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Background External ear canal exostoses are usually bilateral and broad-based, secondary to external ear canal chronic cold exposure, especially water.Objectives The objectives were to analyze the influence of the surgeon’s experience on the 3-year recurrence and on the complication. We also studied the influence of prolonged exposure to cold water on the incidence of recurrence.Material and Methods This monocentric retrospective study included 98 ears operated for canalplasty between 2009 and 2016 by nine different operators including one senior, a junior, and seven beginner surgeons. Senior, Junior, and Beginner groups were compared.Results 3-year recurrence rate was higher in the Beginner and Junior groups than in the Senior group (69% and 38% vs 18%, P= .001). Although there was a difference between the Beginner (69%) and Junior (38%) groups, it was not significant (P= .407). Among the recurrences, 48% had continued exposure to cold water while only 7% of the ears without recidivism were still exposed (P< .001, OR = 1.25 [4.4; 36.1]). The complication rates were similar between groups, concerning pain (8% vs 30% vs 12%), per procedure perforation (17% vs 10% vs 16%), scarring disorders (25% vs 20% vs 13%), and osteitis (8% vs 0% vs 1%). Hearing was unaffected.Conclusions This is the first study evaluating the risk of recurrence of external ear canal exostoses after canalplasty based on the surgeon’s experience. This risk of recurrence seems to decrease with the surgeon’s experience. There was no difference in complication rates.

Objective:Hypothyroidism is the most common complication of hemithyroidectomy for thyroid nodules. This retrospective cohort study investigated the prognostic factors for hypothyroidism following hemithyroidectomy. Methods:We included patients who underwent hemithyroidectomy between 2016 and 2017, excluding those with history of preoperative hypothyroidism or malignancy on histopathological examination. The primary endpoint was development of hypothyroidism during follow-up (TSH≥2 above normal). Results:Twenty-six of the 128 included patients (20%) developed postoperative hypothyroidism. The following independent prognostic factors were found: preoperative TSH level>1.5 mIU/L (OR 2.11; P=0.013), and remaining thyroid volume adjusted for body surface area<4.0mL/m2(OR 1.77; P=0.015). Twenty-one patients (81%) had first TSH values above the upper limit of normal. Postoperatively, first TSH level correlated significantly with the preoperative value (R=0.5779, P<0.001). Levothyroxine was prescribed to 16% of patients, with a mean dose of 0.92μg/kg/day. Conclusion:Patients with TSH>1.5 mIU/or remaining thyroid volume adjusted for body surface area<4.0mL/m2should have intensified clinical and biological follow-up in the first year after surgery.

In this work, an innovative and versatile strategy for the fabrication of nanostructured organic thin films is established based on the wrinkling phenomenon taking place in a bilayer system constituted by a liquid plasma polymer film (PPF) and a top Al coating. By means of morphological characterization (i.e., atomic force microscopy and scanning electron microscopy), it has been demonstrated that the wrinkle dimensions (i.e., wavelength and amplitude) evolve as a function of the PPF thickness according to models established for conventional polymers. The wrinkled surfaces exhibit great stability over time as their dimension did not vary after 100 days of aging, resulting from a pinning phenomenon between the Al layer and the Si substrate, hence freezing the morphology. In a second step, the wrinkled surfaces have been employed as templates for the deposition of an additional PPF third layer, giving rise to the formation of a nanostructured organic-based surface. The chemical composition of the material can be tuned through an appropriate choice of precursor (i.e., allyl alcohol or propanethiol).

Four decades into the HIV epidemic, CNS infection remains a leading cause of preventable HIV-related deaths in routine care. The Driving Reduced AIDS-associated Meningo-encephalitis Mortality (DREAMM) project aimed to develop, implement, and evaluate pragmatic implementation interventions and strategies to reduce mortality from HIV-related CNS infection.

Carbon monoxide (CO) poisoning is one of the most common causes of poisoning death and its diagnosis requires an elevated carboxyhemoglobin (COHb) level. Noninvasive CO saturation by pulse oximetry (SpCO) has been available since 2005 and has the advantage of being portable and easy to use, but its accuracy in determining blood COHb level is controversial. To evaluate the accuracy of SpCO (index test) to estimate COHb (reference test). Systematic review and meta-analysis of diagnostic test accuracy (DTA) studies. Four electronic databases were searched (Medline, Embase, Cochrane Central Register of Controlled Trials, and OpenGrey) on 2 August 2022. All studies of all designs published since the 2000s evaluating the accuracy and reliability of SpCO measurement compared to blood COHb levels in human volunteers or ill patients, including children, were included. The primary outcome was to assess the diagnostic accuracy of SpCO for estimating COHb by blood sampling by modeling receiver operating characteristic (ROC) curves and calculating sensitivity and specificity (primary measures). The secondary measures were to calculate the limits of agreement (LOA) and the mean bias. This systematic review was conducted according to the Preferred Reporting Items for a Systematic Review and Meta-analysis-DTA 2018 guidelines and has been registered on International Prospective Register of Systematic Reviews (PROSPERO, CRD42020177940). The risk of bias was evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Twenty-one studies were eligible for the systematic review; 11 could be included for the quantitative analysis of the primary measures and 18 for the secondary measures. No publication bias was found. The area under the summary ROC curve was equal to 86%. The mean sensitivity and specificity were 0.77, 95% confidence interval (CI, 0.66–0.85) and 0.83, 95% CI (0.74–0.89), respectively (2089 subjects and 3381 observations). The mean bias was 0.75% and the LOA was −7.08% to 8.57%, 95% CI (−8.89 to 10.38) (2794 subjects and 4646 observations). Noninvasive measurement of COHb (SpCO) using current pulse CO oximeters do not seem to be highly accurate to estimate blood COHb (moderate sensitivity and specificity, large LOA). They should probably not be used to confirm (rule-in) or exclude (rule-out) CO poisoning with certainty.

Stilbenes are specialized metabolites that are particularly abundant in Vitisspecies. Although the biosynthetic pathways of stilbenes have been well-characterized, the role of specific peroxidases in stilbene oligomerization remains to be investigated. In this study, we used grapevine cell cultures to characterize the functional role of Vitis viniferaperoxidase 4 (VvPRX4) in the production of resveratrol oligomers after elicitation with methyl jasmonate (MeJA). We showed that MeJA triggers the accumulation of t-resveratrol, resveratrol dimers, and predicted resveratrol trimers in culture medium. This accumulation was correlated with upregulation of the PRX4gene in grapevine cells. Using bacterial crude extracts containing VvPRX4, we demonstrated that VvPRX4 converts t-resveratrol into dimers, t-ε-viniferin into tetramers, and both combined substrates into resveratrol trimers. Additionally, VvPRX4 mediates the formation of glycosylated dimers using t-piceid and t-resveratrol as substrates. These results highlight the functional role of VvPRX4 in stilbene oligomerization in MeJA-elicited grapevine cell cultures.

Governments are negotiating actions intended to halt biodiversity loss and put it on a path to recovery by 2050. Here, we show that bending the curve for biodiversity is possible, but only if actions are implemented urgently and in an integrated manner. Connecting these actions to biodiversity outcomes and tracking progress remain a challenge.

En Francia, se realizan alrededor de 35.000 amigdalectomías anuales en niños, asociadas o no a una adenoidectomía. A pesar de la frecuencia del procedimiento quirúrgico, la amigdalectomía no es una intervención banal y su morbimortalidad no es insignificante, en particular en lo referente al dolor y la hemorragia en el postoperatorio. Desde hace unos 20 años, han aparecido nuevas herramientas quirúrgicas, cuyo empleo en la amigdalectomía ofrece resultados prometedores, en especial la radiofrecuencia y el microdesbridador. Se han publicado muchos estudios que comparan estas técnicas con las más antiguas. Se han producido otros avances en lo que respecta a las indicaciones quirúrgicas. En los niños, las indicaciones de la adenoamigdalectomía por infecciones de repetición han disminuido, dejando su puesto a los síndromes de apneas obstructivas del sueño, que en la actualidad representan más de dos tercios de las indicaciones. Una última evolución es la realización de la amigdalectomía pediátrica como cirugía ambulatoria, según criterios definidos en las recomendaciones.

Protective immunity relies on the interplay of innate and adaptive immune cells with complementary and redundant functions. Innate lymphoid cells (ILCs) have recently emerged as tissue-resident, innate mirror images of the T cell system, with which they share lineage-specifying transcription factors and effector machinery1. Located at barrier surfaces, ILCs are among the first responders against invading pathogens and thus could potentially determine the outcome of the immune response2. However, so far it has not been possible to dissect the unique contributions of ILCs to protective immunity owing to limitations in specific targeting of ILC subsets. Thus, all of the available data have been generated either in mice lacking the adaptive immune system or with tools that also affect other immune cell subsets. In addition, it has been proposed that ILCs might be dispensable for a proper immune response because other immune cells could compensate for their absence3–7. Here we report the generation of a mouse model based on the neuromedin U receptor 1 (Nmur1) promoter as a driver for simultaneous expression of Cre recombinase and green fluorescent protein, which enables gene targeting in group 2 ILCs (ILC2s) without affecting other innate and adaptive immune cells. Using Cre-mediated gene deletion of Id2and Gata3in Nmur1-expressing cells, we generated mice with a selective and specific deficiency in ILC2s. ILC2-deficient mice have decreased eosinophil counts at steady state and are unable to recruit eosinophils to the airways in models of allergic asthma. Further, ILC2-deficient mice do not mount an appropriate immune and epithelial type 2 response, resulting in a profound defect in worm expulsion and a non-protective type 3 immune response. In total, our data establish non-redundant functions for ILC2s in the presence of adaptive immune cells at steady state and during disease and argue for a multilayered organization of the immune system on the basis of a spatiotemporal division of labour.

ABSTRACTStaphylococcus aureusis a skin commensal microorganism commonly colonizing healthy humans. Nevertheless, S. aureuscan also be responsible for cutaneous infections and contribute to flare-up of inflammatory skin diseases such as atopic dermatitis (AD), which is characterized by dysbiosis of the skin microbiota with S. aureusas the predominant species. However, the role of major virulence factors of this pathogen such as phenol-soluble modulin (PSM) toxins in epidermal inflammation remains poorly understood. Stimulation of primary human keratinocytes with sublytic concentrations of synthetic and purified PSM α3 resulted in upregulation of a large panel of pro-inflammatory chemokine and cytokine gene expression, including CXCL1, CXCL2, CXCL3, CXCL5, CXCL8, CCL20, IL-1α, IL-1β, IL-6, IL-36γ and TNF-α, while inducing the release of CXCL8, CCL20, TNF-α and IL-6. In addition, using S. aureusculture supernatant from mutants deleted from genes encoding either α-type PSMs or all PSM production, PSMs were shown to be the main factors of S. aureussecretome responsible for pro-inflammatory mediator induction in human keratinocytes. On the other hand, α-type PSM-containing supernatant triggered an intense induction of pro-inflammatory mediator expression and secretion during both topical and basal layer stimulation of an ex vivomodel of human skin explants, a physiologically relevant model of pluristratified epidermis. Taken together, the results of this study show that PSMs and more specifically α-type PSMs are major virulence factors of S. aureusinducing a potent inflammatory response during infection of the human epidermis and could thereby contribute to AD flare-up through exacerbation of skin inflammation.

In Francia, vengono eseguite ogni anno nei bambini circa 35 000 tonsillectomie, associate o meno a un’adenoidectomia. Nonostante la frequenza della procedura chirurgica, la tonsillectomia non è una procedura banale e la sua morbimortalità rimane significativa, soprattutto in termini di dolore e di emorragia postoperatori. Negli ultimi vent’anni, sono comparsi nuovi strumenti chirurgici e il loro utilizzo nella tonsillectomia sta mostrando dei risultati promettenti. Questi includono la radiofrequenza e il microdebrider. Molti studi confrontano queste tecniche con altre più antiche. Altri sviluppi hanno avuto luogo riguardo alle indicazioni operatorie. Nei bambini, le indicazioni all’adenotonsillectomia per infezioni ricorrenti hanno visto diminuire la loro percentuale a favore delle sindromi delle apnee ostruttive del sonno, che ormai rappresentano oltre i due terzi delle indicazioni. Un’ultima evoluzione è la gestione della tonsillectomia nei bambini in chirurgia ambulatoriale, secondo dei criteri definiti nelle raccomandazioni.

Laboratory diagnosis of histoplasmosis is based on various methods, including microscopy, culture, antigen, and DNA detection of Histoplasma capsulatumvar. capsulatumor Histoplasma capsulatumvar. duboisii. To improve sensitivity of existing real-time quantitative PCR (qPCR) assays, we developed a new RT-qPCR assay that allows amplification of whole nucleic acids of Histoplasmaspp. validated on suspected cases. The limit of detection was 20 copies, and the specificity against 114 fungal isolates/species was restricted to Histoplasmaspp. Whole nucleic acids of 1319 prospectively collected consecutive samples from 907 patients suspected of having histoplasmosis were tested routinely between May 2015 and May 2019 in parallel with standard diagnostic procedures performed in parallel. Forty-four had proven histoplasmosis attributable to H. capsulatumvar. capsulatum(n= 40) or H. capsulatumvar. duboisii(n= 4) infections. The results of RT-qPCR were positive in 43 of 44 patients (97.7% sensitivity) in at least one specimen. Nine of 863 cases (99% specificity) were RT-qPCR positive and therefore classified as possible cases. RT-qPCR was positive in 13 of 30 (43.3%) blood samples tested in proven cases. A positive RT-qPCR result in blood was significantly associated with H. capsulatumvar. capsulatumprogressively disseminated histoplasmosis with a positive RT-qPCR result in 92.3% of the immunocompromised patients with disseminated disease. This new HistoplasmaRT-qPCR assay enabling amplification of H. capsulatumvar. capsulatumand H. capsulatumvar. duboisiiis highly sensitive and allows the diagnosis of histoplasmosis advantageously from blood and bronchoalveolar lavage fluid.

La chirurgie mini-invasive dans la prise en charge de l’hyperparathyroïdie primaire est devenue la technique de référence. Elle nécessite une localisation précise des lésions en préopératoire. L’objectif de ce travail était d’évaluer les performances de l’échographie et de la scintigraphie au 99mTc-sestamibi dans la prise en charge chirurgicale mini-invasive de l’hyperparathyroïdie primaire.

Extensive ecosystem restoration is increasingly seen as being central to conserving biodiversity1and stabilizing the climate of the Earth2. Although ambitious national and global targets have been set, global priority areas that account for spatial variation in benefits and costs have yet to be identified. Here we develop and apply a multicriteria optimization approach that identifies priority areas for restoration across all terrestrial biomes, and estimates their benefits and costs. We find that restoring 15% of converted lands in priority areas could avoid 60% of expected extinctions while sequestering 299 gigatonnes of CO2—30% of the total CO2increase in the atmosphere, or 14% of total emissions, since the Industrial Revolution. The inclusion of several biomes is key to achieving multiple benefits. Cost effectiveness can increase up to 13-fold when spatial allocation is optimized using our multicriteria approach, which highlights the importance of spatial planning. Our results confirm the vast potential contributions of restoration to addressing global challenges, while underscoring the necessity of pursuing these goals synergistically.

Increased efforts are required to prevent further losses to terrestrial biodiversity and the ecosystem services that it  provides1,2. Ambitious targets have been proposed, such as reversing the declining trends in biodiversity3; however, just feeding the growing human population will make this a challenge4. Here we use an ensemble of land-use and biodiversity models to assess whether—and how—humanity can reverse the declines in terrestrial biodiversity caused by habitat conversion, which is a major threat to biodiversity5. We show that immediate efforts, consistent with the broader sustainability agenda but of unprecedented ambition and coordination, could enable the provision of food for the growing human population while reversing the global terrestrial biodiversity trends caused by habitat conversion. If we decide to increase the extent of land under conservation management, restore degraded land and generalize landscape-level conservation planning, biodiversity trends from habitat conversion could become positive by the mid-twenty-first century on average across models (confidence interval, 2042–2061), but this was not the case for all models. Food prices could increase and, on average across models, almost half (confidence interval, 34–50%) of the future biodiversity losses could not be avoided. However, additionally tackling the drivers of land-use change could avoid conflict with affordable food provision and reduces the environmental effects of the food-provision system. Through further sustainable intensification and trade, reduced food waste and more plant-based human diets, more than two thirds of future biodiversity losses are avoided and the biodiversity trends from habitat conversion are reversed by 2050 for almost all of the models. Although limiting further loss will remain challenging in several biodiversity-rich regions, and other threats—such as climate change—must be addressed to truly reverse the declines in biodiversity, our results show that ambitious conservation efforts and food system transformation are central to an effective post-2020 biodiversity strategy.

International trade enables us to exploit regional differences in climate change impacts and is increasingly regarded as a potential adaptation mechanism. Here, we focus on hunger reduction through international trade under alternative trade scenarios for a wide range of climate futures. Under the current level of trade integration, climate change would lead to up to 55 million people who are undernourished in 2050. Without adaptation through trade, the impacts of global climate change would increase to 73 million people who are undernourished (+33%). Reduction in tariffs as well as institutional and infrastructural barriers would decrease the negative impact to 20 million (−64%) people. We assess the adaptation effect of trade and climate-induced specialization patterns. The adaptation effect is strongest for hunger-affected import-dependent regions. However, in hunger-affected export-oriented regions, partial trade integration can lead to increased exports at the expense of domestic food availability. Although trade integration is a key component of adaptation, it needs sensitive implementation to benefit all regions.

Amputation of the second ray is a surgical treatment option when reconstruction and/or reimplantation fail. The aim of our study was to review the outcomes after transmetacarpal resection of the second ray following a post-traumatic injury and to assess indications, functional outcomes, and patient satisfaction. Between January 2003 and December 2013, 25 patients (6 women and 19 men with a mean age of 51 years) underwent transmetacarpal resection of their second ray after a post-traumatic injury. Sixteen patients were right-handed and 9 were left-handed. Injuries involved the dominant hand in 14 cases (60%). In order to differentiate patients with preserved index finger length preoperatively from those with a shorter, amputated index finger stump, patients were divided into 2 groups. Group 1 included those with an “intact finger” and Group 2 included patients with an “amputated stump”. Data collection, including patient satisfaction and functional outcomes, was performed at 83 months postoperative on average. Average length of follow-up was 7.0±1.0 years (range 5–12 years). Group 1 (intact finger) and 2 (amputated stump) included 15 and 10 patients, respectively. Six patients (24%) had primary ray amputation and 19 (76%) had secondary ray amputation. No surgical revision was necessary. In Group 1, the indications were purely functional in all but two cases, whereas aesthetic indications played a role in all patients in Group 2. The average total time off work was 3 months. There was no difference between Group 1 and 2 (P>0.05). However, patients with primary ray resection averaged 10 weeks of lost work compared to 17 weeks for secondary amputation. There was no functional difference between Groups 1 and 2. Scores for cosmetic appearance and patient satisfaction were higher in Group 2. In certain specific situations after complex hand trauma, transmetacarpal amputation of the second ray is indicated as soon as possible, in order to reduce the time off work. Patient satisfaction following this surgical procedure is high, especially in groups with amputated stumps. A 30% decrease in pinch and grip strength is the rule. No secondary surgery is normally required.

En 2015, nous avions relaté notre expérience à propos de la courbe d’apprentissage en chirurgie de la réassignation génitale et souligné un concept d’apprentissage traditionnel en quatre étapes.

Self-healing polymeric materials that can spontaneously repair in a perpetual manner are highly appealing to address safety and restoration issues in different key applications. Usually built from reversible moieties that require to be activated using, for example, temperature, light, or pH changes, most of these self-healing materials rely on energy-demanding processes and/or external interventions to promote self-healing. In this work, we propose to exploit rapid dynamic exchanges between urea-based moieties and moisture as an alternative to promote local and spontaneous healing responses to damage using atmospheric moisture as an external stimulus. Non-hygroscopic urea-based polyurethanes with repetitive moisture-induced healing abilities at different degrees of humidity were thus designed through coupling reactions with non-hygroscopic polypropylene glycol and urea moieties. As supported by density functional theory (DFT) calculations coupled to local FTIR experimental studies, we furthermore established that the healing mechanism is ultimately related to the formation of water–urea clusters. Obviously, this work represents a platform for designing more advanced spontaneous self-healing materials beyond the present study, which hold promise for use in a wide range of technological applications.

Pulmonary embolism (PE) represents 2% to 5% of all causes of out-of-hospital cardiac arrest (OHCA) and is associated with extremely unfavorable prognosis. In PE-related OHCA, inconsistent data showed that thrombolysis during cardiopulmonary resuscitation may favor survival.

We report on metal-assisted chemical etching of Si for the synthesis of mechanically stable, hybrid crystallographic orientation Si superstructures with high aspect ratio, above 200. This method sustains high etching rates and facilitates reproducible results. The protocol enables the control of the number, angle, and location of the kinks via successive etch-quench sequences. We analyzed relevant Au mask catalyst features to systematically assess their impact on a wide spectrum of etched morphologies that can be easily attained and customized by fine-tuning of the critical etching parameters. For instance, the designed kinked Si nanowires can be incorporated in biological cells without affecting their viability. An accessible numerical model is provided to explain the etch profiles and the physicochemical events at the Si/Au–electrolyte interface and offers guidelines for the development of finite-element modeling of metal-assisted Si chemical etching.

Earthquakes in Stable Continental Regions (SCR), where localized present‐day tectonic loading is negligible, remain difficult to explain. The New Madrid Seismic Zone (NMSZ) is a type‐locale for such events, with four M>7 events in 1811–1812 and a regional seismicity that continues to this day. Here, we seek to determine the most favorable conditions for fault reactivation in such a context using 33 earthquakes in the 2.1–4.7 magnitude range with well‐determined focal mechanisms while accounting for the vertical gradient of differential stress with depth. To do so, we developed a Mohr‐Coulomb‐based parametric analysis of fault reactivation that allows us to vary the orientation of the principal stresses, the shape ratio of the stress tensor, the fault friction coefficient, the pore fluid overpressure, and the gradient of differential stress with depth. Doing so, we are able to determine the lowest stress perturbation conditions required for fault reactivation. Our results show that the reactivation of the faults studied here requires pore fluid overpressure, unless their friction coefficient is 0.4 or less. We argue that such weak faults are unlikely and favor a triggering mechanism via deep fluids, possibly upwelling from the upper mantle where a low‐velocity seismic anomaly could indicate their presence. This mechanism, documented in other intraplate areas, does not require local tectonic stress or strain accumulation to explain seismicity in active intraplate regions, where elastic strain is drawn from a prestressed crust. We develop a Mohr‐Coulomb‐based parametric analysis that allows us to determine the most favorable conditions for fault reactivationWe apply the method to focal mechanism in the New Madrid Seismic Zone and find that pore fluid pressure is required unless faults are weakWe argue that weak faults are unlikely and propose a triggering mechanism via deep fluids, possibly upwelling from the upper mantle

Understanding the onset and nature of inelastic deformation in porous rock is important for a range of geological and geotechnical problems. In particular for sandstones and siliciclastic sediments, which often act as hydrocarbon reservoirs, inelastic strain can significantly alter the permeability affecting productivity or storativity. The onset of inelastic strain is defined by a yield curve plotted in effective mean stress (P) versus differential stress (Q) space. Yield curves for porous sandstone typically have a broadly elliptical shape, with the low‐pressure side associated with localized brittle faulting (dilation) and the high‐pressure side with distributed ductile deformation (compaction). However, recent works have shown that, for different porous rocks, the curve shape can evolve significantly with the accumulation of inelastic strain. Here yield curve shape and evolution of two high‐porosity sandstones (36–38%) is mapped along different loading paths using a high‐resolution technique on single samples. The data reveal yield curves with a relatively shallow geometry and with a compactive side that is partly comprised of a near‐vertical limb. Yield curve evolution is found to be strongly dependent on the nature of inelastic strain with samples compacted under a deviatoric load (i.e., with a component of shear strain) having peak stress values that are approximately 3 times greater than similar porosity samples compacted under a hydrostatic load (i.e., purely volumetric strain). These results have important implications for predicting how the strength of porous rock evolves along different stress paths, which differ in reservoirs during burial, fluid extraction, or injection. Porous rocks are the geological sponge of the Earth's crust as they store and transmit vast amounts of fluids such as groundwater and hydrocarbons and can also be used for CO2storage projects. As porous rocks are subject to increased stresses above the rock strength (either tectonic or from pumping fluids in or out), the porosity will change, restricting the amount of storage the rock can provide, as well as the ability for fluid flow through it. As porosity changes, strength also changes. Deformation of porous rock can occur from an increase in pressure, where the stresses are equal in all directions, or from a differential stress where force is applied more strongly in one direction. We show that the change in strength of sandstone as it is deformed depends on the stress path. Sandstones deformed under differential stress become three times stronger than sandstones deformed to the same porosity by increasing only pressure. This is because of differences in microstructural development that significantly affects the rock strength. These results have important implications for predicting the strength, storage capacity, and permeability of sandstone reservoirs during burial or uplift or as fluids are removed or injected during groundwater/hydrocarbon production or CO2storage. Sandstone yield curve evolution, in response to inelastic compaction, is strongly dependent on stress pathYield curves of samples compacted under a deviatoric load are greater than those compacted hydrostatically to the same porosityMicrostructural evolution along different loading paths controls the strength evolution of porous rock

Phased microphone arrays have become a well-established tool for performing aeroacoustic measurements in wind tunnels (both open-jet and closed-section), flying aircraft, and engine test beds. This paper provides a review of the most well-known and state-of-the-art acoustic imaging methods and recommendations on when to use them. Several exemplary results showing the performance of most methods in aeroacoustic applications are included. This manuscript provides a general introduction to aeroacoustic measurements for non-experienced microphone-array users as well as a broad overview for general aeroacoustic experts.

Here, we present the study of the intricate dynamics between the physicochemical properties of liquid propanethiol plasma polymer films (PPFs) and the formation of wrinkles in PPF/Al bilayers. The study investigates the effect of liquid PPF aging in the air before top Al layer deposition by magnetron sputtering on the wrinkling phenomenon for 4 days. Thanks to atomic force microscopy, the wrinkle dimensions were found to decrease by approximately 55% in amplitude and 66% in wavelength, correlated with an increase in the viscosity of the PPF over the aging duration (i.e., from less than 107to 1010Pa·s). This behavior is not linked to alterations in cross-linking degree as evidenced by time-of-flight secondary ion mass spectrometry experiments but rather to network densification driven by the inherent molecular chain mobility due to the viscous state of the PPF. X-ray photoelectron spectroscopy measurements emphasizing the absence of oxidation of the PPF over the aging duration support this, revealing a unique aging mechanism distinct from other plasma polymer families. Overall, this study offers valuable insights into the design and application of mechanically responsive PPFs involved in bilayer systems, paving the way for advancements in nanotechnology and related fields.

Vitrimers are a new class of heterogeneous polymers that combine the best features of thermosets with those of thermoplastics. The introduction of cross-links strongly changes the viscoelastic behavior of vitrimer materials. However, the characterization and understanding of the nanostructures and interfaces in vitrimers resulting from dynamic cross-linking formation remain a major challenge. Here, using dynamic modes of atomic force microscopy (AFM), namely intermodulation AFM (ImAFM) and AFM-based dynamic mechanical analysis (AFM-nDMA), local viscoelastic properties and interfaces at the nanoscale length of high-density polyethylene (HDPE) vitrimer materials are reported. ImAFM imaging in combination with the k-means clustering algorithm clearly reveals two distinct phases in the vitrimer system with highly different viscoelastic properties. AFM-nDMA further provides quantitative nanoviscoelastic properties at the nanoscale to confirm that there is a cross-linking-rich aggregation area forming a nanosize network structure in the cross-linking-poor matrix phase. The cross-linking-rich region shows a similar elastic modulus but much higher adhesion force measured by AFM compared to the cross-linking-poor HDPE matrix. Furthermore, the frequency influence on the local viscoelastic properties of HDPE vitrimer at the nanoscale was initially screened. The observed HDPE vitrimer nanostructures and viscoelastic properties at the nanoscale also provide explanations on the observed bulk HDPE vitrimer crystallinity decrease and dimensional stability increase compared to HDPE. Therefore, probing the viscoelastic properties and interfaces of HDPE vitrimer provides important insights into understanding of the correlations between the vitrimer nanostructure and the bulk mechanical and rheological behaviors.

Nodular fasciitis is a benign reactive lesion, often mistaken for a soft-tissue sarcoma in clinical practice. Involvement of the finger is rare, and a finger joint even rarer. We report on the clinical, radiological and histological features of intra-articular nodular fasciitis in a 52-year-old man, originating from the proximal interphalangeal joint of the right ring finger, with cortical erosion of adjacent bone. The discussion is focused on the tumor diagnosis and therapeutic approach, the differential diagnosis and the importance of immunohistochemical staining to establish the final diagnosis.

We propose an image scoring method to improve the quality and the reproducibility of measurement of the AV interval before establishing reference tables of the measurements and studies on the prevention and treatment of first-degree AV block especially if the first child has been diagnosed AV block.

Titanium and silver atoms were magnetron-sputtered either onto pentaerythritol ethoxylate (PEEL) or 1-butyl-3-methylimidazolium bis(trifluoromethanesulfonyl)imide (BMIMTFSI) ionic liquid (IL), and the formation of nanoparticles (NPs) is discussed based on the chemical interaction between the metal atoms and the host liquid. In the case of PEEL, our data reveal that titanium atoms sputtered in low-pressure argon plasma first form a film over the liquid surface. However, the latter dissolves as the film gets oxidized when vented to the air; asymmetric and faceted titanium dioxide NPs are finally obtained as if they were originating from a dismantled polycrystalline thin film. In the case of silver sputtered on PEEL, a film forms and solvation never occurs even after exposing the sample to air because the oxidation of silver is thermodynamically much less favorable than titanium. Quantum-chemical calculations confirm that the chemical interaction of TiO2with PEEL molecules is favored as compared to metallic Ag or Ti. In contrast to what is observed with PEEL, when silver is sputtered onto the BMIMTFSI IL, no film is observed and spherical and crystallized silver NPs are found. These results suggest that the Ag-NP grows inside the IL because the chemical interaction of the Ag atoms with the BMIMTFSI molecules is highly favorable.

Large earthquakes in stable continental regions remain puzzling as; unlike at plate boundaries, they do not result from the local buildup of strain driven by plate tectonics. The 2017 Mw6.5, Bostwana normal faulting earthquake occurred in a region devoid from recent tectonic activity and where present‐day deformation is negligible. The depth of the event (29 ± 4 km), in a felsic lower crust where ductile deformation is expected, likely requires a transient pulse of fluids from a deep source to activate brittle faulting. The mainshock was preceded by two foreshock swarm‐like sequences that may be further evidence for fluid movement in a critically loaded fault network. Contrary to plate boundary events, the Mw6.5 Botswana earthquake did not require prior localized stress or strain accumulation. We propose that the crust in stable continental regions, even long after the last tectonic episode, constitutes a reservoir of elastic stress that can be released episodically, for instance, as a result of deep fluid migration. Most earthquakes occur at plate boundaries where stress and strain concentrate due to the continuous motion imposed by plate tectonics. However, a significant number of large earthquakes also occur within continents, far from any deforming area. How they are triggered and what is the source of the released stress in such a context are key questions that remain unresolved. We use geodetic data to show that the April 2017 Botswana earthquake, the largest intraplate earthquake in the last 30 years, occurred at a depth of 30 km where rocks flow and should not break. We explore potential mechanisms to explain rock failure at such depth and propose that a local pulse of fluid was responsible for a transient embrittlement of the lower crust. This example shows that, even long after previous mountain building episodes, the crust in stable continental regions remains a reservoir of stress that can be tapped in by earthquakes triggered by local perturbations, including pulses of deep fluids. Our InSAR‐based estimate of the source parameters indicates a deep event with two probable families of modelsWe detect a precursory phase using template matching at teleseismic distances to the mainshockA transient pulse of fluids is required to trigger this event, maybe a common stress perturbation at the origin of intraplate events

Wrinkling is a powerful technique for the preparation of surface structures over large areas, but it is difficult to simultaneously control the direction, period, and amplitude of the wrinkles without resorting to complicated procedures. In this work, we demonstrate a wrinkling system consisting of a liquid crystal polymer network and a thin layer of gold, in which the direction of the wrinkles is controlled by the alignment of the liquid crystal molecules and the average amplitude and period are controlled by a high-intensity UV irradiation. The UV exposure represses the amplitude and period dictated by the total exposure. Using photoalignment and photomasks, we demonstrate an unprecedented control over the wrinkling parameters and were able to generate some striking optical patterns. The mechanism of the wrinkle suppression was investigated and appears to involve localized photodegradation at the polymer–gold interface, possibly due to the formation of mechanoradicals.

Porous rock deformation has important implications for fluid flow in a range of crustal settings as compaction can increase fluid pressure and alter permeability. The onset of inelastic strain for porous materials is typically defined by a yield curve plotted in differential stress (Q) versus effective mean stress (P) space. Empirical studies have shown that these curves are broadly elliptical in shape. Here conventional triaxial experiments are first performed to document (a) the yield curve of porous bassanite (porosity ˜ 27–28%), a material formed from the dehydration of gypsum, and (b) the postyield behavior, assuming that Pand Qtrack along the yield surface as inelastic deformation accumulates. The data reveal that after initial yield, the yield surface cannot be perfectly elliptical and must evolve significantly as inelastic strain is accumulated. To investigate this further, a novel stress-probing methodology is developed to map precisely the yield curve shape and subsequent evolution for a single sample. These measurements confirm that the high-pressure side of the curve is partly composed of a near-vertical limb. Yield curve evolution is shown to be dependent on the nature of the loading path. Bassanite compacted under differential stress develops a heterogeneous microstructure and has a yield curve with a peak that is almost double that of an equal porosity sample that has been compacted hydrostatically. The dramatic effect of different loading histories on the strength of porous bassanite highlights the importance of understanding the associated microstructural controls on the nature of inelastic deformation in porous rock. As porous rock accumulates inelastic strain, the shape and size of the yield curve evolve and are strongly dependent on the loading pathInelastic compaction under a deviatoric stress produces considerably larger yield curves than hydrostatic compaction to the same porosityYield curve size and shape are controlled by microstructural evolution along different loading paths

Introduction: The management of volar plate avulsion fractures in the context of a stable joint and a bony fragment of less than 30% has traditionally been conservative. This study was performed to assess volar plate healing with high-resolution ultrasound in order to provide early full mobilization.Material and Methods: Between January 2012 and December 2013, 78 patients with volar plate injuries of the proximal interphalangeal (PIP) joints (42 distortions and 36 dislocations) were treated conservatively in our department for volar plate avulsion fracture associated with stable joint and bony fragment inferior to 30% of the intra-articular surface assessed both by radiography and ultrasound. Conservative treatment included extension stop splinting for the first 2 weeks and Coban bandage until 6 weeks postinjury. However, it may be possible to modify the duration of extension stop splinting based on clinical and ultrasound findings (with no additional X-ray) performed every 2 weeks for the first 3 months and then at 4 months postinjury. Only patients with residual contracture at the 4-month assessment had prolonged follow-up in order to ensure adequate dynamic splint therapy.Results: The amount of soft tissue oedema and the mobility of the volar plate were factors used to determine return to full mobilization. Mean extension-stop-splint wear was 16 ± 2 days. During the first 2 follow-up assessments, 4 patients were excluded from the study because of the instability of the PIP joint. One patient required refixation of a large fragment of 30%, 2 patients required superficial flexor tendon (FDS) tenodesis of the unstable volar plate in hyperextension and 1 other patient required arthrodesis of the PIP joint. In 51 patients, the postoperative follow-up was free of complications at 4 months. In 18 patients, flexion contracture of 20° (range 11°-40°) and oedema during follow-up required dynamic extension splints for 3 to 5 months. After this time, 5 patients had a residual contracture of 10° to 15°.Conclusion: Avulsion fractures of the volar plate at the PIP joint are common. In general, they have a good outcome using the conservative treatment with extension block splints. Flexion contracture is a common complication and may be reduced by immediate splints in full extension at night and Coban bandage during the day. High-resolution sonography is a convenient tool to evaluate palmar plate stability, to assess reduction of oedema, and thus to guide safe return to full range of movement.

The stalked barnacle Pollicipes pollicipesuses a multi-protein cement to adhere to highly varied substrates in marine environments. We investigated the morphology and adhesiveness of a component 19 kDa protein in barnacle cement gland- and seawater-like conditions, using transmission electron microscopy and state-of-the art scanning probe techniques. The protein formed amyloid fibres after 5 days in gland-like but not seawater conditions. After 7–11 days, the fibres self-assembled under gland-like conditions into large intertwined fibrils of up to 10 µm in length and 200 nm in height, with a distinctive twisting of fibrils evident after 11 days. Atomic force microscopy (AFM)-nanodynamic mechanical analysis of the protein in wet conditions determined E′ (elasticity), E′′ (viscosity) and tan δ values of 2.8 MPa, 1.2 MPa and 0.37, respectively, indicating that the protein is a soft and viscoelastic material, while the adhesiveness of the unassembled protein and assembled fibres, measured using peak force quantitative nanomechanical mapping, was comparable to that of the commercial adhesive Cell-Tak™. The study provides a comprehensive insight into the nanomechanical and viscoelastic properties of the barnacle cement protein and its self-assembled fibres under native-like conditions and may have application in the design of amyloid fibril-based biomaterials or bioadhesives.

Les objectifs de l’étude ont été d’évaluer : i) les performances de la TEP-TDM au FDG pour le diagnostic de récidive infra-clinique (RIC) et cancers métachrones (CM) des carcinomes épidermoïdes (CE) des voies aérodigestives (VADS) ; ii) l’impact pronostique de cette stratégie par rapport au standard de surveillance.

Since it was first described by Song in 1982, then by Katsaros in 1984, the lateral arm flap has become a workhorse technique for upper limb reconstruction. Herein we describe a clinical case of complex foot defect and bring up the possibility of using a composite neuromusculo-fasciocutaneous lateral arm/triceps free flap for its reconstruction. A 19-year-old male nonsmoker suffered ballistic trauma to his right foot with open multifragment Gustilo-IIIb fractures of the first to fifth metatarsal bones. Two weeks after debridement and V.A.C.™ therapy performed in another hospital, we decided to reconstruct the remaining defect with a neuromusculo-fasciocutaneous medial triceps/lateral arm free flap anastomosed with the anterior tibial pedicle. The posterior brachial cutaneous nerve was sutured to a sensory branch of the superficial fibular nerve. The advantages and drawbacks of this technique are discussed and other options for this type of complex foot reconstruction are reviewed. After 3 years’ follow-up, the metatarsal bones were consolidated without residual defect or chronic infection. The foot had sensation with full mobility and no pain. At the donor site, there was no complaint of scarring. Elbow extension/flexion was 0–0–130. Wrist extension/flexion was 60–0–60 and there was no extension deficit of the metacarpophalangeal joints. The composite neuromusculo-fasciocutaneous triceps brachii free flap was an excellent option for this complex foot defect. The choice of this reconstructive procedure among other options was made during our reconstruction board meeting while taking the patient's specific condition and our own experiences into account.

L’annonce d’un événement indésirable grave (EIG) associé aux soins au patient est depuis 2011 un thème prioritaire de la Haute Autorité de santé. L’objectif de ce travail était d’explorer les pratiques déclarées des médecins hospitaliers confrontés à l’annonce d’un EIG. En juin et juillet 2012, tout le personnel médical du CHU de Nantes a reçu un questionnaire en ligne comprenant 3 parties : (1) une vignette clinique médicale ou chirurgicale suivant la spécialité exercée, explorant 5 facettes des pratiques de l’annonce : annonce initiale, divulgation de détails, divulgation de la cause, formulation d’excuses, information sur les actions préventives ; (2) une partie explorant les raisons de l’annonce et 3) une partie consacrée aux besoins d’accompagnement. Le taux global de participation était de 18,8 % (n=322/1709). L’annonce initiale de l’EIG n’était pas du tout réalisée dans 13,4 % des cas, la divulgation de détails dans 24,5 %, la divulgation de la cause dans 44,1 %. Il n’existait pas de formulation d’excuses dans 4 % des cas et l’absence d’information concernant les actions de prévention concernait 11,2 % des participants. Les pratiques des médecins et des chirurgiens étaient significativement différentes concernant la divulgation des détails et de la cause de l’EIG : les chirurgiens choisissaient plus fréquemment que les médecins de « ne pas entrer volontairement dans les détails de l’erreur à moins que le patient ne le demande » (72,9 % contre 16,1 %, p<0,001), à « ne pas annoncer la cause du dommage à moins que le patient ne le demande » (54,2 % contre 42,3 %, p<0,001), et à « ne pas s’excuser ou à ne pas dire être désolé pour ce qui s’est passé » que les médecins (16,7 % contre 1,8 % ; p<0,001). Concernant les justifications des choix des médecins, la préservation de la relation de confiance avec le patient était primordiale, ce qui les poussait à annoncer l’EIG au patient, ou au contraire, à le taire. Les internes paraissaient les plus en difficulté et exprimaient de ce fait un besoin important de formation. Cet état des lieux a permis de sensibiliser les professionnels et de montrer qu’une marge d’amélioration était souhaitable. Il a été complété par la mise en œuvre d’un programme d’amélioration des pratiques d’annonce (sessions de formation, documentation) ainsi que par la définition d’une organisation de soutien.

Background Upper arm deformities secondary to weight loss or senile elastosis have led to an increased demand for aesthetic contouring procedures.Objective To objectively assess whether, in Teimourian high-grade upper arm remodelling, laser-assisted lypolysis (LAL) alone could result in patient satisfaction.Methods Between 2012 and 2013, 22 patients were treated for excessive upper arm fat (Teimourian grade III and IV) solely with LAL. The laser used in the present study was a 1470 nm diode laser (Alma Lasers, Israel) with the following parameters: continuous mode, 15 W power and transmission through a 600 µm optical fibre. Previous mathematical modelling suggested that 0.1 kJ was required to destroy 1 mL of fat. Patients were asked to complete a satisfaction questionnaire. The arm circumference was measured pre- and postoperatively. Treatment parameters, adverse effects and outcomes were recorded.Results Pain during the anesthesia and discomfort after the procedure were minimal. Complications included ecchymoses and prolonged edema. The mean (± SD) arm circumference decreased 5.5±1.0 cm in the right arm (P<0.01) and 5.2±1.1 cm in the left arm (P<0.01) in grade III patients and 4.9±1.1 cm in the right arm (P<0.01) and 4.9±1.1 cm in the left arm (P<0.01) in grade IV patients. Although the circumference of both arms significantly decreased in grade III and grade IV patients, the skin tightening remained incomplete. Overall, the average opinion of treatment was poor for both patients and investigators. Of the 22 patients, only nine (41%) would recommend this treatment.Conclusion LAL for upper arm remodelling is not sufficient to ensure full skin tightening for patients with Teimourian grades III and IV upper arm deformities. A complementary surgery is mandatory for grades III and IV.

Les tumeurs du sac endolymphatique sont des tumeurs bénignes, invasives d’évolution lente, envahissant l’os temporal, se manifestant par une surdité unilatérale. Elles peuvent être sporadiques ou s’intégrer dans un syndrome de von Hippel-Lindau (VHL).

La gangrène des organes génitaux externes est une pathologie rare dont la mortalité demeure élevée. Les études récentes se concentrent sur la prise en charge initiale. L’objectif de cette étude était d’évaluer spécifiquement la qualité de vie à distance d’une série de patients traités pour gangrène des organes génitaux externes.

We address the issue of Ontology-Based Data Access, with ontologies represented in the framework of existential rules, also known as Datalog±. A well-known approach involves rewriting the query using ontological knowledge. We focus here on the basic rewriting technique which consists of rewriting the initial query into a union of conjunctive queries. First, we study a generic breadth-first rewriting algorithm, which takes any rewriting operator as a parameter, and define properties of rewriting operators that ensure the correctness of the algorithm. Then, we focus on piece-unifiers, which provide a rewriting operator with the desired properties. Finally, we propose an implementation of this framework and report some experiments.

Persistent traumatic peroneal nerve palsy, following nerve surgery failure, is usually treated by tendon transfer or more recently by tibial nerve transfer. However, when there is destruction of the tibial anterior muscle, an isolated nerve transfer is not possible. In this article, we present the key steps and surgical tips for the Ninkovic procedure including transposition of the neurotized lateral gastrocnemius muscle with the aim of restoring active voluntary dorsiflexion.

The ability of crustal faults to compact and to pressurize pore fluids is examined by combining geological observations, petrophysical measurements (permeability, Pand Swave velocities, and porosity), and fully coupled hydromechanical modeling. A strike‐slip fault located in the Argentera‐Mercantour crystalline massif (southwestern French‐Italian Alps) was analyzed in the field. This mature fault belongs to a large active fault system characterized by a recurrent seismic swarm activity (Mw< 4) between 2 and 12 km depth. The studied exposure corresponds to a 50 m thick anastomosing fault composed of three types of rock: host‐rock gneiss, damage‐zone phyllonite, and core zone gouge. Laboratory measurements made at effective pressures ranging from 10 to 190 MPa show that the studied fault differs from the classical model and has a high‐porosity, high‐permeability, and low‐rigidity core zone surrounded by a low‐porosity, low‐permeability, and high‐rigidity damage zone with respect to the host rock. The hydraulic and elastic properties are controlled by different microstructures such as foliation, microcracks, and pores developed during the exhumation history of the massif and the reactivation of inherited low‐friction mylonitic foliation. Hydromechanical modeling is then used to investigate the spatio‐temporal evolution of the fluid overpressures across the fault zone elements in response to elastic compaction. Models demonstrate that fluid pressure can be developed and maintained temporally in the studied fault zone. This study concludes on the key role played by the hydromechanical properties of faults during compaction and provides an explanation for seismic swarm triggering and maintenance. Fault zone is characterized by heterogeneous hydraulic and elastic propertiesFluid overpressures can be developed and maintained in heterogeneous fault zonesElastic compaction is a viable mechanism to trigger seismic activity