Evaluation contingente d’aménités paysagères liées à un espace vert urbain. Une application au cas du Parc Balzac de la ville d’Angers

Cet article propose une évaluation contingente des services esthétiques et récréatifs rendus par un parc urbain. Les dispositions à payer d’un échantillon d’usagers d’un parc urbain dans la ville d’Angers (le parc Balzac) ont été révélées sur la base de deux scénarios reflétant des changements d’attributs paysagers. Les attributs retenus correspondent au degré d’ouverture et à l’effort de fleurissement. Lesupport de paiement proposé repose sur une carte de paiement retraçant les augmentations de la taxe d’habitation à prévoir. Nous avons évalué les facteurs qui augmentent la probabilité de donner une disposition à payer positive. Nos résultats montrent que les aménités paysagères recherchées par les visiteurs de deux scénarios du parc Balzac diffèrent. Dans le premier scénario, seul l’usage lié à une activité de loisirs est exprimé, tandis que dans le second, une appréciation esthétique des aménités est également envisagée

L’ostéogenèse imparfaite: à propos d’un cas

L'ostéogenèse imparfaite est une maladie héréditaire caractérisée par une fragilité osseuse secondaire à un défaut de synthèse du collagène de type I. Le diagnostic est suspecté devant des signes échographiques évocateurs et confirmé par une étude génétique. Nous rapportons un cas d'ostéogenèse imparfaite de découverte tardive au troisième trimestre chez une patiente qui n'a pas suivi sa grossesse

Hemangiomes Larynges De L\'adulte A Propos De 9 Cas

L\'hémangiome laryngé de l\'adulte est extrêmement rare et présente des spécificités histologiques et évolutives. Il peut représenter un véritable défi thérapeutique. Les auteurs rapportent 9 cas d\'hémangiomes laryngés de l\'adulte colligés rétrospectivement sur une période de 20 ans (1984- 2004). Il s\'agissait de 6 hommes et 3 femmes, âgés en moyenne de 46 ans (17 à 75 ans). Les signes d\'appel étaient la dysphonie dans tous les cas, associée à des hémorragies de sang rouge extériorisées par voie buccale chez 3 patients. Le diagnostic reposait dans tous les cas sur la laryngoscopie directe qui retrouvait une tuméfaction glottique de couleur bleutée, à surface lisse. Une biopsie avec examen anatomo-pathologique a été systématique. Tous les patients ont bénéficié d\'une exérèse instrumentale de la masse par voie endoscopique, avec hémostase locale. Deux récidives ont été notées, pour lesquels une seconde exérèse instrumentale par voie endoscopique a été réalisée avec une évolution favorable. Le recul moyen était de 9 ans.The adult laryngeal hemangioma is extremely rare and presents histological and evolutionary particularities. It can represent a real therapeutic challenge. The authors report 9 cases of adult laryngeal hemangiomas over a period of 20 years (1984-2004). It was about 6 man and 3 women, old on average of 46 years ( 17 - 75 years). The signs of appeal were the dysphonia in every case, associated to bleedings of red blood exteriorized with oral way in 3 cases. Diagnosis based in every case on the direct laryngoscopy which found a glottic tumefaction of bluish colour, in smooth surface. A biopsy with anatomo-pathological exam was realized in every case. All the patients benefited from an instrumental excision of the mass by endoscopic way, with local haemostasis. Two recurrences were noted, which benefited from a second endoscopic instrumental excision, with a favorable evolution. Average follow up was of 9 years. Journal Tunisien d\'ORL et de chirurgie cervico-faciale Vol. 16 2006: pp. 5-

Pomological and Olive Oil Quality Characteristics Evaluation under Short Time Irrigation of Olive Trees cv. Chemlali with Untreated Industrial Poultry Wastewater

The aim of this work was the investigation of the effect of wastewater generated from the poultry meat industry on the irrigation of olive trees, during a short time period, in order to evaluate its impact on pomological criteria and olive oil quality. Olive trees were subjected to irrigation with different water qualities: (i) poultry wastewater (PWW), (ii) poultry wastewater diluted with tap water 50:50 (v/v) (PWTWW), (iii) rain-fed cultivation system (control). The results showed that PWTWW contains the optimal mineral proportions, leading to improved pomological criteria. However, the highest significant pulp oil content was obtained using poultry wastewater irrigation (69.51%), while this was 66.71% using diluted poultry wastewater, and 58.03 % for the control. Poultry wastewater irrigation yielded the best results in oil standard quality indices. In addition, an enrichment in oil total polyphenols content was achieved. The oil fatty acid profile was not affected following irrigation with poultry wastewater. Nevertheless, there was a significant increase in the contents of oleic acid and alcohols, accompanied by a decrease in total sterols. However, heavy metals accumulation was observed in both fruits and olive oil. In conclusion, our results suggest that among the three water qualities, poultry wastewater is the best alternative to improve olive oil quality

Proenkephalin A 119-159 (Penkid) Is an Early Biomarker of Septic Acute Kidney Injury: The Kidney in Sepsis and Septic Shock (Kid-SSS) Study

Introduction: Sepsis is the leading cause of acute kidney injury (AKI) in critically ill patients. The Kidney in Sepsis and Septic Shock (Kid-SSS) study evaluated the value of proenkephalin A 119-159 (penkid)—a sensitive biomarker of glomerular function, drawn within 24 hours upon intensive care unit (ICU) admission and analyzed using a chemiluminescence immunoassay—for kidney events in sepsis and septic shock. Methods: The Kid-SSS study was a substudy of Adrenomedullin and Outcome in Severe Sepsis and Septic Shock (AdrenOSS) (NCT02393781), a prospective, observational, multinational study including 583 patients admitted to the intensive care unit with sepsis or septic shock and a validation cohort of 525 patients from the French and euRopean Outcome reGistry in Intensive Care Units (FROG-ICU) study. The primary endpoint was major adverse kidney events (MAKEs) at day 7, composite of death, renal replacement therapy, and persistent renal dysfunction. The secondary endpoints included AKI, transient AKI, worsening renal function (WRF), and 28-day mortality. Results: Median age was 66 years (interquartile range 55–75), and 28-day mortality was 22% (95% confidence interval [CI] 19%−25%). Of the patients, 293 (50.3%) were in shock upon ICU admission. Penkid was significantly elevated in patients with MAKEs, persistent AKI, and WRF (median = 65 [IQR = 45–106] vs. 179 [114–242]; 53 [39–70] vs. 133 [79–196] pmol/l; and 70 [47–121] vs. 174 [93–242] pmol/l, all P < 0.0001), also after adjustment for confounding factors (adjusted odds ratio = 3.3 [95% CI = 1.8–6.0], 3.9 [95% CI = 2.1–7.2], and 3.4 [95% CI = 1.9–6.2], all P < 0.0001). Penkid increase preceded elevation of serum creatinine with WRF and was low in renal recovery. Conclusion: Admission penkid concentration was associated with MAKEs, AKI, and WRF in a timely manner in septic patients

Circulating adrenomedullin estimates survival and reversibility of organ failure in sepsis: the prospective observational multinational Adrenomedullin and Outcome in Sepsis and Septic Shock-1 (AdrenOSS-1) study

Background: Adrenomedullin (ADM) regulates vascular tone and endothelial permeability during sepsis. Levels of circulating biologically active ADM (bio-ADM) show an inverse relationship with blood pressure and a direct relationship with vasopressor requirement. In the present prospective observational multinational Adrenomedullin and Outcome in Sepsis and Septic Shock 1 (, AdrenOSS-1) study, we assessed relationships between circulating bio-ADM during the initial intensive care unit (ICU) stay and short-term outcome in order to eventually design a biomarker-guided randomized controlled trial. Methods: AdrenOSS-1 was a prospective observational multinational study. The primary outcome was 28-day mortality. Secondary outcomes included organ failure as defined by Sequential Organ Failure Assessment (SOFA) score, organ support with focus on vasopressor/inotropic use, and need for renal replacement therapy. AdrenOSS-1 included 583 patients admitted to the ICU with sepsis or septic shock. Results: Circulating bio-ADM levels were measured upon admission and at day 2. Median bio-ADM concentration upon admission was 80.5 pg/ml [IQR 41.5-148.1 pg/ml]. Initial SOFA score was 7 [IQR 5-10], and 28-day mortality was 22%. We found marked associations between bio-ADM upon admission and 28-day mortality (unadjusted standardized HR 2.3 [CI 1.9-2.9]; adjusted HR 1.6 [CI 1.1-2.5]) and between bio-ADM levels and SOFA score (p < 0.0001). Need of vasopressor/inotrope, renal replacement therapy, and positive fluid balance were more prevalent in patients with a bio-ADM > 70 pg/ml upon admission than in those with bio-ADM ≤ 70 pg/ml. In patients with bio-ADM > 70 pg/ml upon admission, decrease in bio-ADM below 70 pg/ml at day 2 was associated with recovery of organ function at day 7 and better 28-day outcome (9.5% mortality). By contrast, persistently elevated bio-ADM at day 2 was associated with prolonged organ dysfunction and high 28-day mortality (38.1% mortality, HR 4.9, 95% CI 2.5-9.8). Conclusions: AdrenOSS-1 shows that early levels and rapid changes in bio-ADM estimate short-term outcome in sepsis and septic shock. These data are the backbone of the design of the biomarker-guided AdrenOSS-2 trial. Trial registration: ClinicalTrials.gov, NCT02393781. Registered on March 19, 2015