De Loire Research Articles

Prediction of pathological response to neo-adjuvant chemotherapy using texture parameters of initial 18-FDG PET/CT in estrogen receptor positive/Her2 negative (ER+/HER2-) early breast cancer (eBC).

e12567 Background: ER+/HER2- phenotype represents 70% of eBC and is itself a heterogenic entity in which neoadjuvant chemotherapy (NAC) can be indicated. Early change in 18F-FDG uptake on PET/CT, using standardized uptake value (SUV) parameter, has been shown as a predictive biomarker of response to NAC. However, this parameter can be defaulted in ER+/HER2- BC. The objective of this work was to evaluate the correlation of textural parameters of initial 18-FDG PET/CT with histologic response in ER+/HER2- eBC. Methods: All patients receiving NAC for ER+/HER2- eBC, with 18F-FDG PET/CT prior NAC at the Integrated Center for Oncology Pays de Loire were included between 2012 and 2023. Twenty-nine metabolic and volumetric parameters and 42 textural features (DOSISOFT software, Planet Onco v2.0) were collected. Pathological response was assessed for each breast tumoral lesion in case of multifocal disease. Results: A total of 161 patients with 179 lesions were included. Medium age was 51 years old. 89% and 10% of patients presented a cT1 or cT2 tumoral lesion, 78% with lymph node involvement, 44% with a grade 3 and 46% with a HER2 low status. 21% of patients achieved a pathological complete response in breast (ypT0) and 11% a complete histologic response (ypT0N0). Examinations were performed using three types of PET/CT systems (GE Healthcare and Philips Healthcare). In order to harmonize radiomics data Combat method was used. Thirteen semi-quantitative (MTV and SUVmax, SUVmean, SUVmean(EVPc), SUVpeak, TLG for weight-normalized and lean-body-mass-normalized, respectively) and 6 textural parameters (entropy, homogeneity, SRE, LRE, LGZE, and HGZE) were retained. For all radiomics features used in this study, no statistical difference was found between ypT0 and non-ypT0 patients (p ≥ 0.05). Conclusions: Selected textural parameters were not associated with histologic response in our cohort of ER+/HER2- eBC. However, many other textural features, not retained in this study because influenced by acquisition parameters and segmentation methods, could be taken into account. An ongoing preliminary work (as resampling, normalization) is needed to improve their robustness before evaluating their interest in predicting histologic response to NAC.

Toward an Operational Monitoring of Oak Dieback With Multispectral Satellite Time Series: A Case Study in Centre-Val De Loire Region of France

Toward an Operational Monitoring of Oak Dieback With Multispectral Satellite Time Series: A Case Study in Centre-Val De Loire Region of France

(Invited) Molecular Dynamics Simulation Insights into Plasma Treatment of Emerging Pollutants in Water

Eliminating organic pollutant molecules in water is a world challenge, that non-thermal plasmas at atmospheric pressure are aiming to address. Non thermal plasmas are used for treating contaminated water due to their ability to produce reactive oxygen and nitrogen species, the so-called RONS, which diffuse into water, react with pollutant molecules, and degrade them. Many experimental works have been designed, using different plasma sources [1, 2], but in all cases HO● radicals are acknowledged to play the main role in the degradation process.Classical and ab-initio reactive molecular dynamics (MD) simulations are relevant techniques for describing interactions of HO● with pollutant molecules in water, leading to the knowledge of degradation products, chemical pathways and rates [3]. Basically, MD simulations are solving the Newton equations of motion of a set of species, say atoms, molecules, clusters, etc. It is able to describe system size up to billion of species. It only needs the knowledge of interactions (force fields) between all species as well as initial conditions, preferably consistent with experiments. So it is suitable for addressing chemical reactivity. Classical reactive MD simulations are using available semi-empirical force fields, such as reaxFF, while ab-initio MD are required when no such force field is available. In this case, force fields are calculated quantum mechanically at relevant time steps of MD simulations.In fact, MD simulations act as a predictive "virtual microscope" provided the force fields are enough precise.In this work, MD simulations of the interaction of HO● radicals with molecules representative of various emerging pollutant families, as pesticide, antibiotics, PFAS in water, are studied. For mimicking HO● radicals release into water by non-thermal plasma, HO● radicals are periodically injected into a simulation box containing a pollutant molecule surrounded by several tens of water molecules. For obtaining statistically significant results, at least 10 simulations, with different initial conditions are run. The products that are formed will be compared with experiments, especially HPLC, GCMS and MS/MS measurements of plasma treated water.Another approach, consists in introducing a temperature ramp during the simulation for determining at which temperature products are appearing and in which order. Such an approach is revealing the reaction barriers up to full decomposition of the pollutant molecule. It can thus, by back-analysis, help to define which plasma or other advanced oxidation processing will be relevant [3]. Acknowledgements Part of this work has been supported by Conseil Régional Centre-Val de Loire with grant #2021-00144786 for projectPerturb’Eau. Monica Magureanu, Corina Bradu, Florin Bilea, Olivier Aubry, Dunpin Hong, Manoj Panyamthatta-Tayaroth are gratefully acknowledged for stimulating discussions and for providing experimental results.

Uncovering gender bias in health services: the case of kidney transplantation

Abstract Gender-based inequalities of access to health care are major public health issues. Studies performed in several countries and in some French regions showed that women had less access to kidney transplantation waiting list (KTWL) than men. Through a quantitative study based on REIN registry data, we analysed gender-based disparities in the access to KTWL in France. All incident patients who initiated dialysis from 2017 to 2019 and aged between 18 and 85 years old were included. Cox proportional hazard models, adjusted on age, comorbidities and neighbourhood deprivation level using European Deprivation Index (EDI), at national level and in all French regions, were performed. Among 29 395 patients who started dialysis in 2017-2019, 35% were women. 40% of women and 34% of men lived in most deprived areas. Men were more comorbid than women at dialysis start. At the national level, women had less access to the KTWL compared to men one and three years after dialysis start. Analyses were stratified by age (<60 and ≥ 60 years old). Only women aged more than 60 had less access to the KTWL one year (adjHR: 0.76 [0.71 - 0.82]) and three years (adjHR: 0.75 [0.71 - 0.81]) after dialysis start. At regional level, the same trends were found in Nouvelle Aquitaine and Pays de Loire one year after dialysis start and two more regions (Bourgogne-Franche-Comté and Île-de-France) 3 years after dialysis start. Gender-based disparities in KTWL persist even after controlling for EDI and comorbidities, especially among women over 60. These results are issued from a health service research project on gender-based disparities of access to KTWL in France. A qualitative study is ongoing to better understand the reasons of these disparities. Patients’ perspectives on Kidney transplantation and nephrologists’ practices are studied using Semi-structured interviews in three French regions.

#4642 DO WOMEN HAVE LESS ACCESS TO THE KIDNEY TRANSPLANTATION WAITING LIST THAN MEN IN FRANCE?

Abstract Background and Aims Studies performed in several countries and in some French regions showed that women have less access to kidney transplantation waiting list (KTWL) than men. The aim of this study is to analyse women's access to the kidney transplantation waiting list at the national level and in all French regions. Method This is a retrospective cohort study using the French National Renal Epidemiology registry (REIN). All incident patients initiated dialysis from 2017 to 2019 and aged between 18 and 85 were included. Patients were followed three years from the dialysis start. Our outcome of interest was the registration on the KTWL 1 and 3 years following dialysis initiation. We performed Cox proportional hazard models, adjusted on age, comorbidities and neighbourhood deprivation level using European Deprivation Index (EDI), at national level and in all French regions. The sex/age and sex/EDI interactions were studied. Results 29 395 patients started dialysis in 2017-2019. 35% were women. 40% of female and 34% of male patients lived in most deprived areas. Men were more comorbid than women were at dialysis start. At the national level, women had less access to the KTWL compared to men one (adjHR: 0.91; IC95: [0.87 – 0.96]) and three years (adjHR: 0.87 [0.84 – 0.91]) after dialysis start. There was no significant sex/EDI interaction but a significant sex/age interaction. Therefore, the analyses were stratified by age (<60 and ≥ 60 years old). Only women aged more than 60 had less access to the KTWL at one year (adjHR: 0.76 [0.71 – 0.82]) and three years (adjHR: 0.75 [0.71 – 0.81]). At regional level, the same trends were found in Nouvelle Aquitaine and Pays de Loire one-year after dialysis start and two more regions (Bourgogne-Franche-Comté and Île-de-France) 3 years after dialysis start. Conclusion This study shows that women have less access to KT WL one and three years after dialysis start on the national level and in some regions. This disparity is found to be present especially among patients aged beyond 60 years. A qualitative study is planned to better understand this sex based disparity.

COVID-19 seroprevalence among local authority workers from Orléans Métropole, the Community of Communes of the Terres du Val de Loire, the local public service management centre of the Loiret department and the Region Centre Val de Loire: a prospective epidemiological study

ObjectiveTo evaluate the SARS-CoV-2 seroprevalence among local authority workers, depending on their position and potential interaction with the public.MethodsA cohort of volunteer participants was recruited among local authority workers of...

Breastfeeding and respiratory, ear and gastro-intestinal infections, in children, under the age of one year, admitted through the paediatric emergency departments of five hospitals.

Breastfeeding is a protective factor against respiratory and intestinal infections in developing countries. In developed countries, proof of this protection is more difficult to show. The objective of the study is to compare the proportion of children breastfed during their first year in groups of children with infectious pathologies supposedly prevented by breastfeeding and children free of these infectious pathologies. Questionnaires about diet, socio-demographic data and the motive for consultation were given to the parents upon arrival in the paediatric emergency departments of 5 hospitals located in Pays de Loire (France) in 2018 and 2019. Children with lower respiratory tract infections, acute gastroenteritis and acute otitis media were included in the case group (A), children admitted for other reasons were included in the same control group (B). Breastfeeding was classified as exclusive or partial. During the study period, 741 infants were included, of which 266 (35.9%) in group A. In this group, children were significantly less likely to have been breastfed at the time of admission than children in group B: for example, for children under 6 months, 23.3% were currently breastfed in group A, vs. 36.6% (weaned BF or formula diet) in group B [OR = 0.53 (0.34-0.82); p = 0.004]. Similar results were found at 9 and 12 months. After taking into account the age of the patients, the same results were confirmed with an aOR = 0.60 (0.38-0.94) (p = 0.02) at 6 months, but with when considering six variables six variables, aOR was not significative aOR = 0.65 (0.40-1.05); p = 0.08), meaning that factors such as the childcare out of home, socio-professional categories, and the pacifier decrease the protective effect of breastfeeding. Sensitivity analyses (age-matching, analysis by type of infection) showed the same protection effect provided by breastfeeding when it was pursued for at least 6 months and also that the protective effect of breastfeeding is especially true against gastro-enteritis. Breastfeeding is a protective factor against respiratory, gastrointestinal and ear infections when pursued at least 6 months after birth. Other factors such as collective childcare, pacifiers and low parental professional status can reduce the protective effect of breastfeeding.

First report of barley virus G infecting winter barley (Hordeum vulgare L.) in France.

As part of a cereals virome project high throughput sequencing (HTS)-based viral indexing was performed on plants with symptoms of barley yellow dwarf disease collected in June (2017-2020) in the main French cereals production areas. Total RNAs from 32 individual plants were purified (RNeasy Plant Mini Kit, Qiagen, Courtaboeuf, France) and Illumina sequenced (2x150 nt) following ribodepletion (Genewiz-Azenta, Leipzig, Germany). Following quality trimming, reads for each sample were de novo assembled (CLC Genomics Workbench 21, Qiagen) [1] and contigs annotated by BlastX analysis. In four winter barley samples collected in 2018 (18-58, 18-325 and 18-326) and 2019 (19-30A), besides contigs representing diverse viruses such as barley yellow dwarf viruses-PAV and PAS, Hordeum vulgare endornavirus, cereal yellow dwarf virus-RPV (18-326), wheat dwarf virus (18-325 and 18-326) and a novel Polerovirus (18-58 and 18-326), large contigs with high identity to barley virus G (BVG) were identified. BVG, a tentative Polerovirus, was initially reported in barley in South Korea in 2016 [2] and has so far been identified in a few other hosts including wheat, oat, maize, proso and foxtail millets as well as switchgrass. It has been reported from the USA and Australia [3] and, in Europe, from the Netherlands, Germany, Hungary and Greece [4]. Large BVG scaffolds representing near complete genomes could be reconstructed for each sample, integrating a total of 128.339, 7.188, 8.078 and 20.073 reads, for samples 19-30A, 18-58, 18325 and 18-326 respectively. Given that between 17.2 and 20.5 million reads had been obtained per sample, these values translate into between 0.04% (18-58 and 18-325) and 0.6% (19-30A) of total reads, and to average coverages of between 158x (18-58) and 2866x (19-30A) for the genomic scaffolds. The four assembled sequences (5584-5610 nt) have been deposited in GenBank (ON419453-ON419456). They are nearly identical (98.4 to 99.5% nt identity) and share between 97.7% and 98.5% nt identity with a barley reference isolate from the South Korea (NC_029906). To confirm the presence of BVG, a primer pair was designed based on available BVG sequences. Primers BVG-F(5'-CTAGCCCAACGAGTTGCGGG-3') and BVG-R(5'-GGTACAGAAGCTCTACGGTTC-3') amplifying a 394 nt were used in a two-step RT-PCR on new RNA extracts obtained from the 18-325 and 18-326 infected plants. The amplicons were directly sequenced and showed respectively 99.2% (ON419457, 18-325) and 100% (18-326) nt identity with the corresponding de novo scaffolds. The four analyzed samples have been collected respectively in 2018 (18-58, 18-325, 18-326) and 2019 (19-30A) in three different regions of France (Auvergne-Rhône-Alpes, Occitanie and Centre-Val de Loire), indicating a wide distribution and a persistence over time of BVG in France. To our knowledge, this represents the first report of a natural infection of BVG in cultivated winter barley in France. Presence of BVG may have been overlooked in a range of situation, as indicated by its retrospective discovery in a 34 years old Australian sample [3], possibly explaining its broad distribution in France. While the mixed infection status of the analyzed plants precludes any conclusion on its pathogenicity in French cereals, BVG has been reported to be associated with a range of symptoms in various hosts so that further studies to evaluate its prevalence and impact in France and to begin to understand its epidemiology are clearly warranted by the present results.

Étude qualitative de l’acceptabilité de la téléconsultation pour le traitement préventif du VIH

Introduction : In France, the incidence of HIV infections remains at 6,000 infections a year. Pre-Exposure Prophylaxis (PrEP) could reduce this number. Despite available reimbursement since 2016 to exposed populations, the recipients remain mostly men who have sex with men (MSM) living in large cities. In Center-Val de Loire, where newly HIV diagnoses and difficulties of access to care are tremendous, community tele-support and dedicated teleconsultations have been launched to promote access, particularly in rural areas. This study aimed to identify the interests and limits of these teleconsultations for PreP users.Purpose of research : E-PrEP qualitative study conducted by semi-structured interviews with MSM PrEP users allowing the thematic analysis of eight interviews lasting an average of one hour, conducted with MSM taking at least one teleconsultation.Results : The teleconsultation met user expectations with good acceptability. It integrated naturally into the associated preventive care pathway where applicable. The description of a more impersonal face-to–face exchange is balanced by establishing a trusting relationship. Teleconsultation has sometimes eased talking about sexuality. An enhanced confidentiality could represent a specific motif to choose teleconsultation. Access to the specialist seems to be an asset compared to a GP follow-up hardly chosen for this type of consultation. Fears of lack of discretion or judgmental behavior from these unspecialized healthcare professionals were pronounced..Conclusions : The deployment of teleconsultations can be encouraged to facilitate access to PrEP with vigilance on the associated health path.

Biogeochemical behaviour of geogenic As in a confined aquifer of the Sologne region, France.

Arsenic (As) is one of the main toxic elements of geogenic origin that impact groundwater quality and human health worldwide. In some groundwater wells of the Sologne region (Val de Loire, France), drilled in a confined aquifer, As concentrations exceed the European drinking water standard (10μgL-1). The monitoring of one of these drinking water wells showed As concentrations in the range 20-25μgL-1. The presence of dissolved iron (Fe), low oxygen concentration and traces of ammonium indicated reducing conditions. The δ34SSO4 was anticorrelated with sulphate concentration. Drilling allowed to collect detrital material corresponding to a Miocene floodplain and crevasse splay with preserved plant debris. The level that contained the highest total As concentration was a silty-sandy clay containing 26.9mgkg-1 As. The influence of alternating redox conditions on the behaviour of As was studied by incubating this material with site groundwater, in biotic or inhibited bacterial activities conditions, without synthetic organic nutrient supply, in presence of H2 during the reducing periods. The development of both AsV-reducing and AsIII-oxidising microorganisms in biotic conditions was evidenced. At the end of the reducing periods, total As concentration strongly increased in biotic conditions. The microflora influenced As speciation, released Fe and consumed nitrate and sulphate in the water phase. Microbial communities observed in groundwater samples strongly differed from those obtained at the end of the incubation experiment, this result being potentially related to influence of the sediment compartment and to different physico-chemical conditions. However, both included major Operating Taxonomic Units (OTU) potentially involved in Fe and S biogeocycles. Methanogens emerged in the incubated sediment presenting the highest solubilised As and Fe. Results support the hypothesis of in-situ As mobilisation and speciation mediated by active biogeochemical processes.

Découverte dans le Loiret de la deuxième station mondiale d’une espèce énigmatique de raphidie : Venustoraphidia conviventibus Monserrat & Papenberg, 2012 (Raphidioptera, Raphidiidae)

Discovery in the Loiret of the second world station of an enigmatic species of snakefly: Venustoraphidia conviventibus Monserrat & Papenberg, 2012 (Raphidioptera, Raphidiidae). Authors expose a recent capture of a male of Venustoraphidia conviventibus Monserrat & Papenberg, 2012, in the Loiret department (France), a species only known by a single male captured in Spain, in the Basque Country. The identification criteria are discussed and illustrated. A difference in the length of the pterostigma exists between the two west- European Venustoraphidia species: long in V. conviventibus, short in V. nigricollis (Albarda, 1891). Different hypotheses, including anthropogenic importation, are presented in order to explain the presence of this species in the Centre-Val de Loire.

Environmental and Techno-Economic Feasibility of a BCCUS Project: the CO2SERRE Case Study in Centre-Val De Loire (France)

Environmental and Techno-Economic Feasibility of a BCCUS Project: the CO2SERRE Case Study in Centre-Val De Loire (France)

1484P Impact of time to diagnostic imaging on survival of patients with pancreatic cancer

Excessive waiting time intervals for the diagnosis and treatment of patients (pts) with pancreatic cancer can influence their prognosis but they remain unclear. The objective of this study was to describe time intervals for diagnostic imaging and treatment and their prognostic impact in pancreatic cancer in the Centre-Val de Loire (CVL) region.

Does the Temperature of the prise de mousse Affect the Effervescence and the Foam of Sparkling Wines?

The persistence of effervescence and foam collar during a Champagne or sparkling wine tasting constitute one, among others, specific consumer preference for these products. Many different factors related to the product or to the tasting conditions might influence their behavior in the glass. However, the underlying factor behind the fizziness of these wines involves a second in-bottle alcoholic fermentation, also well known as the prise de mousse. The aim of this study was to assess whether a low temperature (13 °C) or a high temperature (20 °C) during the in-bottle fermentation might have an impact on the effervescence and the foaming properties (i.e., collar height and bubble size) of three French sparkling wines (a Crémant de Loire and two Champagne wines), under standard tasting conditions. Our results showed that sparkling wines elaborated at 13 °C and served in standard tasting conditions (i.e., 100 mL, 18 °C) had better ability to keep the dissolved CO2 (between 0.09 and 0.30 g/L) in the liquid phase than those elaborated at 20 °C (with P < 0.05). Most interestingly, we also observed, for the Crémant de Loire and for one Champagne wine, that the lower the temperature of the prise de mousse, the smaller (with P < 0.05) the bubbles in the foam collar throughout the wine tasting.

Success and risks of pregnancy after breast cancer.

Breast cancer is the most common cancer in women worldwide. The number of childbearing-age women diagnosed with early breast cancer (eBC) is increasing, raising questions over their subsequent fertility. The main objective of this study was therefore to assess, in a cohort of eBC patients with pregnancy desire, the rate of live births achieved spontaneously or by assisted reproductive technology. We conducted an observational, descriptive, retrospective study including patients aged 18-40, treated for eBC at the Institut de Cancérologie de l'Ouest (ICO) Pays de Loire between July 2010 and July 2016, with pregnancy desire. The primary outcome was the rate of live births. Secondary outcomes were overall survival, disease-free survival, time to conception, and spontaneous or assisted pregnancy rate. 61 patients were included, with a live birth rate of 19.7% (12/61). We observed no recurrence or death in women with a pregnancy. Pregnancy started with a median time of 36.4months after the end of treatment (4.1-51.3months). All pregnancies in this cohort were achieved spontaneously. The results of our cohort are consistent with previous results showing that spontaneous pregnancy remains possible after treatment for eBC without increasing the risk of recurrence or death.

Assessment of a multiprofessional training programme by in situ simulation in the maternity units of the Pays de Loire regional perinatal network

IntroductionInitially dispensed in specialized simulation centers, simulation training has recently begun to take place directly in healthcare facilities, that is, in situ. The objective of this study is to assess the effect of training by in situ simulation in obstetrics. Material and methodsThe training program, dispensed over a 2-day period, took place in maternity units of the members of the Pays de la Loire perinatal network, Réseau Sécurité Naissance (Network Safety Birth). All participants received a learner satisfaction questionnaire to complete (5-point Likert-like scales). Then, at least 6 months later, each maternity ward received a general questionnaire to assess the effect of the training, as well as a second questionnaire specific to each institution, about the areas for improvement proposed by the teaching team after debriefings. ResultsThe 14 establishments included in our study returned 375 satisfaction questionnaires. In all, 91.1 % were very satisfied and reported that the training met their expectations, and 99.7 % thought the program would have an impact on their professional practice. More than 94 % of the learners wanted more simulation sessions. Among the 14 facilities, 9 (64.3 %) returned their evaluation questionnaires. In 44.4 % of cases, they reported improvement in team cohesion and in team communication, while the others reported these elements remained stable. All maternity units reported that the training had a positive impact on their team, and that they would be interested in new training program with in situ simulation. DiscussionMost participants clearly appreciated this training. In situ simulation training also led to the identification of areas for improvements, many of them accomplished, through the drafting of protocols or material modifications aimed at improving staff practices and therefore global patient care. There are many ways by which these training programs can be made sustainable, including the development of a new training program of in situ simulation or the creation of onsite simulation sessions on demand or by the professionals at each institution. ConclusionThis survey demonstrated the enthusiasm of healthcare professionals about in situ simulation. Moreover, overall improvement in team communication and cohesion was reported in the medium term (evaluation at more than 6 months). The interest of continuing these training sessions appears undeniable.

Biomass-Origin Carbon Capture, Storage and Utilization in Greenhouses: The Co2serre Project in Centre-Val De Loire (France)

To achieve the objective of the Paris Agreement to limit global warming to well below 2oC, there is a growing need to reduce drastically greenhouse gases emissions and even better to set up also negative emissions. Capturing and storing or valorizing carbon dioxide from biomass origin is a way to obtain negative emissions. The CO2SERRE project investigates techno-economic and environmental feasibility of implementing a “BCCUS” (i.e. CCUS for CO2 of biomass origin) pilot in France, in the Centre-Val de Loire Region. The concept consists in capturing CO2 from a biomass cogeneration plant in Orleans, valorizing it in local greenhouse farms, and storing the unused CO2 in geological reservoirs in the region. In addition to generating negative emissions, this concept promotes local and circular economy. To feed the techno-economic and environmental feasibility assessment, each stage of the CCUS chain is considered and assessed (capture, transport, geological storage, and use in greenhouses). Work carried out so far provides useful insights on technical feasibility of the process. However, the key challenge is the viability of the project on both economic and environmental sides. The LCA and TEA analyses, taking into account the whole CCUS chain, are under development and their outputs will address conditions for feasibility of the CO2SERRE concept. A preliminary assessment of geological storage capacity in the region have shown that targeted reservoir would be able to store the equivalent of the total emissions of the region Centre-Val de Loire. Thus, a longer term perspective for CO2SERRE project is to create a new technical and economic network in the region with platforms gathering CO2 emitter, users and storage.

Suivi ophtalmologique des patients diabétiques en région Centre-Val de Loire : une étude issue du Système national des données de santé (SNDS)

The main objective of this study was to investigate the rate of ophthalmological screening for diabetic retinopathy in diabetic individuals in the Centre-Val de Loire (CVDL) region. This study secondarily aimed to identify factors associated with regular ophthalmological screening. Data were extracted from the French national healthcare database (SNDS). Individuals were identified on the basis of reimbursements for antidiabetic medications. Patients who were identified as having at least one reimbursed eye examination between 2015 and 2016 were considered as having regular follow-up. In total, 118,181 diabetic individuals residing in CVDL were identified in the SNDS, and 74,048 had undergone ophthalmological screening. The rate of eye examination was 62.7% between 2015 and 2016 and was highly variable within the region (from 65.6% in Loiret to 54.0% in Cher). The main factors associated with regular eye screening were: follow-up with an established primary care physician (OR=2.88), regular follow-up with a diabetologist (OR=2.14), and regular follow-up with an internist (OR=1.57). This study suggests that ophthalmological screening for diabetic retinopathy in individuals with diabetes in the CVDL region could be significantly improved, particularly in rural areas. Factors influencing compliance with follow-up are multiple but appear mainly related to the patients' quality of overall medical management. These findings highlight the need for public health policies to improve detection and prevention of diabetic retinopathy by promoting comprehensive medical care for diabetic individuals.

Césarienne en Centre-Val de Loire — Pratiques et Indications — Classification de Robson

BackgroundTo study the cesarean section (c-section) practices in the French Centre-Val de Loire region: incidence of planned c-section and rate variations between maternities, incidence of potentially avoidable cesarean sections. MethodsThe data were extracted from the 2016 regional birth register, which permitted classification of each planned c-section according to the pre-existing risk of c-section (high or low) as defined by the Robson classification. To enhance the data, especially the indications for c-section, which are not included in the register, a survey was conducted from September 2016 to February 2017 in all of the 20 maternities in the region. ResultsIn 2016, nearly 26,000 women gave birth in the CVL region, of whom 19.2% by c-section (7.0% planned c-sections). The planned c-section rate was higher for breech presentation and scarred uterus, and decreased according to level of the maternity (I 41% - II 35% - III 32%). Concerning the c-section indications, 1,979 c-sections were studied during the period (18.6% of births), including 762 planned c-sections (7.1% of births). Among them, 246 (32%) were potentially avoidable, mainly isolated indications of scarred uterus with only one previous c-section or breech presentation, and 17 due to unfavorable radiologic pelvimetry in nulliparous women. ConclusionSpecific actions were identified: targeted use of radiologic pelvimetry, targeted c-section on scarred uterus with only one previous cesarean section or breech presentation, as recommended by the national guidelines. The Robson classification should be widely used to evaluate and enhance practices, in particularly through painstakingly interpreted inter-maternity comparisons.

SCULPTURE3D, du projet de laboratoire à l’exposition numérique

The SCULPTURE3D research project is a collaborative and multidisciplinary laboratory experiment financed by the Centre-Val de Loire region between 2014 and 2018, which aims to explore what 3D brings to the study of sculpture and to interpret the region’s heritage of sculptures from the Renaissance Era. It is an association between researchers from the University of Tours, working with the Centre d’etudes superieures de la Renaissance (CESR) and with the Fundamental and Applied Computer Science of Tours (LIFAT), and various heritage institutions (DRAC Centre, Museum of Fine Arts of Tours, CMN, Château de Blois…) as well as a team of experts on innovative softwares (CETU ILIAD3), and the new small business Kulturae’com, two innovative entities who got their start through that project. The thirty digital objects created with the help of a 3D optical scanner is the first key part of a virtual museum of 3D sculptures from the Renaissance Era in the Val de Loire, intended both for researchers and the general public. Similarly, the Sculpturoscope, la Vierge a l’Enfant du reel au virtuel meta-exposition (at the Museum of Fine Arts of Tours, from May 25th to September 10th 2018) made the results of scientific research available to the general public by using digital medias as both a tool of investigation and mediation.