De Loire Research Articles

Panitumumab as a single agent in 269 metastatic colorectal cancer patients in the real practice: A post EMA approval study.

e14148 Background: Metastatic colorectal cancer (mCRC) management has been improved by targeted therapies. The evaluation of the use of panitumumab (PANI), after approval, in the real life is strategic to assess health politics. Clinical trials concern usually patients younger and with better health status. Little is known about elderly people (over 70 years old). The observatory of Cancer Bretagne - Pays de Loire is a network of private and public cancer centers. Methods: Patients with wild-type KRAS, EGFR-expressing, mCRC progressing after fluoropyrimidine-, oxaliplatin-, and irinotecan-containing chemotherapy , received PANI,6 mg/kg biweekly. Sex, age, primary tumor, line of treatment, toxicity, reason of discontinuation, response, progression free survival (PFS) and overall survival (OS) were collected. Results: 269 patients (183 men and 86 women) treated between second half of 2008 and end of 2010 have been included. Median age: 67 years [36-90] (Amado et al, 2008 : 62.5 years [29-82]). Primary tumor was : colon (74%), rectum (24%) and double site (2%). PANI was used mostly at line 2 (19%), 3 (31%) or 4 (29%). Discontinuation of treatment was due to disease progression: 53%, death: 12% and toxicities: 5% (skin toxicities 3.5%). Clinical response was evaluated for the first 201 patients: partial response (PR): 20%, stable disease (SD): 19% and progression (P): 60% (Amado et al, 2008 PR : 17%, SD : 34%, P : 49%). Median duration of treatment was 2.3 months [0.26-17.52]. Median of OS was 6.71 months which is lower than previously described (Amado : 8.1 months). Median duration between end of treatment and death when death is the cause of end of treatment was 17 days [4-57] (n=24). From our data of 269 patients, a comparison between 123 patients over 70 and 146 patients under 69 will be shown at the meeting. Conclusions: Analysis of patients treated with PANI for a mCRC allows assessing the proper, per label use, in the real life. Complete results on clinical response, PFS, OS and safety as well as previously published data will be shown at the meeting.

Efficacity and safety of panitumumab in mCRC patients: A post-AMM OMIT study.

608 Background: Metastatic colorectal cancer (mCRC) management has been improved by targeted therapies. The evaluation of the use of panitumumab (PANI), after approval, in the real life is strategic to assess health politics. OMIT Bretagne - Pays de Loire is a network of private and public cancer centers. Methods: Data from patients treated with PANI in mCRC were collected. Previously published data are recited. Sex, age, primary tumor, Kras status, line of treatment, toxicity, reason of discontinuation, response, progression free survival (PFS) and overall survival (OS) have been studied. Results: Data of 322 patients treated between second half of 2008 and end of 2010 have been collected. PANI was used alone (85.5%) or with chemotherapy (14.5%) : mainly FOLFIRI, IRINOTECAN or FOLFOX). KRAS status was wild-type (WT 96.5%), mutated (0.5%), undetermined (2.5%) or not searched (0.5%). Only KRAS WT patients treated with monotherapy of PANI at 6 mg/kg every 2 weeks were analysed (n=263). Sexe : 177 men and 86 women. Median age : 67 years [36-90] (Van Custem JCO 2007: 62 years [27-83]). Primary tumor of patients was : colon (75%), rectum (22%) and others (3%). They received PANI mostly at line 2 (25%), 3 (46%) or 4 (19%). Discontinuation of treatment was mostly due to disease progression : 64%, death: 15% and toxicities : 7% (skin toxicities 3.7%). Clinical response was evaluated for the first 84 patients: partial response (PR): 30%, stable disease (SD): 14% and progression (P): 56%. In KRAS WT patients treated by PANI, Amado described 17% of PR, 34% of SD and 49% of P (Amado JCO 2008). Median duration of treatment was 69 days [0;360] (n=249). Median duration between end of treatment and death when death is the cause of end of treatment was 13 days [0;54] (n=35). Median of OS was 137 days [0;816] (n=143) which is lower than previously described (Van Cutsem JCO 2007 : 192 days regardless of KRAS status ; Amado JCO 2008 : 243 days in KRAS WT). Conclusions: The OMIT analysis of patients treated by PANI in Bretagne/Pays de Loire for a mCRC allows to assess the good use, according to its label, in the real life. Complete results about clinical response, PFS (cut-off 01/12/2011), OS and safety as well as previously published data will be shown at the meeting.

How to manage gait and balance disorders among older adults aged 65 years and older with mild to moderate dementia in clinical practice?

Gait and balance disorders are frequent in demented older adults. Their management (i.e., diagnosis, assessment and treatment) is challenging in daily practice because of numerous evaluation tests available, difficulties to select the most adapted intervention, and the lack of knowledge of physicians and health professionals concerning adapted centers to refer their patients to those patients. Thus, a working group of experts was organized by the Gérontopôle of Pays de Loire, France, in December 2010 with the aim to provide clinical guidelines for the management of older adults aged 65 years and older with mild to moderate dementia with gait and balance disorders. These guidelines provide answers to the following questions: 1) Is there gait and/or balance disorders? 2) Which specific tests used? and 3) How to treat patients?

Impact of the hypomethylating agent 5-azacytidine on dendritic cells function

Recent evidence suggested that 5-azacytidine (5-aza) can impact important immune functions via epigenetic modifications, making it an attractive candidate for pharmacologic manipulation of the immune system. The aim of this work was to study the effects of 5-aza on human dendritic cells (DC) generated from peripheral blood monocytes, and to test the type of immune response induced in patients treated with 5-aza. On the phenotypic level, CD40 and CD86 expression was significantly increased on mature DC exposed to 5-aza (5-aza-DC), compared with control untreated DC. Mature control DC and mature 5-aza-DC secreted comparable amounts of interleukin (IL)-6, IL-12p70, IL-23, and tumor necrosis factor-α. However, mature 5-aza-DC secreted significantly lower levels of IL-10 and IL-27 compared to mature control DC (p = 0.04 and p = 0.005, respectively). In the peripheral blood of 14 patients (7 males and 7 females; age range, 53-81 years) with advanced myeloid malignancies (8 acute myeloid leukemia and 6 myelodysplastic syndrome) treated with 5-aza, there was a significant decrease of IL-4-secreting CD4(+) T cells (p = 0.001), and a significant increase of IL-17A- and IL-21-secreting CD4(+) T cells (p = 0.003 and p = 0.01, respectively, compared to 5 healthy donors) suggesting a Th17 response pattern in the blood of patients receiving 5-aza. In all, these data suggest potentially novel mechanisms of action of epigenetic therapies, such as 5-aza, which may have broader implications for immunotherapeutic strategies.

Long Term Persistent Alopecia and Suboptimal Hair Regrowth after Adjuvant Chemotherapy for Breast Cancer: Alert for an Emerging Side Effect: ALOPERS Observatory.

Abstract Background: Since 2003, through the impetus given by Pr Erick Gamelin and the Regional Health Agency in Western France (Bretagne, Pays de Loire), a network called OMIT (Drugs and Emerging Therapeutics Observatory) has been created, including the Breast Cancer Forum. Anthracyclins and taxanes are the cornerstones of adjuvant chemotherapy for breast cancer. In France, since the PACS 01 publication1, FEC 100 followed by docetaxel 100 has been the standard adjuvant chemotherapy regimen in breast cancer. Long term toxicities like persistent alopecia or suboptimal hair regrowth have been observed.Methods: Over the last year, the first cases of persistent alopecia or suboptimal hair regrowth after adjuvant chemotherapy have been reported to the Breast Cancer Forum. Consequently, OMIT quickly drew up a case report form and mailed it to every oncologist in Western France to collect data.Results: From May 2008 to April 2009, 66 cases of persistent alopecia or suboptimal hair regrowth after adjuvant chemotherapy from 15 different institutions were declared to OMIT: median age: 60 years (35-78), hypothyroidia: 11, fine hair before treatment: 2. Alopecia was localized: 13, diffuse: 49, complete: 4. The time lapse between the end of chemotherapy and persisting alopecia has been more than 3 months: 5 patients, more than 6 months: 10, more than 12 months: 22, more than 24 months: 29. The chemotherapy regimens were various: schedule FEC (epirubicin 100 mg/msq), 3 courses followed by docetaxel 100 mg/msq, 3 courses: 54, docetaxel 100 mg/msq: 3, TCH (docetaxel-carboplatin-trastuzumab) or TH: 2, FEC 100: 2, epirubicin 75 mg/msq in association with docetaxel 75 mg/msq: 2. Hormonotherapy: letrozole: 13, anastrozole: 18, exemestane: 3, tamoxifene: 14, LH-RH agonist: 3. No hormonotherapy: 13. In some institutions, according to the ECOG trial2, some oncologists quickly decided to change their standard regimen from FEC 100 - docetaxel 100, to EC 100 4 courses followed by weekly paclitaxel for 12 weeks: forthcoming data on persistent alopecia, suboptimal hair regrowth or neuropathy after this ECOG adjuvant chemotherapy regimen will be presented at the symposium.Conclusion: For the first time in France, Western OMIT offers us data about persistent alopecia or suboptimal hair regrowth after adjuvant chemotherapy: it is an important side effect and must be considered by oncologists as optimal information to give to curable patients. The next step is to evaluate the real incidence of this phenomen on the population of patients treated by adjuvant chemotherapy for breast cancer: OMIT is currently working with the Federation Nationale des Centres de Lutte contre le Cancer (FNCLCC) to collect data from prospective trials such as PACS 01 (FEC versus FEC-docetaxel), PACS 04 (FEC versus epirubicin-docetaxel) and PACS 05 (FEC 6 courses versus 4 courses), to create the ALOPACS database.1- Roché H. Sequential Adjuvant Epirubicin-based Regimen and Docetaxel Chemotherapy for node-positive Breast Cancer Patients: the FNCLCC PACS 01 Trial. J Clin Oncol. 2006 dec 20; 24 (36) 5664-71.2- Sparano JA.Weekly Paclitaxel in the Adjuvant Treatment in Breast Cancer. N Engl J Med. 2008 Apr 17; 358(16): 1663-71. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3174.

3603 Management of unresectable metastatic colorectal cancer (MRCC) in the real world with successive regimens with targeted therapies (Bevacizumab and cetuximab): the experience of the OMIT Bretagne Pays de Loire

3603 Management of unresectable metastatic colorectal cancer (MRCC) in the real world with successive regimens with targeted therapies (Bevacizumab and cetuximab): the experience of the OMIT Bretagne Pays de Loire

AVASTERB OUEST: A prospective cohort study of unresectable metastatic colon cancer treated successively by FOLFIRI bevacizumab and cetuximab irinotecan

e15103 Background: Bevacizumab and cetuximab regimen are approuved since 2005 in Europe for Metastatic Colorectal Cancer Patients (MCCP). Very few studies have reported data concerning the sequence (FOLFIRI BEVA and after failure CETUXIMAB- CAMPTO) in MCCP from the real world. Methods: Since 2003, in west of France, (Bretagne-Pays de Loire),a network called OMIT(Observatoire des Médicaments et Innovations Thérapeutiques) directed by Regional Health Agencies has been created. This structure gathered prospectively data from MCCP treated with targeted therapies. Since 2006, a cohort of MCCP treated successively by FOLFIRI BEVACIZUMAB (same protocol : same dose) as first line to progression or unacceptable toxicity and CETUXIMAB- CAMPTO after the first line failure was constitued (AVASTERB cohort). Criteria for initial unresectability of metastic lesions was based on investigator's evaluations during local comitee (surgeons and oncologists). In order to have a large follow up, the 35 first patients of the cohort were studied in this abstract.Age, sex, response rate to the different regimens,secondary metastatic lesion resection, time to progression to the different regimens, follow up and overall survival are the criterias studied. Results: Median age 60 years (49–83), Males : 60%, colon 71%,rectum: 17%, colorectal jonction :12%.Response rate(OR+SD)with Folfiri Bevacizumab : 45.7%. 17% of the patients underwent hepatic surgery with curative intent (all during Folfiri bevacizumab) Time to progression with Bevacizumab : 6 months. Fifty eight percent of the patients are still alive with a median follow up of 25 months (11–29)Median overall survival was not reached.The 12 months and 24 months overall survival rates are respectively 71.4% and 45.7% (date of point: 01/01/2009). Actualisation of the data will be provided during the meeting Conclusions: The results from this prospective unselected cohort of MCCP treated with the sequence FOLFIRI BEVA and after failure CETUX-CAMPTO from the real world show promising TTP, and overall survival. The study of the Kras mutation and others biomarkers could improve these results by personalization of the treatment. This part of our study is actually ongoing. No significant financial relationships to disclose.

La patrimonialisation des fleuves et des rivières.

L’analyse des dynamiques de patrimonialisation des fleuves et des rivières s’appuie sur la comparaison de deux sites inscrits au patrimoine mondial de l’UNESCO : le val de Loire et la vallée de la Kadisha. L’article met en évidence les continuités/discontinuités territoriales ou temporelles au sein des jeux d’acteurs dans la conduite des différents projets. Il replace la gestion de ces patrimoines dans les dynamiques territoriales qui les entourent. La mise en perspective du double processus patrimonialisation/territorialisation renseigne sur les enjeux et les conflits qui animent la gestion et la conservation des ressources naturelles et culturelles des deux pays.

Réactivité et communication des décisions de pharmacovigilance des autorités de santé vers les professionnels de santé : exemples du pergolide et du célécoxib

evaluate the impact of Health Authorities' communication on medical practices through 2 examples: celecoxib, taking into account the recent countra indication related to cardio vascular risks; pergolide, taking into account the risk of cardiac valvulopathy. Use of the Pays de Loire Health Insurance Administration data base to monitor the number of cardio vascular patients at risk who receive celecoxib, and cardiac surveillance of pergolide exposed patients. Communication from Health Authorities resulted in a major decrease (71.9%) of the number of risking patients who take celecoxib, and a significant 14% decrease of pergolide treated patients needing cardiac monitoring Unlike the information related to pergolide, the information related to celecoxib was fully taken into account. The difference seems to come from the fact that one was widely relayed by medias, not the other.

L'activité des médecins des structures d'accueil régulier d'enfants de moins de 6 ans : attentes des responsables de structures

This work aims to describe the activities of nurseries' medical practitioners and the expectations of the nurseries' supervisors. It is based on the analysis of 139 questionnaires received from nursery schools' managers from the Pays de Loire region in 2005. Ninety percent of the nurseries that accommodate children less than six years-old, do employ a medical practitioner. She or he is often a salaried paediatrician with a full-time job or clinical practice, who consults twice a month for two hours and forty minutes in each nursery which employs him/her. Her/his main activity consists of conducting standard medical examinations when children are admitted into the nursery and on-going follow-up of their adaptation and healthy early childhood development. She or he also ensures that hygienic preventive measures are respected in case of an epidemic or other potentially hazardous health situations. Moreover, two-thirds of the establishments offer prevention follow-up for the children, whereas health promotion programmes and interventions are only carried out in just over half of them. Emergency medical procedures are conducted in a quarter of them only. Most of the nursery directors are satisfied with the medical services provided, despite some criticism. They mainly wish that practitioners were more available and more regularly present on-site in order to supply further preventive care, to develop training programmes for other staff members, and to participate in thematic meetings. Encouraging improved synergy between the professionals working in the nurseries, placing child psychologists to work in the facilities and fostering better relationships with the independent medical practitioners would all help the process of development and the evolution of the operational function of the medical practitioners in these structures.

Coxibs: evolution of prescription's behaviour in France

The aim of the present study was, first to characterize profiles of coxibs' prescribers [general practitioners (GPs) and rheumatologists] in 2002 in France and, secondly, to identify factors associated with modification of this profile 1 year later. All GPs and rheumatologists from Midi-Pyrenees, Aquitaine, Languedoc-Roussillon and Pays de Loire areas (South of France: 11 050 000 inhabitants) were included in the study. For each practitioner, we used data concerning all non-steroidal anti-inflammatory drugs (NSAIDs) including coxibs reimbursed during period 1 (P1; January-March 2002) and period 2 (P2; January-March 2003). The ratio between the number of coxibs' prescriptions and the total number of NSAIDs' prescriptions (including coxibs) was used to define the two profiles of prescribers, one with a low level of coxibs' prescriptions and another one with a high level of coxibs' prescriptions. Characteristics of practitioners and characteristics of their practices were compared according to this profile. In the second step, we investigated the characteristics (of practitioners and practices) associated with an increase in the level of coxibs' prescriptions in P2 for practitioners with a low level of coxibs' prescriptions in P1. Results are expressed as odds ratio with their 95% confidence intervals. A positive statistical link was found between a high level of coxibs' prescriptions, the speciality of rheumatologist or extra costs for consultation. In contrast, a negative association was observed with female gender or age below 44 years. No relationship was found with the status of referent. Concerning practices' characteristics of practitioners, there was a positive statistical link between a high ratio of coxibs' prescriptions and high co-prescriptions of gastroprotective agents and a negative association with a high number of acts, a high proportion of patients with chronic disabling diseases (CDD) or a high number of patients between 15 and 64 years. There was no statistical link with proportion of patients covered by Universal Medical Coverage (UMC) or aged more than 65 years. Among the factors involved in the increase in the ratio (between P1 and P2), no relationship was found with practitioners' characteristics. In contrast, some factors related to practices (level of gastroprotective co-prescriptions, number of acts, number of CDD patients) were related to a change in coxibs' prescriptions between P1 and P2. This study allowed to discuss some relationships between coxibs' prescription and practitioners' (age, gender, medical speciality or extra costs for consultation) or practices' (level of medical practice, patients' age, number of CDD patients or level of gastroprotective prescriptions) characteristics. In contrast, some other factors like the referent status or the number of patients with UMC are not related. Physicians, initially low prescribers of coxibs and increasing their coxibs' prescriptions during the period of our study, were those with a high level of gastroprotective prescriptions, a low number of acts or a small proportion of CDD patients.

High Resolution Colonoscopy With Chromoscopy Versus Standard Colonoscopy for the Detection of Colonic Neoplasia: A Randomized Study

High-resolution colonoscopy with chromoscopy (HRC) is a technique designed to improve the detection of colonic neoplasias. We prospectively compared standard colonoscopy (SC) and HRC in a randomized multicenter trial. Patients (n = 203; age, 58 +/- 10 years; sex ratio, 1) were recruited according to the following criteria: (1) a history of either familial or personal colonic neoplasia or (2) alarm symptoms after the age of 60 years. After randomization, an SC was performed in 100 patients (resolution, < or = 410,000 pixels) and a HRC in 103 patients (Fujinon EC485ZW, 850,000 pixels). In the HRC group, each colonic segment was examined before and after spraying with indigo carmine 0.4%. Two hundred seventy-six polyps were detected in 198 patients. One hundred sixty of them were hyperplastic polyps, 116 were adenomas, and 2 were carcinomas. The numbers of hyperplastic polyps and purely flat adenomas were significantly higher in the HRC group than in the SC group (1.1 +/- 1.6 vs 0.5 +/- 1.4 and 0.22 +/- 0.68 vs 0.07 +/- 0.29, respectively; P = .01 and P = .04), but there was no significant difference in the total number of adenomas per patient (primary end point) detected between the HRC and the SC groups (0.6 +/- 1.0 vs 0.5 +/- 0.9, respectively). Although HRC improves detection of purely flat adenomas and hyperplastic polyps, the overall detection of colonic adenomas in a population at increased risk of neoplasia is not significantly improved. These findings do not support the routine use of HRC in clinical practice.

Comparison of different scaling techniques for sensory analysis of wines

&lt;p style="text-align: justify;"&gt;The use of sensory analysis for the winemaking industry is an interesting tool for objective evaluation of wine quality. Its development forces us to properly define and to adapt the methodology of tasting to this particular product – wine. The development of methodology of sensory analysis adapted to the wine industry constitutes one of the objectives of research carried out by the team of research from the laboratory GRAPPE of ESA (Ecole Supérieure d’Agriculture of Angers) in collaboration with Interprofession of the Wines of the Loire. The influence of scaling techniques on sensory evaluation results was studied during the setting up of a wine sensory trained panel and in order to obtain objective and pertinent characterisations of wine. Three different scales were used : a 10-point category scale ; a line scale consisting of a line where each taster’s appreciation is converted to a mark between 0 and 10 ; a scale mixing the first two.&lt;/p&gt;&lt;p style="text-align: justify;"&gt;For each scale, five red wines from different appellations of Val de Loire – France were tested by the wine trained panel of the Laboratoire GRAPPE. Each set was repeated once. The products discrimination was better with the line scale and the category one. Nevertheless, interactions between judges and products were higher with the first. Results were less satisfactory with the category line scale. This method seemed to be less discriminating and interactions were more important. This fact can be explained by the different use of the scale by tasters. This study enabled us to verify the impact of the number of wine tested in the same session. Indeed, some attributes were significantly higher for the repeated wines. These results might justify establishing a different order of passage of wine for each assessor, thus minimising the order effect.&lt;/p&gt;&lt;p style="text-align: justify;"&gt;This experimentation opens interesting perspectives for the optimisation of sensory analysis methodology in the winemaking industry. Complementary studies are taking place in the Laboratoire GRAPPE.&lt;/p&gt;

Distribution of mtDNA haplotypes (cyt b) of Emys orbicularis in France and implications for postglacial recolonization

Abstract The European pond turtle, Emys orbicularis, is a wide ranging species, distributed from Northwest Africa over a large part of Europe and Asia Minor to the Caspian and Aral Seas. For 106 pond turtles from France mtDNA sequence variation has been assessed, using a 1031 bp portion of the mitochondrial cytochrome b gene. Three of nine haploclades currently known from the entire species' range were found in France. One clade (II) is represented with four very similar haplotypes, differing by one mutation, and the two other clades (V, VI) are represented with one haplotype each. A syntopic occurrence of clades II and V is reported for the first time for the Camargue. Besides, clade II occurs in the French regions Aquitaine, Centre-Val de Loire, and Rhône-Alpes. Outside of France, it is found mainly in the catchment areas of the Danube and Oder rivers and in the Balkans. Haploclade V, which is also known from the Apennine peninsula, Sardinia, and the northern Mediterranean coast of Spain, is restricted in France to Corsica and the Provence-Alpes-Côte d'Azur region. A single individual bearing a haplotype of an Iberian and North African clade (VI) was found in Aquitaine near Pau. This could indicate gene flow between the Iberian peninsula and West France, if the specimen is native. The distribution of the distinct haploclades in France probably reflects Holocene range expansions, especially of haploclade II turtles. In the postglacial, haploclade II terrapins arrived from the east and spread over the Rhône corridor to the Mediterranean coast. In the southern Rhône area they met and hybridized with haploclade V turtles. Further research is needed to clarify whether this hybridization is a locally restricted phenomenon.

Changes in storminess and surges in western France during the last century

French meteorological data provide some information on wind direction since 1890. Since 1951, wind speed and direction have been digitised every three hours in many stations. The Brest tide gauge has recorded hourly sea levels since 1860, thus enabling hourly surges to be calculated and studied. This set of data has been organised into a data base and analysed in order to recognize evolution and trends. Strong winds are increasing in frequency in the western part of Brittany and decreasing in Normandy and Pays de Loire. Surges associated with these winds do present a slight decreasing trend. A more precise analysis allows to distinguish between southerly winds, which are slightly decreasing, and strong winds from other directions, which display a more or less important increase in frequency. The analysis shows trends that may be linked to the global circulation pattern, and that result in a new spatial distribution of winds on western France.

The behaviour of four red grapevine varieties of Val de Loire according to climatic variables

&lt;p style="text-align: justify;"&gt;The behaviour of 4 grapevine varieties - Cabernet franc, Cabernet Sauvignon, Gamay noir and Grolleau noir – was studied from 1988 to 1998 at the INRA experimental Station, in Montreuil-Bellay, France. Very contrasted climatic years occurred within this period. The study of some phenological stages allowed to classify the varieties in 2 groups of maturation : early for Gamay and Grolleau, late for Cabernets. The former had large berries (&amp;gt;2 g), the latter small berries (&amp;lt;1,5 g). Sugar content of Cabernets and Gamay was much higher than for Grolleau, respectively &amp;gt;190 g/L and &amp;lt;170 g/L. For a same maturity index, titratable acidity of Gamay was higher than Grolleau, and Cabernet Sauvignon higher than Cabernet franc. Malic acid was identified as explaining better the acidity level. The anthocyanin content and polyphenolic index of late varieties was superior to those of the precocious ones. The variety and the climate of the vintage play an important role on final grape composition. Berry weight, sugar content, titratable acidity and malic acid could be explained by simple climatic variables, mainly temperature and rainfall during the vegetative cycle as well as wind velocity before harvest. For the phenolic compounds, the analysis looked more complex ; it seemed that the climatic variables had only a minor effect after veraison, but the role of each one of them before this stage is still to be understood.&lt;/p&gt;

Réseau de suivi des nouveau-nés à risque de développer un handicap : l’exemple du réseau « Grandir ensemble en Pays-de-la-Loire »

Newborns are given attentive perinatal care but the organization of further follow-up can be haphazard. The main consequences are the difficulties parents have in finding appropriate medical assistance for caring for high-risk infants and the absence of appropriate surveillance or efficient care. An inpatient-outpatient healthcare network enables early care of these infants and can reduce the consequences of neurosensorial sequelae. The overall impact of the regional perinatal care can also be evaluated. Such a network has been implemented in the Pays de Loire region in France since early 2003. In six months, among 1000 initially included infants, 500 were followed by pediatricians working in an outpatient (40%) or inpatient (60%) setting. This organization enables correction of over-centralization of neonatal care and the absence of coordination for follow up.

Structural and palaeogeographical evolution of the Paris Basin during the Mid-Cimmerian events

Abstract Presentation. The deposition of unconformable condensed layers associated with frequent sedimentary gaps record the Mid-Cimmerian events in the Paris Basin, dated as Aalenian to lowermost Bajocian. In order to document the Mid-Cimmerian episodes, a set of 250 commercial wells (fig. 1) together with several outcropping sections located on the southern and southeastern borders of the Paris Basin have been interpreted in terms of sequence stratigraphy. Seventeen third-order depositional sequences sensu Vail et al. [1991] have been identified and correlated. These are numbered as To1 to To7, Aa1 and Aa2, Bj1 to Bj5, Bt1 to Bt3 (fig. 2). They have been mapped out from subsurface data and from a few available outcrop data. Isopach maps corresponding to the depositional sequences illustrate both the role of synsedimentary faults and the evolution with time of depocenters (figs. 10 to 17). One purpose is to compare through time the depocentres location with the fault pattern (fig. 1). The well-known Jurassic Paris Basin faults make a three-branch system that converges towards the centre of the Paris Basin. These are as follows: NW-SE trending faults. These include the Pays de Bray, Somme River and Lower-Seine River faults. They intersect the northwestern border of the Paris Basin. They acted several times as major extensional faults from Permian through early Cretaceous times ; the NE-SW trending Luxembourg, Metz and other faults. They were typically extensional faults as a remote effect of the Tethyan rifting episodes. They have been active during late Toarcian through Bajocian times in Burgundy as shown from outcrop data ; the N-S trending group, including the Saint Martin de Bossenay, Sens, Loire and Sennely fault lines, are mainly located at the southern side of the Bray fault system. They probably correspond to the reactivation of an old Hercynian lineament such as the sillon houiller in the Massif Central. They have been documented also from outcrops in Burgundy and in the Macon area. Development of the main Cimmerian events in the Paris Basin During the overall regressive phase dated as Middle to Late Toarcian (fig. 3), the central Paris Basin and the northern Champagne are characterised by relatively thick deposits (fig. 11 to 14). Then, the onset of mid-Cimmerian events is marked by stratigraphic gaps and condensed layers dated as latermost Toarcian through Aalenian in the same areas (fig. 5). The correlative long-term maximum regression dated as close to the Aalenian/Bajocian boundary is expressed by maximum progradation of the carbonate platforms towards the Swabische Jura and the western Sub-Alps, i.e. the nascent Tethyan margin. At the same time the sedimentary accumulation was considerably attenuated within the whole Paris Basin during Aalenian times (fig. 9). This illustrates the structural high position of the Paris Basin during the Cimmerian events. Nevertheless, the central Paris Basin has been episodically flooded as a consequence of two, short duration and wide amplitude, transgressive events dated as middle and late Aalenian, related to Murchisonae and Concavum ammonite zones respectively (fig. 2). Bajocian times are marked by the onset of the Middle Jurassic transgression (fig. 7). Some faults active during Triassic and Liassic times are concealed by the Bajocian layers (fig. 8). This is accompanied by a new distribution of the depocentres location with respect to the Toarcian situation (compare figs 11–13 to fig. 7). The structural control of the Paris Basin development during the Mid-Cimmerian events can be illustrated on both (2D) isopach maps (figs. 5, 7 and 10 to 19) and 3D diagrams (fig. 19). They both document the evolution with time of the main groups of synsedimentary fault lines. Third-order and second-order cycles and bounding unconformities have been found to be coeval from the North Sea to the Tethyan margins including North Africa. This documents the partly eustatic control of the Mid-Cimmerian events.

Épidémiologie de la résistance du pneumocoque aux antibiotiques

Streptococcus pneumoniae may be considered like multiresistant bacteria, responsible for non-nosocomial infections. In France during 1999, 44 % of the strains were non-susceptible to penicillin G (PNSP) (with 12 % of resistant strains), 26 % were non-susceptible to amoxicilline (with 1,8 % of resistant strains) and 17,1% were non-susceptible to cefotaxime (with 0,4 % of resistant strains). The percentage of resistant strains was 1.8 % for amoxicilline and 0.4 % for cefotaxime. The PNSP's percentage was variable with regions, from 32 % in the “Pays de Loire” to 60 % in “Brie”. It was higher for children (52.7 %) than for adults (39.8 %). It was also a function of sample's site and age (child/adult): bloodstream 41.8 % / 37.2 %, broncho-pulmonary sample 54.2 % / 41.4 %, and cerebrospinal fluid 45.5 % / 37.5 %. These PNSP were often poly-resistant : 30.1 % of penicillin susceptible pneumococci but 82.2 % of the PNSP were resistant to erythromycin's. In children, the percentage of erythromycin's resistant pneumococci was about 73.2 % for ears, 66 % for broncho-pulmonary, 50.2 % for bloodstream and 56.3 % in cerebrospinal fluid. The most common serotype for PNSP strains was the 23 serotype. Lastly, for anti-pneumococci fluoroquinolones, few resistant strains have been mentioned.

DISTRIBUTION AND HABITAT REQUIREMENTS OF THE WHITE-CLAWED CRAYFISH, AUSTROPOTAMOBIUS PALLIPES, IN A STREAM FROM THE PAYS DE LOIRE REGION, FRANCE: AN EXPERIMENTAL AND DESCRIPTIVE STUDY

A population of white-clawed crayfish (Austropotamobius pallipes) was studied from January to October 2000 in a stream from the Pays de Loire region (Western France). An experimental modification of habitat was performed in four stream sections by providing refuges for crayfish, followed by a regular survey of population dynamics in these areas. The crayfish distribution along the brook was studied in relation to several parameters, including water quality, current speed, brook depth and presence of refuges for crayfish. Presence of hiding places was the only habitat parameter correlated with crayfish distribution along the stream whereas colonization process in modified sections was determined by sun exposure and current speed conditions. Despite a presumably high growth rate and its ability to reach locally important densities, the population appeared to be fragmented.