La bibliothèque Carnegie

La ville de Reims s’enorgueillit de posséder l’une des plus belles bibliothèques de France, véritable joyau bibliothéconomique et architectural : la bibliothèque Carnegie. Construit dans un contexte historique bien particulier, ce bâtiment spectaculaire abrite le patrimoine écrit de la ville de Reims. Du fait qu\u27elle est l’un des pôles de la BMVR bicéphale rémoise, la bibliothèque a profité, lors de sa rénovation menée en 2003-2004, de tous les progrès technologiques lui permettant d’assurer de façon optimale ses fonctions de bibliothèque d’étude et de conservation

Le coeur et la raison

Quand la censure s’applique aux hommes, cela s’appelle l’« exclusion ». Pourtant ne s’agit-il pas d’un même geste ? Interdire l’accès, soustraire à la vue ? Les enjeux sont-ils foncièrement différents

De la difficulté de prévoir

Le souci de maîtrise énergétique remonte à plusieurs décennies, pourtant, lorsque ouvre un nouvel établissement, les surprises sont encore souvent au rendez-vous. La programmation initiale ne suffit pas toujours à empêcher des choix techniques inadéquats ou des problèmes de suivi de chantier qui conduisent à un fonctionnement décevant et/ou coûteux. La vigilance est donc requise à toutes les étapes. Exemple

Clinical Study Adoptive TIL Transfer in the Adjuvant Setting for Melanoma: Long-Term Patient Survival

Two first analyses of our clinical trial on TIL as adjuvant therapy for melanoma were published in 2002 and 2007. We present here an update of the clinical results after a 17-year median followup. In this trial, disease-free patients were randomly assigned to receive either TIL/IL-2 or IL-2. The relapse-free survival (RFS) was the primary objective. Eighty-eight patients were enrolled. A new analysis performed in May 2013 did not show significant changes in RFS or OS duration. However, our first finding on the association between the number of invaded lymph nodes and TIL effectiveness was strengthened. The Cox model adjusted on this interaction showed for the first time a significant treatment effect when considering the overall population, both on the RFS and OS. Patients treated with TIL had a longer RFS ( = 0.023) or OS ( = 0.020). This study being with a very long followup (17 years), confirmed the association between TIL effectiveness and the number of invaded lymph nodes, indicating that a low tumor burden could be a crucial factor enhancing the curative effect of TIL in possible microscopic residual disease. Moreover, we confirmed that a prolonged survival was associated with the presence of specific TIL and a decrease in Foxp3 expression

Coping Strategies at the Time of Diagnosis and Quality of Life 2 Years Later: A Study in Primary Cutaneous Melanoma Patients

International audienceBACKGROUND: While coping has been found to have time-lagged effects on psychological adjustment in cancer patients, studies addressing this issue are missing in melanoma patients. OBJECTIVE: The aim of this study was to provide more insight into the links between coping strategies at the time of diagnosis and quality of life (QOL) 2 years later in patients with primary cutaneous melanoma. METHODS: Patients who received diagnosis of melanoma (n = 78) were assessed regarding coping strategies within 1 month of diagnosis (T1); their anxiety, depression, control, QOL, and life satisfaction were evaluated 24 months later (T2). Relevant medical and sociodemographic data were collected at T1 and T2. Hierarchical regression analyses were performed. RESULTS: Consistent with the literature, we found that higher positive reframing was associated with greater life satisfaction and that increased behavioral disengagement was related to decreased cognitive functioning. Surprisingly, our results highlighted that higher active coping predicted lower emotional functioning and that greater religious coping was associated with more reports of nausea symptoms. We also noticed that depression was strongly related to QOL beyond the end of interferon α therapy. CONCLUSION: The findings of the present study suggest that specific coping strategies may have time-lagged effects on QOL when the treatment is completed. IMPLICATIONS FOR PRACTICE: These findings provide new insights into the coping strategies that could be promoted in coping skills interventions in dermatology units and reveal the significant role of preventive care concerning the posttreatment period

Mycosis fongoïde bulleux : une présentation clinique exceptionnelle

International audienceIntroduction: Mycosis fungoides (MF) is the most common form of cutaneous lymphoma and usually manifests as erythematous and scaly patches or plaques. Its phenotypic or histologic presentation can be heterogeneous. Herein we report a very rare form of MF bullosa.Patients and methods: A 73-year-old man presented with a 4-month history of erythematous, scaly and itchy plaques on the trunk, as well as blistering lesions present for 2 months and which appeared on the trunk and lower limbs, both on patches of MF and on apparently healthy skin. Histopathology confirmed the diagnosis of bullous mycosis fungoides. Gene rearrangement of TCR showed a monoclonal profile in the skin. The hypothesis of bullous pemphigoid was ruled out by additional exams. Our patient was successively treated with combined interferon, bexarotene and methotrexate, followed by vorinostat, resulting in partial remission.Discussion: Cases of bullous MF are very rare. In the literature, the clinical presentation is heterogeneous, with tense or flaccid bullae that can occur on unaffected skin or on erythematous plaques. The bullae generally appear after the plaques. The histologic blister site may be subepidermal or, more rarely, intra-epidermal. The exact mechanism of blister formation is not clear. Its treatment is poorly codified but follows the usual treatment of MF in its classical form.Conclusion: Bullous MF is a very rare entity that can mimic autoimmune blistering disease, and this diagnosis must therefore be ruled out

Hypodermite sous inhibiteur de BRAF et/ou inhibiteur de MEK : revue de la littérature à partir d’une nouvelle observation

International audienceIntroduction: BRAF inhibitors±MEK inhibitors can cause panniculitis. Since the initial case described in 2012 by Zimmer et al., some sixty further cases have been reported. Based on a clinical study and a recent and complete review of the literature, we set out in detail the characteristics of panniculitis occurring during BRAF and MEK inhibition therapy as well as the treatment thereof.Patients and methods: A 25-year-old-patient followed for multi-metastatic melanoma and taking dabrafenib and trametinib consulted for the appearance, twenty-two days after the start of targeted therapy (TT), of panniculitis of the legs and forearms possibly induced by the TT after other causes had been ruled out. The TT had been continued following dose reduction and corticoid therapy for ten days, and complete resolution occurred after fifteen days.Results: Fifty-three cases of panniculitis during BRAF±MEK inhibition therapy were analysed. The condition occurred mainly with BRAF inhibitors alone (especially vemurafenib), but it was also described with three combinations of BRAF and MEK inhibitors, regardless of age (median: 45 years), with a M/F ratio of 0.51, and in 50 % of cases, it occurred within the first month (time to onset: between 1 and 480 days). Non-specific biopsy is useful to rule out differential diagnoses. Symptomatic anti-inflammatory treatment, whether systemic or topical, may be given. In the absence of signs of severity, the TT may be continued.Conclusion: When panniculitis occurs during BRAF±MEK inhibitor therapy, the causal role of the TT must be considered after full etiological investigation. It is essential to determine whether a causal relationship exists in order to avoid unwarranted cessation of treatment