La production scientifique issue de la formation initiale à la faculté de médecine d’Angers entre 2002 et 2008 : de bonne qualité mais insuffisante

IntroductionL’activité de publication scientifique issue de la formation initiale est mal connue. Nous avons évalué la proportion des thèses et des mémoires de spécialité aboutissant à une publication, leur impact en termes de points SIGAPS et les principaux obstacles à la publication de ces travaux. Méthodes Les thèses de doctorat en médecine soutenues de 2002 à 2008 à la faculté de médecine d’Angers ont été recensées à partir du système universitaire de documentation (SUDOC), et les mémoires de spécialité directement auprès des diplômés. Les publications ont été recherchées dans Medline via Pubmed, ISI Web of Knowledge et dans les trois rapports SIGAPS de 2002 à 2008. Une enquête cherchant à connaître les obstacles à la publication a été lancée auprès de tous les directeurs de thèses et responsables de discipline impliqués. Résultats Cinq cent quatre-vingt-dix-huit thèses ont été soutenues, 311 (52 %) en médecine générale et 287 (48 %) en spécialités. Cent soixante-cinq thèses ont donné lieu à publication (28 %) dont 97 (16 %) indexés dans Medline via Pubmed (soit 11 % en médecine générale et 22 % en spécialité). Trente-trois de ces 97 articles (35 %) ont été publiés dans des journaux de haute qualité classés A, B ou C de la classification SIGAPS. Ces articles issus des thèses ont représenté 4,17 % du score SIGAPS du CHU calculé sur un total de 2088 articles au cours de cette période. Deux cent quatre mémoires de spécialités ont donné lieu à 69 articles (33,8 %), dont 50 (24,5 %) indexés dans Medline. Les taux de publication des mémoires de DES et de DESC ont été respectivement de 31 % (45/145) et de 40,7 % (24/59). Ils ont représenté 1,9 % (432 points) du score total SIGAPS. Les principaux obstacles ressentis pour la publication ont été le manque de temps des directeurs, l’éloignement des étudiants après la soutenance et le manque de moyens logistiques. Conclusion La production scientifique issue de la formation initiale à la faculté de médecine d’Angers a été de bonne qualité mais insuffisante quantitativement et peu contributive au financement du CHU malgré un nombre important de diplômés. Un soutien logistique mérite d’être envisagé afin de valoriser la production scientifique issue de la formation initiale

Thigh Ultrasound Monitoring Identifies Decreases in Quadriceps Femoris Thickness as a Frequent Observation in Critically Ill Children.

OBJECTIVES: Significant muscle wasting develops in critically ill adults, with subsequent worse outcomes. In the pediatric setting, occurrence and effects of muscle wasting are undescribed; this is in part due to a lack of validated, objective methods for assessing muscle wasting. A single measurement of quadriceps femoris thickness has failed to show consistent reproducibility. We hypothesized that averaging repeated measurements could afford good reproducibility to allow for quadriceps femoris thickness decline detection and monitoring. DESIGN: A prospective bedside observational study. SETTING: Two PICUs. PATIENTS: Mechanically ventilated critically ill children were 15 years and younger. INTERVENTIONS: Transverse and longitudinal axis measurements of quadriceps femoris anterior thickness were undertaken using bedside ultrasound. The average of four measurement values was recorded. The location of measurement was marked for consistency within subsequent measurements by the same or another trained operator, to assess intra- and interoperator repeatability and reproducibility of the technique. Where feasible, serial measurements were undertaken until the time of extubation in a group of children with prolonged PICU stay (> 5 d). MEASUREMENTS AND MAIN RESULTS: Seventy-three children were enrolled to assess intra- and interoperator ultrasound reliability. Their median (25-75 interquartile range) age and weight were 30 months (4.5-96) and 10 kg (5-23.5). In the intraoperator repeatability study, mean relative difference in quadriceps femoris muscle thickness was 0.36% ± 2.5% (lower and upper limits of agreement: -4.5/+5.2%). In the interoperator reproducibility study, intraclass correlation coefficient was 0.998. In the 17 children monitored over their PICU stay, quadriceps femoris thickness significantly decreased at day 5 by 9.8% (p = 0.006) and by 13.3% (< 0.001) at the last performed measurement. CONCLUSIONS: Quadriceps femoris thickness decrease, proposed as a surrogate for muscle mass, is an early, frequent, and intense phenomenon in PICU. Quadriceps femoris ultrasonography is a reliable technique to monitor this process and in future could help to guide rehabilitation and nutrition interventions.The study was founded by ALLP (Association Lyonnaise de Logistique posthospitalière) 2015 grant. FVV has received consultant honoraria from Nutricia and Baxter and grants from Baxter, Nestle, Institut Aguettant, ALLP and Fresenius Kabi. For the remaining authors none were declared

Exploration de la variabilité génétique présente dans cinq peuplements naturels de pin Laricio de Corse (Pinus nigra ssp. laricio var. corsicana Loud.)

International audienc

Contrast-Enhanced and Time-of-Flight MRA at 3T Compared with DSA for the Follow-Up of Intracranial Aneurysms Treated with the WEB Device

International audienceBACKGROUND AND PURPOSE:Imaging follow-up at 3T of intracranial aneurysms treated with the WEB Device has not been evaluated yet. Our aim was to assess the diagnostic accuracy of 3D-time-of-flight MRA and contrast-enhanced MRA at 3T against DSA, as the criterion standard, for the follow-up of aneurysms treated with the Woven EndoBridge (WEB) system.MATERIALS AND METHODS:From June 2011 to December 2014, patients treated with the WEB in our institution, then followed for ≥6 months after treatment by MRA at 3T (3D-TOF-MRA and contrast-enhanced MRA) and DSA within 48 hours were included. Aneurysm occlusion was assessed with a simplified 2-grade scale (adequate occlusion [total occlusion + neck remnant] versus aneurysm remnant). Interobserver and intermodality agreement was evaluated by calculating the linear weighted κ. MRA test characteristics and predictive values were calculated from a 2 × 2 contingency table, by using DSA data as the standard of reference.RESULTS:Twenty-six patients with 26 WEB-treated aneurysms were included. The interobserver reproducibility was good with DSA (κ = 0.71) and contrast-enhanced-MRA (κ = 0.65) compared with moderate with 3D-TOF-MRA (κ = 0.47). Intermodality agreement with DSA was fair with both contrast-enhanced MRA (κ = 0.36) and 3D-TOF-MRA (κ = 0.36) for the evaluation of total occlusion. For aneurysm remnant detection, the prevalence was low (15%), on the basis of DSA, and both MRA techniques showed low sensitivity (25%), high specificity (100%), very good positive predictive value (100%), and very good negative predictive value (88%).CONCLUSIONS:Despite acceptable interobserver reproducibility and predictive values, the low sensitivity of contrast-enhanced MRA and 3D-TOF-MRA for aneurysm remnant detection suggests that MRA is a useful screening procedure for WEB-treated aneurysms, but similar to stents and flow diverters, DSA remains the criterion standard for follow-up