Étude comparative tensiomètre automatique versus doppler à ultrasons dans la mesure de l’index de pression systolique à la cheville (Ipsc)

ObjectifL’évaluation de l’index de pression systolique à la cheville (IPSC) est la méthode non invasive la plus simple de dépistage de l’artériopathie des membres inférieurs (AOMI) mais reste peu usitée en pratique courante, car elle est chronophage, implique un équipement et une formation appropriés. Le but de notre étude est d’évaluer la validité et la fiabilité de la mesure de l’IPSC à l’aide d’un tensiomètre automatique par comparaison avec les résultats obtenus par doppler continu, méthode de référence. Méthodes Les patients de 65 ans et plus hospitalisés au CHU d’Angers de juillet 2008 à mars 2009 en médecine interne et n’ayant pas d’AOMI documentée au moment de l’inclusion ont participé à l’étude. Les critères d’exclusion étaient la présence d’une fibrillation auriculaire et une incompressibilité des artères distales des membres inférieurs. Pour chaque patient, l’IPSC a été évalué par tensiomètre automatique et par la méthode Doppler de référence ; ces mesures étant faites par le même examinateur. La concordance entre les deux mesures était appréciée par la méthode de Bland et Altman et le coefficient de corrélation intraclasse (ICC). Résultats Sur 287 patients participant à l’étude, 221 ont étés inclus. Cinquante-six (25 %) de ces patients avaient un IPSC < 0,90. La concordance entre les deux méthodes était médiocre : ICC à 0,35 ± 0,08 et moyenne à 0,08 ± 0,26 selon la méthode de Bland et Altman. Conclusion La méthode de dépistage de l’AOMI par mesure de l’IPSC par tensiomètre automatique ne peut être retenue comme une alternative à la méthode Doppler

Roughness at the depinning threshold for a long-range elastic string

In this paper, we compute the roughness exponent zeta of a long-range elastic string, at the depinning threshold, in a random medium with high precision, using a numerical method which exploits the analytic structure of the problem (`no-passing' theorem), but avoids direct simulation of the evolution equations. This roughness exponent has recently been studied by simulations, functional renormalization group calculations, and by experiments (fracture of solids, liquid meniscus in 4He). Our result zeta = 0.390 +/- 0.002 is significantly larger than what was stated in previous simulations, which were consistent with a one-loop renormalization group calculation. The data are furthermore incompatible with the experimental results for crack propagation in solids and for a 4He contact line on a rough substrate. This implies that the experiments cannot be described by pure harmonic long-range elasticity in the quasi-static limit.Comment: 4 pages, 3 figure

Width distribution of contact lines on a disordered substrate

We have studied the roughness of a contact line of a liquid meniscus on a disordered substrate by measuring its width distribution. The comparison between the measured width distribution and the width distribution calculated in previous works, extended here to the case of open boundary conditions, confirms that the Joanny-de Gennes model is not sufficient to describe the dynamics of contact lines at the depinning threshold. This conclusion is in agreement with recent measurements which determine the roughness exponent by extrapolation to large system sizes.Comment: 4 pages, 3 figure

Antithrombotic effects of hydroxychloroquine in primary antiphospholipid syndrome patients

International audienc

Impact of front line relative dose intensity for methotrexate and comorbidities in immunocompetent elderly patients with primary central nervous system lymphoma

Primary central nervous system lymphomas (PCNSL) are non-Hodgkin lymphomas strictly localized to the CNS, occurring mainly in elderly patients with comorbidities. Current treatment in fit patients relies on high-dose methotrexate and high-dose cytarabine. The aim of this study was to evaluate the efficacy and feasibility of this treatment in elderly patients and to assess potential prognostic factors associated with survival. We conducted a retrospective study in two centers between January 2008 and September 2015 including 35 elderly immunocompetent patients who received first-line treatment with high-dose methotrexate. With a median follow-up of 19.8 months (range: 1.7-73.4 months), median overall survival (OS) was 39.5 months (95% confidence interval (95% CI): 18.3-60.7) and median progression-free survival (PFS) was 25.8 months (95% CI: 5.2-46.4). In univariate analysis, administration of high-dose cytarabine and achieving a relative dose intensity for methotrexate > 75% were associated with increased OS (p = 0.006 and p = 0.003, respectively) and PFS (p = 0.003 and p = 0.04, respectively) whereas comorbidities, defined by a CIRS-G score ≥ 8, were associated with decreased OS and PFS (p = 0.02 and p = 0.04, respectively). A high MSKCC score was associated with decreased OS (p = 0.02). In multivariate analysis, administration of high-dose cytarabine was associated with increased OS and PFS (p = 0.02 and p = 0.007, respectively). Comorbidities and relative dose intensity for methotrexate are important for the prognosis of elderly patients with PCNSL. These results must be confirmed in prospective trials

Splenectomy and/or cyclophosphamide as salvage therapies in thrombotic thrombocytopenic purpura: the French TMA Reference Center experience: SALVAGE THERAPIES IN SEVERE TTP

BACKGROUND: The objective was to assess the efficacy and safety of splenectomy and cyclophosphamide as salvage therapies in severe thrombotic thrombocytopenic purpura (TTP).STUDY DESIGN AND METHODS: During a 10-year period, patients who did not improve with plasma exchanges, steroids, vincristine, and/or rituximab were considered for splenectomy or cyclophosphamide. Patients with a documented severe (<10% of normal value) acquired ADAMTS13 deficiency are reported here. RESULTS: Eighteen patients with a severe acquired ADAMTS13 deficiency required a salvage therapy. Thirteen patients had a splenectomy 19 (interquartile range [IQR], 10-51) days after TTP diagnosis. One patient died the day after splenectomy. The remaining patients improved platelets (PLTs) until Day 6, along with a rapid and major lactate dehydrogenase improvement. Six patients, however, subsequently experienced a transient worsening. Durable PLT count recovery in survivors was observed within 13 (IQR, 11.5-25.5) days. Postoperative complications included thromboembolic events (two cases) and infections (five cases). Five patients received pulses of cyclophosphamide 12 (IQR, 12-15) days after TTP diagnosis. All patients recovered PLTs 10 (IQR, 9-24) days after the first pulse and two experienced a transient worsening. Three patients experienced infections. Three relapses occurred 5 months, 2.5 years, and 4.5 years after splenectomy and one relapse occurred 3.5 years after cyclophosphamide. After a 2.5 (IQR, 0.75-6.2)-year follow-up, the overall survival was 94%. CONCLUSION: Cyclophosphamide and splenectomy provide comparable high remission rates in severe TTP with acceptable side effects and should be considered in the more severe patients who do not improve with other therapies

Genome-wide meta-analysis of common variant differences between men and women

The male-to-female sex ratio at birth is constant across world populations with an average of 1.06 (106 male to 100 female live births) for populations of European descent. The sex ratio is considered to be affected by numerous biological and environmental factors and to have a heritable component. The aim of this study was to investigate the presence of common allele modest effects at autosomal and chromosome X variants that could explain the observed sex ratio at birth. We conducted a large-scale genome-wide association scan (GWAS) meta-analysis across 51 studies, comprising overall 114 863 individuals (61 094 women and 53 769 men) of European ancestry and 2 623 828 common (minor allele frequency >0.05) single-nucleotide polymorphisms (SNPs). Allele frequencies were compared between men and women for directly-typed and imputed variants within each study. Forward-time simulations for unlinked, neutral, autosomal, common loci were performed under the demographic model for European populations with a fixed sex ratio and a random mating scheme to assess the probability of detecting significant allele frequency differences. We do not detect any genome-wide significant (P < 5 × 10−8) common SNP differences between men and women in this well-powered meta-analysis. The simulated data provided results entirely consistent with these findings. This large-scale investigation across ∼115 000 individuals shows no detectable contribution from common genetic variants to the observed skew in the sex ratio. The absence of sex-specific differences is useful in guiding genetic association study design, for example when using mixed controls for sex-biased trait