Rifted margins classification and forcing parameters.

Rifted margins are the result of the successful process of thinning and breakup of the continental lithosphere leading to the formation of new oceanic lithosphere. Observations on rifted margins are now integrating an increasing amount of multi-channel seismic data and drilling of several Continent-Ocean Transitions. Based on large scale geometries and domains observed on high-quality multi-channel seismic data, this article proposes a classification reflecting the mechanical behavior of the crust from localized to diffuse deformation (strong/coupled to weak/decoupled mechanical behaviors) and magmatic intensity leading to breakup from magma-rich to magma-poor margins. We illustrate a simple classification based on mechanical behavior and magmatic production with examples of rifted margins. We propose a non-exhaustive list of forcing parameters that can control the initial rifting conditions but also their evolution through time. Therefore, rifted margins are not divided into opposing types, but described as a combination and continuum that can evolve through time and space.

Should a psychotic or manic episode be considered an early manifestation of Multiple Sclerosis? A multiple case study.

BACKGROUND: Early manifestations of Multiple Sclerosis (MS) can be atypical and misleading, and several case report studies have highlighted that MS onset sometimes takes the form of a psychotic or manic episode. METHODS: All neurologists belonging to the French Multiple Sclerosis Observatory network were contacted by email and were asked to find patients with MS who presented with a history of psychiatric episode(s) near MS onset. RESULTS: Seventeen patients were selected that met the criteria of presenting with psychotic or manic symptoms either before the diagnosis of MS (N=8), or at the time of the first neurological episode or shortly after (N=9). Patients with a history of a psychiatric episode occurring before the first neurological episode were diagnosed on average 7 years later than patients with either a first neurological or a mixed (both neurological and psychiatric) episode. However, psychiatric symptoms in the first group and the first neurological symptoms of MS in the second group occurred at a similar age. CONCLUSION: Based on this multiple case study, we question whether past psychotic or manic episode should be considered equivalent to a first manifestation of MS.

Scoring system to predict the risk of surgical-site infection after colorectal resection.

BACKGROUND: There is no dedicated scoring system for predicting the risk of surgical-site infection (SSI) after resection of the colon or rectum. Generic scores, such as the National Nosocomial Infections Surveillance index, are not used by colorectal surgeons. METHODS: Multivariable analysis of risk factors for SSI was performed in patients who underwent resection of the colon or rectum, and were followed during the first month after operation. A logistic regression model was used to identify determinant variables and construct a predictive score. RESULTS: There were 534 patients of whom 114 (21·3 per cent) developed SSI. In multivariable analysis, four parameters correlated with an increased risk of SSI: obesity (odds ratio (OR) 2·93, 95 per cent confidence interval 1·71 to 5·03), contamination class 3-4 (OR 3·33, 2·08 to 5·32), American Society of Anesthesiologists grade III-IV (OR 1·82, 1·14 to 2·90) and open surgery (OR 2·22, 1·01 to 4·88). Each of these contributed 1 point to the risk score. The observed risk of SSI was 5 per cent for a score of 0, 12·0 per cent for a score of 1 point, 18·7 per cent for 2 points, 44 per cent for 3 points and 68 per cent for 4 points. The area under the receiver operating characteristic curve for the score was 0·729. CONCLUSION: A simple clinical score based on four preoperative variables was clinically useful in predicting the risk of SSI in patients undergoing colorectal surgery.

[Limbic encephalitis with severe sleep disorder associated with voltage-gated potassium channels (VGKCs) antibodies]. / Encéphalite limbique avec anticorps anticanaux potassiques voltage dépendants et troubles sévères du sommeil.

INTRODUCTION: Voltage-gated potassium channels (VGKCs) antibodies are associated with neuromyotonia, limbic encephalitis and Morvan syndrome. CASE REPORT: We report the case of a patient who, after three weeks of fever, presented an anamnestic syndrome, associated with confusion and partial seizures. MRI showed left hyperintensity of mesial temporal structures on Flair images and right hippocampal atrophy on T1 weighted sequences. Laboratory tests only showed high level of anti-TPO antibodies. Thus, the patient was considered as having Hashimoto's encephalopathy. She was treated with intravenous methylprednisolone with no improvement of symptoms. On the contrary, the patient suffered from insomnia, deep diurnal drowsiness and complete disappearance of REM sleep. Episodes of hypothermia and severe hyponatremia were recorded. Serum VGKC antibodies were found at high level. After intravenous immunoglobulin treatment followed by methylprednisolone, we noted remarkable improvement of clinical status. Polysomnography showed reappearence of REM sleep. CONCLUSION: This case report broadens the spectrum of clinical manifestations associated with VGKC antibodies and suggests that VGKC are implicated in regulation of sleep. The potential pathophysiological mechanisms linking sleep disturbances and VGKC antibodies are discussed.

[Fatal giant cell arteritis with severe bilateral involvement of the vertebral arteries]. / Maladie de Horton d'évolution fatale avec atteinte sévère bilatérale des artères vertébrales.

With steroid therapy, it is commonly considered that prognosis is good in giant cell arteritis. However serious or even fatal complications may occur. Here we report the case of a patient who developed fatal giant cell arteritis with severe stenosis of both vertebral arteries and right carotid siphon. Several similar cases have been reported in the literature. Initially diagnosis may be difficult because neurological manifestations are intermittent and classical signs of giant cell arteritis may be lacking. In such condition the reason of poor outcome is unknown and therapy remains empiric.

Idiopathic acute transverse myelitis: application of the recent diagnostic criteria.

Despite an extensive diagnostic workup, some cases of acute transverse myelitis (ATM) remain of unknown etiology and have been referred to as "idiopathic" by the Transverse Myelitis Consortium group. In a retrospective study of 288 patients with ATM, 45 cases (15.6%) met the criteria for idiopathic ATM. The patients formed a relatively homogeneous group in terms of clinical and MRI data, but the prognosis was highly variable.

[Asperger syndrome in childhood: review of four cases]. / Syndrome d'Asperger chez l'enfant: à propos de quatre observations.

INTRODUCTION: Asperger syndrome is a pervasive developmental disorder included lately in the international classifications. OBSERVATIONS: We report the observations of four children presenting this syndrome. For every patient, we collected antecedents and psychomotor development; we made neuropsychological assessment and video recording. Three patients underwent an EEG and one a cerebral MRI. RESULTS: These patients were between ten- and sixteen-year old. The neuropsychological assessment showed a heterogeneous intellectual functioning with three times out of four a dissociation between high verbal level and low non-verbal level. Their language appeared sophisticated, apragmatic, their comprehension was inflexible. The mean age at diagnosis was ten years. They showed a sociability and autonomy improvement but they were conscious of their difference and suffered from it. CONCLUSION: Our four cases allow to present Asperger syndrome, slightly known in France. Collaborative studies and genetic studies are necessary to improve the knowledge of this syndrome.

Hashimoto's encephalopathy: exacerbations associated with menstrual cycle.

The authors report a patient who had five relapses of encephalopathy with seizures and aseptic meningitis that coincided with the end of the menstrual cycle. High titers of antithyroid antibodies and the patient's response to corticosteroids suggested Hashimoto's encephalopathy. Pharmacologic suppression of the menstrual cycle made it possible to withdraw corticosteroids.

Structure and low-temperature thermal relaxation of ion-implanted germanium.

The structure of implantation-induced damage in Ge has been investigated using high resolution extended X-ray absorption fine structure spectroscopy (EXAFS). EXAFS data analysis was performed with the Cumulant Method. For the crystalline-to-amorphous transformation, a progressive increase in bond-length was observed without the presence of an asymmetry in interatomic distance distribution (RDF). Beyond the amorphization threshold the RDF was dose dependent and asymmetric, where the bond-length and asymmetry increased as functions of ion dose. Such an effect was attributed to the formation of three- and five-fold coordinated atoms within the amorphous phase. Low-temperature thermal annealing resulted in structural relaxation of the amorphous phase as evidenced by a reduction in the centroid, asymmetry and width of the RDF, as consistent with a reduction in the fraction of non four-fold coordinated atoms. The results have been compared to other EXAFS studies of amorphous Ge, and it is suggested that the range of bond-lengths reported therein is related to the sample preparation method and state of relaxation.

Disease expression of Lyme borreliosis in northeastern France.

Since very little is known about the clinical expression of Lyme borreliosis in Western Europe, a 3-year prospective study was conducted that included all patients seen for suspected Lyme borreliosis at the Strasbourg University Hospital in northeastern France. The diagnosis of Lyme borreliosis was made on the basis of the presence of erythema migrans or on the basis of another suggestive clinical manifestation and laboratory confirmation. A total of 132 patients, 70 women and 62 men, mean age 54 years, had Lyme borreliosis according to these criteria. Within this study group, 77% of the patients were regularly exposed to tick bites and 64% could remember one. Erythema migrans, the most frequent clinical manifestation, occurred in 60% of the patients and was the only sign of Lyme borreliosis in 40%. Lymphocytoma and acrodermatitis chronica atrophicans were rare (1 and 3 patients, respectively). Nervous system involvement (mainly radiculoneuropathy), the second most common clinical manifestation, was found in 40% of the patients and was the only sign of Lyme borreliosis in 22%. Musculoskeletal involvement was present in 26% of the patients and was an isolated finding in 14%. During the study period, no patient was diagnosed with Lyme carditis. There was serological evidence of Lyme borreliosis in 75% of the cases and direct evidence of borrelial infection in 10 (7.5%). The results show that the clinical expression of Lyme borreliosis in northeastern France is similar to that in other European countries but different from that in North America.

[HIV-1 Tat protein induces IL-10 production by human monocytes: implications of the PKC and calcium pathway]. / La protéine Tat du VIH-1 induit la production d'IL-10 par le monocyte humain: implication de la voie PKC et de la voie calcique.

In asymptomatic patients infected by HIV-1, the level of IL-10, a cytokine with immunosuppressive activity, is associated with the course of HIV infection towards AIDS. We show that HIV-1 Tat, a viral protein secreted by infected cells, induces IL-10 production by human peripheral blood monocytes. The analysis of the signal transduction pathways strongly suggests that the protein kinase C may play an essential role in this induction. Stimulation by Tat induces nuclear translocation of the transcription factor NFkB the activation of which seems to be necessary for IL-10 production. Using microspectrofluorimetry and confocal microscopy, we also show that Tat induces a calcium influx.

In patients with cirrhosis, serum albumin determination should be carried out by immunonephelometry rather than by protein electrophoresis.

OBJECTIVE: Serum albumin is a key parameter for prognosis in cirrhosis. We compared levels of serum albumin determined by both protein electrophoresis and immunonephelometry, with special reference to the Child-Pugh classification. DESIGN AND METHODS: One hundred and thirty-one patients, including 39 with cirrhosis, were included prospectively during 2 months. The aetiology of cirrhosis was mainly alcoholism (67%) and hepatitis C virus (HCV) (18%). Serum albumin was determined simultaneously by electrophoresis (Hydrasys SEBIA following protein determination by the biuret reaction) and by immunonephelometry (BECKMAN Nephelometer). Values were compared by non-parametric tests. RESULTS: For the whole population, electrophoretic and immunonephelometric values correlated (p = 0.85; P < 0.0001), but electrophoresis significantly overestimated serum albumin by a median 1.6 g/l (P < 0.0001) with a large spread in values (range, -3.9 to 12.7). Median overestimation in cirrhosis was 2.6 g/l (P < 0.0001; range, -2.0 to 10.2) and 1.0 g/l (P < 0.0001; range, -3.9 to 12.7) in patients without cirrhosis (difference, P < 0.02). For 6/39 (15.4%) patients with cirrhosis, this overestimation led to an underestimation in the Child-Pugh classification. CONCLUSION: In our experience, electrophoresis can lead to serum albumin values which are significantly different compared to those obtained by immunonephelometry. This discrepancy may lead to an incorrect Child-Pugh classification. Therefore, in the follow-up of cirrhotic patients, serum albumin should be determined by immunonephelometry.

Assessment of wrought ASTM F1058 cobalt alloy properties for permanent surgical implants.

The behavior of the ASTM F1058 wrought cobalt-chromium-nickel-molybdenum-iron alloy (commonly referred to as Elgiloy or Phynox) is evaluated in terms of mechanical properties, magnetic resonance imaging, corrosion resistance, and biocompatibility. The data found in the literature, the experimental corrosion and biocompatibility results presented in this article, and its long track record as an implant material demonstrate that the cobalt superalloy is an appropriate material for permanent surgical implants that require high yield strength and fatigue resistance combined with high elastic modulus, and that it can be safely imaged with magnetic resonance.

Neointima formation following arterial placement of self-expanding stents of different radial force: experimental results.

PURPOSE: Radial force delivered by self-expanding stents has been discussed as a factor affecting thickness of neointima formation. METHODS: Two types of Wallstents were studied experimentally in vitro and in vivo. Due to an altered braiding angle of the stent filaments, one stent type (LS type) delivers half the radial force to the vascular wall than the conventional type. The radial force was evaluated in a compression-expansion test which related changes in stent length to the compressing force. Fourteen LS and 16 conventional stents were implanted into 15 femoropopliteal arteries of 10 dogs. Autopsy was performed after 4 weeks (14 stents) or 6 months (16 stents). RESULTS: All stents remained patent over the follow-up period with no evidence of stenosis. Neointimal overgrowth was complete and smooth in all. Medial atrophy was a constant finding after placement of both types. Neointimal thickness did not exceed 100 microns after 4 weeks and 6 months and did not significantly differ between LS stents and conventional stents. CONCLUSION: It is concluded that in normal dogs self-expanding stents of the Wallstent type do not induce neointimal buildup that exceeds 100 microns in the femoropopliteal artery. A reduced radial force was not found to result in reduced neointima formation.