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The latest mobile mapping innovations are transforming how we manage, design and monitor our critical infrastructure--in particular, reshaping road maintenance. Through the advance of mobile mapping and reality capture imagery, [...]

To evaluate the association between dose of skin-to-skin contact (SSC) per day and initiation time with the occurrence of deaths in newborns with weight up to 1800g.

Intensive care unit (ICU) healthcare workers (HCWs) are at the forefront of the coronavirus disease 2019 pandemic. To overcome the lack of human resources during this crisis, some ICUs had to mobilise staff from a reinforcement pool, with no or outdated ICU experience. This study aimed to investigate and to compare the psychological impact of the pandemic on regular ICU staff members and reinforcement workers.

La stratégie de prise en charge des lithiases de la voie biliaire principale (VBP) chez les patients de plus de 75 ans constitue un réel enjeu mettant en balance la multiplication des procédures et leur morbidité propre. L’objectif est de comparer le traitement chirurgical en un temps à l’association endoscopie-chirurgie en deux temps en termes d’efficacité de libération de la VBP et de morbi-mortalité chez le sujet âgé.

BackgroundThe 7th Airborne Forward Surgical Team (FST) has deployed to Chad in 2015 and 2016, in support of French military forces. Humanitarian surgical care is known to represent a significant part of the surgical activity in such missions, but to date limited data have been published on the subject.MethodsAll surgical patients from a civilian host population treated by the FST during these missions have been prospectively included. Indications, operative outcomes and postoperative outcomes were evaluated.ResultsDuring this period, the FST operated on 358 patients. Humanitarian surgical care represented 95% of the activity. Most patients (92.7%) were operated for elective surgery. Emergencies and infectious diseases represented, respectively, 7.3% and 9.1% of cases. The mean length of stay (LOS) was three days (2–4), and the median follow-up was 30 days (22–34). Mortality rate was 0.6% and morbidity was 5.6%. Parietal surgery had no significant complication and had shorter LOS (p<0.001). Emergent surgeries were more complicated (p<0.01) and required more reoperations (p<0.05). Surgical infectious cases had longer LOS (p<0.01).ConclusionsHumanitarian surgical care can be provided without compromising the primary mission of the medical forces. Close surveillance and follow-up allowed favourable outcomes with low morbidity and mortality rates. Humanitarian care is responsible for a considerable portion of the workload in such deployed surgical teams. Accounting for humanitarian care is essential in the planning and training for such future medical operations.

En cas d’attentats terroristes ou de catastrophes industrielles, la prise en charge d’un afflux massif de blessés doit tenir compte d’impératives logistiques tout en obéissant aux principes de bases de la traumatologie. Ceci implique, pour éviter désordre et confusion, une doctrine ferme, univoque et précise dans les soins à chaque stade. Le triage médicochirurgical réalise le classement des blessés de manière logique en fonction de la gravité de la ou des blessures, de la nécessité d’un traitement et de son délai optimal. Ce triage doit être précoce, dynamique et aboutir à une catégorisation qui permettra d’optimiser les moyens au profit d’une prise en charge efficace.

La prise en charge des traumatismes pénétrants abdominaux, pelviens, vasculaires et des confins dépend du statut hémodynamique du blessé et du type de lésions, sachant que l’association lésionnelle est la règle. Leur gravité est liée au risque hémorragique initial puis au risque septique secondaire et enfin aux séquelles des associations lésionnelles. En cas d’instabilité hémodynamique, l’objectif de la prise en charge est l’obtention rapide de l’hémostase et de la coprostase. Cette attitude conduira à réaliser une laparotomie d’emblée pour les plaies abdominales, un packing sous-péritonéal (PSP) et la mise en place d’un ballon d’occlusion aortique (REBOA) au déchoquage pour les plaies pelviennes, la pose d’un shunt vasculaire temporaire (SVT) pour les traumatismes des vaisseaux proximaux des membres et la ligature pour les lésions hémorragiques des vaisseaux distaux et enfin le contrôle des saignements extériorisés au moyen de garrot tourniquet, de pansement compressifs jonctionnels ou de compresses hémostatiques pour les plaies des confins. En cas de stabilité hémodynamique, des examens d’imagerie préopératoire permettront un bilan lésionnel plus précis, notamment en ce qui concerne les lésions rétropéritonéales ou thoraco-abdominales, difficilement explorable chirurgicalement. Les voies d’abord chirurgicales seront larges, systématisées, agrandies à la demande permettant d’appliquer les principes du damage control.

The surgical military activity on deployment has been constantly decreasing. Hall et al have demonstrated the low volume of activity has a negative impact (technical, morale and efficiency of care) in the American army, but it can also be observed in the French surgical teams.

La prise en charge des plaies pénétrantes de l’abdomen a largement bénéficié de l’essor du scanner notamment chez le patient stable. Dans ce contexte, le scanner constitue l’examen de référence. Notre étude vise à évaluer les performances du scanner préopératoire pour les lésions pénétrantes abdominales.

Penetrating chest trauma is common but few need surgical treatment (10–20%). The mortality of gunshot wounds of the heart is 45%, among the wounded arriving at the hospital. The suspicion of wound heart with an inlet in the heart area (limited by costal awnings down, clavicles top, and mid-clavicular line outside) and pericardial effusion remains a surgical indication. Gunshot wounds of the heart with migration of the projectile in the pulmonary artery are rare. Migration of projectile into the pulmonary artery is described most often with lesions of peripheral veins without concomitant cardiac involvement. The indication of projectile extraction is not clearly defined in the literature. Conservative management of selected cases of pulmonary artery bullet emboli may be warranted in light of the risks of extraction.

ObjectivesThe Seventh Airborne Forward Surgical Team (FST) has been deployed in Gao, Mali, and in Bangui, Central African Republic (CAR), for two 3-month periods in 2014. The initial role of the FST was to provide emergent care to French and coalition soldiers but it was expanded to include humanitarian assistance. The aim of the present study was to describe and compare injuries and surgical activity of the Seventh Airborne FST during these two conflicts.MethodsAll surgical patients treated by the FST between January and December 2014 have been included. Patient demographics, mechanisms of injury, surgical management including triage categories and types of surgery performed and evacuation modalities were recorded.ResultsDuring the 6-month deployment period in 2014, the FST performed 129 operations on 134 patients, 61 of which were trauma patients (45 battle injuries (BI)). The remaining 73 patients were treated as part of the humanitarian mission. Thirty of the BI were managed during the Malian conflict and 15 in CAR; 29 patients (64%) were military. The median Injury Severity Score (range) was 20 (10–34) in Mali and 8 (5–21) in CAR with median (range) evacuation time of 390 min (240–947) in Mali and 120 min (60–120) in CAR (p<0.0001). The most frequent mechanisms of injury were gunshot wounds in Mali (15/30) and road traffic accident in CAR (7/15). Extremity injuries were most common (58%) with head, face and neck injuries and thoracic injuries in 15% of cases each and 12% had suffered abdominopelvic injuries. Ten patients were categorised as T1 and underwent urgent surgery, five had damage control surgery and four received transfusion. The average length of stay was 2 days (1–2), with most patients being transferred to another hospital.ConclusionsCasualties from Mali and CAR presented with a wide variety of injury patterns, and there were some instances where damage control surgery and whole blood transfusion were necessary. Surgical equipment scales must allow treatment of a large variety of injuries including all body regions and extreme emergency procedures. These two conflicts differ in terms of scope, one being an urban guerrilla and the other an open conflict in a large desertic area. Long distances in the Malian desert increase significantly the evacuation time. It has to be taken into account in the FST location when coalition forces are deployed in such places.

Mucormycosis is a rare but serious opportunistic fungal infection. Several clinical forms have been described, including cutaneous localization that is frequently associated with soft tissue trauma or burns. We report a case of cutaneous mucormycosis in a diabetic patient with severe occlusive arterial disease. The diagnosis was made early with mold growth on an amputation wound and the presence of nonseptate hyphae on direct microscopic examination, later identified on culture as Lichtheimia ramosa. Aggressive treatment, including the control of underlying diseases, systemic and local amphotericin B, and extensive surgical debridement permitted successful outcomes.

IMPORTANCE Central pancreatectomy, as an alternative to standard resection for benign and low-grade pancreatic neoplasms, has been described in mainly small retrospective series. OBJECTIVE To describe a large single-center experience with central pancreatectomy. DESIGN, SETTING, AND PARTICIPANTS A retrospective case series in a tertiary referral center included 100 consecutive patients undergoing central pancreatectomy with pancreaticogastrostomy from January 1, 2000, to March 1, 2012. MAIN OUTCOMES AND MEASURES Surgical indications, postoperative morbidity, mortality, and long-term outcomes regarding pancreatic function and recurrence. RESULTS Central pancreatectomies were performed mainly for neuroendocrine tumors (35%), intraductal papillary mucinous neoplasms (33%), solid pseudopapillary neoplasms (12%), and mucinous cystadenomas (6%). The postoperative mortality rate was 3% (due to pulmonary embolisms in 2 patients and hemorrhage after pancreatic fistula in 1 patient). Clavien-Dindo III or IV complications occurred in 15% of patients and were due mainly to pancreatic fistula, requiring 10 radiologic drainage procedures, 7 endoscopic procedures, and 6 reoperations overall. After a median follow-up of 36 months, the rates of new-onset exocrine and endocrine insufficiency were 6% and 2%, respectively. Overall, 7 lesions could be considered undertreated, including 3 node-negative R0 microinvasive intraductal papillary mucinous neoplasms (without recurrence at 27, 29, and 34 months) and 4 node-positive neuroendocrine tumors (with 1 hepatic recurrence at 66 months). Among the 25 patients with a doubtful preoperative diagnosis, 9 could be considered overtreated (ie, operated on for benign nonevolutive asymptomatic lesions). CONCLUSIONS AND RELEVANCE Central pancreatectomy is associated with an excellent pancreatic function at the expense of a significant morbidity and a non-nil mortality rate, underestimated by the published literature. The procedure is best indicated for benign or low-grade lesions in young and fit patients who can sustain a significant postoperative morbidity and could benefit from the excellent long-term results.

The article discusses the developments in the music industry in Great Britain. It features former British Prime Minister Margaret Thatcher and her contributions to the country's music sector. According to Respect Member of Parliament (MP), George Galloway, Thatcher was instrumental in achieving Great Britain's golden age of music.

Infected aortic aneurysms represent 0.85 to 1.3% of aortic aneurysms. Most often, the implicated bacteria species are Salmonellasp., Staphylococcussp. and Streptococcussp. Brucella-related infected aortic aneurysms are very rare. Most often, they result from endocarditis or from a local septic focus. Combined treatment by antibiotics and surgery is the standard for infectious aneurysms. In the absence of formal factual data, the surgical treatment is still discussed in the literature, especially since endovascular treatments have been in full expansion. We are reporting the case of a female patient presenting with a Brucella-related infra-renal abdominal aortic aneurysm, without primitive infectious source (area) or identified endocarditis. Surgical treatment with in situ prosthetic replacement and omentoplasty in association with adapted antibiotics allowed a favorable outcome with an excellent result after an 8-year follow up.

In order to better understand the mechanisms of actinide uptake by specific biomolecules, it is essential to explore the intramolecular interactions between the cation and the protein binding site. Although this has long been done for widely investigated transition metals, very few studies have been devoted to complexation mechanisms of actinides by active chelation sites of metalloproteins. In this field, X-ray absorption spectroscopy has been extensively used as a structural and electronic metal cation probe. The two examples that are presented here are related to two metalloproteins in charge of iron transport and storage in eukaryote cells: transferrin and ferritin. U(VI)O22+, Np(IV) and Pu(IV) have been selected because of their possible role as contaminant from the geosphere.

The human paraoxonase-1 (PON-1) is a serum high-density lipoprotein-associated phosphotriesterase secreted mainly by the liver. This enzyme is able to hydrolyze toxic organophosphate xenobiotics, endogenous oxidized phospholipids, and homocysteine thiolactone. Physiologically, it is thought to protect against cardiovascular diseases. The level of PON-1 gene expression is a major determinant of paraoxonase-1 status but little is known regarding the regulation of this gene. We identified several transcription start sites and characterized the regulation of its promoter by fibrates and statins. In HuH7 human hepatoma cells, the PON-1 secreted enzymatic activity and mRNA levels were increased by fenofibric acid (approximately 70%) and decreased by several statins (approximately 50%). Transient and stable transfection assays in HuH7 cells indicated that the modulation of the mRNA and enzymatic activity levels could be accounted for by the regulation of the PON-1 gene promoter activity by these drugs. These effects are probably not mediated by the PPAR alpha because over-expression of this receptor decreased the fibrate effect and did not modify statins activity. The repressive effect of statins is reversed by mevalonate and 22(R)-hydroxycholesterol, suggesting the involvement of the liver X receptor in the mechanism. The opposite effects of fenofibrate and statins could be consistent with clinical data on homocysteine levels after hypolipidemic drug treatment. Regarding the toxicological aspects, the induction achieved with fenofibric acid, although limited, could increase organophosphate metabolism and may be relevant in certain conditions for protective treatments.

Purified humic acid has been covalently bound on activated epoxy silica gel particles. Determination of physical properties and chemical properties was conducted in order to characterize the material at different stages of the preparation. FTIR spectra and the PEC of the surface bound humic acid is very similar to that of humic acid starting material. This shows that the humic acid was not deteriorated during the surface binding process. This humic gel can be used as an analogue for sediment associated humic acid, with the advantage that covalently bound humic acid does not desorb, and thus allows for simple species separation between non-complexed and humic bound metal ions in batch and column experiments.

The development of optical communications has generated a huge expansion of the use of optoelectronic components for transmission, mainly for transmitters, receivers and optical amplifiers. This development has been possible because the technology is now mature, meaning that performance and reliability have greatly improved over the last years. This paper will give a short history of the evolution of the reliability of optical components, and will describe the current status. Main failures mechanisms analyses and a comparison between reliability calculations and actual field operational results will be made.

Abstract:  Before using bark to determine the degree of acidity in the environment due to atmospheric pollution, a better understanding of the internal factors which are involved in the evolution of the physico-chemical characteristics of bark is necessary. In this paper, variation of acidity and bark conductivity over the trunk length of silver fir and Norway spruce are examined. First, we show that it is more accurate to measure average bark pH and conductivity in each 2 m section of a tree by starting at the top than by starting at the base of the tree. A positive pH and conductivity gradient is observed over the trunk length; bark thickness decreases towards the top of the trunk. In the upper part of both silver fir and Norway spruce there are good correlations between acidity, conductivity, bark thickness and height, but in the lower part of the trees, silver fir and Norway spruce show contradictory behaviour. In silver fir, pH is linked with bark thickness and distance from the ground, while conductivity is not correlated with these two criteria. In Norway spruce we observe opposite results. It appears that conductivity measured on the external part of bark is directly influenced by the proximity of internal tissues, which are rich in ions, while acidity depends on the length of exposure to leaching due to water flowing down the trunk.

L’endométriose pelvienne profonde avec atteinte rectale (ER) est la forme la plus grave de la maladie endométriosique responsable de douleurs pelviennes chroniques et d’infertilité. Le but de cette étude était de comparer le traitement chirurgical de l’ER par laparotomie (L) et par laparoscopie (l).

Artificial radionuclides are released into the aquatic environment. Some of them are incorporated into aquatic organisms. An attempt has been made to elucidate the accumulation of radionuclides within the intracellular constituents of these organisms. On chronically radiolabelled animals (labelled sea water), the subcellular localisation of 241Am in the digestive gland cells of periwinkles and of oysters was determined. Similar experiments were performed on the hepatopancreas of the lobster (labelled food) with 241Am, 238Pu and 95Tcm, and in pyloric caeca of sea-stars with 241Am, 252Cf and 95Tcm. The distribution of 137Cs was studied in cytosolic fractions of muscle and liver of eels and in the oyster. Distribution of radioelements appeared to correlate with the metabolic pathways of the species studied and with the chemical nature of the radionuclide. The results provide data in radioprotection research and may explain the biokinetics which were observed for whole organisms.