Prise en charge des endométriomes et de l'endométriose recto-vaginate et vésicate [Management of endometrioma, recto-vaginal and bladder endometriosis].

Endometriosis is a frequent, benign, chronic disease associated with pain and/or infertility. Classically the lesions are found on the pelvic peritoneum, ovary (endometrioma), rectovaginal septum and bladder. Management of endometrioma has evolved over the last few years to individualised treatment. Indeed endometrioma cystectomy can decrease pain and the risk of recurrence but is also associated with a decrease in ovarian reserve. A multi-disciplinary team should manage recto-vaginal or bladder endometriosis. Surgical resection of these lesions must be as complete as possible and can be complex.

Conduction mechanisms and charge storage in Si-nanocrystals metal-oxide-semiconductor memory devices studied with conducting atomic force microscopy

In this work, we demonstrate that conductive atomic force microscopy (C-AFM) is a very powerful tool to investigate, at the nanoscale, metal-oxide-semiconductor structures with silicon nanocrystals (Si-nc) embedded in the gate oxide as memory devices. The high lateral resolution of this technique allows us to study extremely small areas ( ~ 300nm2) and, therefore, the electrical properties of a reduced number of Si-nc. C-AFM experiments have demonstrated that Si-nc enhance the gate oxide electrical conduction due to trap-assisted tunneling. On the other hand, Si-nc can act as trapping centers. The amount of charge stored in Si-nc has been estimated through the change induced in the barrier height measured from the I-V characteristics. The results show that only ~ 20% of the Si-nc are charged, demonstrating that the electrical behavior at the nanoscale is consistent with the macroscopic characterization.

Simulations in evolution. II. Relative fitness and the propagation of mutants.

In Neo-Darwinism, variation and natural selection are the two evolutionary mechanisms which propel biological evolution. Our previous article presented a histogram model [1] consisting in populations of individuals whose number changed under the influence of variation and/or fitness, the total population remaining constant. Individuals are classified into bins, and the content of each bin is calculated generation after generation by an Excel spreadsheet. Here, we apply the histogram model to a stable population with fitness F(1)=1.00 in which one or two fitter mutants emerge. In a first scenario, a single mutant emerged in the population whose fitness was greater than 1.00. The simulations ended when the original population was reduced to a single individual. The histogram model was validated by excellent agreement between its predictions and those of a classical continuous function (Eqn. 1) which predicts the number of generations needed for a favorable mutation to spread throughout a population. But in contrast to Eqn. 1, our histogram model is adaptable to more complex scenarios, as demonstrated here. In the second and third scenarios, the original population was present at time zero together with two mutants which differed from the original population by two higher and distinct fitness values. In the fourth scenario, the large original population was present at time zero together with one fitter mutant. After a number of generations, when the mutant offspring had multiplied, a second mutant was introduced whose fitness was even greater. The histogram model also allows Shannon entropy (SE) to be monitored continuously as the information content of the total population decreases or increases. The results of these simulations illustrate, in a graphically didactic manner, the influence of natural selection, operating through relative fitness, in the emergence and dominance of a fitter mutant.

Prise en charge actuelle de l'incontinence anale [Current management of anal incontinence]

Even though anal incontinence affects a significant proportion of the population, causing a major burden to both patient and society, it still remains "the last closet issue". Less than a third of patients will share this problem with their physician. Consequently, the incidence of anal incontinence is difficult to determine, varying from 2-50%. Since this disabling condition is often associated with urinary incontinence and/or pelvic organ prolapse, a multidisciplinary team approach is required. A wide range of therapeutic options are available. When dietary, medical and rehabilitative treatments have failed, sacral neuromodulation should be considered in selected cases. More invasive surgery is usually undertaken in the presence of major structural defects. The aim of this article is to suggest a comprehensive way of identifying and treating anal incontinence.

Epidémiologie et prise en charge du cancer du sein en Valais : 2008-2010

Dans le cadre de la collaboration entre le Registre valaisan des tumeurs (RVsT) de l'Observatoire valaisan de la santé (OVS) et le Département valaisan d'oncologie (DVO), il a été décidé de faire une étude sur l'épidémiologie et la prise en charge du cancer du sein en Valais de 2008 à 2010. Le but de cette étude est de décrire la fréquence, les modes de présentation, les traitements et la survie à 1 et 2 ans du cancer du sein en Valais.

Influence of configurational atomic order on the relative stability of bcc and close-packed structures in Cu-based alloys

We present a study of the influence of atomic order on the relative stability of the bcc and the 18R martensitic structures in a Cu2.96Al0.92Be0.12 crystal. Calorimetric measurements have shown that disorder increases the stability of the 18R phase, contrary to what happens in Cu-Zn-Al alloys for which it is the bcc phase that is stabilized by disordering the system. This different behavior has been explained in terms of a model recently reported. We have also proved that the entropy change at the martensitic transition is independent of the state of atomic order of the crystal, as predicted theoretically. Our results suggest that differences in the vibrational spectrum of the crystal due to different states of atomic order must be equal in the bcc and in the close-packed phases.

Compétences en santé déficientes: obstacle à une prise en charge optimale [Low health literacy: barrier to optimal care].

Les carences en compétences en santé touchent principalement certaines populations à risques en limitant l'accès aux soins, l'interaction avec les soignants et l'autoprise en charge. L'utilisation systématique d'instruments de dépistage n'est pas recommandée et les interventions préconisées en pratique consistent plutôt à diminuer les obstacles entravant la communication patient-soignant. Il s'agit d'intégrer non seulement les compétences de la population en matière de santé mais aussi les compétences communicationnelles d'un système de santé qui se complexifie. Health literacy is defined as "the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions." Low health literacy mainly affects certain populations at risk limiting access to care, interaction with caregivers and self-management. If there are screening tests, their routine use is not advisable and recommended interventions in practice consist rather to reduce barriers to patient-caregiver communication. It is thus important to include not only population's health literacy but also communication skills of a health system wich tend to become more complex.

Prise en charge du traumatisme cranio-cérébral sévère [Update on the management of severe traumatic brain injury]

Prognosis after severe traumatic brain injury (TBI) is determined by the severity of initial injury and secondary cerebral damage. The main determinants of secondary cerebral damage are brain ischemia and oedema. Traumatic brain injury is a heterogeneous disease. Head CT-scan is essential in evaluating initial type of injury and severity of brain oedema. A standardised approach based on prevention and treatment of secondary cerebral damage is the only effective therapeutic strategy of severe TBI. We review the classification, pathophysiology and treatment of secondary cerebral damage after severe TBI and discuss the management of intracranial hypertension, cerebral perfusion pressure and brain ischemia.

Prise en charge de l'asthme en médecine de premier recours [Management of asthma in primary care medicine].

The international recommendations issued by GINA (Global Initiative for Asthma) have undergone considerable adaptations over the last years. This article proposes the local adaptation of those guidelines bearing on the practical aspects of the treatment for the general practitioner's use. One of the fundamental changes in these new guidelines on good practice relates to the permanent adaptation of the treatment on the basis of symptom control rather than on the severity of the asthma. Another change from the old recommendations concerns the manner in which the asthma is categorised into different phases.

Prise en charge initiate du sepsis sévère et du choc septique [Management of severe sepsis and septic shock].

Severe sepsis and septic shock are systemic manifestations of the host response to infection. Mortality remains high despite advances in pathophysiological knowledge. Hemodynamic and respiratory management is largely supportive, while early antibiotics administration and source of infection's control are crucial for patient outcome. We review the principles guiding the initial management of these patients in emergency situation.

Polyarthrite rhumatoïde du sujet agé: présentation clinique et prise en charge [Late-onset rheumatoid arthritis: clinical presentation and management]

Onset of rheumatoid arthritis in an elderly patient is common, in fact more common than in younger subject. If the reality of true differences in clinical presentation between younger and older subjects remained discussed, the central point remains that the prognosis is not better in older patients. Finally, conventional disease-modifying antirheumatic drugs (DMARD) and biological treatments are as efficient and safe than in younger patients, and the same strict management objectives used for younger subjects must be applied in the elderly.