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Reverse Potts shunt (RPS) and lung or heart–lung transplantation are life-extending surgical interventions for pediatric patients with severe pulmonary arterial hypertension (PAH). Robust criteria for identifying patients who will benefit from these procedures remain elusive. Based on 30 years of experience, we sought to refine the surgical indications. This single-center retrospective cohort study included 61 consecutive pediatric patients with PAH managed by RPS (2004-2020) or transplantation (1988-2020). Their mid-term outcomes were assessed. Compared with the 20 patients managed by RPS, the 41 transplant waitlist patients, of whom 28 were transplanted, were older (14.9 vs 8.0 years, P =.0001), had worse right ventricular impairment (tricuspid annular plane systolic excursion, 12.5 mm vs 18.0 mm, P =.03), and were managed later in the evolution of the disease (6.0 vs 1.7 years, P =.002). After implementation of a high-priority allocation program in 2007, waitlist mortality decreased from 52.6% to 13.6% (P =.02) and 5-year survival increased from 57.1% to 74.7% after RPS and 55.6% to 77.2% after transplantation. At a median follow-up of 8.6 years after RPS and 5.9 years after transplantation, functional capacity had improved significantly, and PAH-specific drug requirements had diminished markedly in the RPS group. Two patients successfully underwent double-lung transplant 6 and 9 years after RPS. In selected children with suprasystemic PAH, RPS is associated with functional capacity improvements and decreased pharmacotherapy needs over the midterm. RPS deserves consideration earlier in the course of pediatric PAH, with transplantation being performed in the event of refractory RV failure. [ABSTRACT FROM AUTHOR]

Pulmonary vein stenosis (PVS) is a rare and unique disease of infants and young children. PVS is attended by high morbidity and mortality, and for many decades, effective therapy eluded the practitioner. However, in the most recent era, interventional techniques when employed in combination with systemic (primary) therapy have had a remarkable impact on outcomes in these at-risk children. Despite apparent complete relief of PVS in a discrete region of a pulmonary vein, stenosis reliably recurs and progresses. In this review, we discuss the current state-of-the-art interventional techniques, through the lens of our collective experiences and practices. [ABSTRACT FROM AUTHOR]

To assess the residual risk of waterborne contamination by Pseudomonas aeruginosa from a water network colonized by a single genotype [sequence type (ST) 299] despite the presence of antimicrobial filters in a medical intensive care unit (ICU). During the first 19-month period since the ICU opened, contamination of the water network was assessed monthly by collecting water upstream of the filters. Downstream water was also sampled to assess the efficiency of the filters. P. aeruginosa isolates from patients were collected and compared with the waterborne ST299 P. aeruginosa by multiplex-rep polymerase chain reaction (PCR), pulsed-field gel electrophoresis (PFGE) and whole-genome sequencing. Cross-transmission events by other genotypes of P. aeruginosa were also assessed. Overall, 1.3% of 449 samples of filtered water were positive for P. aeruginosa in inoculum, varying between 1 and 104 colony-forming units/100 mL according to the tap. All P. aeruginosa hydric isolates belonged to ST299 and displayed fewer than two single nucleotide polymorphisms (SNPs). Among 278 clinical isolates from 122 patients, 10 isolates in five patients showed identical profiles to the hydric ST299 clone on both multiplex-rep PCR and PFGE, and differed by an average of fewer than five SNPs, confirming the water network reservoir as the source of contamination by P. aeruginosa for 4.09% of patients. Cross-transmission events by other genotypes of P. aeruginosa were responsible for the contamination of 1.75% of patients. Antimicrobial filters are not sufficient to protect patients from waterborne pathogens when the water network is highly contaminated. A microbiological survey of filtered water may be needed in units hosting patients at risk of P. aeruginosa infections, even when all water points-of-use are fitted with filters. [ABSTRACT FROM AUTHOR]

Current classifications for proximal ulna fracture patterns rely on qualitative data and cannot inform surgical planning. We propose a new classification system based on a biological and anatomical stress analysis. Our hypothesis is that fragment types in complex fractures can be predicted by the tendon and ligament attachments on the proximal ulna. First, we completed a literature review to identify quantitative data on proximal ulna soft tissue attachments. On this basis, we created a 3-dimensional model of ulnar anatomy with SliceOMatic and Catia V5R20 software and determined likely locations for fragments and fracture lines. The second part of the study was a retrospective radiological study. A level-1 trauma radiological database was used to identify computed tomography scans of multifragmentary olecranon fractures from 2009 to 2021. These were reviewed and classified according to the " fragment specific " classification and compared to the Mayo and the Schatzker classifications. Twelve articles (134 elbows) met the inclusion criteria and 7 potential fracture fragments were identified. The radiological study included 67 preoperative computed tomography scans (mean 55 years). The fragments identified were the following: posterior (40%), intermediate (42%), tricipital (100%), supinator crest (25%), coronoid (18%), sublime tubercle (12%), and anteromedial facet (18%). Eighteen cases (27%) were classified as Schatzker D (comminutive) and 21 (31%) Mayo 2B (stable comminutive). Inter-rater correlation coefficient was 0.71 among 3 observers. This proposed classification system is anatomically based and considers the deforming forces from ligaments and tendons. Having a more comprehensive understanding of complex proximal ulna fractures would lead to more accurate fracture evaluation and surgical planning. [ABSTRACT FROM AUTHOR]

Toxoplasma gondii is an intracellular protozoon found worldwide, which completes its life cycle between felids (its definitive host) and other warm-blooded animals. While the infection rarely leads to severe complications in humans, many animal species are very susceptible to this infection, for example the squirrel monkey (Saimiri sciureus) which is the subject of this study. Toxoplasmosis is lethal for 80% of cases in this species, and fatal outbreaks are frequently reported in zoological parks. No efficient treatment exists, but a new vaccine prepared with maltodextrin nanoparticles containing killed T. gondii antigens has been tested recently in French zoos. The animals were immunized through heterologous administrations, with two nasal doses at one-month interval, followed by nasal/subcutaneous boosts thereafter. No death has been reported since the beginning of this vaccination campaign, but we felt the protocol could be simplified. Here, an improved and less-invasive immunization protocol was evaluated on 6 Saimiri sciureus in the French zoo La Palmyre. It consisted of two nasal administrations at one-month interval, followed by a nasal boost at 6 months. A specific memory T-cell immunity was observed by ELISPOT after two administrations in all the animals, without humoral responses. The results suggest that 2 nasal administrations induce a protective immune response against T. gondii infection and might be sufficient to induce a strong Tcell memory, further improving immunity. [Display omitted] • Efficient nasal vaccine of Squirrel Monkeys against Toxoplasma gondii. • Nasal vaccination induces a specific T-cell immunity against Toxoplasma gondii. • Nanoparticle-born nasal vaccine against Toxoplasma gondii in zoo animals. [ABSTRACT FROM AUTHOR]

Adenovirus (ADV) outbreaks in neonatal intensive care units (NICU) can lead to durable transmission and serious adverse outcomes. This study describes the investigation and control of an ADV-D8 outbreak in an NICU, associated with ophthalmologic equipment used during retinopathy of prematurity (ROP) screening. Cases were observed in neonates, parents and nurses. The outbreak investigation was performed including sampling patients, parents and health care workers as well as the environment for molecular detection of ADV DNA. The investigation was also conducted in the guest house where some parents were temporary residents. A retrospective cohort study focused on neonates hospitalized during the epidemic period to assess the risk associated with ROP examination. Fifteen cases were identified in neonates; all but one presented with conjunctivitis. Two healthcare workers and 18 parents acquired conjunctivitis. ADV DNA was identified on the RetCam and on the freezer shared by parents. All ADV-positive samples were typed as ADV-D8. ADV infections occurred more frequently in neonates who had ROP examinations (37.8% (14/37) vs (0.9% (1/110); P <0.001) (relative risk 41.6; (5.7–305.8)). The RetCam was disinfected between two examinations using a disinfectant that was virucidal on ADV after a 30-min contact. This outbreak was significantly associated with ROP examination with a RetCam that had a disinfection protocol ill-adapted to rapid patient turnover. In addition, nosocomial transmission via the parents to neonates and parent-to-parent transmission is likely to have played a role in the dissemination of cases. No further cases were observed after the new disinfection procedure was enforced. [ABSTRACT FROM AUTHOR]

Postoperative hypoparathyroidism, resulting from removal and/or devascularization of one or more parathyroid glands, is a feared complication of total thyroidectomy. Two forms, which are distinguished by their frequency, their time to onset and their duration as well as by their presentation, must be individualized: early postoperative hypocalcemia, often secondary to early hypoparathyroidism is a frequent and often transient situation occurring within the first days after surgery; permanent hypoparathyroidism, which is rarer, manifests when parathyroid function remains impaired for more than six months after surgery. Because of their severity, these conditions must be known and ideally prevented during total thyroidectomy. The objective of this article is to provide surgeons with practical recommendations for the prevention, diagnosis, and treatment of hypoparathyroidism after total thyroidectomy. These recommendations, which are the fruit of a medico-surgical consensus, were developed by the Francophone Association of Endocrine Surgery (AFCE), the French Society of Endocrinology (SFE) and the French Society of Nuclear Medicine and Molecular Imaging. (SFMN). The content, grade and level of evidence for each recommendation was decided after consultation within a panel of experts, based on an analysis of recent literature. [ABSTRACT FROM AUTHOR]

Laparoscopic sleeve gastrectomy (SG) is the most commonly performed bariatric surgery. The resected gastric segment is routinely sent for pathology evaluation. No formal national recommendation exists that mandates pathology review. We proposed to study the largest histopathologic series in SG patients yet reported. The primary objective of our study was to determine whether a subgroup of patients who underwent bariatric surgery in the northeastern Unites States is more susceptible to having clinically significant pathologic findings that may benefit from routine histopathologic evaluation of the gastric sleeve specimen. University hospital. A retrospective electronic chart review of patients who underwent SG at a single large academic institution was performed. Patient demographics, body mass index, and histopathologic reports of the gastric specimens obtained during SG were analyzed. The records of 3543 patients were reviewed. A total of 1076 patients had abnormal pathologies, including gastritis (938), follicular gastritis (98), intestinal metaplasia (25), gastrointestinal stromal tumor (12), leiomyoma (1), lymphoma (1), and other malignancy (1). Black and Hispanic patients had a higher incidence of developing gastrointestinal stromal tumor and intestinal metaplasia. A higher incidence of Helicobacter pylori infection among specimens with abnormal pathologies was noted. The findings of this study call into question the routine use of pathology workup in gastric specimens after SG. Our data suggest that such analysis may be warranted in certain subtypes of patients such as older Black and Hispanic patients in the northeastern United States. [ABSTRACT FROM AUTHOR]

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In recent years, per and polyfluoroalkyl substances (PFAS) have garnered significant attention due to their persistent and harmful effects on the environment and human health. Traditional treatment methods often fall short of effectively removing PFAS from water, prompting the need for innovative techniques. One promising approach is electrochemical advanced oxidation, based on highly reactive chemical species generated through electrochemical reactions to degrade organic pollutants. In this study, a specific reactive electrochemical membrane (REM) anode was used to degrade perfluorooctanoic acid (PFOA). The anode is a tubular Ti 4 O 7 -based REM (mixture of Ti 4 O 7 and Ti 5 O 9 Magneli phases) with a water permeability of 3300 L m−2 h−1 bar−1. The impact of various operating parameters, including current density, flux through REM, and feed concentration, on PFOA degradation efficiency was investigated. It was found that higher current densities, feed concentrations and lower flux through REM led to increased PFOA removal rates. With this type of REM, a total degradation of PFOA was observed at PFOA flux (passing throw the REM) under 0.2 g h−1 m−2 even at the lowest current density (71 A/m2). The degradation mechanism was investigated by evaluating the generated by-products after several degradation cycles, and the results confirmed that the degradation occurs via the decomposition cycle of CF 2. Energy consumption has been taken into account, as it is the major limitation of advanced oxidation processes, exhibiting value under 5 kWh/g for the lowest current density and the highest PFOA flux. The originality of this study relies on the use of a specific anode; a tubular shape Ti 4 O 7 -based REM (by Saint Gobain Company). Such concentric REM reactor is optimal for the treatment of recalcitrant effluent containing PFOA as it significantly improved mass transfer leading to a very interesting energy efficient system that can easily be scale up. [Display omitted] • Originality relies on the use of a tubular shape Magnéli-based reactive electrochemical membrane (REM). • High permeability membranes were used for PFAS degradation by anodic oxidation. • Using REM anode overcomes mass transfer limitation due to diffusion. [ABSTRACT FROM AUTHOR]

Since the 2000s, transcatheter closure has been the primary treatment for ostium secundum atrial septal defect (osASD) in children and adults. This study aims to identify factors associated with short-term adverse outcomes following this procedure in a large cohort. A prospective, single-center cohort study included 2,253 consecutive patients (median age 28 years; children: n = 865, 38.4%) who underwent transcatheter ASD closure with the Amplatzer Septal Occluder (ASO; Amplatzer™ Atrial Septal Occluder Device, Abbott, Chicago, USA) from May 1998 to December 2021. Peri-procedural data associated with major adverse events were investigated retrospectively. The mean ASD diameter, as measured by transthoracic echocardiography, was 18 mm. About 8.9% of patients had an ASD size-to-body surface area (BSA) ratio of ≥ 20 mm/m2. Deficient rims (< 5 mm) were identified in 27.9% of patients, with retroaortic rim deficiency in 22.7% and inferior rim deficiency in 0.9%. The median ASO diameter was 24 mm, with a procedural success rate of 98.2%. ASD/BSA ≥ 20 mm/m2 was associated with procedural failure, while age and weight were not. Major peri-procedural adverse events occurred in 31 patients (1.4%), with 19 device embolizations and 2 cardiac erosions. No peri-procedural deaths were reported. Multivariate analysis showed that deficiency of the inferior vena cava rim and an ASD size/BS ratio ≥ 20 mm/m2 were significantly associated with major adverse events (P = 0.002 and P = 0.035, respectively) (Fig. 1). Transcatheter osASD closure using ASO is safe and effective in a large spectrum population with low rate of peri-procedural adverse events and favorable short-term outcomes. ASD size-to-body surface area ratio (≥ 20 mm/m2) and inferior rim deficiency are key morphological risk markers for major adverse events following this procedure. [ABSTRACT FROM AUTHOR]

Biomethane is one of the main renewable gases available today to offset fossil gas and decarbonize the energy system. The EU is seeking to rapidly replace part of the natural gas usually stored in deep saline aquifers by biomethane which contains up to 10000 ppm of O 2. This study presents for the first-time assessment of deep aquifers' resilience to biomethane and natural gas blend injection into two sandstone reservoirs with different mineral paragenesis from the Paris Basin (France). Multiphase reactive transport modeling allowed to evaluate changes in gas and water quality, mineralogy and moreover, to identify major resilience properties of storage facilities necessary to buffer the oxygen reactivity and induced acidification coming from gas–water–rock interactions. In the presence of pyrite, the injected oxygen is consumed during pyrite oxidation and contributes to the acidification of the formation water close to the injection point. However, the injection of 1% mole fraction of CO 2 (g) contained in the gas blend is found to be the main acidification factor. The analysis of reservoir resilience showed three protection levels of pH buffering capacity, which can effectively mitigate an increase in oxygen content up to 1000 ppm: (i) calcite dissolution, (ii) plagioclase and clay dissolution and (iii) clay sorption capacity. Models predict that the gas blend injection could induce minimal but long-term change in the mineralogy without significantly impacting the global porosity. Overall, both sandstones can preserve the quality of the gas plume despite partial CO 2 (g) exsolution induced by the geochemical perturbation of the formations. The developed models will be used as a basis for assessment of renewable natural gas storage facilities in the long-term. [Display omitted] • Reactivity of co-injected O 2 with pyrite leads to water acidification. • Co-injected 1 mol% of CO 2 is the main acidification factor. • 3 levels of reservoir resilience: carbonates, plagioclases and clays, clay sorption. • Site-dependent multiphase reactive transport modeling for gas storage. • Studied reservoirs show a good buffering capacity with oxygen content up to 1000 ppm. [ABSTRACT FROM AUTHOR]

An altered gut microbiome characterized by reduced abundance of butyrate producing bacteria and reduced gene richness is associated with type 2 diabetes (T2D). An important complication of T2D is increased risk of cognitive impairment and dementia. The biguanide metformin is a commonly prescribed medication for the control of T2D and metformin treatment has been associated with a significant reduction in the risk of dementia and improved cognition, particularly in people with T2D. To investigate the associations of metformin use with cognition exploring potential mechanisms by analyzing the gut microbiome and plasma metabolome using shotgun metagenomics and HPLC-ESI-MS/MS, respectively. We explored two independent cohorts: an observational study (Aging Imageomics) and a phase IV, randomized, double-blind, parallel-group, randomized pilot study (MEIFLO). From the two studies, we analyzed four study groups: (1) individuals with no documented medical history or medical treatment (n = 172); (2) people with long-term T2D on metformin monotherapy (n = 134); (3) people with long-term T2D treated with oral hypoglycemic agents other than metformin (n = 45); (4) a newly diagnosed T2D subjects on metformin monotherapy (n = 22). Analyses were also performed stratifying by sex. Several bacterial species belonging to the Proteobacteria (Escherichia coli) and Verrucomicrobia (Akkermansia muciniphila) phyla were positively associated with metformin treatment, while bacterial species belonging to the Firmicutes phylum (Romboutsia timonensis , Romboutsia ilealis) were negatively associated. Due to the consistent increase in A. muciniphila and decrease in R.ilealis in people with T2D subjects treated with metformin, we investigated the association between this ratio and cognition. In the entire cohort of metformin-treated T2D subjects, the A.muciniphila / R.ilealis ratio was not significantly associated with cognitive test scores. However, after stratifying by sex, the A.muciniphila / R. ilealis ratio was significantly and positively associated with higher memory scores and improved memory in men. Metformin treatment was associated with an enrichment of microbial pathways involved in the TCA cycle, and butanoate, arginine, and proline metabolism in both cohorts. The bacterial genes involved in arginine metabolism, especially in production of glutamate (astA, astB, astC, astD, astE, putA), were enriched following metformin intake. In agreement, in the metabolomics analysis, metformin treatment was strongly associated with the amino acid proline, a metabolite involved in the metabolism of glutamate. The beneficial effects of metformin may be mediated by changes in the composition of the gut microbiota and microbial-host-derived co-metabolites. • Metformin's beneficial effects may be mediated by changes in gut microbiota composition and functionality. • Metformin was associated with an increase in E. coli and A. muciniphila and a decrease in R. ilealis. • A. muciniphila / R. ilealis ratio was associated with improved memory scores in men, but not in women. • Metformin was associated with an enrichment of pathways involved in the arginine, and proline metabolism. • The bacterial functions of arginine metabolism (astA, astB, astC, astD, astE, putA) were involved in glutamate synthesis. [ABSTRACT FROM AUTHOR]

Taxanes are one of the most effective chemotherapies (CT) in breast cancer (BC), but the efficacy of taxanes rechallenge in early metastatic relapse has been poorly studied in patients previously treated by taxanes in the (neo)adjuvant setting. Our study aimed to analyse the efficacy of taxane rechallenge in case of early metastatic relapse in a multicentre retrospective observational study compared with other chemotherapies. We analysed the French national ESME metastatic BC (MBC) database and selected HER2- MBC patients who received CT in first-line treatment for a metastatic relapse occurring 3–24 months after previous (neo)adjuvant taxanes treatment. Of 23,501 female patients with MBC in ESME, 1057 met the selection criteria. 58.4% received a taxane-based regimen (75.4% concomitant bevacizumab) and 41.6% received other CT. In hormone-receptor positive (HR+)/HER2- MBC, multivariate analysis showed no difference in OS between taxanes without bevacizumab compared to other CT (HZR = 1.3 [0.97; 1.74], but taxanes was significantly associated with worse PFS (HZR = 1.48 [1.14; 1.93]). In TNBC, taxanes without bevacizumab and carboplatin/gemcitabine were not superior to other CT for OS (HZR = 1.07 [0.79; 1.44] and HZR = 0.81 [0.58; 1.13], respectively), while for PFS, taxanes was inferior (HZR = 1.33 [1.06–1.67]) and carboplatin plus gemcitabine was superior to other CT (HZR = 0.63 [0.46; 0.87]). For both subtypes, the worse outcome observed with paclitaxel was no longer observed with the addition of bevacizumab. With the limitation of retrospective design, taxanes rechallenge in early metastatic relapse of BC may result in a worse PFS in TNBC and HR+/HER2- MBC, which was not observed with the addition of bevacizumab. • Patients with HER2-advanced breast cancer (ABC) have often previously received taxanes in the (neo)adjuvant setting. • Current guidelines suggest a rechallenge by taxanes in ABC with DFI≥12 months, few data are available for DFI ≤24 months. • Taxane rechallenge in early metastatic relapse of BC (DFI ≤24 months) may result in a worse PFS in TNBC and HR+/HER2- ABC. • In TNBC, the addition of bevacizumab to taxanes improves PFS and OS for DFI ≤24 months. [ABSTRACT FROM AUTHOR]

Les troubles musculosquelettiques (TMS) sont la première cause de maladie professionnelle en France et en Europe, et sont responsables de lourdes conséquences économiques et sociales, à l'échelle individuelle, de l'entreprise et du pays. Les TMS sont d'origine multifactorielle, associant des facteurs de susceptibilité individuelle et un faisceau de causes biomécaniques, psychosociales, organisationnelles et managériales de la situation de travail. La prévention des TMS nécessite une approche globale et intégrée, privilégiant la réduction des risques à la source par une action en milieu de travail, le dépistage et la prise en charge précoce des patients-travailleurs souffrant de ces troubles et, si nécessaire, de maintien en emploi. Leur prise en charge repose sur une évaluation globale de la situation clinique et socioprofessionnelle. La coordination des prises en charge médicale, réadaptative et professionnelle est un élément capital du pronostic professionnel et du maintien en emploi. Musculoskeletal disorders (MSDs) are the leading cause of occupational disease in France and in Europe and are responsible for serious economic and social consequences, at individual, company and country level. MSDs are of multifactorial origin, combining individual susceptibility factors and a range of biomechanical, psychosocial, organizational and managerial causes of the workplace. The prevention of MSDs requires a global and integrated approach, favoring the reduction of risks at source through action in the workplace, screening and early management of patient-workers suffering from these disorders and, if necessary, maintenance employed. Their management is based on an overall assessment of the clinical and socioprofessional situation. The coordination of medical, rehabilitative and professional care is a key element of professional prognosis and job retention. [ABSTRACT FROM AUTHOR]

The reverse sequence of neoadjuvant chemotherapy, preoperative radiotherapy, mastectomy then immediate breast reconstruction is currently proposed for selected patients with locally advanced breast cancer. Few studies have compared it to the standard sequence of neoadjuvant chemotherapy, mastectomy and radiotherapy with or without differed reconstruction. Our study compares overall (OS) and recurrence-free (RFS) survivals of breast cancer patients treated with reverse sequence compared to the standard technique. In this retrospective, single center study at a Comprehensive Cancer Center in France, patients were included if: female, age <65y, had received neoadjuvant chemotherapy, mastectomy and radiotherapy, and were M0. Outcomes for patients treated by reverse sequence (RS) are compared to those for patients treated by standard sequence (ST). Data was collected from medical records. From January 2009 to April 2018, 222 eligible patients were treated, 46 by RS and 176 by ST. Mean follow-up was 61.7 months. Five-year OS and RFS did not differ between groups. 5-yr OS: 88.4% 95%CI [74.1–95.0] for RS and 81.5% 95%CI [74.0–87.0] for ST (P = 0.4412); 5-yr RFS: 78.3% 95%CI [61.9–88.3] for RS and 70.1% 95%CI [62.2–76.7] for ST (P = 0.3003). Overall treatment time was significantly shorter in the RS group, and the rate of severe surgical complications did not differ between groups. For locally advanced breast cancer patients with an indication for radiation therapy the reverse sequence offers similar safety and efficacy results as the standard treatment while allowing immediate breast reconstruction. However, careful patient selection is necessary, particularly with regard to preoperative lymph node invasion. [ABSTRACT FROM AUTHOR]

This paper presents a study of using site-specific statistical meteorological data in the construction of curved flight procedures to explore its potential in reducing the environmental impact of air traffic near the airports. In the study, the statistical meteorological data which covers a 10-year period of time, from 2009 to 2018, have been collected for the air space centred two major Swedish airports, Arlanda at Stockholm (ESSA) and Landvetter at Göteborg (ESGG). Two procedure design practices, one is an area navigation (RNAV) standard instrument departure (SID) procedure from runway 08 of Arlanda airport and another is a required navigation performance authorization required (RNP AR) approach procedure heading to the runway 03 at Landvetter airport, have been performed and analyzed. Applying the 95th percentile wind speed from statistical meteorological data, instead of the ICAO standardized tailwind component (TWC), offers varying benefits depending on the specific case. For the RNAV SID procedure from ESSA, the part of the designed departure path which is outside of the regulated noise dispersion area is significantly reduced. Whilst for the RNP AR approach procedure to ESGG, the smaller turning radius resulted from the lower TWC which is calculated from the local meteorological data makes it possible to avoid flying over an inhabited area. Besides the notable potential of noise impact reduction, flight distance shortening of 3.7 NM (RNAV SID ESSA case) and 1 NM (RNP AR ESGG case) compared to the same procedures designed on ICAO standard TWC have been observed. In general, the presented results are positive in supporting the use of local meteorological data in planning curved flight procedures during departures and approaches. A validation performed using an A320 full flight simulator has confirmed the operability of the ESGG RNP AR procedure from the design practice. In the full flight simulator, even with the 100th percentile wind condition from the collected statistical meteorological data, the designed RNP AR approach procedure can be operable considering RNP 0.3 corridor while a 30° bank angle is required for approximately 20 s during the turn. • Implementing statistical meteorological data in curved flight procedure design and demonstrating its benefits. • Conducting RNP AR design study using updated statistical meteorological data and latest design manuals. • Providing guidelines on selecting and applying suitable statistical data into procedure design. • Offering practical design cases which are designed by operators and validated by pilots in flight simulators. • Encouraging R&D in curved flight design using statistical meteorological data by demonstrating individual cases. [ABSTRACT FROM AUTHOR]

The development of biomaterials such as synthetic scaffolds for peripheral nerve regeneration requires a precise knowledge of the mechanical properties of the nerve in physiological-like conditions. Mechanical properties (Young's modulus, maximum stress and strain at break) for peripheral nerves are scarce and large discrepancies are observed in between reports. This is due in part to the absence of a robust testing device for nerves. To overcome this limitation, a custom-made tensile device (CMTD) has been built. To evaluate its reproducibility and accuracy, the imposed speed and distance over measured speed and distance was performed, followed by a validation using poly(dimethylsiloxane) (PDMS), a commercial polymer with established mechanical properties. Finally, the mechanical characterization of rodents (mice and rats) sciatic nerves using the CMTD was performed. Mouse and rat sciatic nerves Young's modulus were 4.57 ± 2.04 and 19.2 ± 0.86 MPa respectively. Maximum stress was 1.26 ± 0.56 MPa for mice and 3.81 ± 1.84 MPa for rats. Strain at break was 53 ± 17% for mice and 32 ± 12% for rats. The number of axons per sciatic nerve was found to be twice higher for rats. Statistical analysis of the measured mechanical properties revealed no sex-related trends, for both mice and rats (except for mouse maximum stress with p = 0. 03). Histological evaluation of rat sciatic nerve corroborated these findings. By developing a robust CMTD to establish the key mechanical properties (Young's modulus, maximum stress and strain at break) values for rodents sciatic nerves, our work represent an essential step toward the development of better synthetic scaffolds for peripheral nerve regeneration. [Display omitted] • A custom-made tensile device specific to tissues characterization was validated. • Mechanical characterization of rodents' sciatic nerves as conducted. • Rat nerve Young's modulus was found 4 times higher than mouse one. • Morphometric analyses corroborated mechanical results. • Rodents sciatic nerves mechanical properties were established from robust data. [ABSTRACT FROM AUTHOR]

Human pluripotent stem cells (hiPSC) represent a unique opportunity to model lung development and chronic bronchial diseases. We generated a hiPSC line from a highly characterized healthy heavy smoker male donor free from emphysema or tobacco related disease. Peripheral blood mononuclear cells (PBMCs) were reprogrammed using integration-free Sendai virus. The cell line had normal karyotype, expressed pluripotency hallmarks, and differentiated into the three primary germ layers. The reported UHOMi007-A iPSC line may be used as a control to model lung development, study human chronic bronchial diseases and drug testing. [ABSTRACT FROM AUTHOR]

Introduction This study aims at identifying mechanical characteristics under bi-axial loading conditions of extracted swine pia mater (PM) and dura and arachnoid complex (DAC). Methods 59 porcine spinal samples have been tested on a bi-axial experimental device with a pre-load of 0.01 N and a displacement rate of 0.05 mm·s−1. Post-processing analysis included an elastic modulus, as well as constitutive model identification for Ogden model, reduced Gasser Ogden Holzapfel (GOH) model, anisotropic GOH model, transverse isotropic and anisotropic Gasser models as well as a Mooney-Rivlin model including fiber strengthening for PM. Additionally, micro-structure of the tissue was investigated using a bi-photon microscopy. Results Linear elastic moduli of 108 ± 40 MPa were found for DAC longitudinal direction, 53 ± 32 MPa for DAC circumferential direction, with a significant difference between directions (p < 0.001). PM presented significantly higher longitudinal than circumferential elastic moduli (26 ± 13 MPa vs 13 ± 9 MPa, p < 0.001). Transversely isotropic and anisotropic Gasser models were the most suited models for DAC (r2 = 0.99 and RMSE:0.4 and 0.3 MPa) and PM (r2 = 1 and RMSE:0.06 and 0.07 MPa) modelling. Conclusion This work provides reference values for further quasi-static bi-axial studies, and is the first for PM. Collagen structures observed by two photon microscopy confirmed the use of anisotropic Gasser model for PM and the existence of fenestration. The results from anisotropic Gasser model analysis depicted the best fit to experimental data as per this protocol. Further investigations are required to allow the use of meningeal tissue mechanical behaviour in finite element modelling with respect to physiological applications. This study is the first to present biaxial tensile test of pia mater as well as constitutive model comparisons for dura and arachnoid complex tissue based on such tests. Collagen structures observed by semi-quantitative analysis of two photon microscopy confirmed the use of anisotropic Gasser model for pia mater and existence of fenestration. While clear identification of fibre population was not possible in DAC, results from anisotropic Gasser model depicted better fitting on experimental data as per this protocol. Bi-axial mechanical testing allows quasi-static characterization under conditions closer to the physiological context and the results presented could be used for further simulations of physiology. Indeed, the inclusion of meningeal tissue in finite element models will allow more accurate and reliable numerical simulations. [Display omitted] [ABSTRACT FROM AUTHOR]

Entre 2002 et 2020, 172 anaphylaxies alimentaires observées chez le sénior ont été rapportées au RAV. On observe un sex-ratio H/F de 0,85 et une moyenne d'âge de 67,3 ans (60–93). Les allergènes les plus fréquents sont d'origine végétale : en premier, les légumineuses (20 cas), puis les céréales (16 cas) et les fruits à coque (15 cas), principalement la noisette. Les protéines PR-10 sont en cause dans au moins 11,7 % des anaphylaxies. À l'instar du soja, les anaphylaxies attribuées à Cor a 1 sont surtout rapportées par des allergologues exerçant en Belgique et dans le nord-est de la France. Les anaphylaxies liées aux viandes rouges et abats sont les plus fréquentes (24 cas soit 13,9 %), toujours associées à un syndrome alphaGal quand il est recherché, 16 sont attribuées aux crustacés, 8 aux mollusques et aux poissons respectivement et 6 cas à Anisakis. Cette série confirme la rareté de l'allergie au lait de vache et à l'œuf chez le sénior. Le RAV a colligé 4 anaphylaxies de grade I, 77 de grade II, 84 de grade III et 5 de grade IV dont un décès. La gravité est significativement liée à des antécédents de cardiopathie ou HTA. Quarante pour cent des sujets avaient déjà présenté une allergie dans le passé avec l'aliment suspecté et seulement 55 % disposaient d'un stylo d'adrénaline et 33 % d'un plan d'action. Cette grande série souligne l'intérêt d'un bilan allergologique détaillé chez le sujet âgé. Leur prise en charge doit non seulement comporter un protocole de soins d'urgence avec auto-injecteur d'adrénaline, mais aussi une éducation thérapeutique et diététique pour le patient et son entourage. Elle devrait être formalisée par un PAI, à l'instar de l'enfant scolarisé, compte tenu du risque de récidive, des comorbidités et perte d'autonomie pour certains. Between 2002 and 2020, 172 food anaphylaxis cases in senior citizens were reported to the RAV. Sex ratio M/F was 0.85 and the average age was 67.3 years (60–93). The most frequent allergens are of plant origin: first, legumes (20 cases), then cereals (16 cases) and nuts (15 cases), mainly hazelnut. PR-10 proteins are involved in at least 11.7% of anaphylaxis cases. Like soy, anaphylaxis attributed to Cor a 1 is mainly reported by allergists practicing in Belgium and northeastern France. Anaphylaxis related to red meat and offal is the most frequent (24 cases, 13.9%), always associated with an alphaGal syndrome when anti-alphaGal IgE was tested. Sixteen are attributed to crustaceans, 8 to mollusks and fish respectively and 6 to Anisakis. This series confirms the rarity of cow's milk and egg allergy in the elderly. The RAV collected 4 grade I, 77 grade II, 84 grade III and 5 grade IV anaphylaxis cases including one death. Severity was significantly related to a history of heart disease or hypertension. Forty percent of the subjects had already presented an allergy in the past with the suspected food and only 55% had an adrenaline pen and 33% an action plan. This large series underlines the interest of a detailed allergological assessment in the elderly. Their management should not only include an emergency care protocol with an adrenaline auto-injector, but also therapeutic and dietary education for patient, his family and entourage. It should be formalized by a personalized care project (PCP), as for schoolchildren, given the risk of recurrence, comorbidities and loss of autonomy for some. [ABSTRACT FROM AUTHOR]

While bariatric surgery has demonstrated physical and psychological benefits, a risk of suicide and non-fatal self-harm has also been shown. The aim of this study was to compared the rate of hospitalization for self-harm during a three-year observational follow-up period between adolescents/young adults who underwent bariatric surgery in France in 2013–2014 and two control groups. All individuals aged 12–25 years old who underwent bariatric surgery in France between January 1st, 2013, and December 31st, 2014, were identified with a validated algorithm from the French national hospital database, and compared to a healthy sample of the general population matched for age and gender. Information relative to hospitalizations, including for self-harm (ICD-10 codes X60-84), were extracted i) between 2008 and the surgery, and ii) for a three-year follow-up period. A second unmatched control group with obesity but no bariatric surgery was also identified. Survival analyses with adjustments for confounding variables were used. In 2013–2014, 1984 youths had bariatric surgery in France. During follow-up, 1.5% were hospitalized for self-harm vs. 0.3% for controls (p < 0.0001). After adjustment, subsequent hospitalization for self-harm was associated with bariatric surgery (HR 3.64, 95% CI 1.70–7.81), prior psychiatric disorders (HR 7.76, 95% CI 3.76–16.01), and prior self-harm (HR 4.43, 95% CI 1.75–11.24). When compared to non-operated youths with obesity, bariatric surgery was not associated with self-harm while prior mental disorders and self-harm were. Mortality reached 0.3% after surgery. Bariatric surgery is associated with an increased risk of self-harm, mainly in relation to preexisting psychological conditions. Vigilance and appropriate care are thus warranted in vulnerable individuals. [ABSTRACT FROM AUTHOR]

The widespread loss of weed diversity and associated ecosystem functions is raising important concerns. Field edges could play a major role in the maintenance of weed functional diversity in arable landscapes as these habitats still harbour high weed diversity, owing to either a reduced farming management intensity and/or to a spillover of species from adjacent perennial field margins. Here, we investigated the taxonomic and functional characteristics of weed species recorded in surveys of field edges and their associated field cores over six consecutive years in 60 arable fields farmed with five crop management strategies. We found that field edges were richer, with species more functionally diverse and composition more stable over years than field core surveys. The distribution of individual functional traits differed between field edges and field cores, with higher values for seed mass and nitrophily (Ellenberg.N), and a wider distribution of specific leaf area values in field edges. The bimodal distribution of plant height and germination period observed in field edges became unimodal in field cores. Field edges harboured species with ecological strategies associated with field cores (ruderal species) plus a conservative strategy which could be explained by a spillover from the adjacent perennial field margins. Crop management strategies impacted field edge flora, though to a lesser extent than the field core flora whereas the functional differences between the field edge and the field core flora were less marked when crop management intensity was lower. These results indicate that field edges harbour a unique assemblage of species and highly contribute to the maintenance of weed diversity in arable landscapes. Future studies should thus focus on the importance of these specific functional traits to the agroecosystem functioning. [ABSTRACT FROM AUTHOR]

Background: The main objective was to assess the performance of the neutrophil-lymphocyte ratio (NLR) for early prediction of delayed neurological impairment and cerebral contusion worsening in patients with mild-to-moderate traumatic brain injury (TBI).Methods: Over a 3-year period, every adult patient triaged to our level 1 trauma center with brain contusion and Glasgow Coma Scale (GCS) of 10 or greater were retrospectively included. The main study outcome was the occurrence of delayed clinical deterioration, defined as a GCS < 10 and/or a secondary need for mechanical ventilation, within 5 days after TBI. The performance of NLR for prediction of delayed clinical deterioration was assessed by receiver operating characteristic (ROC) curve.Results: Overall, 115 patients were included and 16 (14%) presented a delayed clinical deterioration. Overall, the NLR at ED admission was higher in patients who developed a delayed clinical deterioration (18 [12-29] vs 8 [5-13], p = 0.0003). The area under the ROC curves for NLR at ED admission in predicting delayed clinical deterioration was 0.79 [0.65-0.93] and NLR > 15 was found to be independently associated with the occurrence of delayed clinical deterioration (adjusted OR = 10.1 [95%CI: 2.3-45.6]).Conclusion: The NLR at ED admission was independently associated with the occurrence of delayed clinical deterioration, although limited by a poor discriminative value by itself. Further studies are needed to test the predictive value of composite scoring systems including NLR for prevention of under-triage of patients with mild-to-moderate TBI. [ABSTRACT FROM AUTHOR]

Submassive pulmonary embolism (PE) refers to patients presenting with acute PE without systemic hypotension, but evidence of either right ventricular (RV) systolic dysfunction or myocardial necrosis. The novel parameter ePLAR (echocardiographic Pulmonary to Left Atrial Ratio) has been validated as a non-invasive marker of trans pulmonary gradient (TPG). ePLAR (m/s) = TRVmax (m/s)/mitral E/e' (TR = tricuspid regurgitation). Evaluate the diagnostic yield of ePLAR in predicting increased transpulmonay gradient in patients having submassive pulmonary embolism in comparison to the standard echocardiographic markers of elevated pulmonary pressures. We carried out a retrospective study including patients having acute PE confirmed by CT-scan or perfusion lung scan with an echocardiographic assay the days following diagnosis. A control cohort of "normal" patients not having PE was generated from our data base. A comprehensive echocardiographic exam was performed with evaluation of the left ventricular (LV) systolic function per standard protocol. LV filling pressures were measured with mitral annular E/e' ratio obtained by tissue Doppler imaging (DTI). RV function comprised measurement of TAPSE and tricuspid annular TDI S wave velocity. TRVmax was obtained by continuous Doppler and ePLAR was calculated by the above mentioned formular with values > 0.28 m/s indicating elevated TPG (Fig. 1). A total of 76 patients were included in the final analysis. Mean ePLAR value was significantly greater in patients having PE than in the control group (0.36 ± 0.16 m/s vs. 0.27 ± 0.15 m/s, P 0.007). Mitral E/e' ratio was lower in the control group (8 ± 3.1 vs. 9.60 ± 3.5, P 0.024). For prediction of EP, ePLAR had the best diagnostic yield (sensibility 70%, specificity 63%) compared to TRVmax, TAPSE and Tricuspid DTI S wave velocity. Most patients having sub massive acute PE presented with normal systolic pulmonary artery pressure and conserved RV function. Regardless of that, they had a significantly higher ePLAR value, suggesting increased TPG with precapillary flow obstruction. This novel parameter could also offer a more sensitive echocardiographic sign to disturbed haemodynamics in these patients. [ABSTRACT FROM AUTHOR]

Objective: While the surgical stages of single ventricle (SV) palliation serve to separate pulmonary venous and systemic venous return, and to volume-unload the SV, staged palliation also results in transition from parallel to series circulation, increasing total vascular resistance. How this transition affects pressure loading of the SV is as yet unreported.Methods: We performed a retrospective chart review of Stage I, II, and III cardiac catheterization (CC) and echocardiographic data from 2001-2017 in all SV pts, with focus on systemic, pulmonary, and total vascular resistance (SVR, PVR, TVR respectively). Longitudinal analyses were performed with log-transformed variables. Effects of SVR-lowering medications were analyzed using Wilcoxon rank-sum testing.Results: There were 372 total patients who underwent CC at a Stage I (median age of 4.4 months, n=310), Stage II (median age 2.7 years, n = 244), and Stage III (median age 7.3 years, n = 113). Total volume loading decreases with progression to Stage III (P< 0.001). While PVR gradually increases from Stage II to Stage III, and SVR increases from Stage I to Stage III, TVR dramatically increases with progress towards series circulation. TVR was not affected by use of systemic vasodilator therapy. TVR, PVR, SVR, and CI did not correlate with indices of SV function at Stage III.Conclusions: TVR steadily increases with an increasing contribution from SVR over progressive stages. TVR was not affected by systemic vasodilator agents. TVR did not correlate with echo-based indices of SV function. Further studies are needed to see if modulating TVR can improve exercise tolerance and outcomes. [ABSTRACT FROM AUTHOR]

La lombalgie est un problème majeur de santé publique dans les pays occidentaux. Le caractère bénin de la lombalgie contraste régulièrement avec son retentissement sur la qualité de vie du fait de son caractère volontiers récidivant et de sa potentielle évolution vers la chronicité, stade auquel elle s'accompagne régulièrement d'une restriction de participation sociale et professionnelle. La pratique d'une activité physique (AP) régulière et d'exercices physiques (EP) est essentielle pour la prise en charge de la lombalgie et la prévention des récidives. L'AP est ainsi recommandée à tous les stades de la lombalgie. Or, la douleur, les croyances erronées et les comportements inappropriés vis-à-vis de la douleur font régulièrement obstacles à la pratique d'une AP. Selon le modèle biopsychosocial, la lombalgie chronique est liée à un ensemble de facteurs qui rendent sa prise en charge complexe. Ce constat a conduit à la mise en place de programmes multidisciplinaires de réentraînement à l'effort comprenant une prise en charge des composantes physique, psycho-comportementale et socioprofessionnelle de la lombalgie chronique. La composante rééducative des programmes comprend classiquement des exercices de renforcement musculaire et d'étirement, des activités aérobies et de stabilisation rachidienne. Les autres aspects de la prise en charge incluent l'amélioration des paramètres psychosociaux et comportementaux via notamment les thérapies cognitives et comportementales et l'éducation thérapeutique du patient. Enfin, la plupart des programmes proposent également une évaluation et un accompagnement socioprofessionnel en vue d'améliorer le retour au travail ou le maintien en emploi. L'approche multidisciplinaire de la prise en charge de la lombalgie chronique a montré son efficacité, notamment en termes d'incapacité fonctionnelle et d'intensité de la douleur alors que les effets concernant l'absentéisme et le retour au travail sont plus hétérogènes. Favoriser les comportements actifs et l'autonomie des patients au décours de la prise en charge supervisée, sur le long terme, est un enjeu crucial. Cela nécessite donc, d'une part, de prendre en compte la préférence du patient pour le choix de l'AP et des EP, mais également de mettre l'accent sur les stratégies motivationnelles. Low back pain (LBP) is a major public health problem in Western countries. The benign nature of LBP regularly contrasts with its impact on quality of life due to its readily recurrent nature and its potential progression to chronicity, a stage at which it is regularly accompanied by a restriction of social and professional participation. Regular physical activity (PA) and exercise (PE) are essential for the management of LBP and the prevention of recurrence. PA is therefore recommended for all stages of LBP. However, pain, mistaken beliefs and inappropriate pain-related behaviours regularly form obstacles to practicing PA. According to the biopsychosocial model, chronic LBP is linked to a set of factors that make its management complex. This observation has led to the establishment of multidisciplinary functional restoration programs including management of the physical, psycho-behavioural and socio-professional components of chronic LBP. The rehabilitation component of programs typically includes muscle strengthening and stretching exercises, aerobic activities and spinal stabilisation. Other aspects of care include improving psychosocial and behavioural parameters, notably through cognitive and behavioural therapies and therapeutic education of the patient. Lastly, most programs also offer socio-professional assessment and support with a view to improving return to work or job retention. The multidisciplinary approach to the management of chronic LBP has shown its effectiveness, particularly in terms of functional disability and pain intensity, while the effects concerning absenteeism and return to work are more heterogeneous. Promoting active behaviours and patient autonomy during the course of supervised care, over the long term, is a crucial issue. This therefore requires, on the one hand, to take into account the patient's preference for the choice of PA and PE, but also to focus on motivational strategies. [ABSTRACT FROM AUTHOR]

Background: Heart rate follows a diurnal variation, and slow heart rhythms occur primarily at night.Objective: The lower heart rate during sleep is assumed to be neural in origin, but here we tested whether a day-night difference in intrinsic pacemaking is involved.Methods: In vivo and in vitro electrocardiographic recordings, vagotomy, transgenics, quantitative polymerase chain reaction, Western blotting, immunohistochemistry, patch clamp, reporter bioluminescence recordings, and chromatin immunoprecipitation were used.Results: The day-night difference in the average heart rate of mice was independent of fluctuations in average locomotor activity and persisted under pharmacological, surgical, and transgenic interruption of autonomic input to the heart. Spontaneous beating rate of isolated (ie, denervated) sinus node (SN) preparations exhibited a day-night rhythm concomitant with rhythmic messenger RNA expression of ion channels including hyperpolarization-activated cyclic nucleotide-gated potassium channel 4 (HCN4). In vitro studies demonstrated 24-hour rhythms in the human HCN4 promoter and the corresponding funny current. The day-night heart rate difference in mice was abolished by HCN block, both in vivo and in the isolated SN. Rhythmic expression of canonical circadian clock transcription factors, for example, Brain and muscle ARNT-Like 1 (BMAL1) and Cryptochrome (CRY) was identified in the SN and disruption of the local clock (by cardiomyocyte-specific knockout of Bmal1) abolished the day-night difference in Hcn4 and intrinsic heart rate. Chromatin immunoprecipitation revealed specific BMAL1 binding sites on Hcn4, linking the local clock with intrinsic rate control.Conclusion: The circadian variation in heart rate involves SN local clock-dependent Hcn4 rhythmicity. Data reveal a novel regulator of heart rate and mechanistic insight into bradycardia during sleep. [ABSTRACT FROM AUTHOR]

To examine the available literature to better understand the objective and patient-reported outcomes using peroneus longus tendon (PLT) autograft compared with more commonly used autografts, such as the quadrupled hamstring tendons (HT), in patients undergoing primary for anterior cruciate ligament reconstruction (ACLR). A comprehensive search of published literature in PubMed, Web of Science, Cochrane Library, Ovid, and EMBASE databases was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria included patients undergoing ACLR with PLT autograft, inclusion of patient-recorded outcome measures, and availability in English language. Publications that included only biomechanical analysis or ACLR with use of allograft or combination grafts were excluded. A total of 16 studies (Level of Evidence range: I-IV) met inclusion criteria, with follow-up ranging from 3 months to 5 years. In the available case series, patient-reported outcomes ranged from Lysholm = 80.7 to 95.1, International Knee Documentation Committee 78.1 to 95.7. In prospective cohorts and randomized controlled trials, PLT performance was comparable with HT autografts (PLT/HT: Lysholm = 88.3-95.1/86.5-94.9, International Knee Documentation Committee = 78.2-92.5/87.4-93.4). The majority of PLT grafts diameters were equal or greater than HT counterparts with a mean of >8 mm (PLT/HT: 7.0-9.0 mm/7.65-8.5 mm). There was minimal donor-site morbidity associated with PLT harvest. Although limitations exist within the available literature, existing evidence suggests that PLT autograft routinely produces adequately sized grafts with comparable early outcomes to HT autograft and low risk of donor-site morbidity. However, the PLT autograft is yet to demonstrate superiority to any of the more-traditional autograft selections. Level IV, systematic review of Level I-IV studies. [ABSTRACT FROM AUTHOR]

Sustainability scientists are increasingly expressing concerns about the lack of creativity and reflexivity, vital elements for driving sustainability transformations, in their profession. We argue that these concerns stem from established scientific practices of knowledge accumulation and interdisciplinary research, often neglecting the influence of group values and disciplinary paradigms. In response, we propose the narrative-led dialog as a tool for sustainability scientists to recognize, analyze and engage with such values and paradigms within interdisciplinary scientific practice. Building upon existing methods, the use of narratives offers scientists an additional way to identify and address the complexities of conflicts, overlaps, and uncertainties inherent in the values and paradigms that guide scientific research and collaboration. This process of revelation can assist sustainability scientists in disrupting traditional academic boundaries, fostering an environment that better nurtures sustainability transformation. Through the narrative-led dialog, scientists can achieve several crucial objectives; they can (1) deepen their scientific practice, (2) identify, discuss and negotiate the underlying values shaping their research, and (3) create an environment conducive to breakthrough ideas, both within their specific fields and across broader sustainability science communities. • Discover a method to uncover hidden assumptions in sustainability research. • The narrative-led dialogue reorganizes 'common' knowledge along underlying values. • Discovering, discussing and negotiating these values disrupts (narrow) science circles. • Challenging existing science circles promotes transparency, diversity and democratizes scientific discourse. [ABSTRACT FROM AUTHOR]

Stenotrophomonas maltophilia has been demonstrated herein to reduce CO 2 without any cofactor, photon or hydrogen (H 2) addition during reaction. S. maltophilia reduces 13CO 2 into 13C-labeled formate in batch mode. Two intracellular enzymes are curently being considered for their ability to catalyze the CO 2 reduction reaction: a Fe-nitrogenase and a formate dehydrogenase (FeS-FDH). The reaction was intensified by implementing the bacteria in an electrolysis cell continuously fed with CO 2. In this configuration, CO 2 removal reached up to 25% v/v at 30°C and atmospheric pressure. [Display omitted] • An isolated S. maltophilia bacterium was demonstrated to reduce CO 2 without H 2. • A commercial strain whose genome matches at 99.9% has similar CO 2 -reducing activity. • Fed-batch electrolysis allowed increasing CO 2 removals by at least 20-times. • The strain was active for at least 46 days and CO 2 removals up to 25% v/v were got. • The bacterial strain S. maltophilia was also demonstrated to reduce N 2. [ABSTRACT FROM AUTHOR]

Evaluate the midwives' practices and knowledges with regard to the management of the smoking cessation in pregnant women and analyse the profile of midwives prescribing nicotine replacement therapy (NRT). A national practice survey amongst 23,541 French midwives was conducted from 1 September 2020 to 15 September 2021 using an online self-administered questionnaire. The analysis of the 1,216 usable questionnaires (97, 7% women, mostly aged 30 to 49 years and non-smokers) showed that 93.4% of midwives frequently questioned pregnant women about their smoking consumption during pregnancy. The minimal counselling was known and practiced by 91% of midwives, the Fagerström test by 26.9% and the measurement of exhaled CO by 27.1%. Concerning NRT, 60% of the midwives prescribed them in a usual way and 36.8% were aware of the possibility of prescribing them to the pregnant woman's entourage. The profile of midwives prescribing NRT was significantly more concerned with smoking cessation in pregnant women; worked more frequently in a hospital; carried out 25% or more of antenatal monitoring consultations; and had significantly better knowledge of the evaluation tools, without influence of sex or smoking status. Improving the training of midwives in the screening and management of smoking cessation during pregnancy seems necessary. [ABSTRACT FROM AUTHOR]

Among metastatic breast cancer (MBC) patients, those with a triple-negative breast cancer phenotype (mTNBC) have the worst prognosis, but the benefit of chemotherapy beyond second line on outcome remains uncertain. The purpose of this study was to identify predictive factors of outcome after third- or fourth-line chemotherapy. The ESME-MBC database is a French prospective real-life cohort with homogeneous data collection, including patients who initiated first-line treatment for MBC (2008–2016) in 18 cancer centers. After selection of mTNBC cases, we searched for independent predictive factors (Cox proportional-hazards regression models) for overall survival (OS) on third- and fourth-line chemotherapy (OS3, OS4). We built prognostic nomograms based on the main prognostic factors identified. Of the 22,266 MBC cases in the ESME cohort, 2903 were mTNBC, 1074 (37%) and 598 (20%) of which had received at least 3 or 4 lines of chemotherapy. PFS after first- and second-line chemotherapy (PFS1, PFS2) and number of metastatic sites ≥3 at baseline were identified by multivariate analysis as prognostic factors for both OS3 (HR = 0.76 95%CI[0.66–0.88], HR = 0.55 95%CI[0.46–0.65], HR = 1.36 95%CI[1.14–1.62], respectively), and OS4 (HR = 0.76 95%CI[0.63–0.91], HR = 0.56 95%CI[0.45–0.7], HR = 1.37 95%CI[1.07–1.74]), respectively. In addition, metastasis-free interval was identified as a prognostic factor for OS3 (p = 0.01), while PFS3 influenced OS4 (HR = 0.75 95%CI[0.57–0.98]). Nomograms predicting OS3 and OS4 achieved a C-index of 0.62 and 0.61, respectively. The duration of each previous PFS is a major prognostic factor for OS in mTNBC patients receiving third- or fourth-line chemotherapy. The clinical utility of nomograms including this information was not demonstrated. • After 3rd- or 4th-line therapy, PFS remained linear in the majority of women with metastatic triple-negative breast cancer. • The duration of each previous PFS had an impact on the OS associated with subsequent lines. • PFS2 was more strongly predictive of outcome than PFS1 for third-line therapy. • PFS2 and PFS3 had an impact on outcome irrespective of PFS1 for fourth-line therapy. • The clinical utility of nomograms including duration of each previous PFS to predict OS was not sufficient. [ABSTRACT FROM AUTHOR]

Background: This study aims to investigate the occurrence of unplanned hospitalizations in older patients with cancer and to determine predictive factors. Methods: A prospective Belgian multicentre (n = 22), observational cohort study was performed. Patients ≥70 years with a malignant tumor were included. Patients underwent G8 screening followed by geriatric assessment (GA) if abnormal at baseline and were followed for unplanned hospitalizations at approximately three months. Uni- and multivariable regression models were performed to determine predictive factors associated with unplanned hospitalizations in older patients with an abnormal G8. Results: In total, 7763 patients were included in the current analysis of which 2409 (31%) patients with a normal G8 score and 5354 (69%) with an abnormal G8 score. Patients with an abnormal G8 were hospitalized more frequently than patients with a normal G8 (22.9% versus 12.4%; p < 0.0001). Reasons for unplanned hospitalizations were most frequently cancer related (25.7%) or cancer therapy related (28%). In multivariable analysis, predictive factors for unplanned hospitalizations in older patients with cancer and an abnormal G8 were female gender, absence of surgery, chemotherapy, ADL dependency, malnutrition and presence of comorbidities. Conclusion: Older patients with cancer and an abnormal G8 screening present a higher risk (23%) for unplanned hospitalizations. Predictive factors for these patients were identified and include not only patient and treatment related factors but also GA related factors. [ABSTRACT FROM AUTHOR]

Stereolithography (SLA) ceramic crown frameworks are suitable for clinical use, but the impact of SLA build orientation has not been identified. The purpose of this in vitro study was to investigate the effect of 3 build orientations on the physical and mechanical properties and the microstructure of SLA alumina dental ceramics. The physical and mechanical properties and microstructures of 3 different oriented SLA alumina ceramics (ZX, ZY, and XY) were evaluated by visual observation, hydrostatic weighing (n=10/group), Weibull analyses (n=30/group), scanning electron microscopy, 3-point flexural strength (n=30/group), fracture toughness (indentation, single-edge-V-notched-beam) (n=4/group), and Vickers hardness (n=15/group) testing. The hydrostatic weighing, 3-point flexural strength, fracture toughness, and Vickers hardness testing data were statistically analyzed (α=.05). The minimum resting period of slurries between the polymerization of 2 layers was shorter for the ZY- and ZX-oriented specimens and increased with the layer surface. The density and Vickers hardness of the SLA-manufactured specimens were similar for all groups (P >.05). The 95% confidence intervals of the Weibull moduli of the ZX- and ZY-oriented specimens were higher than that of the XY-oriented specimens, with no overlap fraction. The ZY-oriented specimens displayed significantly higher 3-point flexural strength (P <.05) and fracture toughness as evaluated by the single-edge-V-notched-beam method than the ZX-oriented specimens (P <.05). They also displayed significantly higher 3-point flexural strength than the XY-oriented specimens (P <.05). The microstructural analysis showed that the texturing was heterogeneous and that the major axis of the large grains of alumina ran parallel to the orientation of the layers. The ZY orientation produced a reliable dental ceramic by SLA, with the shortest general manufacturing time and the highest mechanical strength when the layers were perpendicular to the test load surface. [ABSTRACT FROM AUTHOR]

High Body mass index (BMI) is a risk factor for breast cancer among postmenopausal women and an adverse prognostic factor in early-stage. Little is known about its impact on clinical outcomes in patients with metastatic breast cancer (MBC). The National ESME-MBC observational cohort includes all consecutive patients newly diagnosed with MBC between Jan 2008 and Dec 2016 in the 18 French comprehensive cancer centers. Of 22 463 patients in ESME-MBC, 12 999 women had BMI data available at MBC diagnosis. Median BMI was 24.9 kg/m2 (range 12.1–66.5); 20% of women were obese and 5% underweight. Obesity was associated with more de novo MBC, while underweight patients had more aggressive cancer features. Median overall survival (OS) of the BMI cohort was 47.4 months (95% CI [46.2–48.5]) (median follow-up: 48.6 months). Underweight was independently associated with a worse OS (median OS 33 months; HR 1.14, 95%CI, 1.02–1.27) and first line progression-free survival (HR, 1.11; 95%CI, 1.01; 1.22), while overweight or obesity had no effect. Overweight and obesity are not associated with poorer outcomes in women with metastatic disease, while underweight appears as an independent adverse prognostic factor. • This is the first large multicenter cohort reporting BMI's effect on outcomes among patients with metastatic breast cancer. • Overweight or obese status does not negatively influence outcome of metastatic breast cancer patients, whatever the subtype. • Underweight is a strong negative independent prognostic factor on outcomes, whatever the subtype. [ABSTRACT FROM AUTHOR]