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Purpose Wide-neck bifurcation aneurysms remain challenging for the neurointerventionist and/or neurosurgeon despite many recent advances. The pCONus (Phenox, Bochum, Germany) is an emerging device for endovascular neck protection, we report the first long-term results of this device. Methods We performed a retrospective analysis of all consecutive intracranial wide-neck bifurcation aneurysms treated with the pCONus. Patients' characteristics were reviewed, procedural complications, angiographic (Roy-Raymond scale) and clinical outcomes were documented. Results Between January 2016 and September 2019, 43 patients (74% female, median age 56 [49–66] years) with 43 wide-neck bifurcation aneurysms (mean width of 6.8 ± 2.1 mm, dome/neck ratio of 1.3 ± 0.2 and neck of 5.2 ± 1.3 mm) were included. A procedural angiographic complication was reported in five patients (12%), no patient presented a post-operative neurological deficit or long-term complication, mortality rate was 0%. At last follow-up (median of 46.5 months [38.3–51.7]), an adequate occlusion (complete and neck remnant) was observed in 37/43 patients (86%) and an aneurysm remnant in 6/43 (14%). Four patients (9%) needed retreatment. No in-stent stenosis or branch occlusion was depicted. Conclusion pCONus device provides a safe and efficient alternative for endovascular wide-neck bifurcation aneurysms management, with long-term stability.

We report a case of cerebral aneurysm rerupture 24 months after initial bleeding and complete occlusion using a WEB device. A middle-aged patient was transferred at our institution because of a recurrent aneurysmal bleeding. The patient was graded WFNS2 and unenhanced CT showed a modified Fisher grade 3 SAH. DSA showed an increased compaction and an evolutive “proximal recess” of the WEB device associated with a small unprotected part of the aneurysm wall and a bleb pointing towards the haemorrhage. Balloon- and stent-assisted coiling was performed, allowing to completely occlude the recurrence. The patient suffered no neurological deficit neither delayed complication and was discharged at day 16.

International audience; Drawing upon a study carried out at a funeral home, a hospital, and a police station, this article explores the sociological study of emotions at work and their political dimension. First, it emphasizes the methodological contributions of comparative ethnography, arguing in favor of this combined methodology by seeking to highlight its refined use of observation and interviews by mobilizing various professional circles. Second, the article aims to understand the political handling of emotions in the workplace (especially what we term “emotional risk”). Emotional risk is often an invisible risk because it is normalized. It is an important issue for working conditions and their negotiation, but it is difficult to bring to the fore. It is often explained and legitimized by professional culture, more or less ignored by management, and relatively forgotten by trade union action. As a result, it rarely or never detaches itself from the local sphere and therefore does not acquire a broader political dimension, although public policies are showing a growing interest in matters of well-being at work.; En s’appuyant sur une enquête menée dans les pompes funèbres, à l’hôpital et dans la police, l’article propose de traiter de l’étude sociologique des émotions au travail et de leur dimension politique. D’un côté, il souligne donc les apports méthodologiques de l’ethnographie comparée. L’article plaide en faveur de cette méthodologie combinée en cherchant à montrer la finesse qu’elle permet par l’usage de l’observation et des entretiens en mobilisant divers milieux professionnels. D’un autre côté, l’article vise à comprendre comment les émotions au travail (surtout ce que nous avons appelé le « risque émotionnel ») sont traitées politiquement. Le risque émotionnel peut apparaître souvent comme un risque invisibilisé, car normalisé. Il constitue un enjeu important pour les conditions de travail et leur négociation, mais il est délicat à mettre en avant. Il est souvent expliqué et légitimé par la culture professionnelle, plus ou moins nié par les logiques gestionnaires et relativement oublié de l’action syndicale. Par conséquent, il s’extrait peu ou pas du champ local et n’acquiert donc pas une dimension politique plus large, alors même que l’on observe un intérêt croissant des politiques publiques pour les questions de bien-être au travail.

Introduction Stent-assisted coiling has widened indications and improved stability of endovascular treatment of intracranial aneurysms. However, stent-assisted coiling is usually not used to treat acutely ruptured intracranial aneurysms to avoid antiplatelet therapy. The objective of this study is to evaluate a strategy of staged endovascular treatment of ruptured intracranial aneurysms including coiling at the acute phase with complementary stenting with or without coiling at the subacute phase. Material and methods Between 2012 and 2017, we retrospectively identified, in our prospectively maintained database, all patients treated for a ruptured intracranial aneurysm based on this staged stenting strategy. Clinical charts and imaging follow-up were analyzed to assess the procedural safety and feasibility as well as clinical and anatomical outcome. Results We identified 23 patients with 23 intracranial aneurysms including 15 (65.2%) women with a mean age of 50 years (range 24–69 years). No rebleeding occurred during the mean delay of 24.3 days between initial coiling and stenting. All procedures were successful and additional coiling was performed in 5/23 procedures (21.7%). Clinical status was unchanged in all patients. At follow-up, the modified Rankin scale was graded 0 in 19/23 (82.6%), 1 in 2/23 (8.7%), and 2 in 2/23 (8.7%) patients, respectively. The rate of complete occlusion rose from 30.4% before the stenting procedure to 52.2% immediately after and 72.7% at follow-up. Conclusion This strategy of early staged stenting in selected patients is safe and improves immediate intracranial aneurysm occlusion and long-term stability in this population at high risk of intracranial aneurysm recurrence with coiling alone.

Background and PurposeGood clinical outcome predictors have been established in mechanical thrombectomy (MT) for acute ischemic stroke (AIS) caused by large vessel occlusion (LVO). An early neurological improvement (ENI), defined as a reduction of ≥8 on the National Institutes of Health Stroke Scale (NIHSS), compared with the baseline score or an NIHSS of 0 or 1 at 24 h after MT, is a strong predictor of favorable outcome. We aimed to study the impact of ENI after MT for distal medium vessel occlusions (DMVO).MethodsWe retrospectively analyzed the data of consecutive patients who underwent MT for a primary DMVO in one large academic center. We compared clinical outcomes between patients with DMVO stratified by ENI. Multivariate analyses were performed to determine the impact of ENI on good 90-day outcome (modified Rankin scale of 0–2) and identify factors contributing to ENI.ResultsBetween January 2018 and January 2021, 61 patients underwent an MT for an AIS with a primary DMVO. An ENI was seen in 24 (39%) patients (ENI+). Outcomes were significantly better in ENI+ patients, with 83% achieving a good outcome at 3 months vs. 43% for patients without ENI (ENI–; p = 0.019). ENI was an independent predictive factor of good clinical outcome even after adjusting for potential confounding factors [odds ratio 12.49 (1.49–105.01), p = 0.020]. The use of intravenous tissue plasminogen activator [IVtPA; Odds-ratio 6.59 (1.82–23.89), p = 0.004] was a positive predictor of ENI.ConclusionENI at day 1 following MT for DMVO stroke is a strong independent predictor of good to excellent 3-month clinical outcome.

Purpose To evaluate the safety and efficacy of the Tigertriever 13 (Rapid Medical, Yoqneam, Israel) stent retriever in acute ischemic stroke (AIS) patients with primary or secondary distal, medium vessel occlusions (DMVO). Methods We performed a retrospective analysis of all consecutive AIS patients who underwent thrombectomy with the Tigertriever13 for DMVO. Patients’ characteristics were reviewed, procedural complications, angiographic (modified thrombolysis in cerebral infarction score [mTICI]) and clinical (modified Rankin Scale [mRS]) outcomes were documented. Results Between November 2019 and November 2020, 16 patients with 17 DMVO were included (40% female, median age 60 [50–65] years). The Tigertriever13 was used in 11/17 (65%, median NIHSS of 8 [6–15]) primary DMVO and in 6/17 (35%, median NIHSS of 20 [13–24]) cases of secondary DMVO after a proximal thrombectomy. The successful reperfusion rate (mTICI 2b, 2c, 3) was 94% (16/17) for the dedicated vessel. At day 1, CT imaging showed a subarachnoid hemorrhage in 29% of the cases and a parenchymal hematoma in 12%. At 3 months, 65% of the patients (11/17) had a favorable outcome (mRS 0–2). Conclusion Mechanical thrombectomy using the Tigertriever13 appears to be safe and effective for DMVO. Clinical and anatomical results are in line with those of patients with proximal occlusions.

Background and Purpose: Previous studies have noted the angiographic appearance of early venous filling (EVF) following recanalisation in acute ischemic stroke. However, the prognostic implications of EVF as a novel imaging biomarker remain unclear. We aimed to evaluate the correlation between EVF with (i) the risk of subsequent reperfusion hemorrhage (RPH) and (ii) the association of EVF on both the NIHSS score at 24 h and functional outcome as assessed with the Modified Rankin Scale (mRS) score at 90 days. Methods: We conducted a retrospective cohort study of patients presenting with an acute ischemic stroke due to a proximal large-vessel occlusion of the anterior circulation treated by thrombectomy. Post-reperfusion digital subtraction angiography was reviewed to look for EVF as evidenced by the contrast opacification of any cerebral vein before the late arterial phase. Results: EVF occurred in 22.4% of the 147 cases included. The presence of EVF significantly increased the risk of RPH (p = 0.0048), including the risk of symptomatic hemorrhage (p = 0.0052). The presence of EVF (p = 0.0016) and the absence of RPH (p = 0.0021) were independently associated with a better outcome as defined by the NIHSS difference at 24 h, most significantly in the EVF+RPH- group. No significant relationship was however found between either EVF or RPH and a mRS score ≤ 2 at 90 days. Conclusion: Early venous filling on angiographic imaging is a potential predictor of reperfusion hemorrhage. The absence of subsequent RPH in this sub-group is associated with better outcomes at 24 h post-thrombectomy than in those with RPH., info:eu-repo/semantics/published

International audience

Au milieu des annees 1990, plusieurs reformes ont profondement transforme l’organisation de la Police nationale francaise, en particulier en ce qui concerne les differentes categories de personnels. L’une de ces reformes a conduit a conferer, sous certaines conditions, aux agents de police des pouvoirs d’enquete et de coercition auparavant reserves a des enqueteurs specialises ou aux niveaux superieurs de la hierarchie. Le present article examine les consequences de ces reformes sur les pratiques des agents et le fonctionnement de l’institution, a partir d’une enquete aupres d’un service judiciaire de premiere ligne, dans un service de police d’une grande ville.

Large vessel occlusion (LVO) leads to debilitating stroke and responds modestly to recombinant tissue plasminogen activator (rt-TPA). Early thrombectomy improves functional outcomes in selected patients with proximal occlusion but it is not available in all medical facilities. The best imaging modality for triage in an acute stroke setting in drip-and-ship models is still the subject of debate., info:eu-repo/semantics/published

Stent-assisted coiling (SAC) has widened indications of endovascular treatment of intracranial aneurysms (wide-neck, fusiform aneurysms); moreover, it is associated with more stable anatomical results. Besides the development of other techniques such as flow diverter stents, bifurcation stents, or intrasaccular flow disruptors, SAC remains one of the most used endovascular techniques because it provides good clinical and anatomical results for most aneurysms. Several devices based on the same principle are available and have undergone many adaptations and developments over 20 years of intracranial stenting.The purpose of this article is to review and compare intrinsic properties of available devices and their anatomical and clinical performance.Based on this review and our experience of SAC, we will discuss the behavior and performance of those devices in different anatomic and clinical situations.

Cet article propose d’aborder la question des émotions dans la relation socio-éducative en prenant l’exemple d’un service pédiatrique hospitalier et de deux brigades de police. Il soutient l’idée que le travail sur les émotions réalisé par les professionnels est fondamental dans la relation de service ; en d’autres termes, qu’il s’agit d’une compétence professionnelle. Il montre alors la forme que peut prendre cette intelligence émotionnelle. En outre, l’article interroge l’origine de cette intelligence en soulignant qu’elle est à la fois le fruit d’une organisation collective et d’un parcours individuel. Based on a comparative study of hospital pediatric services and two police departments, the article studies the emotions in socio-educational relation. He supports the idea that the work on the feelings realized by the professionals is fundamental in this relationship ; in other words, it is a professional skill. This article shows the shape that this emotional intelligence can set. Besides, he questions the origin of this intelligence by underlining that it is at the same time the result of a collective organization and an individual caree. Este artículo aborda la cuestión de las emociones en la relación socioeducativa tomando como ejemplo un servicio pediátrico hospitalario y dos brigadas de policía. Apoya la idea de que el trabajo sobre las emociones que realizan los profesionales es fundamental en la relación de servicio ; en otras palabras, se trata de una competencia profesional. El artículo muestra así la forma que puede tomar esta inteligencia emocional. Además, cuestiona el origen de esta inteligencia haciendo hincapié en que es, a la vez, fruto de una organización colectiva y de una trayectoria individual.

International audience; A new prompt fission neutron spectra (PFNS) measurement in the 238U(n,f) reaction was performed at LANSCE/WNR facility. Evaluated data show discrepancies on the low (below 1 MeV) and high (above 5 MeV) energy parts in the PFNS for different major and minor actinides. The goal is to improve these measurements in a wide range of incident energy. The energy of the incoming neutron, inducing the fission, and the prompt neutron energies, are measured by time-of-flight method. A dedicated fission chamber was developed, in order to improve alpha-fission discrimination, timing resolution, actinide mass, and to reduce the amount of neutron scattering. To detect prompt neutrons, the 54 Chi-Nu scintillator cells array were surrounding the fission chamber. High statistics were recorded during this experiment, allowing a precise study of PFNS behavior as a function of incident neutron energy, from 1 MeV to 200 MeV. This experiment also showed that all the new tools developed to improve PFNS measurements are performing. Therefore, measurements of PFNS with others actinides such as 239Pu are planned.

Ce chapitre d'ouvrage traite de la requisition de police d'une entreprise des pompes funebres par un officier de police judiciaire. Il montre que si la requisition de police revet toutes les caracteristiques du sale boulot dans les pompes funebres (risque emotionnel, activite stigmatisante, etc.), elle est aussi envisagee par les agents funeraires comme un challenge, une epreuve pour temoigner de son professionnalisme aupres des pairs. Des lors, plus la requisition de police est insolite, plus elle permet a l'individu de se valoriser aupres de son collectif.

A new 238U(n,f) prompt fission neutron spectra (PFNS) measurement has been recently performed at the WNR facility of the Los Alamos National Laboratory. The measurement allows one to explore the dependence of the prompt fission neutron energy spectra on the incident neutron energy. The experimental setup couples the Chi-Nu scintillator array to a newly developed fission chamber, characterized by an improved alphafission discrimination and time resolution, a reduced amount of matter in the neutron beam and a higher actinide mass. The dedicated setup and the high statistics collected allow us to obtain a good precision on the measured fission neutron energy, as well as to explore the low energy region, down to 650keV, and the high energy region, above 5 MeV, of the emitted neutron spectrum. These are indeed the regions where discrepancies in the evaluated PFNS data are found. We present here the first preliminary results of the experiment.

International audience