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Objective To evaluate the association between dose of skin-to-skin contact (SSC) per day and initiation time with the occurrence of deaths in newborns with weight up to 1800g. Method Multicentric cohort in five Brazilian neonatal units, including newborns with a birth weight of ≤1800g. The time of SSC was registered in individual file, by the team or family during the hospitalization. Maternal and newborn data were obtained through questionnaires applied to mothers and in medical records. Classification Tree was used for data analysis. Results The performance of the first SSC after 206h was significantly associated with death (p = 0.02). Although there was no association between SSC/day and death (p = 0.09), the number of deaths among those who performed more than 146.9 minutes/day was lower (3;1.5%) than among those who performed this practice for a shorter time (13;6.4%), a fact considered of great clinical importance. Early and late infections present statistically significant associations with the outcome. The chance of death was equal to zero when there was no early infection in the group with the longest duration of SSC. This probability was also equal to zero in the absence of late sepsis for the group with less than 146.9 minutes/day of SSC. Conclusions The first SSC before 206 hours of life is recommended in order to observe a reduction in the risk of neonatal death. Staying in SSC for more than 146.9 min/day seems to be clinically beneficial for these neonates mostly when it was associated with the absence of infection.

International audience; Background: Intensive care unit (ICU) healthcare workers (HCWs) are at the forefront of the coronavirus disease 2019 pandemic. To overcome the lack of human resources during this crisis, some ICUs had to mobilise staff from a reinforcement pool, with no or outdated ICU experience. This study aimed to investigate and to compare the psychological impact of the pandemic on regular ICU staff members and reinforcement workers.Material and methods: Self-assessment questionnaires were completed by HCWs who worked from March 1 to April 30, 2020, in our 16-bed neurological ICU at La Pitié-Salpêtrière Hospital in Paris, France, which was converted to a COVID ICU. The Hospital Anxiety and Depression Scale, the Post-traumatic Stress Disorder Checklist for DSM-5, McGill Quality of Life Questionnaire-Revised, and 10-item Connor-Davidson Resilience Scale were used to assess anxiety, depression and post-traumatic stress disorder, quality of life, and resilience, respectively.Results: Sixty-nine ICU HCWs completed the survey (37 from the team of regular staff members, i.e., from the public health service, and 32 from a reinforcement pool, either from non-ICU public health service or from private healthcare interim employment agencies). Prevalence of anxiety, depression, and post-traumatic stress disorder symptoms was high, at 19%, 9%, and 16%, respectively, with limited impairment in quality of life or resilience scores. Depression symptoms were observed more in regular staff members than in welcomed reinforcement workers, at 16% and 0%, respectively.Conclusions: These results revealed that during the pandemic, HCWs from the team of regular staff members were at greater risk of developing psychological disorder compared with reinforcement workers, with higher levels of depressive symptoms.

Summary Introduction The management strategy for common bile duct stones (CBD) in patients over 75 years is a real challenge that requires balancing the efficacy of a multiplicity of procedures against their own morbidity. The objective is to compare one-stage surgical treatment versus the two-stage combination of endoscopy and surgery in terms of efficacy of clearing the CBD of stones and the morbidity and mortality in elderly patients. Material and methods This study included eighty-two patients over 75 years of age with symptomatic CBD stones who presented between 2010 and 2017. Patients were treated either by one-stage surgery alone (S group, n = 40) or by sequential endoscopy and surgery (ES group, n = 42). Results Immediate and 30-day mortality, morbidity and duration of hospitalization were comparable. The failure rate for clearing CBD lithiasis was significantly higher in the ES group (26.2% vs. 7.5%, P = 0.038, 95% CI). In multivariate analysis, two-stage treatment and multiple CBD stones were associated with a significantly higher risk of failure. Fewer anesthetic procedures were needed in the S group. Twelve patients (14.4%) had multiple stones packing the CBD (> 3 stones); four were treated with choledocho-duodenal anastomosis and eight with endoscopic sphincterotomy and stone removal with 100% and 50% efficacy, respectively. Conclusion The “surgery alone” attitude compared to 2-stage endoscopic and surgical management is associated with better efficacy in terms of clearing the CBD of lithiasis and requires fewer anesthetic procedures in elderly subjects while being comparable in terms of morbidity and mortality. In patients whose CBD is packed with multiple stones, choledocho-duodenal anastomosis is an alternative to endoscopy for management of choledocholithiasis.

Resume Introduction La strategie de prise en charge des lithiases de la voie biliaire principale (VBP) chez les patients de plus de 75 ans constitue un reel enjeu mettant en balance la multiplication des procedures et leur morbidite propre. L’objectif est de comparer le traitement chirurgical en un temps a l’association endoscopie-chirurgie en deux temps en termes d’efficacite de liberation de la VBP et de morbi-mortalite chez le sujet âge. Materiel et methodes Quatre-vingt deux patients de plus de 75 ans presentant une lithiase de la VBP symptomatique entre 2010 et 2017 ont ete inclus. Les malades etaient traites par chirurgie seule (groupe CS, n = 40) ou par endoscopie et chirurgie (groupe EC, n = 42). Resultats La mortalite immediate et a 30 jours, la morbidite et la duree d’hospitalisation etaient comparables. Le taux d’echec de liberation de la VBP etait significativement plus eleve dans le groupe EC (26,2 % vs 7,5 %, p = 0,038, IC95 %). En analyse multivariee, un traitement en deux temps et un empierrement choledocien etaient associes a un risque significativement plus eleve d’echec. Moins de procedures anesthesiques etaient necessaires dans le groupe CS. Douze patients (14,4 %) presentaient un empierrement choledocien (> 3 calculs) dont 4 traites par anastomose choledoco-duodenale et 8 par endoscopie avec respectivement 100 % et de 50 % d’efficacite. Conclusion L’attitude « tout chirurgical » en comparaison a une prise en charge en 2 temps est associee a une meilleure efficacite en termes de liberation de la VBP et requiert moins de procedures anesthesiques chez les sujets âges tout en etant comparable en termes de morbi-mortalite. Chez ces patients, l’anastomose choledoco-duodenale est une alternative a l’endoscopie pour traiter les empierrements.

Resume La prise en charge des traumatismes penetrants abdominaux, pelviens, vasculaires et des confins depend du statut hemodynamique du blesse et du type de lesions, sachant que l’association lesionnelle est la regle. Leur gravite est liee au risque hemorragique initial puis au risque septique secondaire et enfin aux sequelles des associations lesionnelles. En cas d’instabilite hemodynamique, l’objectif de la prise en charge est l’obtention rapide de l’hemostase et de la coprostase. Cette attitude conduira a realiser une laparotomie d’emblee pour les plaies abdominales, un packing sous-peritoneal (PSP) et la mise en place d’un ballon d’occlusion aortique (REBOA) au dechoquage pour les plaies pelviennes, la pose d’un shunt vasculaire temporaire (SVT) pour les traumatismes des vaisseaux proximaux des membres et la ligature pour les lesions hemorragiques des vaisseaux distaux et enfin le controle des saignements exteriorises au moyen de garrot tourniquet, de pansement compressifs jonctionnels ou de compresses hemostatiques pour les plaies des confins. En cas de stabilite hemodynamique, des examens d’imagerie preoperatoire permettront un bilan lesionnel plus precis, notamment en ce qui concerne les lesions retroperitoneales ou thoraco-abdominales, difficilement explorable chirurgicalement. Les voies d’abord chirurgicales seront larges, systematisees, agrandies a la demande permettant d’appliquer les principes du damage control.

Background Intraoperative photography is used extensively for communication, research, or teaching. The objective of the present work was to define, using a standardized methodology and literature review, the best technical conditions for intraoperative photography. Materials and methods Using either a smartphone camera, a bridge camera, or a single-lens reflex (SLR) camera, photographs were taken under various standard conditions by a professional photographer. All images were independently assessed blinded to technical conditions to define the best shooting conditions and methods. Results For better photographs, an SLR camera with manual settings should be used. Photographs should be centered and taken vertically and orthogonal to the surgical field with a linear scale to avoid error in perspective. The shooting distance should be about 75 cm using an 80–100-mm focal lens. Flash should be avoided and scialytic low-powered light should be used without focus. The operative field should be clean, wet surfaces should be avoided, and metal instruments should be hidden to avoid reflections. For SLR camera, International Organization for Standardization speed should be as low as possible, autofocus area selection mode should be on single point AF, shutter speed should be above 1/100 second, and aperture should be as narrow as possible, above f/8. For smartphone, use high dynamic range setting if available, use of flash, digital filter, effect apps, and digital zoom is not recommended. Conclusions If a few basic technical rules are known and applied, high-quality photographs can be taken by amateur photographers and fit the standards accepted in clinical practice, academic communication, and publications.

Penetrating traumas are rare in France and mainly due to stabbing. Knives are less lethal than firearms. The initial clinical assessment is the cornerstone of hospital care. It remains a priority and can quickly lead to a surgical treatment first. Urgent surgical indications are hemorrhagic shock, evisceration and peritonitis. Dying patients should be immediately taken to the operating room for rescue laparotomy or thoracotomy. Ultrasonography and chest radiography are performed before damage control surgery for hemodynamic unstable critical patients. Stable patients are scanned by CT and in some cases may benefit from non-operative strategy. Mortality remains high, initially due to bleeding complications and secondarily to infectious complications. Early and appropriate surgery can reduce morbidity and mortality. Non-operative strategy is only possible in selected patients in trained trauma centers and with intensive supervision by experienced staff.

The hemangioma of the adrenal gland is an adrenal gland lesion rare, benign and usually asymptomatic. Discovered incidentally during an abdominal imaging study, it is part of incidentalomas. Imagery is the best to characterise these silent adrenal masses (computed tomography [CT], Magnetic Resonance Imaging [MRI]± Positron Emission Tomography [PET scan] with 18F-FDG). The main risks of the hemangioma are ignorance of malignancy, bleeding and abdominal mass syndrome. The analysis of the literature shows the importance of laparoscopy. A multidisciplinary discussion on this type of lesion appears indispensable both diagnostic and therapeutic.

Resume Introduction. – La scintigraphie pulmonaire constitue une exploration fonctionnelle regionale de la ventilation et de la perfusion pulmonaire. Elle permet un depistage precoce d'eventuelles lesions pulmonaires, notamment au cours de la mucoviscidose et d'autres bronchopneumopathies chroniques obstructives de l'enfant. Observations. – Nous rapportons deux observations d'enfants atteints, l'un de mucoviscidose, l'autre de bronchopneumopathie chronique obstructive (BPCO) d'etiologie indeterminee qui presentaient un trouble ventilatoire majeur localise, diagnostique a la scintigraphie pulmonaire, avant l'apparition de signes cliniques et radiologiques. Dans les deux cas, un bouchon muqueux obstruant la bronche lobaire correspondante fut mis en evidence et retire a l'aide du fibroscope bronchique souple. Conclusion. – La scintigraphie pulmonaire est un outil de depistage precoce d'anomalies pulmonaires localisees, parfois indetectables sur la radiographie de thorax et peu marquees a la tomodensitometrie (TDM) thoracique. Elle peut reveler la presence d'un obstacle bronchique et ainsi eviter l'apparition de dilatations des bronches grâce a une prise en charge rapide adaptee.

This paper demonstrates the complementary relation between functional parameters and electroluminescence spectroscopy for reliability investigations of 1550 nm Semiconductor Optical Amplifiers of 700 μm length active region. Ageing tests have been set to 270 mA-100 °C-1500 h and realized on two different wafers showing more impact on wafer 1 than on wafer 2. Our investigations are particularly focused on interpretation of electroluminescence spectra, from reference and aged SOAs of wafer 1, leading to an improvement of degradation mechanisms understanding. The shift rate to lower energies of the recombination energy peak at 1550 nm, as reported by electroluminescence spectra between reference and aged SOAs in relation with the decrease of optical power measured at 200 mA for the degraded SOA and completed by I(V) characterizations, suggest occurrence of non radiative deep centers near the buried ridge structure in relation with the cleaning process uniformity of interfaces before epitaxial overgrowth. These defects mainly trap majority injected carriers instead of minority carriers reducing the luminescence in the active zone. By monitoring the most sensitive failure indicator (pseudo-threshold current), lifetime distributions are also calculated to determine failure rate, between 150 and 200 FITs over 15 years for operating conditions (25 °C-200 mA) using experimental degradation laws and statistic computations, demonstrating the overall robustness of this technology.

Ferritin has been shown as being the principal iron storage in the majority of living organisms. In marine species, ferritin is also involved in high-level accumulation of (210)Po. As part of our work on the investigation of these radionuclides' concentration in natural environment, ferritin was searched at the gene and protein level. Ferritin was purified from the visceral mass of the oyster Crassostrea gigas by ion-exchange chromatography and HPLC. SDS-PAGE revealed one band of 20 kDa. An Expressed Sequence Tag (EST) library was screened and led to the identification of two complementary DNA (cDNA) involved in ferritin subunit expression. The complete coding sequences and the untranslated regions (UTRs) of the two genes were obtained and a 5' Rapid Amplification of cDNA Ends (RACE) was used to obtain the two iron-responsive elements (IREs) with the predicted stem-loop structures usually present in the 5'-UTR of ferritin mRNA. Sequence alignment in amino acid of the two new cDNA showed an identity with Pinctada fucata (85.4-88.3%), Lymnaea stagnalis (79.3-82.2%) and Helix pomatia (79.1-79.1%). The residues responsible for the ferroxidase center, conserved in all vertebrate H-ferritins, are present in the two oyster ferritin subunits. Oyster ferritins do not present the special characteristics of other invertebrate ferritins like insect ferritins but have some functional similarities with the vertebrate H chains ferritin.

Specific immunotherapy involves the administration of allergen extracts to achieve clinical tolerance of the allergens which cause symptoms in patients with allergic conditions. Immunotherapy has been shown to be effective in patients with mild forms of allergic diseases, specially in upper airway diseases. Recent studies suggest that specific immunotherapy may also modify the course of allergic disease, by reducing the risk of developing new allergic sensitizations, and also inhibiting the development of clinical asthma in children treated for allergic rhinitis. The traditional subcutaneous route is burdened with the risk of severe adverse events, therefore, local routes have been investigated and developed. The sublingual route is supported by numerous controlled trials showing its efficacy in rhinitis. The safety profile, assessed in clinical trials studies, is satisfactory. Several points still need to be elucidated, including mechanisms of action, optimal dosage, cost-effectiveness, and adherence. New approaches using mimic bacterial DNA vaccines alone or associated to modified allergen, which enhances immunogenicity in terms of eliciting a Th1-type response vaccines, are also undergoing serious consideration.

The purpose of this study is to present three-dimensional simulations using finite element method (FEM) of thermomechanical stresses and strains in 1550 nm Laser modules induced by Nd:YAG crystal Laser welds and thermal cycles on two main sub-assemblies: Laser submount and pigtail. Non-linear FEM computations, taking into account of experimental σ(e) measured curves, show that Laser welding process can induce high level of strains in columns of the Laser platform, bearing the Laser diode, responsible of an optical axis shift and a gradual drop of the optical power in relation with relaxation of accumulated stresses in the sub-assembly. In the case of thermal cycles, stresses can occur on elements sensitive to coefficient of thermal expansion mismatches such as solder joint between the Laser platform and thermoelectric cooler and as fiber glued into the pigtail leading to crack propagation with sudden drop of optical power. The main objective of the paper is to evaluate thermomechanical sensitivity and critical zones of the Laser module in order to improve mechanical stability after Laser weld and reach qualification standards requirements without failures. Experimental analyses were also conducted to correlate simulation results and monitor the output optical power of Laser modules after 500 thermal cycles (−40 °C/+85 °C VRT).

Resume L’asthme de l’adulte est une maladie chronique inflammatoire caracterisee principalement par un infiltrat eosinophilique. Objectif. – Evaluer la relation entre differents phenotypes cliniques chez l’enfant asthmatique et les cellules retrouvees dans le lavage broncho-alveolaire (LBA). Patients et methodes. – Nous avons realise un LBA chez 79 enfants asthmatiques âges de 5 mois a 18 ans. Quarante-huit pour cent presentaient un asthme allergique et 43 % un asthme persistant severe. La relation phenotype clinique et profil cellulaire du LBA a ete analysee par une methode multivariee. Resultats. – Les resultats montrent que : 1) les nourrissons ont une elevation significative du nombre de cellules alveolaires totales (particulierement les macrophages alveolaires) par rapport aux enfants plus âges ; 2) l’asthme allergique est associe a la presence d’eosinophiles alveolaires ; 3) l’asthme persistant severe et l’anciennete de l’asthme sont associes a une augmentation du nombre de neutrophiles alveolaires. Conclusions. – Nous montrons pour la 1re fois que dans l’asthme du nourrisson et de l’enfant, l’eosinophile alveolaire n’est retrouve que dans l’asthme allergique.

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

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