[Evaluation of the implantation of a de-prescribing process for proton pump inhibitor (PPI) using an algorithm within an internal medicine department]. / Évaluation de l'implantation d'un processus de dé-prescription des inhibiteurs de la pompe à protons (IPP) à l'aide d'un algorithme au sein d'un service de médecine interne.

INTRODUCTION: The prescription of proton pump inhibitors (PPIs) seems excessive. Taken over the long term, PPIs can cause serious side effects. It therefore turns out to be justified to suspend treatments whose expected benefit seems too low compared to the risks involved : it is deprescription. The objective of this study is to assess a process for the deprescription of PPIs in a hospital internal medicine department. METHOD: After collegial deliberation, an algorithm for assisting in the deprescription of PPIs was validated. If necessary, the PPI was phased out over 1 month. A telephone follow-up at 1, 2 and 3 months was carried out in order to assess the maintenance of deprescription and the occurrence of digestive symptoms. The evaluation criteria were the rate of deprescription and the rate of maintenance of deprescription at 3 months following reports from patients, their caregivers or a family member. RESULTS: 105 patients with a mean age of 72 years were included over a period of 21 weeks, and in 31 cases (29%), deprescription was performed. After 3 months of follow-up, there was 71% maintenance of deprescription. Three patients were lost to follow-up and 6 patients resumed PPI. CONCLUSION: The approach undertaken resulted in the suspension of PPI intake in almost 3 out of 10 cases. This result was maintained at least three months for a large majority of patients. It will be interesting to continue this process and extend the monitoring over longer periods, in order to ensure that PPI de-prescription is maintained in the long term.

Hubless keypoint-based 3D deformable groupwise registration.

We present a novel algorithm for Fast Registration Of image Groups (FROG), applied to large 3D image groups. Our approach extracts 3D SURF keypoints from images, computes matched pairs of keypoints and registers the group by minimizing pair distances in a hubless way i.e. without computing any central mean image. Using keypoints significantly reduces the problem complexity compared to voxel-based approaches, and enables us to provide an in-core global optimization, similar to the Bundle Adjustment for 3D reconstruction. As we aim to register images of different patients, the matching step yields many outliers. Then we propose a new EM-weighting algorithm which efficiently discards outliers. Global optimization is carried out with a fast gradient descent algorithm. This allows our approach to robustly register large datasets. The result is a set of diffeomorphic half transforms which link the volumes together and can be subsequently exploited for computational anatomy and landmark detection. We show experimental results on whole-body CT scans, with groups of up to 103 volumes. On a benchmark based on anatomical landmarks, our algorithm compares favorably with the star-groupwise voxel-based ANTs and NiftyReg approaches while being much faster. We also discuss the limitations of our approach for lower resolution images such as brain MRI.

Femtosecond laser ablation of polypropylene: A statistical approach of morphological data.

We have investigated femtosecond (fs) laser (130 fs, 800 nm, 5 kHz) ablation of polypropylene (PP). The following laser process conditions were varied: power density and number of pulses. The morphological parameters' response (depth, ablation diameter, ablation volume) to the laser process conditions, measured by an optical profiler, was investigated by the statistical analysis technique to determine the relationship between them. For this, the simple linear regression and the multiple linear regressions are compared. The simple linear regression shows that the ablation volume follows a linear relationship with the product of the power and the number of pulse.

Origin and genetic diversity of Western European populations of the potato cyst nematode (Globodera pallida) inferred from mitochondrial sequences and microsatellite loci.

Native to South America, the potato cyst nematode Globodera pallida is one of the principal pests of Andean potato crops and is also an important global pest following its introduction to Europe, Africa, North America, Asia and Oceania. Building on earlier work showing a clear south to north phylogeographic pattern in Peruvian populations, we have been able to identify the origin of Western European populations with high accuracy. They are all derived from a single restricted area in the extreme south of Peru, located between the north shore of the Lake Titicaca and Cusco. Only four cytochrome b haplotypes are found in Western Europe, one of them being also found in some populations of this area of southern Peru. The allelic richness at seven microsatellite loci observed in the Western European populations, although only one-third of that observed in this part of southern Peru, is comparable to the allelic richness observed in the northern region of Peru. This result could be explained by the fact that most of the genetic variability observed at the scale of a field or even of a region is already observed at the scale of a single plant within a field. Thus, even introduction via a single infected potato plant could result in the relatively high genetic variability observed in Western Europe. This finding has important consequences for the control of this pest and the development of quarantine measures.

[Delayed tamponade and traumatic myocardial contusion: evaluate the risk after blunt chest trauma]. / Tamponnade tardive et contusion myocardique: un risque à évaluer après un traumatisme thoracique fermé

Cardiac contusion is frequently found in patients with blunt chest trauma. It is important to note that even if there is a low incidence of pericardial effusion, iterative echocardiography should be used to provide essential information for the diagnosis of cardiac tamponade which can be life-threatening during hospitalisation. The case has been reported of a 17-year-old patient with blunt thoracic trauma in whom the introduction of anticoagulant treatment induced a delayed cardiac tamponade with myocardiac failure 3 weeks after a cardiac contusion. Thoracic computed tomography confirmed the diagnosis and moreover, revealed a pleural effusion with pulmonary embolism. The drainage of the pericardial effusion (700 ml) rapidly restored haemodynamic stability and as such has been proved to be life-saving.

[Iatrogenic retroperitoneal haematoma after emergency femoral vein catheterisation]. / Hémopéritoine iatrogène après cathétérisme veineux fémoral en urgence.

We report a iatrogenic case of retroperitoneal haematoma consecutive to an emergency femoral venous catheterization. The indication of the catheterisation was a hemorrhagic shock after a dilapidating traumatism of leg in an obese patient in whom peripheric venous access was impossible and vascular filling urgent. In spite of the existence of an initial reassuring blood backward flow, a retroperitoneal haematoma had been constituted gradually and explained an absence of haemodynamic improvement in spite of the surgical haemostasis and an adapted intravascular filling. The CT scan showed an iatrogenic lesion of the right iliac vein and justified the immediate infusion stop. The femoral catheter was withdrawn at the 48th hour and the patient discharged at the 6th day.

Molecular Polymorphism and Morphometrics of Species of the Heterodera avenae Group in Syria and Turkey.

Molecular characterization of the three most common cereal cyst nematode species of the Heterodera avenae group (H. avenae, H. filipjevi, and H. latipons), originating from various locations in major cereal-cultivating areas in Syria and Turkey, showed distinct restriction fragment patterns of the ITS-rDNA following PCR amplification and RFLP digestion with four endonucleases (Hae III, Hinf I, Ita I, and Pst I). Genetic dissimilarity within H. avenae group populations increased in comparison with H. avenae and other species; it was 0.164 with H. filipjevi and 0.354 with H. latipons populations. No intraspecific polymorphism was observed within H. latipons or H. filipjevi populations. Principal component analysis revealed contrasted correlations among 12 morphological parameters of cysts and juveniles of the three Heterodera species that separated them and distinguished differences within populations of H. latipons. Our results showed a clear separation of the three cyst nematode species on cereal using a conventional method for classification and molecular tests, and confirmed the congruence between genetics and morphological traits.

[Amniotic fluid embolism during labor]. / Embolie amniotique en cours de travail.

Amniotic fluid embolism is an unpredictable but dramatical complication of pregnancy that occurs when amniotic fluid enter into the maternal circulation. The classical clinical feature is acute respiratory distress, circulatory distress, seizures and coagulopathy. However there is no routine laboratory diagnosis, so that is a diagnosis of exclusion. We report here the case of a patient, on labor with an epidural analgesia who suddenly suffered from seizures, circulatory arrest, and haemorrhage. A symptomatic management was instituted and a caesarean section was performed. An haemostatic hysterectomy was required. The patient survived without any sequelae. Neurological outcome of the child is still reserved.

[Anesthesia and obesity]. / Anesthésie et obésité

Problems encountered during anesthesia procedures in obese subjects is related to the level of overweight. Obesity multiplies the effect of general anesthesia on the respiratory function and increases the postoperative risk of cardiovascular disorders and deep vein thrombosis. The pharmacokinetic behavior of most general anesthesia drugs is affected by the mass of adipose tissue producing a prolonged less predictable effect. Control of airway permeability and continence is also a major problem with predictable or unpredictable difficulties with endotracheal intubation. Locoregional anesthesia, which avoids the intubation problem, is difficult to implement and does not provide satisfactory results in all cases. The preoperative work-up should assess the consequences of obesity, particularly concerning the respiratory, cardiovascular, and metabolic systems. A proper work-up allows the anesthesist to provide the obese subject with well-informed information on the risk and benefit of proposed options.

Intra-species DNA polymorphism in the tobacco cyst-nematode complex (Globodera tabacum) using AFLP.

Amplified fragment length polymorphism (AFLP) was used to obtain information on the within-species genetic variability of the tobacco cyst-nematode (TCN) complex. AFLP was found to be well suited to this type of study. The current classification of TCN was confirmed. Results indicate that the Globodera tabacum solanacearum group, believed to be restricted to the U.S.A., also occurs in Mexico. The within-species variability of TCN is considerable. Populations from Mexico may form a new subgroup. AFLP group-specific markers were identified for two of the TCN subgroups: Globodera tabacum tabacum and Globodera tabacum solanacearum.

Integrated Fresnel lens on thermally oxidized silicon substrate.

Thin film Fresnel lenses have been achieved on SiO(2)/Si substrates covered with a waveguide layer of Si(3)N(4) grown by low pressure chemical vapor deposition (LPCVD). The phase shift between the different zones is induced by a SiO(2) top layer chemically etched. The use of this additional layer having a smaller refractive index than the waveguide results in a saturation of the lens characteristics vs the thickness of the SiO(2) layer; this feature associated with the good reproducibility of the LPCVD technology allows good control of the lens characteristics.

Planar optical waveguides achieved by ion implantation in zinc telluride: general characteristics.

The optical properties of ZnTe in the visible and the ir and the possibilities of realizing waveguides by ion implantation were investigated in this semiconductor. The main characteristics of the refractive index profiles obtained by implantation of light ions (proton, helium, boron) vs dose, energy, thermal annealing, and wavelength are presented. It is shown that these waveguides are the result of both the macroscopic implantation and the microscopic properties of ZnTe where the damages induced by this implantation extend deep into the substrate. This explains the low losses (1-4 dB/cm) measured in these waveguides. A first physical interpretation of the results is proposed, and some assumptions are discussed.