A dedicated series of L-mode deuterium discharges were performed in WEST in which a broad parameter space in terms of divertor plasma temperature (inner divertor at <10 eV, outer divertor up to 50 eV) and impurity flux density was achieved by variation of X point elevation, upstream plasma density and fuelling position and rate. Density steps provided stable reference plasma conditions whilst density scans up to the point of detachment revealed the sputtering threshold behaviour of the dominant sputtering species. Tungsten gross erosion was quantified via the common WI 400.9 nm line and correlated with the residual gas content.

Tungsten transport is investigated in WEST long pulse L-mode plasmas operated with the strike point on the actively cooled upper tungsten divertor. The pulses are mostly heated by lower hybrid waves. It is experimentally found that tungsten does not centrally accumulate throughout these similar to 30 s reproducible discharges despite large normalised electron density gradients R/L-ne. To explain these observations, turbulent and neoclassical transport of electrons and tungsten ions are computed with GKW Peeters A.G. et al (2009 Computer Phys. Commnun. 180 2650) and NEO Belli E. and Candy J. (2008 Plasma Phys. Control. Fusion 50 095010), Belli E. and Candy J. (2012 Plasma Phys. Control. Fusion 54 015015) respectively. Additionally, interpretative integrated modelling simulations are also performed to keep data coherency despite the lack of measurements of some quantities such as the Ti profiles. Modelled R/Lne are found consistent with interferometry inversions and the tungsten peaking factor R/L-nW remains comparable to R/L-ne due to dominant turbulent diffusivities inside r/a = 0.3-0.8. In the central region r/a < 0.3 neoclassical W transport dominates but the convective velocities are several order of magnitudes lower compared to plasmas with toroidal rotation velocities induced by a neutral beam injection (NBI) torque. Finally, nitrogen is seeded in these pulses leading to an enhanced energy content which is consistent with stabilised ion temperature gradient modes from dilution.

This paper focuses on the wireless powering of implanted medical devices (IMDs) thanks to the widely used technology NFC (Near Field Communications). This technology uses a magnetic coupling at 13.56 MHz. In this work, the IMD is represented by a titanium case with a coil wound around it. CST simulations and VNA measurements are performed with two titanium samples (grade 2, G2, and grade 5, G5) for evaluating the impact of the titanium case on the electrical parameters, mainly the impedance Z parameters matrix. The human body is modeled in simulation and represented in measurements thanks to a phantom. Evaluation of the Z parameters in simulation and measurements are shown in a first step and used in a second one for defining the efficiency reachable in our case of study. The efficiency is computed with simulated and measured results and allows to quantify the ability to consider the NFC link for powering. As the distance between transmitting and receiving coils is in the range of 50 mm, including a distance between reader and human tissue of 30 mm, the efficiency (custom) is in the range of 10 to 20% depending on the load impedance of the IMDs. This work shows a fruitful agreement between simulation and measurements for designing NFC link in the context of IMDs powering. Conclusions are given for improving this physical link by modifying the structure of the reader, and the definition of the efficiency given can be used as a fruitful figure of merit.

Plusieurs études ont suggéré que l’obésité pouvait avoir une influence négative sur la réponse aux anti-TNFα mais il n’existe aucune donnée sur la réponse au rituximab (RTX). Nous avons voulu déterminer si l’indice de masse corporelle (IMC) pouvait affecter la réponse au RTX dans la PR. Nous avons analysé de manière rétrospective les données de 114 patients atteints de PR et traités par RTX. La variation à 6 mois du Disease Activity Score (DAS28), du score douleur sur l’échelle visuelle analogique (EVA), de la vitesse de sédimentation (VS), du taux de protéine C-réactive (CRP), du nombre d’articulations douloureuses (NAD) et du nombre d’articulations gonflées (NAG) par rapport aux valeurs initiales était analysée. Le critère principal de jugement était la diminution du DAS28 ≥ 1,2. Les critères secondaires étaient la bonne réponse EULAR et la rémission EULAR. L’IMC médian initial (intervalle interquartile) était de 26,8 (1,8–23,23–31) kg/m2. Le nombre de patients avec un IMC normal, en surpoids et obèses était respectivement de 38, 41 et 35. À 6 mois, le nombre de patients atteints de PR qui rapportaient une diminution du DAS28 ≥ 1,2 ainsi qu’une bonne réponse thérapeutique EULAR et une rémission EULAR était respectivement de 44 (38,6 %), 27 (23,7 %) et 24 (21,1 %). En analyse univariée, l’IMC médian était similaire chez les sujets répondeurs et non répondeurs pour une diminution du DAS28 ≥ 1,2 (26,9 [1,1–24,24–30] vs. 26,8 [2–6,6–23,23–31], p = 0,78), une bonne réponse EULAR (27,7 [3–7,7–24,24–30] vs. 26,7 [3–5,5–22,22–31], p = 0,57) et une rémission EULAR (26,9 [1–8,8–24,24–30] vs. 26,8 [2–5,5–23,23–31], p = 0,94). L’analyse multivariée ajustée confirmait l’absence de corrélation entre l’IMC et les différents critères de réponse au RTX. L’IMC était seulement négativement corrélé à une baisse du ΔNAG (p = 0,0276) et du ΔNAD (p = 0,0233). L’IMC n’avait aucun impact négatif sur la réponse au RTX dans la PR. Ces données constituent une aide dans le choix d’une biothérapie pour les patients obèses atteints de PR.

To validate the measurement properties and the detection performance of the FLARE‐RA questionnaire in a longitudinal prospective study.

L’adhésion des patients atteints de rhumatisme inflammatoire chronique (RIC) à leur traitement s’avère sous optimal, comme dans la plupart des maladies chroniques. Notre objectif était de développer une analyse qualitative du comportement d’adhésion médicamenteuse des patients atteints de RIC et traités par biothérapie (BT).Sur la base de l’analyse préliminaire des données de la littérature, nous avons construit un plan d’entretien semi-structuré. Nous avons interrogé 12 patients atteints de RIC sur 1. leurs antécédents médicaux, 2. leurs expériences avec les biothérapies, 3. leur perception des bénéfices et des risques des biothérapies. L’analyse de données thématique a été développée, au regard des données de la littérature.Cinq grands thèmes émergent comme explicatifs du défaut d’adhésion médicamenteuse : 1. la maladie, 2. le traitement, 3. le profil démographique et socio-économique du patient, 4. le lien entre le patient et le système de soins, 5. le profil du patient.L’amorce du traitement par BT est assise sur la relation de confiance avec le thérapeute, une représentation favorable des bénéfices du traitement par rapport aux risques encourus ainsi que la facilité de prise du médicament. La maintenance, sous tendue par la peur d’avoir mal à nouveau, se joue sur l’expérience que fait le patient des bénéfices du traitement et sur un soutien adapté de la part des soignants, pour renforcer sa motivation à prendre le traitement.

The Drug Reaction with Eosinophilia and Systemic Symptom (DRESS) is a severe adverse drug-induced reaction. Diagnosing DRESS is challenging due to the diversity of cutaneous eruption and organs involved. We used the RegiSCAR scoring system that grades DRESS cases as “no,” “possible,” “probable,” or “definite” to classify cases reported in the literature. We also analyzed the clinical course and treatments of the cases. A total of 44 drugs were associated with the 172 cases reported between January 1997 and May 2009 in PubMed and MEDLINE. The most frequently reported drug was carbamazepine, and the vast majority of cases were classified as “probable/definite” DRESS cases. Hypereosinophilia, liver involvement, fever, and lymphadenopathy were significantly associated with “probable/definite” DRESS cases, whereas skin rash was described in almost all of the cases, including “possible cases.” Culprit drug withdrawal and corticosteroids constituted the mainstay of DRESS treatment. The outcome was death in 9 cases. However, no predictive factors for serious cases were found. This better knowledge of DRESS may contribute to improve the diagnosis and management of this syndrome in clinical practice.

OBJECTIVE:To survey rheumatologists' preferences for the choice of a second-line disease-modifying antirheumatic drug (DMARD) after inadequate response with methotrexate (MTX) therapy in rheumatoid arthritis (RA).METHODS:Thirty-six rheumatologists stated their preferences for RA treatment after inadequate response with MTX therapy (optimal dose at least 6 months). From the initial scenario, we derived 54 vignettes varying by rheumatoid factor or anti-cyclic citrullinated peptide antibody presence, swollen joint count, Disease Activity Score in 28 joints, and structural damage. Respondents stated their preference among 5 therapeutic options: MTX continuation, switch to another conventional DMARD, addition of another conventional DMARD, addition of anakinra, or addition of a tumor necrosis factor (TNF) blocker. Presentation by pairs yielded 10 combinations of strategies for each variant, totaling 540 vignettes; participants evaluated a random sample of 180 vignettes. Determinants of each top-ranked option were analyzed by logistic regression. The compilation of these data served to define a therapeutic algorithm.RESULTS:The responses of 33 rheumatologists were analyzable. Therapeutic preferences corresponded to the top-ranked options. For patients with mild or moderately active RA, either a switch or step-up strategy to another conventional DMARD was top ranked. TNF blockers were preferred for RA patients with high disease activity or progressive structural damage. On the basis of these preferences, we developed a simple decision tree for use in daily clinical practice.CONCLUSION:Our simple, easy-to-use decision tree developed from rheumatologists' preferences for therapy after failure of MTX therapy in RA treatment may guide rheumatologists in daily practice to choose a second-line DMARD.

Hip involvement is uncommon in familial Mediterranean fever (FMF) and can result either from a process specific to this disease or from a coexisting chronic inflammatory joint disease, usually suggestive of ankylosing spondylitis (AS). We report ten cases of FMF with radiologically-documented inflammatory hip disease. Five patients had AS and one had juvenile idiopathic arthritis. There were six men and four women, with a mean age of 34.4 years +/- 17.6 (range, 15-70 years). Onset of the inflammatory hip disease occurred after bouts of acute hip symptoms in one of the patients with isolated FMF and after protracted hip arthritis in another; the two other patients had no history of hip symptoms. The HLA-B27 antigen was looked for in two of the five patients with FMF and AS, with negative results in both; another patient in this subgroup had severe ulcerative colitis. Total hip replacement or replacement of the acetabulum was required in six patients, including two with isolated FMF. Chronic joint disease has been estimated to contribute fewer than 5% of the joint manifestations in FMF. In previous studies, the hips and knees were affected in 75% of patients with chronic joint disease related to FMF. The association of FMF and AS (usually without the HLA-B27 antigen) has been well documented, although the pathogenic mechanisms that link these two conditions remain unknown.

OBJECTIVE:To assess the ability of anti-proteinase 3 (anti-PR3) classic antineutrophil cytoplasmic antibodies (cANCA) to stimulate endothelial expression of tissue factor (TF), which is the main initiator of the coagulation cascade that can lead to endothelial injury and thrombosis in patients with Wegener's granulomatosis.METHODS:Human umbilical vein endothelial cells (HUVEC) were grown to confluence and stimulated with affinity-purified anti-PR3 antibodies, Igs from healthy subjects, and endotoxin (lipopolysaccharide) as positive control.RESULTS:TF activity was generated in anti-PR3-stimulated cells, as shown by a chromogenic test. This activity was inhibited by specific anti-TF antibodies. TF messenger RNA (mRNA) was found in anti-PR3-stimulated cells, as detected by reverse transcriptase-polymerase chain reaction, but not in cells stimulated with irrelevant human Igs or Igs from normal control sera. TF expression reached maximum levels 12 hours after exposure to the anti-PR3 cANCA, and did not require complement. TF mRNA expression was inhibited by cycloheximide, suggesting a requirement for protein synthesis. When added to the incubation medium, interleukin-1 (IL-1) receptor antagonist inhibited the induced TF mRNA expression, suggesting that cANCA-stimulated cells initiate IL-1 synthesis. Moreover, cANCA induced IL-1alpha mRNA before TF mRNA.CONCLUSION:This study showed that anti-PR3 treatment of HUVEC induces sequential expression of IL-1alpha mRNA and TF mRNA, as well as their corresponding proteins. Both proteins could have pathogenic roles in the vasculitic process, since TF is the main initiator of the coagulation cascade.