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To study the association between BMI and short-term postoperative complications of patients undergoing minimally invasive (MIS) hysterectomy. A cohort study of prospectively collected data. American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database from 2012 – 2020. Patients requiring MIS hysterectomy for benign conditions. MIS hysterectomy. We categorized patients who had undergone MIS hysterectomy into body mass index (BMI) subgroups according to World Health Organization classification and compared rates of 30-day postoperative major and minor complications, defined according to the Clavien-Dindo classification, across BMI groups. A total of 206,944 patients met the inclusion criteria. In multivariable regression analysis, when comparing those with low and high BMI there was a statistically significant increase in any complications [aOR 95%CI 1.06(1.01-1.10)] and minor complications [aOR 95%CI 1.13(1.07-1.19)] in the high BMI group but no differences in major complications across the two groups [aOR 95%CI 0.96(0.88-1.04)]. When comparing classes of obesity to the normal BMI group, Class I, II, and III categories had a lower likelihood of major complications [aOR 95%CI 0.87(0.80-0.93), 0.84(0.77-0.91), 0.82(0.75-0.90), and 0.83(0.75-0.91), respectively] when compared to normal weight individuals. However, patients in the Class II and III categories had a higher likelihood of minor complications [aOR 95%CI 1.12(1.03-1.21), and 1.17(1.08-1.28), respectively] when compared to normal weight individuals. The mean operative time was significantly longer for each BMI group compared to lower BMI groups (range 115.2-144.5 minutes, p<0.05). Higher BMI was associated with a higher risk of all complications and minor complications than low BMI in patients undergoing MIS hysterectomy, as well as increased operative time. However, when comparing across specific BMI categories, overweight and obesity categories were associated with lower risks of major complications compared to the normal BMI category. These findings can help in preoperative patient counseling. [ABSTRACT FROM AUTHOR]

Copyright of Revue Francaise d'Allergologie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

En France, la prescription de tests multi-allergéniques (TMA) alimentaires, tels que les tests Trophatop®, en cas de suspicion d'allergie alimentaire (AA) en médecine générale est débattue. Analyser les différentes situations conduisant les médecins généralistes (MG) à la prescription d'un test Trophatop® dans le cadre d'une consultation pour suspicion d'AA. Mettre en évidence les avantages et les inconvénients de ces tests en médecine générale. Étude qualitative auprès de MG dans les départements du Nord et du Pas-de-Calais. Entretiens individuels semi-dirigés avec analyse inductive. Tous les MG ne prescrivent pas de Trophatop® en cas de suspicion d'AA. En cas de prescription, celle-ci est réalisée de façon systématique ou au cas-par-cas selon le MG. Les différentes situations conduisant les MG de notre étude à la prescription au cas-par-cas d'un Trophatop® étaient : l'absence d'aliment précis retrouvé à l'anamnèse, la demande de tests biologiques par les patients. Les principaux avantages de ces tests soulevés par les MG étaient : examen biologique permettant une orientation diagnostique (allergie), examen permettant de différencier la part des allergènes alimentaires des allergènes respiratoires dans la réaction clinique. Néanmoins, certains pointaient du doigt les inconvénients suivants : la difficulté d'interprétation de ces tests et l'absence d'exhaustivité des allergènes alimentaires pouvant être recherchés. Par ailleurs, le motif de consultation d'un patient pour une suspicion d'AA semble rare et complexe en médecine générale. Pour les MG interrogés, la complexité de la consultation était liée à différents facteurs : variabilité des symptômes de l'allergie, diversité des aliments impliqués dans les réactions, présence de nombreux diagnostics différentiels, les connaissances ou croyances des patients sur les AA. Une réflexion entre MG, allergologues et biologistes pourrait permettre d'harmoniser la prescription des TMA alimentaires en médecine générale et éventuellement de modifier la composition allergénique des mélanges en fonction des besoins des MG. In France, the prescription of food multi-allergen IgE tests (MAT) such as Trophatop® to assess food allergy (FA) is under debate. To analyse the different situations leading general practioners (GP) to prescribe Trophatop® in the context of consultation for suspected FA. To highlight the advantages and disadvantages of those tests in general medicine. Qualitative study with GP in the departments of Nord and Pas-de-Calais. Individual semi-directed interviews with inductive analysis. Not all GP prescribe Trophatop® in the event of suspicion of FA. In the event of a prescription, this is carried out systematically or on a case-by-case basis depending on the GP. The different situations leading the GP in our study to the case-by-case prescription of Trophatop® were: the absence of a specific food found in the anamnesis, the request for biological tests by the patients. The main advantages of these tests raised by the GP were: biological tests allowing a diagnostic orientation (allergy), tests allowing to differentiate the part of food allergens from respiratory allergens in the clinical reaction. However, some pointed out the following disadvantages: the difficulty of interpreting these tests and the lack of exhaustiveness of the measured food allergens. Furthermore, consulting a patient for suspected FA seems rare and complex in general medicine. For the GP interviewed, the complexity of the consultation was linked to different factors: variability of allergy symptoms, diversity of foods involved in the reactions, presence of numerous differential diagnoses, patients' knowledge or beliefs about FA. A dialogue between GP, allergists and pathologists could make it possible to harmonize the prescription of food MAT to assess FA in general medicine and eventually to modify the composition of food allergen mixtures according to GP needs. [ABSTRACT FROM AUTHOR]

Copyright of Revue Francaise d'Allergologie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revue Francaise d'Allergologie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

To determine the effect of a resident-initiated obstetrics and gynecology (Ob-Gyn) lecture on resident knowledge of abortion legislation and confidence in abortion advocacy. In March 2022, in response to recent restrictive abortion legislation, residents requested urgent didactics. Given Ryan Program faculty schedule constraints, a second-year resident designed and executed a didactic session for other residents focused on abortion law. Attendees received an electronic RedCap survey pre- and post-didactics. Survey responses were compared utilizing a paired-T test, alpha=0.05. Eight residents attended the lecture and completed pre- and post-surveys. The average score on knowledge of abortion policy pre-didactic was 4.0 ± 2.8, which increased to 9.1 ± 2.4 post-didactics (p=0.002). Participants' Likert scale ratings of their knowledge of federal and state abortion law, their confidence explaining current legal challenges, and their knowledge of abortion increased significantly (law knowledge, 3.2 ± 1.4 to 4.4 ± 0.53, p=0.0015; current challenges, 2.6 ± 0.66 to 4.2 ± 0.56, p<0.0001; how to advocate 2.6 ± 0.55 to 4.5 ± 0.29, p<0.0001). All participants strongly agreed that the didactic was "useful and informative," "appropriate for my role and level of training" and "would like to see more lectures like this in the future." Ob-Gyn residents have a desire to understand the legislative landscape of abortion access. A resident-implemented didactic on abortion law was effective in increasing knowledge and self-confidence regarding these topics. [ABSTRACT FROM AUTHOR]

The knowledge of the absolute energy distributions of the particles emitted from a clinical accelerator is important for the evaluation of Monte Carlo simulations developed for treatment planning. In this paper, an original approach is presented which allows to measure the absolute energy distribution of the electron beam delivered by a Varian 21Ex medical accelerator. The electron beam was characterized at the isocenter with calibrated image plates covering the exit window of a magnetic spectrometer. The characteristics of the electron beam emitted from an effective source have been inferred from the measurements using the Geant4 Monte Carlo code. The contribution of direct electrons to the absolute depth-dose curve in a water phantom is estimated. [ABSTRACT FROM AUTHOR]

A new deterministic method for calculating the dose distribution in the electron radiotherapy field is presented. The aim of this work was to validate our model by comparing it with the Monte Carlo simulation toolkit, GEANT4. A comparison of the longitudinal and transverse dose deposition profiles and electron distributions in homogeneous water phantoms showed a good accuracy of our model for electron transport, while reducing the calculation time by a factor of 50. Although the Bremsstrahlung effect is not yet implemented in our model, we propose here a method that solves the Boltzmann kinetic equation and provides a viable and efficient alternative to the expensive Monte Carlo modeling. [ABSTRACT FROM AUTHOR]

Effective and adapted criteria for irrigation scheduling are required to improve yield and water use efficiency (WUE) and reduce the environmental impacts associated with water and nutrients losses by runoff and leaching. In this study, field-scale experiments were conducted at four commercial strawberry production sites with contrasting soil and climatic conditions. Within each site, the influence of different soil matric potential-based irrigation thresholds (IT) on yield and WUE was evaluated. Matric potential-based irrigation management was also compared with common irrigation practices used by producers in each site's respective areas. At Site 1 (silty clay loam; humid continental (Dfb) climate), an IT of −15 kPa improved yields by 6.2% without any additional use of water relative to common irrigation practices. At Site 2, with similar soil and climatic conditions, the irrigation treatments did not affect yield and the matric potential-based management decreased WUE relative to common practices. However, the results suggested that maintaining the soil matric potential lower than −9 kPa could induce stressing conditions for the plants. At Site 3 (sandy loam; Mediterranean (Cs) climate), the best yield and WUE were obtained with an IT of −8 kPa and suggested that WUE could be further improved by implementing high-frequency irrigation. At Site 4 (clay loam; Mediterranean (Cs) climate), results suggested that an IT between −10 and −15 kPa could optimize yield and WUE, and matric potential-based irrigation considerably reduced leaching under the root zone relative to common practices. Considering the results from all sites, an IT of −10 kPa appears to be adequate as a starting point for further optimizing irrigation under most field conditions. [ABSTRACT FROM AUTHOR]

Objective Functional capacity evaluation is commonly used to assess the abilities of patients to perform some tasks. Ergo-Kit ® is a validated tool assessing both functional capacities of patients and workplace demands. The objective of this study was to evaluate the relevance of the Ergo-Kit ® data for occupational physicians during the return-to-work process. Methods A retrospective and monocenter study was conducted on all patients included in a rehabilitation program and assessed with the Ergo-Kit ® tool between 2005 and 2014. Workplace demands and patients’ functional capacities were evaluated and confronted. Self-beliefs and perceived disability were also assessed and compared to the functional capacity evaluation. Results One hundred and forty-nine working-age patients (85 men, 64 women; 39 ± 12 years) suffering from musculoskeletal disorders or other diseases were included. Main causes of mismatch between workplace demands and functional capacities were manual handling of loads, postures with arms away from the body and repetitive motions at work; sitting posture was correlated with a lesser physical workload; and Oswestry score was correlated with functional capacities evaluated by the Ergo-Kit ® . Conclusion Ergo-Kit ® is a relevant tool to assess the multidimensional aspects of workplace demands and functional capacities. It could be very helpful for occupational physicians to manage return-to-work. [ABSTRACT FROM AUTHOR]

Highlights: [•] We present the design of the Solidays’ gridshell, constructed in June 2011. [•] An accidental situation is simulated to investigate the ductility of the structure. [•] Two local parts of the gridshell ruin but the structure remains globally safe. [•] Thanks to the redundancy the structure has a pseudo-ductile behaviour. [ABSTRACT FROM AUTHOR]

While it has become commonplace to test the various components of memory in schizophrenia with paper-and-pencil or in-lab tasks, very little data exist on the subjective complaints of patients regarding their memory. Few instruments have been designed to collect systematically the complaints of patients with schizophrenia. We present a work in progress on the Subjective Scale to Investigate Cognition in Schizophrenia (SSTICS), a 21-item, Likert-type scale that is simple and easy to use. It allows a quantitative approach to the subjective and cognitive dimensions of schizophrenia. Stip constructed the scale based on a questionnaire covering several cognitive domains: memory (working memory, explicit long-term memory), attention (divided, distractibility, alertness, sustained), language, and praxia. We evaluated the psychometric properties of the SSTICS in a population of 114 French-speaking patients in Montreal. Patients were recruited in the community and assessed with the Structured Clinical Interview for DSM-III-R (SClD), the Positive and Negative Syndrome Scale (PANSS), and the Extrapyramidal Symptoms Rating Scale (ESRS). Cognition was measured using the Rey Auditory Verbal Learning Test (RAVLT) (long-term memory), Controlled Oral Word Association Test (verbal fluency), and Trails A and B. Preliminary analyses showed very good internal consistency for the global score (alpha = 0.88), and alphas varying from 0.57 to 0.72 for the subscales. Stability over time was very good. The principal components analysis accounted for a multiple structure. Correlations between subjective scores and objective cognitive assessment were significant for several domains. Validation of the SSTICS needs to be completed through further exploration of the factorial structure and testing of the English version. [ABSTRACT FROM AUTHOR]

Les causes d'ischémie distale chez un patient jeune se distinguent en fonction du terrain athéromateux [1]. Chez un jeune patient fumeur, le diagnostic de maladie de Buerger, appelée aussi thrombo-angéite oblitérante, est vite évoqué. Cependant, les critères de validation clinique utilisés pour cette vascularite restent controversés [2]. Nous rapportons ici le cas d'un patient atteint d'une maladie de Buerger ayant été diagnostiqué d'un syndrome l'artère poplitée piégée. Il s'agissait d'un patient de 33 ans ayant pour principaux antécédents plusieurs épisodes de thromboses veineuses profondes et superficielles, et une consommation tabaco-cannabinoïde. Il n'avait pas d'antécédent de phénomène de Raynaud, pas d'exposition au froid et aucune intervention endovasculaire récente. Le patient était hospitalisé dans le service de médecine interne pour un premier épisode d'ischémie aiguë digitale du membre inférieur droit, non ulcéré, avec le pouls pédieux palpable. On ne retrouvait pas d'altération de l'état général, pas de fièvre, pas d'atteinte cutanée. La pression artérielle était normale. Le patient présentait une hyperalgie provoquée par la dorsiflexion et l'extension du pied droit. La manœuvre d'Allen était non pathologique. Le bilan de thrombophilie était négatif, et la numération de formule sanguine sans particularité. Une échographie trans-thoracique ne retrouvait pas d'image en faveur d'une endocardite infectieuse. Le diagnostic de maladie de Buerger a été évoqué avec préconisation d'un arrêt strict du tabac et du cannabis, et introduction de vasodilatateur périphérique par voie IV. À défaut d'une artériographie, un scanner des membres inférieurs injecté était réalisé et retrouvait une sténose suspendue et un aspect irrégulier de façon bilatérale du calibre des artères poplitées plus marqué à droite en faveur d'un syndrome de l'artère poplitée piégée, confirmé par la suite, par un écho-doppler dynamique. Le patient était transféré en urgence en chirurgie vasculaire pour résection greffe en veine saphène de l'artère poplité droite, piégée, thrombosée et libération du piège poplité par section de l'insertion médiane du jumeau interne. Trois mois après son opération, le patient reprenait sa consommation de cannabis, ce qui entraînait une récidive de son ischémie distale avec absence d'argument pour une origine mécanique. L'ischémie de l'orteil est le plus souvent secondaire à une atteinte athéromateuse. Des pathologies vasculaires plus rares, dont le syndrome du piège poplité et la maladie de Buerger, peuvent néanmoins être à l'origine de claudication, voire d'ischémie. Le diagnostic différentiel entre la maladie de Buerger et le syndrome du piège poplité peut parfois être complexe en raison de la similarité de certains symptômes. En effet, ces deux conditions présentent des douleurs chroniques dans les membres, souvent aggravées par certaines activités ou positions. Cependant, l'importance du terrain tabagique dans le cadre de la maladie de Buerger et d'autre part, la gravité des picotements, l'engourdissement et la faiblesse musculaire provoquée à la flexion du genou, lors du syndrome du piège poplité, peuvent orienter le diagnostic [1,2]. À notre connaissance, neuf cas similaires dans la littérature ont été décrits [3]. À ce jour, les critères de Shionoya [2] pour le diagnostic de la maladie de Buerger semblent être trop permissifs. Ces données suggèrent l'importance de la réalisation d'une imagerie, et discutent l'utilité soit d'une angiographie, pour vérifier la présence notamment des collatérales en « tire-bouchon », soit d'un examen histopathologique, à la recherche d'une thrombose et d'une infiltration inflammatoire, pour ne pas méconnaître un diagnostic différentiel. Il est en effet essentiel de déterminer la cause de cette ischémie distale chez le sujet jeune afin d'instaurer rapidement un traitement approprié, en particulier sur le plan chirurgical. L'ischémie aiguë digitale du membre inférieur est une urgence médicale nécessitant une intervention rapide pour éviter des complications graves telles que la nécrose tissulaire ou l'amputation. Il est important de ne pas négliger la possibilité d'une origine mécanique sous-jacente lorsque le diagnostic de la maladie de Buerger est posé chez un patient jeune et fumeur. [ABSTRACT FROM AUTHOR]

Introduction The majority of patients affected by cancer are nowadays treated by radiotherapy, which consists in delivering a homogeneous dose with energetic particles. Magnetic Resonance Imaging (MRI)-guided radiotherapy shows precisely the tumor position in real time and allows to direct the photon beams to the tumor while sparing organs at risks. Our work consists in the validation of a new model developped to simulate the energy deposition of the particles used in radiotherapy (electrons, photons and protons) in the presence of strong magnetic field, within human tissues, and its adaptation to this new technology. Material and methods This model is based on a kinetic entropic closure of the linearized Boltzmann equation [1] , which describes the transport of energetic particles in the matter. This equation takes a lot of computation time to be solved due to the high number of variables. To simplify this, we replace fluences by angular moments, which allows getting rid of the angular variables and improve the calculation time. We obtain a set of angular moments equations, and we close this set using the Boltzmann’s principle of entropy maximization on the two first equations of the set. This model has an accuracy comparable to references Monte-Carlo (MC) codes [2] (Geant4, MCNPx, Penelope), and is less time-consuming than these ones. We added the Lorentz force into our code to study the influence of a magnetic field on the dose deposition, and compared it to the reference full MC code FLUKA. To further validate our model, we have carried out an experimental campaign in which we irradiated a composition of materials of different mass densities, with 6 and 18 MV photon beams of a Varian Clinac 21Ex accelerator, without and with the influence of a 0.87 T magnetic field of amplitude induced by a permanent magnet. Results We show a good agreement between our model and the FLUKA code ( Fig. 1 ). We highlight the effects that occur on the propagation of particles in the matter in presence of a magnetic field of a few Tesla. Indeed, it modifies the dose deposition by shifting the deposition of energy, leading to an increased diffusion depending on the orientation of the magnetic field. Moreover, it also leads to an increase or decrease of the dose deposited at the interfaces between materials depending on their difference between mass densities. The results of our experiments lead to the same conclusions. These effects have to be taken into account in order to prevent creation of hot spots or a spread of energy distribution in a human body, within computation times compatible with the clinical environment. Conclusion Our model is a good candidate for future Treatment Planning Systems since it allows a faster and efficient way to plan a viable treatment for a patient in presence of strong magnetic fields. A magnetic field modifies the profile of the dose deposition such as it has to be taken into account in calculations to prevent the dramatic changes which occur at interfaces between media of different density. This work takes place in the framework of POPRA (Programme Optique Physique et Radiothérapie en Aquitaine), which involves several laboratories around problematics on the topic of cancer treatment. [ABSTRACT FROM AUTHOR]

Introduction In order to quantify the modulation degree of a plan, some metrics have been described in the literature [1] . For a Volumetric Modulated Arc Therapy (VMAT) arc, Modulation Index (MI) and Modulation Complexity Score (MCS) can be calculated by knowing the position of each leaf of the MLC at each control point. The aim of this study is to evaluate the correlation between metrics, respect of dosimetric constraints on DVH and QA results for the treatment of prostate cancer with VMAT. Methods Our retrospective study was focused on 34 consecutive patient treated with VMAT plans using two arcs to deliver 46 Gy (RA46) on pelvis followed by one arc delivering 20 Gy on prostate lodge (RA66). Plans were calculated on Eclipse (v13.7) and delivered on a Clinac21Ex equipped with a 120 leaves MLC. MI and MCS metrics were calculated for each of the 3 arcs for each patient with a home-made Python program, using the DICOM-RT plan. If the MI of an arc is upper than 0.18, the entire VMAT plan is re-optimized with the aim to reach the previous dosimetric goals as the MI stays below 0.18 [2] . D98%, D95% D2% for Planning Target Volume (PTV), D50% D40%, D18% for rectum and D50% for bladder were compared. QA tests are performed with Electronic Portal Imaging Devices (as1000 EPID). Gamma analysis using 3%/3 mm, 2%/2 mm and 1%/1 mm criteria are performed. QA results between initial plan and re-planed plan are compared. Results For RA46 and RA66 respectively, 4 and 12 of 37 plans were recalculated. MI and MCS relative differences are respectively (−9.7 ± 3.8)% and (10.5 ± 3.5)% for RA46, (−19.4 ± 7.6)% and (8.1 ± 10.8)% for RA66. Dosimetric parameters obtained for new plans have relative difference on PTV DVH between (−0.62 ± 0.71)% and (0.32 ± 0.31)% for both RA46 and RA66. Concerning rectum, the difference is between (−0.52 ± 2.47)% and (0.65 ± 4.35)% for both plans. On the bladder DVH, the dosimetric parameters differences are less than (−0.50 ± 0.91)% for RA46 but not for RA66 a moderate increase of the exposure is noticed (2.25 ± 4.33)% on D50%. QA results variation are between −0.68% and 0.75% for 3%/3 mm, 2%/2 mm and 1%/1 mm for RA46. Concerning RA66 plan, the relative difference on the gamma pass is −0.10% for 3%/3 mm, −1.14% for 2%/2 mm and −3.10% for 1%/1 mm. Conclusions Results indicate that plans can be recalculated with a less important modulation with conservation of dosimetric constraints. According to QA results, the decrease of the modulation doesn’t improve pre-treatment QA. The deterioration of QA results with a lower MI and higher MCS scores is an unexpected conclusion. To confirm these results, three hypotheses should be investigated: include more patients to increase their statistical confidence, evaluate the movement of EPID during arc course and investigate the relevance of MI and MCS for quantifying general complexity of plans. [ABSTRACT FROM AUTHOR]

Introduction This work proposes a completely new Grid-Based Boltzmann Solver (GBBS) developed for the transport and energy deposition by energetic particles. Its entropic closure and mathematical formulation allow our entropic model to calculate the delivered dose with an accuracy comparable to Monte Carlo (MC) codes with a computational time that is reduced to the order of few seconds without any special processing power requirement. Methods In contrast to discrete ordinates angular discretization methods, such as Acuros®, our method is based on a reduced number of moment equations closed with Boltzmann's H-theorem. Keeping a good accuracy of calculations, the algorithm can simulate different treatment techniques such as the external radiotherapy even in presence of magnetic field [1,2] (e.g., MRI-guided radiotherapy), brachytherapy or intra-operative radiation therapy. The first validation step consists in simulating dose distributions in complex numerical phantoms including a large number of heterogeneity shapes such as bone, lung and air. For both brachytherapy and external beam radiotherapy, simulations based on CT scan, using the real phase-space of the source, have been performed. The entropic model is validated by a direct comparison with the reference MC code PENELOPE. Results The code is capable of calculating 3D dose distributions with 1 mm3voxels without statistical uncertainties in few seconds instead of several minutes like PENELOPE. In brachytherapy applications the dose distributions significantly differ from those calculated with the TG-43 approximations, thanks to its capability to account for inhomogeneities and strong density gradients. Moreover, for both applications the code shows an excellent agreement with PENELOPE within the 1%/1 mm gamma-index criterion. Conclusions In the comparison with the MC results the excellent accuracy of the model is demonstrated. Thanks to its reduced computational time and its accuracy, this model is a promising candidate to become a real-time dose calculation algorithm. [ABSTRACT FROM AUTHOR]

Introduction Selective internal radiation therapy using 90 Y glass microsphere is a treatment dedicated to non-resectable hepatic tumours. This technique requires two imaging modalities, interventional radiology and scintigraphy and handling of two radionuclides. The aim of this work is to assure a safe delivery of this therapy by establishing an average effective dose and an equivalent dose to the extremities for the involved staff for the entire process. Methods Our study was focused on 5 operators: a radiologist, a nuclear doctor, a radiopharmacist, an interventional radiology (IR) manipulator and a nuclear medicine (NM) manipulator. We considered two phases: the work-up phase that consisting of injecting 99m Tc to check patient eligibility, and the treatment phase with 90 Y microspheres delivery. For both phases, radiopharmaceutical preparation and scintigraphy were performed in the NM department. Three exposure sources were considered: radioscopy, radiography and radionuclides during preparation and injection. The dosimetric evaluations were performed for 5 consecutive patients. Cumulative effective and equivalent (extremities) doses were estimated by dose rate (scopy) and dose (graphy) measurements with an AT1123 radiometer. An Unfors NED dosimeter was used for cumulative hands dose during radioactive source manipulation. Regarding the zoning of operating room, the cartography of cumulative dose carried out for each step. Results For the entire process, considering all phases and exposition modes, the thorax effective dose (without taking into account the shielded apron) was 1.6 μSv for the NM manipulator, 9.1 μSv for the IR manipulator, 1 μ Sv for the nuclear physician and the radiopharmacist and 21.9 μSv for the radiologist. The equivalent hands dose was 358.4 μSv for the NM manipulator, 3.7 μSv for the nuclear physician, 63.4 μSv for the radiologist and 2.2 μSv for the radiopharmacist. A yellow controlled zone was applied for all the areas of the operating room due to total cumulative doses of 147 μSv and 90 μSv at 1 m from the patient for work-up and treatment respectively. Conclusion This “operator maximum dose” study suggests that the radiologist and the NM manipulator receive significant exposure on their hands. However it is completely compatible with the personal radiation ranking due to a limited number of RIS performed per year. The determined yellow radiation controlled area is applied to both work-up and treatment phases. [ABSTRACT FROM AUTHOR]

L'hémophilie A acquise est une maladie rare, se manifestant par un syndrome hémorragique lié à la diminution des taux de facteur VIII secondaire à la production d'anticorps (Ac) anti-facteur VIII. Elle est idiopathique dans 50 % des cas, et est associée à une maladie auto-immune, un cancer solide, une hémopathie maligne, ou une prise médicamenteuse dans l'autre moitié. Nous rapportons ici un cas d'hémophilie A acquise chez un patient drépanocytaire, survenant 22 mois après une allogreffe géno-identique de cellules souches hématopoïétiques. Il s'agissait d'un patient de 30 ans, d'origine cap-verdienne, suivi pour une drépanocytose homozygote SS, allogreffé génoidentiquement en janvier 2022, sans traitement de fond depuis plus de 6 mois. Il consultait pour l'apparition brutale d'une douleur du poignet gauche et de la cuisse droite après réalisation d'une séance de musculation. L'examen physique identifiait une tuméfaction douloureuse du poignet. L'échographie retrouvait une tendinopathie du long palmaire sans épanchement et sans hématome. Le scanner de la cuisse droite retrouvait une ecchymose sous-cutanée étendue, sans hématome profond. La biologie identifiait un allongement du TCA à 82s (ratio 2.87 N), avec un taux de facteur VIII à 1 %. La recherche d'Ac anti-facteur VIII était positive, à 16 UB/mL. L'examen physique, le bilan biologique large et le scanner thoraco-abdomino-pelvien ne retrouvait aucun élément permettant d'orienter la cause de l'hémophilie A acquise, qui était attribuée à l'allogreffe de cellules souches géno-identique. En l'absence de saignement, l'administration de facteur VII recombinant et de PPSB n'étaient pas nécessaire. Un traitement par corticostéroïdes, à la dose de 2 mg/kg/j d'équivalent prednisone, et Rituximab (Schéma 375 mg/m2 J1, J8, J15, J22) ont permis d'obtenir une stabilité clinique et une correction des paramètres biologiques en 1 mois (TCA 37s, facteur VIII 27 %, Ac anti-VIII 0,9 UB/mL). À 6 semaines, la corticothérapie était sevrée, et à 3 mois, le patient n'avait pas présenté de rechute. L'hémophilie A acquise est une pathologie rare, affectant préférentiellement les personnes âgées. Elle peut être primitive ou secondaire à d'autres maladies dysimmunitaires ou oncologiques, qu'il convient de dépister. Compte tenu du jeune âge de notre patient et de l'absence d'autre cause retrouvée, l'hémophilie A acquise apparaît comme une complication dysimmunitaire potentielle de l'allogreffe. Des cas d'hémophilie A acquise ont été décrits après une autogreffe de cellules souches hématopoïétiques chez des patients ayant un lupus érythémateux systémique ou une sclérose en plaques réfractaires [1] , et quelques cas ont été décrits après allogreffe pour leucémies aiguës [2]. À notre connaissance, il s'agit du deuxième cas décrit post allogreffe chez un patient drépanocytaire [3]. Les manifestations auto-immunes post greffe de cellules souches hématopoïétiques sont bien décrites. Notre cas illustre leur potentielle gravité. Les cliniciens doivent savoir les évoquer et les rechercher devant une situation clinique suggestive chez un patient auto ou allogreffé. [ABSTRACT FROM AUTHOR]

• Industrial WLIMS and WHIMS were sampled and analyzed in terms of minerals; • Mineral recoveries are weakly correlated to their magnetic susceptibility; • Except for magnetite, mineral recoveries decrease with increasing particle size. Magnetic separation is used in ore processing to separate the minerals according to their magnetic susceptibility. Particle size also plays a role in the separation although few industrial results are presented in the literature to discuss this matter. Results from sampling industrial Wet Low Intensity Magnetic Separators (WLIMS) and Wet High Intensity Magnetic Separators (WHIMS) for processing an iron ore show that except for the strongly paramagnetic magnetite (Fe 3 O 4), the recovery of minerals decreases with increasing particle size for both WLIMS and WHIMS. The examination of polished sections of the coarse size fractions from the reject streams of the WHIMS does not provide ground to suspect liberation to be responsible for the reduced recovery of coarse particles. Results also show that it is difficult to establish clear relationships between the mineral recoveries and their reported magnetic susceptibilities for WLIMS while for WHIMS a weak trend is observable. [ABSTRACT FROM AUTHOR]