Diagnostics VIH tardifs en 2009 en Suisse: motivation a un dépistage systématique du VIH [Late diagnoses of HIV infection in 2009 in Switzerland: towards a universal HIV testing?]

Individuals who are unaware of their HIV infection constitute a fragile and a critical population both from a personal and from a community-based point of view: if the infection is diagnosed too late, the outcome can be complicated by AIDS-defining diseases, whose prognosis may remain unfavourable even after the initiation of a potent antiretroviral therapy. These patients contribute to the virus spreading into the community, owing to a high viral load. It is now necessary to recognise the limits of a risk behaviour and disease-driven HIV screening policy. Since 2006, the American guidelines recommend a routine HIV testing for all patients age 13 to 64 years unless they specifically refuse the test (opt-out). In Switzerland, the recommendations remain so far risk-centred.

Predictors of mortality from pump failure and sudden cardiac death in patients with systolic heart failure and left ventricular dyssynchrony: results of the CARE-HF trial.

BACKGROUND: Determining a specific death cause may facilitate individualized therapy in patients with heart failure (HF). Cardiac resynchronization therapy (CRT) decreased mortality in the Cardiac Resynchronization in Heart Failure trial by reducing pump failure and sudden cardiac death (SCD). This study analyzes predictors of specific causes of death. METHODS AND RESULTS: Univariate and multivariate analyses used 8 baseline and 3-month post-randomization variables to predict pump failure and SCD (categorized as "definite," "probable," and "possible"). Of 255 deaths, 197 were cardiovascular. There were 71 SCDs with a risk reduction by CRT of 0.47 (95% confidence interval 0.29-0.76; P = .002) with similar reductions in SCD classified as definite, probable, and possible. Univariate SCD predictors were 3-month HF status (mitral regurgitation [MR] severity, plasma brain natriuretic peptide [BNP], end-diastolic volume, and systolic blood pressure), whereas randomization to CRT decreased risk. Multivariate SCD predictors were randomization to CRT 0.56 (0.53-0.96, P = .035) and 3-month MR severity 1.82 (1.77-2.60, P = .0012). Univariate pump failure death predictors related to baseline HF state (quality of life score, interventricular mechanical delay, end-diastolic volume, plasma BNP, MR severity, and systolic pressure), whereas randomization to CRT and nonischemic cardiomyopathy decreased risk; multivariate predictors of pump failure death were baseline plasma BNP and systolic pressure and randomization to CRT. CONCLUSION: CRT decreased SCD in patients with systolic HF and ventricular dyssynchrony. SCD risk was increased with increased severity of MR (including the 3-month value for MR as a time-dependent covariate) and reduced by randomization to CRT. HF death was increased related to the level of systolic blood pressure, log BNP, and randomization to CRT. These results emphasize the importance and interdependence of HF severity to mortality from pump failure and SCD.

La spéciation écologique racontée au travers de l'étude de l'évolution des poissons-clowns et de quelques autres

Ecological speciation and its hallmark, adaptive radiation is a process from which most of the current biodiversity derives. As ecological opportunity allows species to colonise unoccupied niches, natural selection drives adaptive phenotypical change. In this thesis, I begin by describing how this evolutionary process acted on the evolution of the clownfishes. During its infancy, this iconic group of coral reef fishes developed a mutualism with sea anemone species. I show how this event triggered the evolutionary radiation of the group, generating species that now inhabit diverse habitats of the coral reefs. Following the appearance of the mutualism, the diversification of the clownfish was catalysed by hybridisation events which shuffled genes, allowing hybrids to reach new fitness optima. While the clownfishes appeared in the region of the coral triangle, a lineage colonised the eastern shores of Africa. I reconstructed the geographic history of the group and showed that this event lead to the rapid appearance of new species, replicating the evolutionary patterns of the original radiation. To better grasp the mechanisms of ecological speciation, I conducted analyses at the population level and identified similar evolutionary patterns than found at the clade level. I discuss how such result suggests a continuity bridging micro- and macroevolution, which so far only been theorised. In parallel to this study case, I question whether biotic and abiotic interactions can promote or restrain ecological speciation. Indeed, I show how the ecological setting of species can drastically impact on their diversification dynamics. Moreover, tradeoffs can occur between specialisation made on different ecological axes allowing species cohabitation. Overall, I show in this work that regardless of the few simple rules that explain the mechanism of ecological speciation, the unavoidable interactions with the ever changing ecological context lead diversification events to give always a different outcome. It is thus primordial to account for the ecological settings of species when discussing their evolutionary dynamics. LA SPÉCIATION ÉCOLOGIQUE RACONTÉE AU TRAVERS DE L'ÉTUDE DE L'ÉVOLUTION DES POISSONS-CLOWNS ET DE QUELQUES AUTRES Le phénomène de spéciation écologique est à l'origine de la majeure partie de la biodiversité que l'on rencontre aujourd'hui. Au fil des opportunités qu'elles rencontrent, les espèces colonisent l'espace écologique laissant la sélection naturelle forger leur phénotype moyen. Malgré l'omniprésence de ce phénomène dans la nature, beaucoup de questions qui lui sont relatives restent à élucider. C'est afin de mieux comprendre ce mécanisme que j'étudie les poissons-clowns, célèbres habitants des récifs coralliens. Dans ce travail, je démontré que le développement du comportement mutualiste liant les poissons-clowns aux anémones de mer fut l'événement qui déclencha leur diversification. Suite à ce premier événement, j'illustre comment l'hybridation entre lignées primordiales a remodelé la diversité génétique du groupe et catalysé leur radiation évolutive. Je poursuis en reconstruisant l'expansion géographique des poissons-clowns au cours du temps depuis le triangle de corail, leur lieu d'origine, jusqu'aux côtes d'Afrique de l'Ouest. Afin d'affiner ces analyses générales sur le groupe, je continue en étudiant plus finement des populations d'une seule espèce de poisson-clown. Cette fine résolution me permet de comprendre plus précisément quels sont les facteurs écologiques qui permettent aux poissons-clowns de se différencier. Les résultats de ces analyses suggèrent qu'il est important de comprendre les liens entre le contexte écologique et la diversification des espèces. J'étudie cette question dans la seconde partie de ce travail en montrant que l'hétérogénéité du paysage ou les liens entretenus avec un partenaire mutualiste influencent fortement la dynamique évolutive des espèces. Finalement, j'illustre les compromis que chaque espèce réalise en se spécialisant ou non dans ses interactions avec l'environnent. Plus généralement, je souligne dans ce travail l'influence du contexte écologique sur le résultat de la spéciation écologique. Ce sont ces interactions entre les organismes et leur environnent qui sont à l'origine de l'incroyable diversité de la vie. Il est donc primordial de les prendre en compte lors de l'étude de l'évolution des espèces.

An international registry on autoinflammatory diseases: the Eurofever experience.

OBJECTIVE: To report on the demographic data from the first 18 months of enrollment to an international registry on autoinflammatory diseases in the context of the Eurofever project. METHODS: A web-based registry collecting baseline and clinical information on autoinflammatory diseases and related conditions is available in the member area of the PRINTO web-site. Anonymised data were collected with standardised forms. RESULTS: 1880 (M:F=916:964) individuals from 67 centers in 31 countries have been entered in the Eurofever registry. Most of the patients (1388; 74%), reside in western Europe, 294 (16%) in the eastern and southern Mediterranean region (Turkey, Israel, North Africa), 106 (6%) in eastern Europe, 54 in Asia, 27 in South America and 11 in Australia. In total 1049 patients with a clinical diagnosis of a monogenic autoinflammatory diseases have been enrolled; genetic analysis was performed in 993 patients (95%): 703 patients have genetically confirmed disease and 197 patients are heterozygous carriers of mutations in genes that are mutated in patients with recessively inherited autoinflammatory diseases. The median diagnosis delay was 7.3 years (range 0.3-76), with a clear reduction in patients born after the identification of the first gene associated with autoinflammatory diseases in 1997. CONCLUSIONS: A shared online registry for patients with autoinflammatory diseases is available and enrollment is ongoing. Currently, there are data available for analysis on clinical presentation, disease course, and response to treatment, and to perform large scale comparative studies between different conditions.

Geological observation in southeastern Zanskar and adjacent Lahul area (northern Himalaya).

The paper deals with the stratigraphic and structural setting of the sedimentary sequence cropping out in southeastern Zanskar and adjacent Lahul areas. The Tibetan Zone succession of southeastern Zanskar consists of about 6000 m of sediments, Late Precambrian~ ?Eocene in age, arranged in two superposed slabs (Pugh tal Unit, below, and Zangla Unit, above) tectonically resting upon the High Himalayan Crystalline. The Pughtal sequence, mostly terrigenous with carbonate units in the Cambrian, Silurian and Carboniferous, is about 2500 m thick. It was deposited from ?Late Precambrian to Carboniferous or ?Early Permian. The Permian Panjal Traps constitute the "sole" of the Zangla Unit, whose sedimentary sequence, about 3000 m thick, mainly carbonatic, spans from Late Permian (Kuling Formation) to Middle Jurassic (Kioto Limestone) in eastern Zanskar. In the Zangla area Late Jurassic/Cretaceous formations (Spiti Shales, Giumal Sandstone, Chikkim Limestone) are also present. Towards northwest, the sequence ranges up to Paleocene (Spanboth Formation) and ?Eocene (Chulung La Slates). Au nord de la Haute Chaine, dans la partie septentrionale de I'Himalaya, la marge continentale indienne a vu plus de 6000 m de sediments se deposer depuis I'Infracambrien jusqu'a I'Eocene. Lors de l'orogenese himalayenne, ces sediments ont ete decolles de leur substratum originel, dMormes et metamorphises de maniere differenciee suivant leur position. Ils reposent en contact tectonique sur la nappe cristalline du Haut-Himalaya. L'unite inferieure ou unite de Pughtal consiste, la ou elle est complete, en plus de 2500 m de sediments en partie detritiques terrigenes mais marque par l'edification de plates-formes carbonatees au Cambrien, Silurien et Carbonifere. Dans cette unite on releve deux grandes sequences sedimentaires separees par l'evenement epirogenique et magmatique tardi-Cambrien (500 rna), contrecoup de l'orogenese pan-africaine. Un niveau massif de vo1canites basaltiques permiennes ~ les Panjal Traps ~ forme la base ou sole de I'unite superieure (nappe de Zangla). Cette unite, plissee de maniere disharmonique, recouvre progressivement vers l'ouest des niveaux de plus en plus anciens de l'unite inferieure, niveaux eux-memes replisses en grands plis couches kilometriques a vergence nord. Dans la partie occidentale (Ringdom) l'unite superieure repose directement sur la nappe cristalline. Cette unite montre une serie sedimentaire avec des carbonates de plate-forme bien developpes au Trias superieur et au Lias puis des sediments surtout pelagiques et en partie detritiques terrigenes au Jurassique superieur et au Cretace. Des la fin du Cretace et jusqu'au Paleocene superieur s'edifie a nouveau une plate-forme peu profonde. La serie se termine par des couches continentales attribuees a l'Eocene. L'evolution geodynamique durant Ie Paleozoique et Ie Mesozoique est analysee. II en ressort que la sedimentation, a partir de I'Ordovicien, est regJee plus par des grands cycles eustatiques que par des mouvements tectoniques ou epirogeniques regionaux (les orogeneses caledoniennes, hercyniennes et cretacees des auteurs).

Les conteurs galants des XVIIe et XVIIIe siècles ; 5-6. Le fond du sac : recueil de contes en vers. T. 1 / [Félix Nogaret] ; [grav. par Duplessis-Bertaux]

Comprend : Contes

Les conteurs galants des XVIIe et XVIIIe siècles ; 5-6. Le fond du sac : recueil de contes en vers. T. 2 / [Félix Nogaret] ; [grav. par Duplessis-Bertaux]

Comprend : Contes

Genetic studies of body mass index yield new insights for obesity biology

Obesity is heritable and predisposes to many diseases. To understand the genetic basis of obesity better, here we conduct a genome-wide association study and Metabochip meta-analysis of body mass index (BMI), a measure commonly used to define obesity and assess adiposity, in up to 339,224 individuals. This analysis identifies 97 BMI-associated loci (P < 5 × 10(-8)), 56 of which are novel. Five loci demonstrate clear evidence of several independent association signals, and many loci have significant effects on other metabolic phenotypes. The 97 loci account for ∼2.7% of BMI variation, and genome-wide estimates suggest that common variation accounts for >20% of BMI variation. Pathway analyses provide strong support for a role of the central nervous system in obesity susceptibility and implicate new genes and pathways, including those related to synaptic function, glutamate signalling, insulin secretion/action, energy metabolism, lipid biology and adipogenesis.

Différences induites par la définition des périodes diurnes et nocturnes sur la pression artérielle et le dipping lors d'une mesure ambulatoire de la pression artérielle [Effects of nighttime and daytime interval definition on blood pressure and dipping in patients referred for ambulatory blood pressure measurement].

Ambulatory blood pressure monitoring (ABPM) has become indispensable for the diagnosis and control of hypertension. However, no consensus exists on how daytime and nighttime periods should be defined. OBJECTIVE: To compare daytime and nighttime blood pressure (BP) defined by an actigraph and by body position with BP resulting from arbitrary daytime and nighttime periods. PATIENTS AND METHOD: ABPM, sleeping periods and body position were recorded simultaneously using an actigraph (SenseWear Armband(®)) in patients referred for ABPM. BP results obtained with the actigraph (sleep and position) were compared to the results obtained with fixed daytime (7a.m.-10p.m.) and nighttime (10p.m.-7a.m.) periods. RESULTS: Data from 103 participants were available. More than half of them were taking antihypertensive drugs. Nocturnal BP was lower (systolic BP: 2.08±4.50mmHg; diastolic BP: 1.84±2.99mmHg, P<0.05) and dipping was more marked (systolic BP: 1.54±3.76%; diastolic BP: 2.27±3.48%, P<0.05) when nighttime was defined with the actigraph. Standing BP was higher (systolic BP 1.07±2.81mmHg; diastolic BP: 1.34±2.50mmHg) than daytime BP defined by a fixed period. CONCLUSION: Diurnal BP, nocturnal BP and dipping are influenced by the definition of daytime and nighttime periods. Studies evaluating the prognostic value of each method are needed to clarify which definition should be used.

Comorbidity and nutritional indices as predictors of morbidity after transurethral procedures: A prospective cohort study.

INTRODUCTION: Preoperative scores are widely used predictors of complications after major surgery. These scores, however, are not widely used in transurethral procedures. The aim of this study was to assess the value of the Charlson Comorbidity Index (CCI), the age-adjusted CCI, the American Society of Anesthesiologist score (ASA) and the Nutritional Risk Score (NRS) in predicting early morbidity after transurethral urological procedures. METHODS: Consecutive patients undergoing transurethral resection of the bladder or the prostate were prospectively enrolled. The scores were calculated preoperatively; 30-day complications were prospectively recorded according to the Dindo-Clavien classification. Univariate logistic regression was performed to investigate the value of each score and of other factors (i.e., age, sex, body mass index, anemia, smoking habit, type of operation and anaesthesia) as predictors of complications. A multivariate model was then calculated using these predictors. RESULTS: Overall, 197 patients were included. The mean age was 72 (standard deviation ± 10). In total, 26.9% patients had at least 1 complication. Using univariate analysis, we found that each score significantly predicted complications. In multivariate analysis, only the ASA (odds ration [OR] 2.11; 95% confidence interval [CI] 1.01-4.43) and the NRS (OR 2.42; 95% CI 1.56-3.74) remained independent predictors. The best model incorporated ASA, NRS and gender, and predicted morbidity with an area under the curve of 76%. Our study's main limitations are population heterogeneity and limited sample size. CONCLUSION: The ASA and the NRS are important and independent determinants of early morbidity after transurethral procedures. The use of these indices may assist clinicians in the decision-making process to balance the possible benefits of transurethral procedures with the potential risks.

Specificities of defense mechanisms in bipolar affective disorder: relations with symptoms and therapeutic alliance.

Defense mechanisms as a central notion of psychoanalysis have inspired various levels of interest in research in psychotherapy and psychopathology. Defense specificities have only recently been investigated systematically with regard to several clinical diagnoses, such as affective and personality disorders. For the present study, 30 inpatients diagnosed with Bipolar Affective Disorder I (BD) were interviewed. An observer-rater method, the Defense Mechanisms Rating Scales (DMRS), applied to session-transcripts, of assessment of defenses was used. A matched, nonclinical control group was introduced. Defense specificities in BD encompass a set of 5 immature defenses, of which omnipotence is linked with symptom level. The level of the therapeutic alliance is predicted by mature defenses. These results are discussed with regard to the psychological vulnerability of BD, and treatment implications for psychodynamic psychotherapy with such challenging patients are evoked.

Comportamento respiratório e qualidade pós-colheita de graviola (Annona muricata L.) 'morada' sob temperatura ambiente

Objetivou-se avaliar alterações físicas e físico-químicas, relacionando-as às taxas respiratória e de liberação de etileno, durante a maturação da graviola-'Morada'. Frutos colhidos na maturidade fisiológica foram armazenados (23,4 ± 1,1ºC e 81,8 ± 10,6% UR) e avaliados aos 0; 1; 2; 3; 4 e 6 dias, quanto a: atividade respiratória (RS), liberação de etileno (ET), perda de matéria fresca, cor da casca e da polpa, firmeza, pH, acidez total titulável (ATT), sólidos solúveis totais (SST) e açúcares solúveis totais (AST). Utilizou-se o delineamento experimental inteiramente casualizado, com quatro repetições. Aos dois dias, iniciou-se rápido aumento na RS, resultando no primeiro pico (197,60mg CO2·kg-1·h-1), que foi seguido por queda e uma fase lag. Ao término desta, iniciou-se o aumento climatérico (pico = 298,82mg CO2·kg-1·h-1). ET só foi detectada por ocasião do primeiro pico respiratório, atingindo o máximo aos quatro dias. A cor da casca tornou-se mais clara, enquanto na polpa se observou apenas redução da luminosidade. Houve coincidência entre o primeiro aumento na RS, o pico de ET e as mudanças mais significativas na firmeza, na ATT e nos teores de SST e AST. Durante o período, a firmeza diminuiu de 60 para 0,9N, e a ATT aumentou de 0,18 para 0,88% de ácido cítrico.

Principes de style ou Observations sur l'art d'écrire : recueillies des meilleurs auteurs ([Reprod.])

Collection : Archives de la linguistique française ; 197

Development of a harmonised method for the profiling of amphetamine

Résumé : Cette thèse de doctorat est le fruit d'un projet de recherche européen financé par le quatrième programme cadre de la Commission Européenne (DG XII, Standards, Measurement and Testing). Ce projet, dénommé SMT-CT98-2277, a été financé pour la partie suisse par l'Office Fédéral de l'Education et de la Science (OFES, Berne, Suisse). Le but de ce projet était de développer une méthode harmonisée et collaborativement testée pour le profilage des impuretés de l'amphétamine illicite par chromatographie capillaire en phase gazeuse. Le travail a été divisé en sept phases majeures qui concernaient la synthèse de l'amphétamine, l'identification d'impuretés, l'optimisation de la préparation de l'échantillon et du système chromatographique, la variabilité des résultats, l'investigation de méthodes mathématiques pour la classification et la comparaison de profils et finalement l'application de la méthode à des réels échantillons illicites. La méthode résultant de ce travail n'a pas seulement montré que les données étaient interchangeables entre laboratoires mais aussi qu'elle était supérieure en de nombreux points aux méthodes préalablement publiées dans la littérature scientifique. Abstract : This Ph.D. thesis was carried out in parallel to an European project funded by the fourth framework program of the European Commission (DG XII, Standards, Measurement and Testing). This project, named SMT-CT98-2277 was funded, for the Swiss part, by the Federal Office of Education and Science (OFES, Bern, Switzerland). The aim of the project was to develop a harmonised, collaboratively tested method for the impurity profiling of illicit amphetamine by capillary gas chromatography. The work was divided into seven main tasks which deal with the synthesis of amphetamine, identification of impurities, optimization of sample preparation and of the chromatographic system, variability of the results, investigation of numerical methods for the classification and comparison of profiles and finally application of the methodology to real illicit samples. The resulting method has not only shown to produce interchangeable data between different laboratories but was also found to be superior in many aspects to previously published methods.