Place de la tomographie d’émission de positons (TEP) pour l’évaluation thérapeutique et le suivi du cancer du sein

Positron emission tomography (PET) with fluorodeoxyglucose (FDG) is a nuclear imaging method whose interest in oncology has only grown over the past fifteen years. This article summarizes the results in monitoring and therapeutic evaluation of breast cancer. For the search of locoregional or distant recurrence, the performance of FDG-PET are very interesting. The impact of FDG-PET on the therapeutic management is undeniable. For therapeutic evaluation, this imaging is useful to evaluate the neoadjuvant chemotherapy and hormonotherapy efficacy. FDG-PET is indicated in cases of suspected recurrence (clinical, biological or imaging suspicious). It is the most sensitive exam for the detection of bone or visceral metastases. It allows the re-staging during a relapse proved whether local or remote, and can change the therapeutic management.     

Aspects réglementaires et organisationnels de l’activité d’autoconservation. Le point de vue du juriste

At the present time, legal texts in application of bioethics laws only briefly mention cryopreservation. The conditions of cryopreservation differ according to the type of tissue stored: while cryopreservation of oocytes and ovarian tissue corresponds to the field of biomedical research, semen cryopreservation corresponds to medically assisted procreation. Cryopreservation activity is more clearly defined in the draft revision of the bioethics law. Concerning the cryoconservation of ovarian tissue and oocytes, these difficulties result in particular in this activity’s mixed nature. It is located indeed, halfway between research and care. These two spheres of medical activity are subjected to their own distinct and exclusive, and their application is conditioned by the qualification of the implemented act. However, this qualification is dubious here, because of, in particular, the impossibility of determining which acts of sampling, cryoconservation and use might be concerned with a research protocol. Concerning the cryoconservation of sperm, the texts, first of all, seem to assimilate the activity of cryoconservation within an activity of assisted medical procreation. However, such assimilation would be equivalent to the impossibility of its implementation, because of the difficulty of respecting all of the legal conditions of assisted medical procreation. However, another more favourable interpretation of the provisions seems to be possible. Taking into consideration these uncertainties, contradictions and difficulties, the legislator intervened and devoted, by the widening of the indications of assisted medical procreation, the activity of cryoconservation in the project of revision of the laws of bioethics. He however did not solve all the difficulties. These cryoconserved elements can be restored only to the depositor. Indeed, the texts make obstacle to a delivery for a third party of the cryoconserved sperm, whatever the moment. They can also be used. This use can consist of assisted medical procreation, which is the first finality of cryoconservation — but it could only be implemented in respect of the whole of the legal conditions. It seems that the cryoconserved elements could also be used within the framework of research, whatever its nature (biomedical or not) and the moment of its implementation (while the person is alive or after his death). Its implementation should however be subjected to prior agreement and expressed while the person, whose elements were preserved, is alive. Such a use is expressly made possible in the project of revision of the laws of bioethics. Following a partial use or a lack of such a use, the destruction of the cryoconserved elements can be considered, as well as the continuation of the cryoconservation. However, these hypotheses raise difficulties that have not yet been resolved in the draft revision of the bioethics law.     

Les ostracodes et l'évolution paléogéographiqueau quaternaire récent du site d'Ashtart (golfe de gabès,tunisie orientale)

enTwenty-seven samples have been collected in AshtartBasin (Pelagian Sea), along the core KST 100. Studies on ostracods species enables us to recognize four main associations from - 27 000 years to the Recent; the first can be linked to the Würm III regression and the other ones to the Versilian transgression.     

Le site du Gravettien récent,Kostenki 21 (Gmélinskaia) : les résultats préliminaires des travaux archéologiques de sauvetage des années 2013–2016

This paper presents the preliminary results of the archeological rescue works, carried out on the Kostenki 21 (Gmelinskaya) site in 2013–2016, directed by the Kostenki archaeological expedition, organized by the Institute of History of the Material Culture of the Russian Academy of Sciences (Saint-Petersburg). During visual observation of the river bank, three areas of cultural remains of the main cultural layer (III) were discovered and studied. Each of them differs in its structure and composition of inds, which makes it possible to interpret them as functionally different areas: 1) remains of a “dwelling complex” (?); 2) area devoted to the production and re-shaping of burins (including detachment of burin spalls); peripheral (intermediate) part of the site. Despite the fact that the areas in question vary in both the composition of stone inventory and the assortment of raw materials, the available evidence remains insufficient to decide whether the III cultural layer should be subdivided into two independent complexes.     

Temps et réseaux de l’art paléolithique : la grotte de La Covaciella (Asturies,Espagne)

The study of graphic convergences and divergences in Palaeolithic art is used to understand the culture, territories and interaction systems of human groups. La Covaciella cave has fifteen animal representations and other linear, dots and geometric motifs. The bison stands out; some were executed with complex technical procedures. Two of them were dated by C14 AMS, obtaining a result of 14,260 ± 130 BP (17,733–16,973 cal BP) and 14,060 ± 140 BP (17,503–16,260 cal BP). These correspond chronologically with the beginning of the middle Magdalenian or the very end of the lower Magdalenian. Similar depictions to the bison at La Covaciella are located in other areas of Western Europe. The repertoire of parietal bison displaying graphic similarities with those at La Covaciella is very large; both of the Pyrenean model (Niaux morphotype) and of the Perigordian model (Font-de-Gaume morphotype). A first consideration derived from the search for comparisons involves a new interpretation of the territorial value implied by the term Pyrenean style (Asturias, Cantabria, Basque Country, Navarre, Pyrénées-Atlantiques, Hautes-Pyrénées, Haute-Garonne, Ariège, Dordogne, Lot, Ardèche and Vienne). The Font-de-Gaume parietal morphotype is most common in Dordogne. In addition, in some cases, spatial complementariness has been found, with both graphic morphotypes. This article proposes different chronological and anthropological hypothesis to explain the distribution and coexistence of the two graphic models.     

Scintigraphie cérébrale de perfusion et troubles cognitifs d’origine vasculaire

The vascular cognitive impairment (VCI) is a heterogeneous group of various etiologies, which share a presumed vascular cause. Although the age is the most important risk factor, the cardiovascular risk factors are also involved. A relatively high proportion of these cognitive disorders could be prevented or delayed. Only the treatment of arterial hypertension is recognized as a factor in preventing vascular dementia. MRI is the examination of choice for the investigation of cerebral vascular pathology. However, this morphological imaging is insufficient and does not provide useful functional information. Perfusion brain SPECT is not widely used in the exploration of VCI. Strategies for screening VCI are not standardized and long-term studies are needed to establish the better prevention of cognitive vascular disorders. This article aims to summarize the possible benefit of cerebral perfusion SPECT in the exploration of VCI.     

Amputation du gland au cours de la circoncision et réimplantation : à propos d’un cas et revue de la littérature

Penile amputation due to circumcision is a tragic complication in which the operator is responsible. The current treatment is based on microsurgical replantation methods by anastomosing penile dorsal vessels and nerves. We report a new case of penile glans amputation due to circumcision in a 6-year-old boy. Replantation was done without microvascular and nerves anastomosis. After 7 months of treatment, the final result was found to be good in terms of the urinary stream, erectile function, sensitivity and morphological aspect of the glans.     

Préhistoire et art rupestre dans le nord de l’Uruguay. De nouveaux programmes d’étude,de conservation et de valorisation

Since a few years, the study of prehistoric Uruguay and of its symbolical expression, rockart, has become a new subject of interest. Important programs of prospection, researches, protection and valorization of sites have been conducted, especially in the north of the country and contribute to the knowledge of an archeological heritage of an exceptional quality and a great density, that was until now unknown. Thanks to the international scientific cooperation and exchange program “ECOS-Sud”, the Department of Prehistory of the natural history national Museum of France (Paris) and the department of archeology of the Faculty of Human Sciences and Education of the Republic University in Uruguay (Montevideo), an important scientific and technical partnership have been set up. It reinforces and diversifies the existent links between our institutions and more generally between France and numerous countries of South America.     

Buran Kaya,Gravettien et Aurignacien de Crimée

The Buran Kaya III rock shelter has been the subject of various surveys. We present here some aspects of the levels relating to Early Upper Paleolithic (30,000 to 35,000 non cal. BP). Long distances relations may be suggested with the Zagros to the east and with the Carpathians to the west. Crimea occupies a central place in this regional network, precisely at the gateway of the European continent.     

Marqueur d’identification à micro-échelle de l’ivoire de mammouth dans les objets préhistoriques

This paper illustrates the importance of the material identification in order to be able to answer archaeological questions and describes the definition of new markers based on the chemical analysis and the study of the inner micro-morphology of the objects. The challenge for the identification of mammoth ivory is highlighted amongst prehistoric objects, which were heavily worked and used. The applied analytical approach is non-invasive to preserve the integrity of the rare and precious prehistoric objects. The objects are studied by means of Proton Induced X-ray emission (PIXE) and micro X-ray tomography (microCT). Examples of the study of objects dating back to the Upper Palaeolithic nicely illustrate the informative potential of this kind of investigations.     

Intérêt d’une semi-quantification et d’une analyse statistique automatique pour l’interprétation de la tomoscintigraphie cérébrale de perfusion dans la maladie d’Alzheimer

IntroductionAs the visual interpretation of the brain perfusion SPECT for the diagnosis of Alzheimer's disease might be difficult, it is wished to benefit from techniques allowing to improve the diagnostic accuracy especially for the inexperienced readers.Materials and methodsThree readers retrospectively interpreted 77 ^99mTc-ECD SPECT studies within the context of suspected neurodegenerative disease. The probability of Alzheimer's disease was quoted from 1 to 5, and the optimum sensitivity and specificity values were determined from ROC curves. The readers also attributed a hypoperfusion score to 13 brain regions; a diagnosis was obtained from this semi-quantification using a simple logic rule. The SPECT scans were also analyzed using the Planet Neuro software and a diagnosis was reached from a threshold for 2 of the 90 analyzed regions. The gold standard was established by a comprehensive neurological evaluation with at least 5 years of follow-up.ResultsThe sensitivities and specificities of the three readers were 50 %, 56 %, 28 % and 76 %, 83 % and 90 %, respectively. Using the semi-quantification they were 50 %, 67 %, 61 % and 54 %, 85 %, 69 %. The results of two readers were more in agreement. Using the automatic quantification, sensitivity was 78 % and specificity 81 %.ConclusionThe semi-quantification seems to ameliorate the results of and the agreement between certain readers. However, the automatic quantification seems to be the only way of assisting all of the readers to improve their diagnostic performances.     

L’échec de fécondation en F.I.V.: intérêt d’un taux de récolte ovocytaire élevé et étude du taux de récidive

L’analyse de 1132 tentatives de FIV montre comment le taux de récolte détermine la fiabilité de l’estimation de l’échec de fécondation. L’étude de 64 couples ayant réalisé plusieurs tentatives dont une au moins s’est soldée par un échec de fécondation montre que 68,7% d’entre eux obtiennent des embryons lors d’une autre tentative. Les embryons replacés ont les mêmes aptitudes d’implantation et de développement que ceux obtenus par 130 couples ayant subi un premier échec d’implantation. Ces résultats sont mis en relation avec ceux obtenus par insémination subzonale après deux échecs de FIV.     

Le développement de l’inventaire de dépistage ERIraos: un outil global d’appréciation du risque d’évolution psychotique

Adequate identification of patients for early intervention programmes requires reliable and valid assessment tools. Within the German Schizophrenia Network (Kompetenznetz Schizophrenie) a set of schedules for early detection of schizophrenia has been proposed: the Early Recognition Inventory ERIraos. ERIraos is a two-step procedure with a 17-item checklist used at step 1 by GPs, psychologists, teachers, while a comprehensive 110-item symptom list is applied at early intervention centres at the expert level. In addition, ERIraos allows the assessment of several risk factors for psychosis such as familial load, childhood deficiencies, alcohol and drug use by special modules. Some preliminary results are presented here. The frequency of the 17 checklist symptoms increases from the early to the late prodrome, and more specific symptoms occur over time. The 17 checklist symptoms are grouped by factor analysis to 5 factors (psychotic, depressive, disorganised, withdrawn, dysphoric). In addition to prodromal symptoms, most patients (86.2%) report at least one additional risk factor (mean: 1.7 risks). 68% demonstrate some schizotypal features, 53% report alcohol and/or drug consumption, 24% demonstrate some deficiency or delay in childhood development, 21% report definite obstetric or birth complications, and 10% have a family history of schizophrenia or some schizophrenia-like diagnosis in first degree relatives. So far, the results are of a preliminary nature, and when sufficient information on psychotic transitions is available, the predictive value of ERIraos will be determined.