An active contour-based atlas registration model applied to automatic subthalamic nucleus targeting on MRI: method and validation.

This paper presents a new non parametric atlas registration framework, derived from the optical flow model and the active contour theory, applied to automatic subthalamic nucleus (STN) targeting in deep brain stimulation (DBS) surgery. In a previous work, we demonstrated that the STN position can be predicted based on the position of surrounding visible structures, namely the lateral and third ventricles. A STN targeting process can thus be obtained by registering these structures of interest between a brain atlas and the patient image. Here we aim to improve the results of the state of the art targeting methods and at the same time to reduce the computational time. Our simultaneous segmentation and registration model shows mean STN localization errors statistically similar to the most performing registration algorithms tested so far and to the targeting expert's variability. Moreover, the computational time of our registration method is much lower, which is a worthwhile improvement from a clinical point of view.

Is it the grain size or the characteristic pore size that controls the induced polarization relaxation time of clean sands and sandstones?

There is a wide range of evidence to suggest that permeability can be constrained through of induced polarization measurements. For clean sands and sandstones, current mechanistic models of induced polarization predict a relationship between the low-frequency time constant inferred from induced polarization measurements and the grain diameter. A number of observations do, however, disagree with this and indicate that the observed relaxation behavior is rather governed by the so-called dynamic pore radius L. To test this hypothesis, we have developed a set of new scaling relationships, which allow the relaxation time to be computed from the pore size and the permeability to be computed from both the Cole-Cole time constant and the formation factor. Moreover, these new scaling relationships can be also used to predict the dependence of the Cole-Cole time constant as a function of the water saturation under unsaturated conditions. Comparative tests of the proposed new relationships with regard to various published experimental results for saturated clean sands and sandstones as well as for partially saturated clean sandstones, do indeed confirm that the dynamic pore radius L is a much more reliable indicator of the observed relaxation behavior than grain-size-based models.

Trigeminal neuralgia related to megadolichobasilar artery compression: a prospective series of twenty-nine patients treated with gamma knife surgery, with more than one year of follow-up.

BACKGROUND: Trigeminal neuralgia (TN) secondary to megadolichobasilar artery (MBA) compression is considerably difficult to manage surgically. OBJECTIVE: This study aims to evaluate the safety/efficacy of Gamma Knife surgery (GKS) in this special group of patients. METHODS: Between July 1992 and November 2010, 29 patients with >1 year of follow-up presenting with MBA compression were treated with GKS at Timone University Hospital. Radiosurgery was performed using a Gamma Knife (model B, C or Perfexion). A single 4-mm isocenter was positioned in the cisternal portion of the trigeminal nerve at a median distance of 9.1 mm (range: 6-18.2 mm) from the emergence. RESULTS: The median follow-up period was 46.1 months (range: 12.9-157.9 months). Initially, all patients (100%) were pain free; the average time to complete pain relief was 13.5 days (range: 0-240 days). Their actuarial probability of remaining pain free without medication at 0.5, 1 and 2 years was 93.1, 79.3 and 75.7%, respectively, and remained stable until 13 years after treatment. The actuarial probability of hypoesthesia onset at 6 months was 4.3%; at 1 year it reached 13% and remained stable until 13 years after treatment. CONCLUSIONS: GKS proved to be reasonably safe and effective on a long-term basis as a first- and/or second-line surgical treatment for TN due to MBA compression.

From evidence to clinical practice: effective implementation of therapeutic hypothermia to improve patient outcome after cardiac arrest.

OBJECTIVES: Therapeutic hypothermia has been recommended for postcardiac arrest coma due to ventricular fibrillation. However, no studies have evaluated whether therapeutic hypothermia could be effectively implemented in intensive care practice and whether it would improve the outcome of all comatose patients with cardiac arrest, including those with shock or with cardiac arrest due to nonventricular fibrillation rhythms. DESIGN: Retrospective study. SETTING: Fourteen-bed medical intensive care unit in a university hospital. PATIENTS: Patients were 109 comatose patients with out-of-hospital cardiac arrest due to ventricular fibrillation and nonventricular fibrillation rhythms (asystole/pulseless electrical activity). INTERVENTIONS: We analyzed 55 consecutive patients (June 2002 to December 2004) treated with therapeutic hypothermia (to a central target temperature of 33 degrees C, using external cooling). Fifty-four consecutive patients (June 1999 to May 2002) treated with standard resuscitation served as controls. Efficacy, safety, and outcome at hospital discharge were assessed. Good outcome was defined as Glasgow-Pittsburgh Cerebral Performance category 1 or 2. MEASUREMENTS AND MAIN RESULTS: In patients treated with therapeutic hypothermia, the median time to reach the target temperature was 5 hrs, with a progressive reduction over the 18 months of data collection. Therapeutic hypothermia had a major positive impact on the outcome of patients with cardiac arrest due to ventricular fibrillation (good outcome in 24 of 43 patients [55.8%] of the therapeutic hypothermia group vs. 11 of 43 patients [25.6%] of the standard resuscitation group, p = .004). The benefit of therapeutic hypothermia was also maintained in patients with shock (good outcome in five of 17 patients of the therapeutic hypothermia group vs. zero of 14 of the standard resuscitation group, p = .027). The outcome after cardiac arrest due to nonventricular fibrillation rhythms was poor and did not differ significantly between the two groups. Therapeutic hypothermia was of particular benefit in patients with short duration of cardiac arrest (<30 mins). CONCLUSIONS: Therapeutic hypothermia for the treatment of postcardiac arrest coma can be successfully implemented in intensive care practice with a major benefit on patient outcome, which appeared to be related to the type and the duration of initial cardiac arrest and seemed maintained in patients with shock.

Pegfilgrastim to accelerate neutrophil engraftment following peripheral blood stem cell transplant and reduce the duration of neutropenia, hospitalization, and use of intravenous antibiotics: a phase II study in multiple myeloma and lymphoma and comparison with filgrastim-treated matched controls.

This trial was aimed to explore the efficacy of pegfilgrastim to accelerate neutrophil engraftment after stem cell autotransplant. Twenty patients with multiple myeloma and 20 with lymphoma received pegfilgrastim 6 mg on day +1. Forty cases treated with daily filgrastim starting at median day +7 (5-7), matched by age, sex, diagnosis, high-dose chemotherapy schedule, CD34 +  cell-dose, and prior therapy lines, were used for comparison. Median time to neutrophil engraftment was 9.5 vs. 11 days for pegfilgrastim and filgrastim, respectively (p < 0.0001). Likewise, duration of neutropenia, intravenous antibiotic use, and hospitalization favored pegfilgrastim, while platelet engraftment, transfusion requirement, and fever duration were equivalent in both groups. No grade  ≥ 3 toxicities were observed. Patients with lymphoma performed similarly to the entire cohort, while patients with myeloma showed faster neutrophil engraftment and shorter neutropenia but not shorter hospitalization and antibiotic use. The possibility of different outcomes for lymphoma and myeloma suggests that stratification by diagnosis may be useful in future phase III studies.

Bortezomib(Velcade®)-Thalidomide-Dexamethasone (VTD) Is Superior to Thalidomide-Dexamethasone (TD) In Patients with Multiple Myeloma (MM) Progressing or Relapsing After Autologous Transplantation

Introduction: The Thalidomide-Dexamethasone (TD) regimen has provided encouraging results in relapsed MM. To improve results, bortezomib (Velcade) has been added to the combination in previous phase II studies, the so called VTD regimen. In January 2006, the European Group for Blood and Marrow Transplantation (EBMT) and the Intergroupe Francophone du Myélome (IFM) initiated a prospective, randomized, parallel-group, open-label phase III, multicenter study, comparing VTD (arm A) with TD (arm B) for MM patients progressing or relapsing after autologous transplantation. Patients and Methods: Inclusion criteria: patients in first progression or relapse after at least one autologous transplantation, including those who had received bortezomib or thalidomide before transplant. Exclusion criteria: subjects with neuropathy above grade 1 or non secretory MM. Primary study end point was time to progression (TTP). Secondary end points included safety, response rate, progression-free survival (PFS) and overall survival (OS). Treatment was scheduled as follows: bortezomib 1.3 mg/m2 was given as an i.v bolus on Days 1, 4, 8 and 11 followed by a 10-Day rest period (days 12 to 21) for 8 cycles (6 months) and then on Days 1, 8, 15, 22 followed by a 20-Day rest period (days 23 to 42) for 4 cycles (6 months). In both arms, thalidomide was scheduled at 200 mg/Day orally for one year and dexamethasone 40 mg/Day orally four days every three weeks for one year. Patients reaching remission could proceed to a new stem cell harvest. However, transplantation, either autologous or allogeneic, could only be performed in patients who completed the planned one year treatment period. Response was assessed by EBMT criteria, with additional category of near complete remission (nCR). Adverse events were graded by the NCI-CTCAE, Version 3.0.The trial was based on a group sequential design, with 4 planned interim analyses and one final analysis that allowed stopping for efficacy as well as futility. The overall alpha and power were set equal to 0.025 and 0.90 respectively. The test for decision making was based on the comparison in terms of the ratio of the cause-specific hazards of relapse/progression, estimated in a Cox model stratified on the number of previous autologous transplantations. Relapse/progression cumulative incidence was estimated using the proper nonparametric estimator, the comparison was done by the Gray test. PFS and OS probabilities were estimated by the Kaplan-Meier curves, the comparison was performed by the Log-Rank test. An interim safety analysis was performed when the first hundred patients had been included. The safety committee recommended to continue the trial. Results: As of 1st July 2010, 269 patients had been enrolled in the study, 139 in France (IFM 2005-04 study), 21 in Italy, 38 in Germany, 19 in Switzerland (a SAKK study), 23 in Belgium, 8 in Austria, 8 in the Czech republic, 11 in Hungary, 1 in the UK and 1 in Israel. One hundred and sixty nine patients were males and 100 females; the median age was 61 yrs (range 29-76). One hundred and thirty six patients were randomized to receive VTD and 133 to receive TD. The current analysis is based on 246 patients (124 in arm A, 122 in arm B) included in the second interim analysis, carried out when 134 events were observed. Following this analysis, the trial was stopped because of significant superiority of VTD over TD. The remaining patients were too premature to contribute to the analysis. The number of previous autologous transplants was one in 63 vs 60 and two or more in 61 vs 62 patients in arm A vs B respectively. The median follow-up was 25 months. The median TTP was 20 months vs 15 months respectively in arm A and B, with cumulative incidence of relapse/progression at 2 years equal to 52% (95% CI: 42%-64%) vs 70% (95% CI: 61%-81%) (p=0.0004, Gray test). The same superiority of arm A was also observed when stratifying on the number of previous autologous transplantations. At 2 years, PFS was 39% (95% CI: 30%-51%) vs 23% (95% CI: 16%-34%) (A vs B, p=0.0006, Log-Rank test). OS in the first two years was comparable in the two groups. Conclusion: VTD resulted in significantly longer TTP and PFS in patients relapsing after ASCT. Analysis of response and safety data are on going and results will be presented at the meeting.

Exposure to radio-frequency electromagnetic fields from broadcast transmitters and risk of childhood cancer: a census-based cohort study.

We investigated the association between exposure to radio-frequency electromagnetic fields (RF-EMFs) from broadcast transmitters and childhood cancer. First, we conducted a time-to-event analysis including children under age 16 years living in Switzerland on December 5, 2000. Follow-up lasted until December 31, 2008. Second, all children living in Switzerland for some time between 1985 and 2008 were included in an incidence density cohort. RF-EMF exposure from broadcast transmitters was modeled. Based on 997 cancer cases, adjusted hazard ratios in the time-to-event analysis for the highest exposure category (>0.2 V/m) as compared with the reference category (<0.05 V/m) were 1.03 (95% confidence interval (CI): 0.74, 1.43) for all cancers, 0.55 (95% CI: 0.26, 1.19) for childhood leukemia, and 1.68 (95% CI: 0.98, 2.91) for childhood central nervous system (CNS) tumors. Results of the incidence density analysis, based on 4,246 cancer cases, were similar for all types of cancer and leukemia but did not indicate a CNS tumor risk (incidence rate ratio = 1.03, 95% CI: 0.73, 1.46). This large census-based cohort study did not suggest an association between predicted RF-EMF exposure from broadcasting and childhood leukemia. Results for CNS tumors were less consistent, but the most comprehensive analysis did not suggest an association.

Optimal culture incubation time in orthopedic device-associated infections: a retrospective analysis of prolonged 14-day incubation.

Accurate diagnosis of orthopedic device-associated infections can be challenging. Culture of tissue biopsy specimens is often considered the gold standard; however, there is currently no consensus on the ideal incubation time for specimens. The aim of our study was to assess the yield of a 14-day incubation protocol for tissue biopsy specimens from revision surgery (joint replacements and internal fixation devices) in a general orthopedic and trauma surgery setting. Medical records were reviewed retrospectively in order to identify cases of infection according to predefined diagnostic criteria. From August 2009 to March 2012, 499 tissue biopsy specimens were sampled from 117 cases. In 70 cases (59.8%), at least one sample showed microbiological growth. Among them, 58 cases (82.9%) were considered infections and 12 cases (17.1%) were classified as contaminations. The median time to positivity in the cases of infection was 1 day (range, 1 to 10 days), compared to 6 days (range, 1 to 11 days) in the cases of contamination (P < 0.001). Fifty-six (96.6%) of the infection cases were diagnosed within 7 days of incubation. In conclusion, the results of our study show that the incubation of tissue biopsy specimens beyond 7 days is not productive in a general orthopedic and trauma surgery setting. Prolonged 14-day incubation might be of interest in particular situations, however, in which the prevalence of slow-growing microorganisms and anaerobes is higher.

Schizotypal perceptual aberrations of time: correlation between score, behavior and brain activity.

A fundamental trait of the human self is its continuum experience of space and time. Perceptual aberrations of this spatial and temporal continuity is a major characteristic of schizophrenia spectrum disturbances--including schizophrenia, schizotypal personality disorder and schizotypy. We have previously found the classical Perceptual Aberration Scale (PAS) scores, related to body and space, to be positively correlated with both behavior and temporo-parietal activation in healthy participants performing a task involving self-projection in space. However, not much is known about the relationship between temporal perceptual aberration, behavior and brain activity. To this aim, we composed a temporal Perceptual Aberration Scale (tPAS) similar to the traditional PAS. Testing on 170 participants suggested similar performance for PAS and tPAS. We then correlated tPAS and PAS scores to participants' performance and neural activity in a task of self-projection in time. tPAS scores correlated positively with reaction times across task conditions, as did PAS scores. Evoked potential mapping and electrical neuroimaging showed self-projection in time to recruit a network of brain regions at the left anterior temporal cortex, right temporo-parietal junction, and occipito-temporal cortex, and duration of activation in this network positively correlated with tPAS and PAS scores. These data demonstrate that schizotypal perceptual aberrations of both time and space, as reflected by tPAS and PAS scores, are positively correlated with performance and brain activation during self-projection in time in healthy individuals along the schizophrenia spectrum.

Intravenous thrombolysis in stroke attributable to cervical artery dissection.

BACKGROUND AND PURPOSE: Intravenous thrombolysis (IVT) for stroke seems to be beneficial independent of the underlying etiology. Whether this is also true for cervical artery dissection (CAD) is addressed in this study.METHODS: We used the Swiss IVT databank to compare outcome and complications of IVT-treated patients with CAD with IVT-treated patients with other etiologies (non-CAD patients). Main outcome and complication measures were favorable 3-month outcome, intracranial cerebral hemorrhage, and recurrent ischemic stroke. Modified Rankin Scale score <or=1 at 3 months was considered favorable.RESULTS: Fifty-five (5.2%) of 1062 IVT-treated patients had CAD. Patients with CAD were younger (median age 50 versus 70 years) but had similar median National Institutes of Health Stroke Scale scores (14 versus 13) and time to treatment (152.5 versus 156 minutes) as non-CAD patients. In the CAD group, 36% (20 of 55) had a favorable 3-month outcome compared with 44% (447 of 1007) non-CAD patients (OR, 0.72; 95% CI, 0.41 to 1.26), which was less favorable after adjustment for age, gender, and National Institutes of Health Stroke Scale score (OR, 0.50; 95% CI, 0.27 to 0.95; P=0.03). Intracranial cerebral hemorrhages (asymptomatic, symptomatic, fatal) were equally frequent in CAD (14% [7%, 7%, 2%]) and non-CAD patients (14% [9%, 5%, 2%]; P=0.99). Recurrent ischemic stroke occurred in 1.8% of patients with CAD and in 3.7% of non-CAD-patients (P=0.71).CONCLUSIONS: IVT-treated patients with CAD do not recover as well as IVT-treated non-CAD patients. However, intracranial bleedings and recurrent ischemic strokes were equally frequent in both groups. They do not account for different outcomes and indicate that IVT should not be excluded in patients who may have CAD. Hemodynamic compromise or frequent tandem occlusions might explain the less favorable outcome of patients with CAD.

Real-time MR imaging of myocardial regional function using strain-encoding (SENC) with tissue through-plane motion tracking.

PURPOSE: To implement real-time myocardial strain-encoding (SENC) imaging in combination with tracking the tissue displacement in the through-plane direction. MATERIALS AND METHODS: SENC imaging was combined with the slice-following technique by implementing three-dimensional (3D) selective excitation. Certain adjustments were implemented to reduce scan time to one heartbeat. A total of 10 volunteers and five pigs were scanned on a 3T MRI scanner. Spatial modulation of magnetization (SPAMM)-tagged images were acquired on planes orthogonal to the SENC planes for comparison. Myocardial infarction (MI) was induced in two pigs and the resulting SENC images were compared to standard delayed-enhancement (DE) images. RESULTS: The strain values computed from SENC imaging with slice-following showed significant difference from those acquired without slice-following, especially during systole (P < 0.01). The strain curves computed from the SENC images with and without slice-following were similar to those computed from the orthogonal SPAMM images, with and without, respectively, tracking the tag line displacement in the strain direction. The resulting SENC images showed good agreement with the DE images in identifying MI in infarcted pigs. CONCLUSION: Correction of through-plane motion in real-time cardiac functional imaging is feasible using slice-following. The strain measurements are more accurate than conventional SENC measurements in humans and animals, as validated with conventional MRI tagging.

Early prediction of response to sunitinib after imatinib failure by 18F-fluorodeoxyglucose positron emission tomography in patients with gastrointestinal stromal tumor.

PURPOSE: Positron emission tomography with (18)F-fluorodeoxyglucose (FDG-PET) was used to evaluate treatment response in patients with gastrointestinal stromal tumors (GIST) after administration of sunitinib, a multitargeted tyrosine kinase inhibitor, after imatinib failure. PATIENTS AND METHODS: Tumor metabolism was assessed with FDG-PET before and after the first 4 weeks of sunitinib therapy in 23 patients who received one to 12 cycles of sunitinib therapy (4 weeks of 50 mg/d, 2 weeks off). Treatment response was expressed as the percent change in maximal standardized uptake values (SUV). The primary end point of time to tumor progression was compared with early PET results on the basis of traditional Response Evaluation Criteria in Solid Tumors (RECIST) criteria. RESULTS: Progression-free survival (PFS) was correlated with early FDG-PET metabolic response (P < .0001). Using -25% and +25% thresholds for SUV variations from baseline, early FDG-PET response was stratified in metabolic partial response, metabolically stable disease, or metabolically progressive disease; median PFS rates were 29, 16, and 4 weeks, respectively. Similarly, when a single FDG-PET positive/negative was considered after 4 weeks of sunitinib, the median PFS was 29 weeks for SUVs less than 8 g/mL versus 4 weeks for SUVs of 8 g/mL or greater (P < .0001). None of the patients with metabolically progressive disease subsequently responded according to RECIST criteria. Multivariate analysis showed shorter PFS in patients who had higher residual SUVs (P < .0001), primary resistance to imatinib (P = .024), or nongastric GIST (P = .002), regardless of the mutational status of the KIT and PDGFRA genes. CONCLUSION: Week 4 FDG-PET is useful for early assessment of treatment response and for the prediction of clinical outcome. Thus, it offers opportunities to individualize and optimize patient therapy.

Electric bicycles as a new active transportation modality to promote health.

GOJANOVIC, B., J. WELKER, K. IGLESIAS, C. DAUCOURT, and G. GREMION. Electric Bicycles as a New Active Transportation Modality to Promote Health. Med. Sci. Sports Exerc., Vol. 43, No. 11, pp. 2204-2210, 2011. Electrically assisted bicycles (EAB) are an emerging transportation modality favored for environmental reasons. Some physical effort is required to activate the supporting engine, making it a potential active commuting option. Purpose: We hypothesized that using an EAB in a hilly city allows sedentary subjects to commute comfortably, while providing a sufficient effort for health-enhancing purposes. Methods: Sedentary subjects performed four different trips at a self-selected pace: walking 1.7 km uphill from the train station to the hospital (WALK), biking 5.1 km from the lower part of town to the hospital with a regular bike (BIKE), or EAB at two different power assistance settings (EAB(high), EAB(std)). HR, oxygen consumption, and need to shower were recorded. Results: Eighteen sedentary subjects (12 female, 6 male) age 36 +/- 10 yr were included, with (V) over dotO(2max) of 39.4 +/- 5.4 mL.min(-1).kg(-1). Time to complete the course was 22 (WALK), 19 (EAB(high)), 21 (EAB(std)), and 30 (BIKE) min. Mean %(V) over dotO(2max) was 59.0%, 54.9%, 65.7%, and 72.8%. Mean%HR(max) was 71.5%, 74.5%, 80.3%, and 84.0%. There was no significant difference between WALK and EAB(high), but all other comparisons were different (P < 0.05). Two subjects needed to shower after EAB(high), 3 needed to shower after WALK, 8 needed to shower after EAB(std), and all 18 needed to shower after BIKE. WALK and EAB(high) elicited 6.5 and 6.1 METs (no difference), whereas it was 7.3 and 8.2 for EAB(std) and BIKE. Conclusions: EAB is a comfortable and ecological transportation modality, helping sedentary people commute to work and meet physical activity guidelines. Subjects appreciated ease of use and mild effort needed to activate the engine support climbing hills, without the need to shower at work. EAB can be promoted in a challenging urban environment to promote physical activity and mitigate pollution issues.

Can resistance to trastuzumab be reversed by endocrine therapy? Combination of trastuzumab and letrozole after resistance to sequential trastuzumab and aromatase inhibitor monotherapies in patients with ER-positive, HER-2 positive, advanced breast cancer: a proof-of-concept trial (SAKK 23/03)

Introduction: Trastuzumab (T) is a cornerstone in the treatment of patients with HER2-overexpressing advanced breast cancer and development of resistance to T is a major therapeutic problem. HER-2 is part of a highly interactive signaling network that may impair efficacy of endocrine therapy. A sequential treatment design was chosen in this trial to ensure complete resistance to single agent therapy before receiving both a non-steroidal aromatase inhibitor (AI) and T. Any kind of clinical activity with combined treatment of AI and T after progression of single agent treatments could indicate restoration of sensitivity as a consequence of cross-talking and networking between both pathways. Methods: Key eligibility criteria included postmenopausal patients (pts.) with advanced, measurable, HER-2 positive (assessed by FISH, ratio (≥2)), HR positive disease and progression on prior treatment with a non-steroidal AI, e.g. letrozole or anastrozole, either in an adjuvant or advanced setting. Pts. received standard dose T monotherapy either weekly or three-weekly in step 1 and upon disease progression, continued T in combination with letrozole in step 2. The primary endpoint was clinical benefit response (CBR: CR, PR or SD for at least 24 weeks (+/- 1 week) according to RECIST) in step 2. Results: Thirteen pts. were enrolled in five centers in Switzerland. In step 1, six pts. (46%) achieved CBR. Median time to progression (TTP) was 161 days (Range: 50 - 627). Based on data collected until the end of May 2010, CBR was observed in seven out of the eleven evaluable pts. (64%) in step 2, including one pt. with partial response. Four of the seven pts. within step 2 that achieved CBR also had CBR in step 1. Seven out of eleven pts. have documented tumor progression during step 2 treatment. Median TTP for all eleven pts. was 184 days (range 61 - 471). Mean time on study treatment (TTP in step 1 plus TTP in step 2) for pts. reaching step 2 was 380 days (range 174 - 864). Adverse events were generally mild. Conclusion: Results of this proof-of-principle trial suggest that complete resistance to both AI and T can be overcome in a proportion of pts. by combined treatment of AI and T, as all pts. served as their own control. Our results appear promising for a new treatment strategy which offers a chemotherapy-free and well-tolerated option for at least a subset of the pts. with HR positive, HER-2 positive breast cancer. Further trials will need to corroborate this finding.

GIS and geodatabases application to global scale plate tectonics modelling

Les reconstructions palinspastiques fournissent le cadre idéal à de nombreuses études géologiques, géographiques, océanographique ou climatiques. En tant qu?historiens de la terre, les "reconstructeurs" essayent d?en déchiffrer le passé. Depuis qu?ils savent que les continents bougent, les géologues essayent de retracer leur évolution à travers les âges. Si l?idée originale de Wegener était révolutionnaire au début du siècle passé, nous savons depuis le début des années « soixante » que les continents ne "dérivent" pas sans but au milieu des océans mais sont inclus dans un sur-ensemble associant croûte « continentale » et « océanique »: les plaques tectoniques. Malheureusement, pour des raisons historiques aussi bien que techniques, cette idée ne reçoit toujours pas l'écho suffisant parmi la communauté des reconstructeurs. Néanmoins, nous sommes intimement convaincus qu?en appliquant certaines méthodes et certains principes il est possible d?échapper à l?approche "Wégenerienne" traditionnelle pour enfin tendre vers la tectonique des plaques. Le but principal du présent travail est d?exposer, avec tous les détails nécessaires, nos outils et méthodes. Partant des données paléomagnétiques et paléogéographiques classiquement utilisées pour les reconstructions, nous avons développé une nouvelle méthodologie replaçant les plaques tectoniques et leur cinématique au coeur du problème. En utilisant des assemblages continentaux (aussi appelés "assemblées clés") comme des points d?ancrage répartis sur toute la durée de notre étude (allant de l?Eocène jusqu?au Cambrien), nous développons des scénarios géodynamiques permettant de passer de l?une à l?autre en allant du passé vers le présent. Entre deux étapes, les plaques lithosphériques sont peu à peu reconstruites en additionnant/ supprimant les matériels océaniques (symbolisés par des isochrones synthétiques) aux continents. Excepté lors des collisions, les plaques sont bougées comme des entités propres et rigides. A travers les âges, les seuls éléments évoluant sont les limites de plaques. Elles sont préservées aux cours du temps et suivent une évolution géodynamique consistante tout en formant toujours un réseau interconnecté à travers l?espace. Cette approche appelée "limites de plaques dynamiques" intègre de multiples facteurs parmi lesquels la flottabilité des plaques, les taux d'accrétions aux rides, les courbes de subsidence, les données stratigraphiques et paléobiogéographiques aussi bien que les évènements tectoniques et magmatiques majeurs. Cette méthode offre ainsi un bon contrôle sur la cinématique des plaques et fournit de sévères contraintes au modèle. Cette approche "multi-source" nécessite une organisation et une gestion des données efficaces. Avant le début de cette étude, les masses de données nécessaires était devenues un obstacle difficilement surmontable. Les SIG (Systèmes d?Information Géographiques) et les géo-databases sont des outils informatiques spécialement dédiés à la gestion, au stockage et à l?analyse des données spatialement référencées et de leurs attributs. Grâce au développement dans ArcGIS de la base de données PaleoDyn nous avons pu convertir cette masse de données discontinues en informations géodynamiques précieuses et facilement accessibles pour la création des reconstructions. Dans le même temps, grâce à des outils spécialement développés, nous avons, tout à la fois, facilité le travail de reconstruction (tâches automatisées) et amélioré le modèle en développant fortement le contrôle cinématique par la création de modèles de vitesses des plaques. Sur la base des 340 terranes nouvellement définis, nous avons ainsi développé un set de 35 reconstructions auxquelles est toujours associé un modèle de vitesse. Grâce à cet ensemble de données unique, nous pouvons maintenant aborder des problématiques majeurs de la géologie moderne telles que l?étude des variations du niveau marin et des changements climatiques. Nous avons commencé par aborder un autre problème majeur (et non définitivement élucidé!) de la tectonique moderne: les mécanismes contrôlant les mouvements des plaques. Nous avons pu observer que, tout au long de l?histoire de la terre, les pôles de rotation des plaques (décrivant les mouvements des plaques à la surface de la terre) tendent à se répartir le long d'une bande allant du Pacifique Nord au Nord de l'Amérique du Sud, l'Atlantique Central, l'Afrique du Nord, l'Asie Centrale jusqu'au Japon. Fondamentalement, cette répartition signifie que les plaques ont tendance à fuir ce plan médian. En l'absence d'un biais méthodologique que nous n'aurions pas identifié, nous avons interprété ce phénomène comme reflétant l'influence séculaire de la Lune sur le mouvement des plaques. La Lune sur le mouvement des plaques. Le domaine océanique est la clé de voute de notre modèle. Nous avons attaché un intérêt tout particulier à le reconstruire avec beaucoup de détails. Dans ce modèle, la croûte océanique est préservée d?une reconstruction à l?autre. Le matériel crustal y est symbolisé sous la forme d?isochrones synthétiques dont nous connaissons les âges. Nous avons également reconstruit les marges (actives ou passives), les rides médio-océaniques et les subductions intra-océaniques. En utilisant ce set de données très détaillé, nous avons pu développer des modèles bathymétriques 3-D unique offrant une précision bien supérieure aux précédents.<br/><br/>Palinspastic reconstructions offer an ideal framework for geological, geographical, oceanographic and climatology studies. As historians of the Earth, "reconstructers" try to decipher the past. Since they know that continents are moving, geologists a trying to retrieve the continents distributions through ages. If Wegener?s view of continent motions was revolutionary at the beginning of the 20th century, we know, since the Early 1960?s that continents are not drifting without goal in the oceanic realm but are included in a larger set including, all at once, the oceanic and the continental crust: the tectonic plates. Unfortunately, mainly due to technical and historical issues, this idea seems not to receive a sufficient echo among our particularly concerned community. However, we are intimately convinced that, by applying specific methods and principles we can escape the traditional "Wegenerian" point of view to, at last, reach real plate tectonics. This is the main aim of this study to defend this point of view by exposing, with all necessary details, our methods and tools. Starting with the paleomagnetic and paleogeographic data classically used in reconstruction studies, we developed a modern methodology placing the plates and their kinematics at the centre of the issue. Using assemblies of continents (referred as "key assemblies") as anchors distributed all along the scope of our study (ranging from Eocene time to Cambrian time) we develop geodynamic scenarios leading from one to the next, from the past to the present. In between, lithospheric plates are progressively reconstructed by adding/removing oceanic material (symbolized by synthetic isochrones) to major continents. Except during collisions, plates are moved as single rigid entities. The only evolving elements are the plate boundaries which are preserved and follow a consistent geodynamical evolution through time and form an interconnected network through space. This "dynamic plate boundaries" approach integrates plate buoyancy factors, oceans spreading rates, subsidence patterns, stratigraphic and paleobiogeographic data, as well as major tectonic and magmatic events. It offers a good control on plate kinematics and provides severe constraints for the model. This multi-sources approach requires an efficient data management. Prior to this study, the critical mass of necessary data became a sorely surmountable obstacle. GIS and geodatabases are modern informatics tools of specifically devoted to store, analyze and manage data and associated attributes spatially referenced on the Earth. By developing the PaleoDyn database in ArcGIS software we converted the mass of scattered data offered by the geological records into valuable geodynamical information easily accessible for reconstructions creation. In the same time, by programming specific tools we, all at once, facilitated the reconstruction work (tasks automation) and enhanced the model (by highly increasing the kinematic control of plate motions thanks to plate velocity models). Based on the 340 terranes properly defined, we developed a revised set of 35 reconstructions associated to their own velocity models. Using this unique dataset we are now able to tackle major issues of the geology (such as the global sea-level variations and climate changes). We started by studying one of the major unsolved issues of the modern plate tectonics: the driving mechanism of plate motions. We observed that, all along the Earth?s history, plates rotation poles (describing plate motions across the Earth?s surface) tend to follow a slight linear distribution along a band going from the Northern Pacific through Northern South-America, Central Atlantic, Northern Africa, Central Asia up to Japan. Basically, it sighifies that plates tend to escape this median plan. In the absence of a non-identified methodological bias, we interpreted it as the potential secular influence ot the Moon on plate motions. The oceanic realms are the cornerstone of our model and we attached a particular interest to reconstruct them with many details. In this model, the oceanic crust is preserved from one reconstruction to the next. The crustal material is symbolised by the synthetic isochrons from which we know the ages. We also reconstruct the margins (active or passive), ridges and intra-oceanic subductions. Using this detailed oceanic dataset, we developed unique 3-D bathymetric models offering a better precision than all the previously existing ones.