [45%] of 11 women vs 12 [8%] of 145 women; p=0·0030).InterpretationDespite treatment adhering to international recommendations, a proportion of women with antiphospholipid syndrome developed a thrombotic or severe haemorrhagic complication related to pregnancy, most frequently in the post-partum period. Lupus anticoagulant and placental insufficiency were risk factors for these life-threatening complications. These complications are difficult to prevent, but knowledge of the antenatal characteristics associated with them should increase awareness and help physicians manage these high-risk pregnancies

Partnership for Research on Ebola VACcination (PREVAC): protocol of a randomized, double-blind, placebo-controlled phase 2 clinical trial evaluating three vaccine strategies against Ebola in healthy volunteers in four West African countries

International audienceAbstract Introduction The Ebola virus disease (EVD) outbreak in 2014–2016 in West Africa was the largest on record and provided an opportunity for large clinical trials and accelerated efforts to develop an effective and safe preventative vaccine. Multiple questions regarding the safety, immunogenicity, and efficacy of EVD vaccines remain unanswered. To address these gaps in the evidence base, the Partnership for Research on Ebola Vaccines (PREVAC) trial was designed. This paper describes the design, methods, and baseline results of the PREVAC trial and discusses challenges that led to different protocol amendments. Methods This is a randomized, double-blind, placebo-controlled phase 2 clinical trial of three vaccine strategies against the Ebola virus in healthy volunteers 1 year of age and above. The three vaccine strategies being studied are the rVSVΔG-ZEBOV-GP vaccine, with and without a booster dose at 56 days, and the Ad26.ZEBOV,MVA-FN-Filo vaccine regimen with Ad26.ZEBOV given as the first dose and the MVA-FN-Filo vaccination given 56 days later. There have been 4 versions of the protocol with those enrolled in Version 4.0 comprising the primary analysis cohort. The primary endpoint is based on the antibody titer against the Ebola virus surface glycoprotein measured 12 months following the final injection. Results From April 2017 to December 2018, a total of 5002 volunteers were screened and 4789 enrolled. Participants were enrolled at 6 sites in four countries (Guinea, Liberia, Sierra Leone, and Mali). Of the 4789 participants, 2560 (53%) were adults and 2229 (47%) were children. Those < 18 years of age included 549 (12%) aged 1 to 4 years, 750 (16%) 5 to 11 years, and 930 (19%) aged 12–17 years. At baseline, the median (25th, 75th percentile) antibody titer to Ebola virus glycoprotein for 1090 participants was 72 (50, 116) EU/mL. Discussion The PREVAC trial is evaluating—placebo-controlled—two promising Ebola candidate vaccines in advanced stages of development. The results will address unanswered questions related to short- and long-term safety and immunogenicity for three vaccine strategies in adults and children. Trial registration ClinicalTrials.gov NCT02876328 . Registered on 23 August 2016

Outcomes in Newly Diagnosed Atrial Fibrillation and History of Acute Coronary Syndromes: Insights from GARFIELD-AF

BACKGROUND: Many patients with atrial fibrillation have concomitant coronary artery disease with or without acute coronary syndromes and are in need of additional antithrombotic therapy. There are few data on the long-term clinical outcome of atrial fibrillation patients with a history of acute coronary syndrome. This is a 2-year study of atrial fibrillation patients with or without a history of acute coronary syndromes