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International audience; Background: Rate of abdominoperineal resection (APR) varies from countries and surgeons. Surgical impact of preoperative treatment for ultra-low rectal carcinoma (ULRC) initially indicated for APR is debated. We report the 10-year oncological results from a prospective controlled trial (GRECCAR 1) which evaluate the sphincter saving surgery (SSR).Methods: ULRC indicated for APR were included (n = 207). Randomization was between high-dose radiation (HDR, 45 + 18 Gy) and radiochemotherapy (RCT, 45 Gy + 5FU infusion). Surgical decision was based on tumour volume regression at surgery. SSR technique was standardized as mucosectomy (M) or partial (PISR)/complete (CISR) intersphincteric resection.Results: Overall SSR rate was 85% (72% ISR), postoperative morbidity 27%, with no mortality. There were no significant differences between the HDR and RCT groups: 10-year overall survival (OS10) 70.1% versus 69.4%, respectively, 10.2% local recurrence (9.2%/14.5%) and 27.6% metastases (32.4%/27.7%). OS and disease-free survival were significantly longer for SSR (72.2% and 60.1%, respectively) versus APR (54.7% and 38.3%). No difference in OS10 between surgical approaches (M 78.9%, PISR 75.5%, CISR 65.5%) or tumour location (low 64.8%, ultralow 76.7%).Conclusion: GRECCAR 1 demonstrates the feasibility of safely changing an initial APR indication into an SSR procedure according to the preoperative treatment tumour response. Long-term oncologic follow-up validates this attitude.

International audience; Purpose - This study aimed to determine and compare the accuracy of different activity monitors in assessing intermittent outdoor walking in both healthy and clinical populations through the development and validation of processing methodologies. Methods - In study 1, an automated algorithm was implemented and tested for the detection of short (≤1 min) walking and stopping bouts during prescribed walking protocols performed by healthy subjects in environments with low and high levels of obstruction. The following parameters obtained from activity monitors were tested, with different recording epochs0.1s/0.033s/1s/3s/10s and wearing locationsscapula/hip/wrist/ankle: GlobalSat DG100 (GS) and Qstarz BT-Q1000XT/-Q1000eX (QS) speed; ActiGraph wGT3X+ (AG) vector magnitude (VM) raw data, VM counts, and steps; and StepWatch3 (SW) steps. Furthermore, linear mixed models were developed to estimate walking speeds and distances from the monitors parameters. Study 2 validated the performance of the activity monitors and processing methodologies in a clinical population showing profile of intermittent walking due to functional limitations during outdoor walking sessions. Results - In study 1, GS1s, scapula, QS1s, scapula/wrist speed, and AG0.033s, hip VM raw data provided the highest bout detection rates (>96.7%) and the lowest root mean square errors in speed (≤0.4 km·h-1) and distance (

The authors investigated the agreement between StepWatch3™ (SW3) and ActiGraph™ wGT3X+ monitors for measuring step-based metrics in patients with peripheral artery disease and older adults. In 23 patients with peripheral artery disease and 38 older participants, the authors compared the metrics obtained during an outdoor (400-m track) walking session (step count) and a 7-day free-living period (step count and 60/30/5/1-min maximal or peak step accumulation) using the SW3 (ankle) and the wGT3X+ (hip) with the low-frequency extension filter enabled (wGT3X+/LFE) or not (wGT3X+/N). During outdoor walking session, agreement was high, particularly for wGT3X+/LFE: correlations ≥.98, median absolute percentage errors

Study Objective Minimally invasive surgery decreases postoperative morbidity after radical hysterectomy (RH) for early-stage cervical cancer. However, a randomized trial and large retrospective data question its safety after observing lower rates of survival than open surgery [ 1 , 2 ]. The causes of this higher recurrence rate are not definitely established but may result from cancer exposure to the peritoneum during vaginal section and cancerous cells’ spillage enhanced by pneumoperitoneum or a uterine manipulator. The aim of this surgical video was to present a standardized step-by-step approach for robotic RH according to the recent recommendations from the ARCAGY –Group of National Investigators for the Study of Ovarian and Breast Cancers surgeon's group [3] . Design Step-by-step video demonstration of the technique. Setting Tertiary center specialized in gynecologic oncology and minimally invasive surgery. Interventions A 48-year-old woman was diagnosed with a stage IB2 endocervical adenocarcinoma (International Federation of Gynecology and Obstetrics 2018) with a tumor size of 27 mm. Surgery was planned after preoperative pulsed dose rate uterovaginal brachytherapy. Surgery was performed following 10 reproducible steps: • Pelvic sentinel node identification according to the SENTICOL-III trial • Right infundibulopelvic and round ligaments transection • Right uterine vessels transection • Parametrectomy • Right uterosacral ligament transection • Bladder mobilization • Identical left dissection • Rectovaginal space development • Colpectomy by vaginal route after complete pneumoperitoneum exsufflation • Robotic vaginal cuff closure and pelvic inspection Thorough robotically assisted vaginal cuff closure was carried out as a comparative study suggesting that abdominal closure may decrease vaginal complications and dehiscence [3] . Conclusion No international recommendations for the RH approach have yet been endorsed. Patients must be clearly informed about the benefit-risk ratio of the surgical route. If a minimally invasive RH is still decided, the patient should be referred to experienced centers, and precautionary measures must be implemented [4] . Colpotomy by vaginal route without pneumoperitoneum is recommended. Uterine manipulators have to be strictly avoided. Preoperative brachytherapy has been reported in experienced centers in France with favorable histologic response with high rates of pathologic complete response (near 70%) and seems particularly worthwhile for tumor sizes ranging from 2 to 4 cm or presenting with lymphovascular invasion [5] .

Introduction: The new SARS-CoV2 pandemic is not equally affecting all ages. Children are showing milder symptoms across the globe. We reviewed the incidence and the severity in the pediatric populations of several Middle Eastern countries. Materials and Methods: We contacted the Lebanese Ministry of Health and colleagues in different countries of the region for information about their local cases, we reviewed updated information from the CDC and searched Pubmed for publications related to COVID-19 in pediatric patients till the end of April 2020. Results: Different countries had different number of affected children and different percentage of pediatric versus adult cases confirmed to be tested positive. Qatar showed the highest number of total cases but had one of the lowest percentage of pediatric infection versus adults. Conclusion: Our local experience was similar to other affected countries worldwide with children less than 18 years old showing milder symptoms and are less affected than adults.

International audience; Real-time health surveillance becomes important and necessary with the increase of the elderly population to preserve their quality of life. Real-time models aim to provide alerts before the severe illness occurs. Acute respiratory distress syndrome is a crucial disease of the respiratory system that threats the health of the elderly. This paper proposes a real-time model for the surveillance of ARDS based on belief functions theory. Non-invasive physiological signals are considered such as heart rate, respiratory rate, oxygen saturation and mean airway blood pressure. Different linear and nonlinear parameters are extracted from these signals; then a parameters selection procedure is performed to reduce their dimensionality. Afterwards, classifiers are constructed using parameters distributions defined in the evidence framework. Real-time prediction is then performed by combining all classifiers decisions. As results, high performances are obtained over the testing sets with performances of 77% and 71% for sensitivity and specificity, respectively.

International audience; The high incidence of pathologies implies the necessity of developing and implementing health surveillance technologies. This paper proposes a multi-class surveillance approach for a particular pathology, which is the acute respiratory distress syndrome. The multi-class model uses parameters extraction and belief functions theory applied on four vital signs. Vital signs are heart rate, respiratory rate, blood oxygen saturation and blood pressure. Thus, different linear and nonlinear parameters are extracted from these vital signs. A modeling of each class according to each parameter is performed in the framework of the belief functions theory. Then, these models are affected by a measure of confidence according to each parameter and combined together to lead finally to one model that distinguishes between the multi classes. This multi-class surveillance approach has shown interesting performances for the prediction of ARDS.

International audience; Information fusion techniques are at high interest with the increase in dimensionality of the data being handled. They are applied in different applications, such as in the biomedical domain. This paper proposes an information fusion model that predicts the occurrence of ARDS using vital signs. This model uses features fusion based on the belief functions theory. Different linear and nonlinear parameters are first extracted from the signals, and a parameters selection procedure is proposed to select only pertinent parameters. These parameters are then used to construct mass functions in the belief functions framework. Afterwards, the prediction is performed in real-time by combining all the constructed mass functions. Results present the effectiveness of the belief theory predicting ARDS using the MIMIC II public database. Index Terms-acute respiratory distress syndrome, belief functions theory, features fusion, linear and non-linear parameters

International audience; Acute respiratory distress syndrome (ARDS) is a critical condition that disturbs the respiratory system and may lead to death. Early identification of this syndrome is crucial for the implementation of preventive measures. The present paper focuses on the prediction of the onset of this syndrome using physiological records of patients. Heart rate, respiratory rate, peripheral arterial oxygen saturation and mean airway blood pressure were considered. The method proposed in this paper uses first distance-based novelty detection that allows detecting deviations from normal states for each signal. Then, linear and nonlinear kernel-based data fusion algorithms are introduced to combine the individual signal decisions. The proposed method is evaluated using the MIMIC II physiological database. As a result, ARDS is detected in the early phases of occurrence with sensitivity and specificity of 65% and 100% respectively for the combination of all the signals in study. Moreover, the proposed method outperforms current state-of-the-art methods in real-time surveillance of ARDS using only physiological data with an average prediction before 39 h of onset.

International audience; OBJECTIVE:The aim of this study is to compare robotic total mesorectal excision (R-TME) with laparoscopic TME (L-TME) in a series of consecutive rectal cancer patients.BACKGROUND:R-TME and L-TME have drawn contradictory reports. A recent phase III trial (ROLARR) concluded that R-TME performed by surgeons with varying experience did not confer an advantage in rectal cancer resection.PATIENTS AND METHODS:In this retrospective single-center cohort study (8/2008 to 4/2015), data were prospectively registered. A total of 200 L-TME and 200 R-TME were operated consecutively without selection. The primary outcome was the conversion rate to open laparotomy or transanal TME. The secondary endpoints were type of anastomosis, operative time, postoperative morbidity, circumferential radial (CRM) and distal margins, quality of life, bladder and sexual dysfunction, and oncological outcomes.RESULTS:Baseline characteristics were well balanced. Type of anastomosis [colo-anal anastomosis (CAA) 40% vs 49%; p

International audience; Acute Respiratory Distress Syndrome (ARDS) is a crucial pathology affecting 40% of patients, and may cause mortality. However, there is a lack in the literature in characterizing it using vital signs. Thus, the aim of this study is to characterize the ARDS using different time series data, and to find out linear and non-linear parameters that can differentiate statistically between subjects who are going to develop ARDS and others who do not. For this purpose, three vital signs are considered that are the heart rate, the respiratory rate and the oxygen saturation. These signals are used for the simplicity of the procedure of acquisition from patients without disturbing them. From these signals, windows having different lengths (12, 18, 24 and 30 hours) are taken from the end of the signals or before the onset of ARDS. Then, Linear and non-linear parameters were extracted, as mean, standard deviation, skewness, sample entropy, detrended fluctuation analysis, poincare plot, and others. Statistical analysis was performed using the kolmogorov-smirnov test. Results show that sample entropy and detrended fluctuation analysis presented significant difference between ARDS and non-ARDS groups over almost all the windows for heart rate and respiratory rate, while oxygen saturation presented different parameters for each window as a, kurtosis, SD2 and both factors from the detrended fluctuation analysis. Therefore, ARDS can be modeled using parameters extracted from time series data in order to implement prediction algorithms.

This paper investigates the behaviour of steel beams upgraded using locally pre-stressed reinforcing steel bars. The reinforcing bars were welded to the beam's flange or web at both ends and tensioned using a manual screw jack to increase the load-carrying capacity and stiffness of the beam. In total, seven beams were upgraded and tested under three-point bending, using different configurations of reinforcing steel. Results showed that the level of pre-stress, the type of local prestress (internal or external) and the diameter of rebars used significantly affected the beams' stiffness and their ultimate load-carrying capacity. The results obtained in this study were compared to those of other methods used for upgrading steel beams.

This paper investigates the behaviour of damaged steel beams repaired using locally pre-stressed reinforcing steel bars. Regular reinforcing bars are welded to the beam’s web at both ends and then pretensioned using a manual screw jack to increase the effectiveness of the repair. Six beams with different bar diameters and levels of pre-stress were repaired and tested under three-points bending. Results showed that the level of pre-stress controlled the beams’ stiffness, while restoration of their ultimate load-carrying capacity was governed by the bar size. Significantly higher repaired capacities were achieved by this method than by other published methods used for the strengthening of steel beams.

BACKGROUND: Infants and young children are obligate nose breathers; therefore, a transnasal route seems the logical delivery method of inhaled aerosols. The efficiency of aerosol delivery depends on several factors, such as interface, type of nebulizer, and patient age and breathing pattern. We hypothesized that the use of a vibrating mesh nebulizer, a tight-fitting face mask, and a head model and breathing pattern of an older child would result in a higher lung dose. We also hypothesized that the use of an anatomically correct model would more accurately reflect lung dose than models that do not include airways. METHODS: A model comprising a breathing simulator and an anatomically correct model of a 7-month-old infant and a 5-y-old child with an interposed collection filter (lung dose) were used. Breathing patterns of a newborn, infant, and child were used with 7 interfaces. A continuous output and a vibrating mesh nebulizer were loaded with albuterol sulfate solution (5 mg/3.5 mL) and operated for 5 min. Albuterol mass was determined via spectrophotometer (276 nm). RESULTS: Lung dose varied between 0 and 3%. The jet nebulizer was more efficient than the vibrating mesh nebulizer. The front-loaded mask was the most efficient interface. We also found that higher tidal volumes were associated with higher lung doses and that the use of a larger airway model resulted in a lower lung dose. Finally, the model showed a good correlation with in vivo data and rendered lung doses severalfold lower than previous data obtained with oral models. CONCLUSIONS: Careful pairing of the aerosol generator and interface is very important during transnasal aerosol delivery.

Respiratory syncytial virus (RSV) is a major cause of lower respiratory tract infections (LRTIs) in children, especially those with cancer. Data on RSV infections in this vulnerable population is limited. We conducted a retrospective study of all RSV infections in children with cancer from 1998 to 2009 to determine characteristics and outcomes of these infections, identify risk factors for LRTI and mortality, and the effect of antiviral therapy on these outcomes. We identified 59 patients with a median age of 5 years; 53% had hematologic malignancy, 32% were hematopoietic stem cell transplant recipients, 39% had received corticosteroids, and 76% cytotoxic chemotherapy within 1 month before RSV infection. LRTI developed in 22 (37%) patients with a trend of higher rate in males (odds ratio=2.57 [0.86-7.62], P=0.09) and children with lymphocytopenia (odds ratio=2.95 [0.86-10.12], P=0.085). No significant differences were observed in the rates of progression to LRTI (3/10 [30%] vs. 19/49 [39%], P=0.729) and RSV-associated mortality (0/10 [0%] vs. 3/49 [6%], P=0.422) for patients receiving antiviral therapy at upper respiratory tract infection stage compared with those who did not. However, patients with LRTI had significantly better outcomes when treated with aerosolized ribavirin plus immunomodulators (mainly palivizumab) when compared with aerosolized ribavirin alone (mortality rates: 0/6 [0%] vs. 3/4 [75%], P=0.03). Ribavirin did not show any benefit in reducing LRTI or mortality; however, addition of palivizumab to the treatment regimen may be potentially beneficial, especially for children with LRTI.

OBJECTIVES Respiratory syncytial virus (RSV) infections are well recognized as a significant cause of morbidity and mortality in allogeneic haematopoietic stem cell transplant (allo-HSCT) recipients. We evaluated the spectrum of clinical manifestations, management (including ribavirin-based antiviral therapy) and outcomes of RSV infections and determined the risk factors associated with RSV lower respiratory tract infection (LRTI) and all-cause mortality. METHODS In this retrospective study, we analysed clinical data from all laboratory-confirmed RSV infections in allo-HSCT recipients (n = 280) who presented at our institution from January 1996 to May 2009. RESULTS Of the 280 patients, 80 (29%) developed LRTI within 20 days (median 1 day, range 0-19 days) and 44 (16%) died within 90 days (median 26 days, range 1-82 days) from RSV diagnosis. Multivariable logistic regression analyses identified several significant risk factors associated with RSV LRTI and all-cause mortality, including age, male sex, neutropenia, lymphocytopenia and lack of ribavirin-based antiviral therapy at the upper respiratory tract infection (URTI) stage. Aerosolized ribavirin-based therapy at the URTI stage was the single most significant factor in reducing the risk of RSV LRTI (83%), all-cause mortality (57%) and RSV-associated mortality (87%) in these patients (P

International audience; Acute Respiratory Distress Syndrome (ARDS) is a critical lung condition occurring in ill patients. Like many other cardiac disorders, ARDS can be assessed by physiological measurements. This study aims to predict ARDS in hospitalized patients using only physiological signals as heart rate and breathing rate. An approach based on hypothesis testing is developed to detect whether subjects' signals deviate from their initial states. The approach is applied on mechanically ventilated subjects in the MIMIC II database. As results, a sensitivity going up to 85% is achieved, with a prediction remaining possible before 24 hours of ARDS occurrence.

This study aims to predict Acute Respiratory Distress Syndrome (ARDS) in hospitalized patients using their physiological signals such as heart rate, breathing rate, peripheral arterial oxygen saturation and mean airway blood pressure. A data fusion approach based on hypothesis testing was developed, and applied to mechanically ventilated subjects in the MIMIC II database. By combining the information extracted from the signals using an aggregation rule, we are able to enhance the sensitivity of the ARDS prediction process. As a result, we obtained a sensitivity of up to 85% for individual signals, reaching approximately 92% using the data fusion rule.

Novel 2009/H1N1 influenza has significant impact on immunocompromised children with cancer; however, it is uncertain how it compares with seasonal influenza (SFlu) in this vulnerable population. We compared clinical characteristics and outcomes for these 2 infections in children with cancer and identified risk factors for progression to lower respiratory infection (LRI) and/or death.Influenza infections confirmed by positive viral culture and/or fluorescence antigen test between January 1998 and February 2010 were identified from microbiology databases at a comprehensive cancer center. Characteristics and outcomes were compared for the 2 groups. Kaplan-Meier survival curves and Cox proportional hazards model were generated to identify risk factors for LRI and/or death.When compared with SFlu, 2009/H1N1 cases had significantly lower acute physiology and chronic health evaluation II score (median: 9 versus 14), fewer comorbidities (15% versus 46%), fewer hematopoietic stem-cell transplantation (5% versus 16%), more solid tumors (45% versus 16%), higher LRI at presentation (20% versus 4%), higher rates of antiviral therapy (90% versus 48%) and higher mortality (10% versus 0%). Male gender (hazard ratio [HR]: 8.4, 95% confidence interval [CI]: 1.08-65.2, P = 0.042), acute physiology and chronic health evaluation II score15 (HR: 3.29, 95% CI: 1.04-10.39, P = 0.027) and a 24-hour delay in initiation of antiviral treatment (HR: 1.12, 95% CI: 1.02-1.23, P = 0.015) were the most significant predictors of progression to LRI and mortality, regardless of virus strain.Significant differences between 2009/H1N1 and SFlu with respect to clinical presentation, management and associated outcomes were identified. Early diagnosis and prompt initiation of antiviral therapy may prevent serious complications of influenza in children with cancer.

International audience; This study aims to characterize the heart rate variability of subjects with reflex syncope during head-up tilt test and to find out non-linear parameters that can differentiate between subjects who develop syncope during the test and others who do not. For this purpose, the Empirical Mode Decomposition was applied to RR time series of subjects underwent a head-up tilt test. It decomposes the time series into waveforms called Intrinsic Mode Functions (IMF). The IMFs and their cumulative sums were used to extract several parameters as Sample Entropy, Detrended Fluctuation Analysis and indicators from Poincare plot. The results show that the proposed parameters are significantly different between the two groups in several time scales (p-value

We developed an immunodeficiency scoring index for respiratory syncytial virus (ISI-RSV) infection, based on a cohort of 237 allogeneic hematopoietic cell transplant (allo-HCT) recipients, that can predict the risk of progression to lower respiratory tract infection (LRTI) and RSV-associated mortality. A weighted index was calculated using adjusted hazard ratios for immunodeficiency markers. Based on the ISI-RSV (range, 0-12), patients were stratified into low (0-2), moderate (3-6), and high (7-12) risk groups. A significant trend of increasing incidence of LRTI and RSV-associated mortality was observed as the risk increased from low to moderate to high (P < .001). Patients in the high-risk group had the greatest benefit of ribavirin-based therapy at the upper respiratory tract infection stage and the highest risk for progression to LRTI and death when antiviral therapy was not given (6.5 [95% confidence interval (CI), 1.8-23.6] and 8.1 [95% CI, 1.1-57.6], respectively). The ISI-RSV is designed to stratify allo-HCT recipients with RSV infection into groups according to their risk for progression to LRTI and RSV-associated mortality. Identification of high-risk groups using this index would distinguish patients who would benefit the most from antiviral therapy, mainly with aerosolized ribavirin. The ISI-RSV should be validated in a multi-institutional study.