Éditeur(s) : HAL CCSD Wiley
Résumé : International audience
OBJECTIVE: The WEGENT trial and other short-term studies suggested that azathioprine or methotrexate could effectively maintain granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA) remission. Whether differences in relapse or adverse event rates would appear after discontinuation of those 2 maintenance regimens and longer follow-up remains unknown. METHODS: Long-term outcomes for the patients enrolled in the WEGENT trial were analyzed according to their randomization group. Parameters at trial entry were evaluated as potential prognostic factors for death, relapse or damage in multivariate models. RESULTS: Data were returned for 88.8% of the 126 original participants. Median [95% confidence interval] followup was 11.9 [11.3-12.5] years. For the azathioprine and methotrexate arms, respectively, the 10-year overall survival rates were 75.1% [64.8-86.9] and 79.9% [70.3-90.8] (P = 0.56), and relapse-free survival rates 26.3% [17.3-40.1] and 33.5% [23.5-47.7] (P = 0.29). No between-arm differences were observed for relapse, adverse events, damage, survival rates without severe side effects and survival rates without relapse and severe side effects. Considering only the 97 GPA patients, no between-arm survival differences were observed. Relapse-free survival was shorter for GPA than MPA patients but the multivariate analysis retained anti-PR3-ANCA-positivity, and not GPA, as being independently associated with relapse. CONCLUSION: This long-term analysis confirms that azathioprine and methotrexate are comparable options for maintaining GPA or MPA remission. Despite good overall survival, relapses, adverse events and damage remain matters of concern and further studies are needed to reduce them.
ISSN: 2326-5205

hal-01217989
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01217989
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01217989/document
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01217989/file/Long-term%20outcomes%20of%20the%20WEGENT%20trial_accepted.pdf
DOI : 10.1002/art.39450

Éditeur(s) : HAL CCSD
Résumé : International audience
Up-to-date estimates of the health outcomes of preterm children are needed for assessing perinatal care, informing parents, making decisions about care, and providing evidence for clinical guidelines. To determine survival and neonatal morbidity of infants born from 22 through 34 completed weeks' gestation in France in 2011 and compare these outcomes with a comparable cohort in 1997. The EPIPAGE-2 study is a national, prospective, population-based cohort study conducted in all maternity and neonatal units in France in 2011. A total of 2205 births (stillbirths and live births) and terminations of pregnancy at 22 through 26 weeks' gestation, 3257 at 27 through 31 weeks, and 1234 at 32 through 34 weeks were studied. Cohort data were collected from January 1 through December 31, 1997, and from March 28 through December 31, 2011. Analyses for 1997 were run for the entire year and then separately for April to December; the rates for survival and morbidities did not differ. Data are therefore presented for the whole year in 1997 and the 8-month and 6-month periods in 2011. Survival to discharge and survival without any of the following adverse outcomes: grade III or IV intraventricular hemorrhage, cystic periventricular leukomalacia, severe bronchopulmonary dysplasia, retinopathy of prematurity (stage 3 or higher), or necrotizing enterocolitis (stages 2-3). A total of 0.7% of infants born before 24 weeks' gestation survived to discharge: 31.2% of those born at 24 weeks, 59.1% at 25 weeks, and 75.3% at 26 weeks. Survival rates were 93.6% at 27 through 31 weeks and 98.9% at 32 through 34 weeks. Infants discharged home without severe neonatal morbidity represented 0% at 23 weeks, 11.6% at 24 weeks, 30.0% at 25 weeks, 47.5% at 26 weeks, 81.3% at 27 through 31 weeks, and 96.8% at 32 through 34 weeks. Compared with 1997, the proportion of infants surviving without severe morbidity in 2011 increased by 14.4% (P < .001) at 25 through 29 weeks and 6% (P < .001) at 30 through 31 weeks but did not change appreciably for those born at less than 25 weeks. The rates of antenatal corticosteroid use, induced preterm deliveries, cesarean deliveries, and surfactant use increased significantly in all gestational-age groups, except at 22 through 23 weeks. The substantial improvement in survival in France for newborns born at 25 through 31 weeks' gestation was accompanied by an important reduction in severe morbidity, but survival remained rare before 25 weeks. Although improvement in survival at extremely low gestational age may be possible, its effect on long-term outcomes requires further studies. The long-term results of the EPIPAGE-2 study will be informative in this regard.
ISSN: 2168-6211

hal-01258705
http://hal.univ-brest.fr/hal-01258705
PUBMED : 25621457
DOI : 10.1001/jamapediatrics.2014.3351

Éditeur(s) : HAL CCSD Oxford University Press (OUP): Policy B
Résumé : International audience
AIMS: Indications for surgery in acute infective endocarditis (IE) are detailed in guidelines, but their application is not well known. We analysed the agreement between the patient's attending physicians and European Society of Cardiology guidelines regarding indications for surgery. We also assessed whether surgery was performed in patients who had an indication. METHODS AND RESULTS: From the 2008 prospective population-based French survey on IE, 303 patients with definite left-sided native IE were identified. For each case, we prospectively recorded (i) indication for surgery according to the attending physicians and (ii) indication for surgery according to guidelines. Surgery was indicated in 194 (65%) patients according to attending physicians and in 221 (73%) according to guidelines, while 139 (46%) underwent surgery. Agreement was moderate between attending physicians and guidelines (kappa 0.41-0.59) and between indication according to guidelines and the performance of surgery (kappa 0.38). Of the 90 (30%) patients not operated despite indication, contraindication to surgery was reported by the attending physicians in 42 (47%), and indication was not identified in 48 (53%). One-year survival was 76% in patients with indication and surgery performed (n = 131), 69% in patients without indication and no surgery (n = 74), 56% in patients with identified indication and contraindication to surgery (n = 42), and 60% in patients with no identified indication (n = 48; P = 0.059). CONCLUSION: Cardiac surgery during acute IE was recommended in almost three out of four patients, although fewer than half were actually operated. Indication was not acknowledged by the attending physicians in one out of six patients
ISSN: 0195-668X

hal-01255874
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01255874
DOI : 10.1093/eurheartj/ehv650
PUBMED : 26685134

Éditeur(s) : HAL CCSD Taylor & Francis
Résumé : International audience
To analyze the characteristics and outcome of infective endocarditis (IE) according to the time interval between IE first symptoms and diagnosis.
Among the IE cases of a French population-based epidemiological survey, patients having early-diagnosed IE (diagnosis of IE within 1 month of first symptoms) were compared with those having late-diagnosed IE (diagnosis of IE more than 1 month after first symptoms).
Among the 486 definite-IE, 124 (25%) had late-diagnosed IE whereas others had early-diagnosed IE. Early-diagnosed IE were independently associated with female gender (OR = 1.8; 95% CI [1.0-3.0]), prosthetic valve (OR= 2.6; 95% CI [1.4-5.0]) and staphylococci as causative pathogen (OR = 3.7; 95% CI [2.2-6.2]). Cardiac surgery theoretical indication rates were not different between early and late-diagnosed IE (56.3% vs 58.9%), whereas valve surgery performance was lower in early-diagnosed IE (41% vs 53%; p = .03). In-hospital mortality rates were higher in early-diagnosed IE than in late-diagnosed IE (25.1% vs 16.1%; p < .001).
The time interval between IE first symptoms and diagnosis is closely related to the IE clinical presentation, patient characteristics and causative microorganism. Better prognosis reported in late-diagnosed IE may be related to a higher rate of valvular surgery. KEY MESSAGES Infective endocarditis, which time interval between first symptoms and diagnosis was less than one month, were mainly due to Staphylococcus aureus in France. Staphylococcus aureus infective endocarditis were associated with septic shock, transient ischemic attack or stroke and higher mortality rates than infective endocarditis due to other bacteria or infective endocarditis, which time interval between first symptoms and diagnosis was more than one month. Infective endocarditis, which time interval between first symptoms and diagnosis was more than one month, were accounting for one quarter of all infective endocarditis in our study and were associated with vertebral osteomyelitis and a higher rate of cardiac surgery performed for hemodynamic indication than other infective endocarditis.
ISSN: 0785-3890

hal-01509563
https://hal.archives-ouvertes.fr/hal-01509563
PUBMED : 27607562

Éditeur(s) : HAL CCSD Elsevier
Résumé : International audience
Fromthe Proterozoic to the Quaternary, the evolution of the Earthwas characterised by recurrent periods of glaciation.However, the margins of many ancient ice-sheets are poorly defined on palaeogeographic reconstructions.The extent and outlines of ancient ice sheets can be better understood through careful documentation ofsediments deposited at the ice-sheet margin. An outstanding example is provided herein based on an end-Ordovician archive in Libya (Tihemboka area, Murzuq Basin). The four sets of structures include: i) subglacialglaciotectonic structures and soft sediment deformations from flowing glacier ice, such as intraformational glacialstriae, intraformational deformation (shear planes, sheath folds), normal microfaults, and large-scaleglaciotectonic folds-and-thrusts; (ii) structures resulting from overpressured subglacial (meltwater) flowssuch as clastic dykes and tunnel valleys; (iii) proglacial depositional structures and facies related to highmagnitudemeltwater floods such as sandstone intraclasts, large-scale bedforms resulting from supercriticalflows, climbing-dune cross-stratification and kettle holes; and (iv) deformation structures resulting from freefloating and nonglacier ice such as ice-keel scours and ice-crystal marks. Such a set of structures points to anice-marginal (essentially continental) depositional setting, and provides an excellent suite of criteria to identifymargins of ancient ice sheets in the stratigraphic record. At a regional scale, a reconstruction through time andspace of the related depositional wedge is proposed. This corresponded to a seismic-scale (N120 m in thickness,40 km in length) ice-marginal wedge in front of an essentially warm-based ice-sheet inducing concomitantlarge-scale glaciotectonic deformation, glacial basin and tunnel valley downcuttings. The related ice-front wasassociated with high-energy meltwater flows feeding a network of deeply incised proglacial channels downstreamand, beyond them, a fluvioglacial deltaic system. Shallow ice-marginal permafrost most likely affectedthe depositional wedge. At a larger scale, the Tihemboka ice-marginal wedge is interpreted as related to a stillstandperiod over the Gondwana platform, developed over an estimated interval of a few thousands of years.Based on these data, the conditions that arose in a particularly favourable context for the development, the preservationand the identification of ice-marginal wedges in the geological record are reviewed. Significantmeltwater-derived sediment deposition and aggradation in an accommodation space resulting either frompreglacial inheritance, glacial downcuttings and/or glacio-isostatic lithospheric flexure, or active tectonic subsidence(>1 Myr) are required for their formation and subsequent preservation.
ISSN: 0012-8252

insu-01184739
https://hal-insu.archives-ouvertes.fr/insu-01184739
DOI : 10.1016/j.earscirev.2015.06.006

Éditeur(s) : HAL CCSD Oxford University Press (OUP)
Résumé : International audience
OBJECTIVES: Tracheobronchial stenosis (TBS) is noted in 12-23% of patients with granulomatosis with polyangiitis (GPA), and includes subglottic stenosis and bronchial stenosis. We aimed to analyse the endoscopic management of TBS in GPA and to identify factors associated with the efficacy of endoscopic interventions. METHODS: We conducted a French nationwide retrospective study that included 47 patients with GPA-related TBS. RESULTS: Compared with patients without TBS, those with TBS were younger, more frequently female and had less frequent kidney, ocular and gastrointestinal involvement and mononeuritis multiplex. Endoscopic procedures included 137 tracheal and 50 bronchial interventions, mainly endoscopic dilatation, local steroid injection and conservative laser surgery, and less frequently stenting. After the first endoscopic procedure, the cumulative incidence of endoscopic treatment failure was 49% at 1 year, 70% at 2 years and 80% at 5 years. Factors significantly associated with a higher cumulative incidence of treatment failure were a shorter time from GPA diagnosis to endoscopic procedure [hazard ratio (HR) 1.08 (95% CI 1.01, 1.14); P = 0.01] and a bronchial stenosis [HR 1.96 (95% CI 1.28, 3.00); P = 0.002]. A prednisone dose ≥30 mg/day at the time of the procedure was associated with a lower cumulative incidence of treatment failure [HR 0.53 (95% CI 0.31, 0.89); P = 0.02]. CONCLUSION: TBS represents severe and refractory manifestations with a high rate of restenosis. High-dose systemic CSs at the time of the procedure and increased time from GPA diagnosis to bronchoscopic intervention are associated with a better event-free survival. In contrast, bronchial stenoses are associated with a higher rate of restenosis than subglottic stenosis.
ISSN: 1462-0324

hal-01155105
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01155105
DOI : 10.1093/rheumatology/kev129
PUBMED : 26001634

Éditeur(s) : HAL CCSD
Résumé : International audience
Partant du présupposé selon lequel les sciences, par leurs prétentions à l'universalité, constitueraient un terrain privilégié pour réunir des communautés fonctionnant sur des valeurs très différentes, notre recherche vise deux objectifs : la conception d'un outil permettant l'apprentissage des sciences à des enfants roms âgés de 6 à 8 ans, non scolarisés ; une évaluation de l'impact de cet outil en terme de scolarisation.
Un premier prototype a été conçu : une mallette contenant du matériel non coûteux et généralement disponible dans les foyers, permettant aux enfants de conduire aisément des expérimentations sur des sujets en relation avec des préoccupations proches de leur milieu de vie.
L'étude en cours concerne trois communautés roms de Roumanie, ayant de jeunes enfants non scolarisés. Lors d'une première visite, le matériel est présenté aux familles et les participants volontaires sont accompagnés lors de la réalisation des premières expérimentations. La mallette étant laissée à leur disposition, les familles sont visitées une seconde fois, un mois plus tard, pour discuter avec les utilisateurs des activités qu'ils ont pu conduire et leur apporter des explications.
On s'attend à ce que, au moyen de cet outil, les enfants accèdent à des connaissances scientifiques inaccessibles d'ordinaire au sein de leurs communautés et à ce que les familles transforment leur regard sur l'école et l'investissent comme moyen d'accéder à des connaissances utiles.
Nous présenterons dans cette communication les principes à la base de la conception des activités contenues dans la mallette, leur mise en œuvre dans les trois communautés ainsi que l'évaluation réalisée.
Différences et inéquités : enjeux culturels et scolaires pour les sciences et les techniques
Chamonix, France

halshs-00280412
https://halshs.archives-ouvertes.fr/halshs-00280412

Éditeur(s) : HAL CCSD Paris : L'Harmattan
Résumé : International audience
Cet article se propose d'apporter quelques éléments de réponse et de réflexion au lecteur - étudiant, enseignant - intéressé par ces questions. Afin de comprendre comment les outils informatiques se sont peu à peu installés dans le paysage scolaire français, nous allons rappeler dans ses grandes lignes le processus d'intégration de ces outils dans l'enseignement général, tous niveaux confondus, depuis son commencement dans les années 1970 jusqu'à aujourd'hui. Nous verrons que ce processus s'est réalisé en deux grands mouvements, d'expérimentation puis de généralisation, articulés autour de la période charnière de la fin des années 1980 qui allait marquer l'avènement du multimédia et les premiers pas de l'Internet dans la société. Ce panorama effectué, nous nous pencherons sur les pratiques quotidiennes des élèves - et plus précisément des collégiens -, telles qu'elles se manifestent aujourd'hui en France et nous verrons de fait comment elles s'articulent avec les pratiques scolaires.
ISSN: 1967-5798

halshs-00730378
https://halshs.archives-ouvertes.fr/halshs-00730378
https://halshs.archives-ouvertes.fr/halshs-00730378/document
https://halshs.archives-ouvertes.fr/halshs-00730378/file/Bernard-Ailincai-RFEC.pdf

Éditeur(s) : HAL CCSD Elsevier
Résumé : International audience
: In South America, disseminated histoplasmosis due to Histoplasma capsulatum var. capsulatum (H. capsulatum), is a severe and frequent opportunistic infection in AIDS patients. In areas outside the USA where specific-Histoplasma antigen detection is not available, the diagnosis is difficult. With the galactomannan antigen (GM) detection, a test commonly used for invasive aspergillosis diagnosis, there is a cross-reactivity with H. capsulatum that can be helpful for the diagnosis of histoplasmosis. The aim of this study was to evaluate the GM detection for the diagnosis of disseminated histoplasmosis in AIDS patients. The performance of the GM detection was evaluated with serum collected in French Guiana where H. capsulatum is highly endemic. Sera from AIDS patients with disseminated histoplasmosis occurring from 2002 to 2009 and from control HIV-positive patients without histoplasmosis were tested with the GM detection and Histoplasma-specific antibody detection (IEP). In 39 AIDS patients with proven disseminated histoplasmosis, the sensitivity of the Histoplasma IEP was only 35.9% and was linked to the TCD4+ lymphocyte level. For the GM detection, the sensitivity (Se) was 76.9% and specificity (Sp) was 100% with the recommended threshold for aspergillosis diagnosis (0.5). The test was more efficient with a threshold of 0.4 (Se: 0.82 [95% CI: 0.66-0.92], Sp: 1.00 [95% CI: 0.86-1.00], LR+: >10, LR-: 0.18). This study confirms that the GM detection can be a surrogate marker for the diagnosis of disseminated histoplasmosis in AIDS patients in endemic areas where Histoplasma EIA is not available.
ISSN: 1438-4221

inserm-01065096
http://www.hal.inserm.fr/inserm-01065096
http://www.hal.inserm.fr/inserm-01065096/document
http://www.hal.inserm.fr/inserm-01065096/file/2014_Iriart_-_Complementary_tool_for_managementsur histo_infections_in_AID.pdf
DOI : 10.1016/j.ijmm.2014.07.016

Éditeur(s) : HAL CCSD CRDP de Guyane
Résumé : Ce chapitre se propose d'apporter quelques éléments de réponse et de réflexion au lecteur - étudiant, enseignant - afin de comprendre comment les outils informatiques se sont peu à peu installés dans le paysage scolaire français. Nous allons rappeler dans ses grandes lignes le processus d'intégration de ces outils dans l'enseignement général, tous niveaux confondus, depuis son commencement dans les années 1970 jusqu'à aujourd'hui. Nous verrons que ce processus s'est réalisé en deux grands mouvements, d'expérimentation puis de généralisation, articulés autour de la période charnière de fin des années 1980 qui allait marquer l'avènement du multimédia et les premiers pas de l'Internet dans la société. Ce panorama effectué, nous nous pencherons sur les pratiques quotidiennes des élèves - et plus précisément des collégiens -, telles qu'elles se manifestent aujourd'hui en France et nous verrons de fait comment elles s'articulent avec les pratiques scolaires. Nous terminerons notre réflexion avec le cas singulier de la Guyane et ses sites isolés des bords de fleuves. Nous nous appuierons sur l'exemple de Camopi où nous avons mené en 2009 une étude avec les élèves de 3ème du collège, à propos d'un environnement d'apprentissage collaboratif sur ordinateur.
Pratiques éducatives dans un contexte multiculturel. L'exemple plurilingue de la Guyane. Le secondaire

hal-00638675
https://hal.archives-ouvertes.fr/hal-00638675
https://hal.archives-ouvertes.fr/hal-00638675/document
https://hal.archives-ouvertes.fr/hal-00638675/file/Chapitre_4.pdf