This is the first prospective study analysing the mortality rate of BP in an entire country. The calculated mortalities are in the lower range of those reported in previous European studies. However, in line with the latter, our findings confirm a high case-fatality rate for BP, with an increased 1-year mortality rate compared with the expected mortality rate for age- and sex-adjusted general population.

SummaryBackground Prospective systematic analyses of the clinical presentation of bullous pemphigoid (BP) are lacking. Little is known about the time required for its diagnosis. Knowledge of the disease spectrum is important for diagnosis, management and inclusion of patients in therapeutic trials. Objectives The primary aims of the study were: (i) to characterize the clinical features of BP at time of diagnosis; and (ii) to assess the diagnostic delay in BP and its impact on prognosis Methods All new cases of BP diagnosed in Switzerland between 1 January 2001 and 31 December 2002 were prospectively registered by means of a standardized data collection form. Results One hundred-seventeen patients with BP were included in the study. 97cases (82.9%) had typical features with vesicles, blisters and ⁄or erosions at time of diagnosis, while in the remaining cases (17.1%) only excoriations, eczematous and ⁄or urticarial infiltrated lesions were observed. Head ⁄neck as well as palmo-plantar involvement were found in up to 20% of patients, while mucosal lesions were present in 14.5% of the cases. Diagnosis was made after a mean of 6.1 months after the first symptoms. In patients, in whom the diagnostic delay was 4 months or more (defined as late diagnosis group), lesions were more often limited to one body area. The type of lesions did not affect the diagnostic delay. Diagnosis was made more rapidly in patients with limb involvement compared to those without. The calculated mortality rate in the early and late diagnosis group was 18.9% and 17.9%, respectively, without significant difference. Conclusion BP often presents with bullous lesions at time of diagnosis after a mean diagnostic delay of 6 months. Nevertheless, up to 20% of patients lack obvious blistering and postbullous erosions, mimicking thus a variety of inflammatory dermatoses. Localized disease is associated with an increased diagnostic delay, which has however no impact on prognosis.

Observational studies have indicated a high but heterogeneous prevalence of low bone mineral density for adult patients with cystic fibrosis. Fracture complications were also described. The objective of this study was to determine the prevalence of osteoporosis, osteopenia, and fractures among adult patients with cystic fibrosis. A systematic literature review was conducted using electronic databases. The keywords used were "cystic fibrosis [MeSH] AND bone density." Original studies were eligible if they reported the prevalence of osteoporosis and/or osteopenia and/or fractures in adult patients with cystic fibrosis. A meta-analysis of pooled proportions was performed. Heterogeneity was tested with the Cochran Q statistic, and in the case of heterogeneity a random effect model was used. Of 117 studies, 12 were selected, i.e., that represented a total of 1055 patients. Mean age ranged from 18.5 to 32 years (median: 28.2 years). Mean body mass index ranged from 19.9 to 22.4 (median: 20.7); 53.8% were men. The pooled prevalence of osteoporosis in adults with cystic fibrosis was 23.5% (95% CI, 16.6-31.0). The pooled prevalence of osteopenia was 38% (95% CI, 28.2-48.3). The pooled prevalences of radiological vertebral fractures and nonvertebral fractures were 14% (95% CI, 7.8-21.7) and 19.7% (95% CI, 6.0-38.8), respectively. In conclusion, this systematic literature review with meta-analysis emphasized the high prevalence of osteopenia and osteoporosis in young adults with cystic fibrosis. The prevalence of fracture was also high.

International audienceA new stress resultant constitutive model for reinforced concrete plates under cyclic solicitations ispresented. This model is built by the periodic homogenisation approach using the averaging methodand couples damage of concrete and periodic debonding between concrete and steel rebar. Inone-dimensional situations, we derive a closed-form solution of the local problem useful to verify andset up the plate problem. The one dimensional macroscopic constitutive model involves a limited numberof parameters, the sensibility of which is studied. Comparison to experimental results underlines the pertinenceof the model by considering internal debonding in order to properly represent the mechanicaldissipation occurring during cyclic loadings on reinforced concrete panels

This paper reports the results obtained by the development of a new wet method of hydroxyapatite (HA) thin layer deposition. The method is based on the localized precipitation of HA on metallic substrates activated by induction heating. The technique developed has been shown to allow for the complete coating of substrates with micrometric thin films of HA within a low processing time. The method has been successfully applied to coat Ti plaques and Ti-6A1-4V cylinders.

International audienceThe buckling and crushing mechanics of cellular honeycomb materials is an important engineering problem. Motivated by the pioneering experimental and numerical studies of Papka and Kyriakides (1994, 1999a,b), we review the literature on finitely strained honeycombs subjected to in-plane loading and identify two open questions: (i) How does the mechanical response of the honeycomb depend on the applied loading device? and (ii) What can the Bloch wave representation of all bounded perturbations contribute to our understanding of the stability of post-bifurcated equilibrium configurations? To address these issues we model the honeycomb as a two-dimensional infinite perfect periodic medium. We use analytical group theory methods (as opposed to the more common, but less robust, imperfection method) to study the honeycomb's bifurcation behavior under three different far-field loadings that produce (initially) the same equi-biaxial contractive dilatation. Using an FEM discretization of the honeycomb walls (struts), we solve the equilibrium equations to find the principal and bifurcated equilibrium paths for each of the three loading cases. We evaluate the structure's stability using two criteria: rank-one convex-ity of the homogenized continuum (long wavelength perturbations) and Bloch wave stability (bounded perturbations of arbitrary wavelength). We find that the post-bifurcation behavior is extremely sensitive to the applied loading device, in spite of a common principal solution. We confirm that the flower mode is always unstable, as previously reported. However, our (first ever) Bloch wave stability analysis of the post-bifurcated equilibrium paths shows that the flower mode is stable for all sufficiently short wavelength perturbations. This new result provides a realistic explanation for why this mode has been observed in the finite size specimen experiments of Papka and Kyriakides (1999a)

An extension of the phase field method to model interfacial damage in elastoplastic composites is proposed. In the matrix, an elastoplastic phase field is employed to model the fracture process. To introduce interfacial damage between inclusions and the matrix, a strain density function depending on the jump due to decohesion is added to the total energy. Smooth indicator functions are used to maintain the regularized character of the approximation. They weight the different terms in the energy with respect to the vicinity of interfaces. Then, the different problems (mechanical and phase field problems) are derived and an algorithmic procedure is described. Numerical examples show the capabilities of the method to handle initiation, propagation and interactions between both elastoplastic fracture and interfacial cracks in complex elastoplastic composite microstructures. It is also shown that the solutions are convergent with respect to the mesh refinement.

HAL is a multi-disciplinary open access archive for the deposit and dissemination of scientific research documents, whether they are published or not. The documents may come from teaching and research institutions in France or abroad, or from public or private research centers. Reinforced Concrete, is expressed within the usual thin plate kinematics framework. It is built by a periodic homogenisation approach using the averaging method and it couples concrete damage and periodic debonding between steel rebar and surrounding concrete. The generality of the proposed method leads to a generic closed-form for the Helmholtz strain energy density function and the two dissipation pseudo-potentials that can be adapted to any material with an internal structure similar to the RC structural element one. A restricted number of geometric and material characteristics are needed from which the whole set of model parameters are identified through an automatic numeric procedure performed on a Representative Volume Elements (RVEs) of the RC plate. Finally, comparisons of finite element simulations with experimental results concerning the seismic behaviour of reinforced concrete wall made structures are proposed and discussed.