Le retour d'expérience

Dans l'avant propos de l'Archipel du danger, G.Y. Kervern et P. Rubise écrivent que "depuis le tremblement de terre de Lisbonne en 1755 et la polémique qui s'ensuit entre Voltaire et Rousseau sur la place de l'homme et de Dieu dans les catastrophes, l'homme s'est déclaré "Responsable du danger" passant donc d'un fatalisme résigné à un volontarisme moderne ouvrant la voie à la maîtrise du danger". Malgré des efforts croissants pour maîtriser le danger dont témoigne le développement de ces différentes sciences du danger -les cindyniques- dont nous avons eu des exemples variés pendant ces 3 jours, "l'être humain, conscient de ses limites, a rangé au placard le romantisme du zéro-risque et reconnaît même sportivement le besoin d'un certain danger pour se sentir exister". C'est au coeur de ce débat, entre la volonté de l'homme de maîtriser le danger et les limites de l'être humain , limites individuelles et collectives à le contrôler, qu'apparaît en toute évidence l'intérêt du "retour d'expérience" qu'on pourrait définir ainsi

A new application of smart walker for quantitative analysis of human walking

International audienceThis paper presents a new nonintrusive device for everyday gait analysis and health monitoring. The system is a standard rollator equipped with encoders and inertial sensors. The assisted walking of 25 healthy elderly and 23 young adults are compared to develop walking quality index. The subjects were asked to walk on a straight trajectory and an L-shaped trajectory respectively. The walking trajectory, which is missing in other gait analysis methods, is calculated based on the encoder data. The obtained trajectory and steps are compared with the results of a motion capture system. The gait analysis results show that new index obtained by using the walker measurements, and not available otherwise, are very discriminating, e.g., the elderly have larger lateral motion and maneuver area, smaller angular velocity during turning, their walking accuracy is lower and turning ability is weaker although they have almost the same walking velocity as the young people

Exquisite Sensitivity of TP53 Mutant and Basal Breast Cancers to a Dose-Dense Epirubicin−Cyclophosphamide Regimen

BACKGROUND: In breast cancers, only a minority of patients fully benefit from the different chemotherapy regimens currently in use. Identification of markers that could predict the response to a particular regimen would thus be critically important for patient care. In cell lines or animal models, tumor protein p53 (TP53) plays a critical role in modulating the response to genotoxic drugs. TP53 is activated in response to DNA damage and triggers either apoptosis or cell-cycle arrest, which have opposite effects on cell fate. Yet, studies linking TP53 status and chemotherapy response have so far failed to unambiguously establish this paradigm in patients. Breast cancers with a TP53 mutation were repeatedly shown to have a poor outcome, but whether this reflects poor response to treatment or greater intrinsic aggressiveness of the tumor is unknown. METHODS AND FINDINGS: In this study we analyzed 80 noninflammatory breast cancers treated by frontline (neoadjuvant) chemotherapy. Tumor diagnoses were performed on pretreatment biopsies, and the patients then received six cycles of a dose-dense regimen of 75 mg/m(2) epirubicin and 1,200 mg/m(2) cyclophosphamide, given every 14 days. After completion of chemotherapy, all patients underwent mastectomies, thus allowing for a reliable assessment of chemotherapy response. The pretreatment biopsy samples were used to determine the TP53 status through a highly efficient yeast functional assay and to perform RNA profiling. All 15 complete responses occurred among the 28 TP53-mutant tumors. Furthermore, among the TP53-mutant tumors, nine out of ten of the highly aggressive basal subtypes (defined by basal cytokeratin [KRT] immunohistochemical staining) experienced complete pathological responses, and only TP53 status and basal subtype were independent predictors of a complete response. Expression analysis identified many mutant TP53-associated genes, including CDC20, TTK, CDKN2A, and the stem cell gene PROM1, but failed to identify a transcriptional profile associated with complete responses among TP53 mutant tumors. In patients with unresponsive tumors, mutant TP53 status predicted significantly shorter overall survival. The 15 patients with responsive TP53-mutant tumors, however, had a favorable outcome, suggesting that this chemotherapy regimen can overcome the poor prognosis generally associated with mutant TP53 status. CONCLUSIONS: This study demonstrates that, in noninflammatory breast cancers, TP53 status is a key predictive factor for response to this dose-dense epirubicin–cyclophosphamide regimen and further suggests that the basal subtype is exquisitely sensitive to this association. Given the well-established predictive value of complete responses for long-term survival and the poor prognosis of basal and TP53-mutant tumors treated with other regimens, this chemotherapy could be particularly suited for breast cancer patients with a mutant TP53, particularly those with basal features

Prévalence et étiologies de l'anémie du sujet âgé ambulatoire de 65 ans et plus (à propos d'une étude descriptive de 413 cas)

NICE-BU Médecine Odontologie (060882102) / SudocSudocFranceF

Risques liés à la dégradation des céramiques à base de zircone en odontologie

Depuis des années, l'Odontologie cherche à s'affranchir de l'utilisation d'alliages métalliques dans les restaurations prothétiques pour des raisons en Odontologie en 2003. Elle présente des avantages incontestables par ses propriétés mécaniques (résistance à la flexion, ténacité à la rupture), esthétiques et par sa biocompatibilité exceptionnelle. Cependant, au début des années 2000, des échecs en Orthopédie on été décrits dans le cadre des prothèses de hanche, soulevant des questions au sujet de la résistance au vieillissement de ce matériau. S'appuyant sur ces constatations orthopédiques, cette thèse bibliographique a pour objectif de recenser les études odontologiques analysant le comportement de la zircone. Cela comprend: des études in vitro mesurant la dureté, la résistance à la flexion et à l'usure et des études in vivo précisant les risques d'échecs ultérieurs en déterminant le taux de survie/échec des restaurations prothétiques à base de zircone. Des études fractographiques enfin permettent de déterminer l'étiologie des échecs constatés, en précisant l'origine de la fracture et la direction de sa propagation. Ces échecs peuvent être liés à des contraintes mécaniques (usure, torsion) ou à des erreurs de manipulation. Des paramètres fondamentaux ont ainsi pu être mis en évidence: taille et homogénéité des grains, effet des stabilisants et des dopants, rôle majeur de la céramique cosmétique. Au total, il semble que la pérennité d'une restauration céramo-céramique passe par le respect de plusieurs facteurs liés au matériau, mais aussi au prothésiste et au praticien. Une plus longue période d'observation et des recherches complémentaires permettront d'affiner ces résultats afin d'obtenir la meilleure compatibilité possible et la liaison optimale dans cette structure bi-couche, et de mieux appréhender les mécanismes complexes de propagation de fissures à son interface.CLERMONT FD-BCIU Odontol. (631132226) / SudocCLERMONT FD-BCIU-Santé (631132104) / SudocSudocFranceF

L'INERIS et ses partenaires en Europe et dans le Monde

National audienc

Limiting nutrients of oyster pond seawaters in the Marennes-Oléron region for

Bioassays were carried out with the ‘blue diatom' Haslea ostrearia Simonsen, which is responsible for oyster greening during the fattening period of Crassostrea gigas Thunberg in oyster ponds. Samples of seawater were taken from two oyster ponds: one without oysters and the other with 20 oysters per m[sup2 ], maximal density allowed by the French AFNOR norm for ‘refinement'. The aims were to clarify the nutrient requirements of this diatom, also to elucidate the eventual influence of C. gigas at this density on the seawater fertility and to envisage the mass production of this diatom by pond fertilization. Examination of cell numeric densities at the end of bioassays allows us to conclude that silicate was the first limiting nutrient, closely followed by phosphate. Chlorophyll a concentrations led to different conclusions: phosphate was the first limiting factor, but after the seawater storage period in ponds, seawater quality evolved to a deficiency of nitrogen. Silicate addition increased cell division rate, and silicate depletion increased chl a synthesis for this species. Examination of nutrient assimilation ratios confirms that H. ostrearia requires a large amount of silicon. From these results, it was possible to prepare a N + P + Si simplified medium which has been tested in laboratory and field mesocosm conditions. In both conditions, similar results were observed: a significant increase in H. ostrearia cell concentrations and consequently an evolution up to the greening stage. Applications of this work are numerous; the principal permits us to envisage the production of this species in 25-m3 ponds, with the aim of allowing constant production of the greening phenomenon