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Although lean manufacturing emerged in the 1990s, and since then, it has become known and recognised worldwide, companies still struggle to implement it successfully, especially in less developed countries. The purpose of this paper is to assess the level of maturity of lean production within small and medium-sized companies, identify what the benefits of lean implementation are, and present an exploration and analysis of the barriers that influence the implementation of lean production in these companies.To achieve this objective, items from previous studies were extracted through a systematic literature review and then validated by interviews with Moroccan experts in the manufacturing and non-manufacturing industry; on the other hand, a questionnaire survey was conducted with 78 small and medium enterprises in Morocco. Subsequently, all collected responses were statistically analysed using Statistical Package for Social Sciences (SPSS V21.0). The results show that the lean approach is unfortunately not yet adopted and applied by all Moroccan SMEs (24% of our respondents have not yet tried to apply lean). In addition, the most significant benefits announced by Moroccan small and medium enterprises are 'the elimination of waste (82.1%)', 'the reduction of costs (78.2%)', and 'the improvement of efficiency and performance of production units (70.5%)'. Finally, the principal component analysis indicated that the two main difficulties that need to be maintained are poor management (with 63.6 % of the total variance) and lack of financial resources, monitoring, and skilled labours (with 7.7 % of the total variance). [ABSTRACT FROM AUTHOR]

The impact of maintenance strategies is a critical key performance factor in industry. Simulation concept has become the primary technique used for optimizing models of maintenance strategies. This paper aims to report the state of the art of the techniques provided to model and to optimize maintenance systems. The authors offer a summary of classified papers published in the field. The need of simulation approach is highly recommended by authors given the complexity found in real industrial cases. Few papers have been reviewed based on a specific maintenance strategy and the most retain minimizing cost as a single optimization function, in a finite horizon planning. Discrete Event Simulation (DES) has been the most figured simulation approach and has been coupled sometimes with other techniques. Moreover, this paper highlights various tools used in modelling and simulation in order to optimize maintenance strategies. Real cases have been figured out while academical ones are highly reported in the literature. The findings emphasize on investigating the gaps between theory and real systems to assist in building a generic approach in order to overcome the reported limitation. [ABSTRACT FROM AUTHOR]

The construction industry is considered among the largest consumers of natural resources (non-renewable materials, fossil fuels, water...). It is also an important source of generation of solid waste and greenhouse gas emissions. In addition to its negative impacts on the environment, most construction projects are characterized by the non-respect of the triptych (Cost, Time, Quality) and a high accident rate compared to other sectors. Lean construction (LC) is a new production philosophy which has the potential of bringing innovative improvements in the construction sector. It is a systemic approach to meeting customer expectations by maximizing added value and reducing all forms of waste. Based on international standards (AFNOR, GRI, UNEP, ISO 26000...) and recent researches published in the most reliable databases, this study aims at exploring the concept of sustainable development in the context of the construction industry and examines how the LC tools (Prefabrication, Value Stream Mapping, Poka-Yoke, visual Management, and 5S) can have an impact on the three dimensions of sustainable development (environment, economy, society). This work brings a new reflection by constructing an interaction matrix between the Lean Construction tools and sustainable development. [ABSTRACT FROM AUTHOR]

In this work, we develop CASVM and CANN algorithms for semi-supervised classification problem. The algorithms are based on a combination of ensemble clustering and kernel methods. A probabilistic model of classification with the use of cluster ensemble is proposed. Within the model, error probability of CANN is studied. Assumptions that make probability of error converge to zero are formulated. The proposed algorithms are experimentally tested on a hyperspectral image. It is shown that CASVM and CANN are more noise resistant than standard SVM and kNN.

Introduction: Mediastinal infection is a persistent and difficult widespread infectious disease caused by secondary complications of adjacent organs. It spreads easily and is often misdiagnosed because of the lack of typical manifestations., Material and Methods: To highlight the clinical features, medical and surgical strategy of descending necrotizing mediastinitis we performed a retrospective study of 25 documented cases during a 10-year period at our hospital, all treated surgically, 10 from the ORL department and 15 from our thoracic surgery department., Results: Patients were aged from 20 to 84 years, with a median age of 41 years, male predominance (19 men and 6 women), sex ratio of 3.6. A cervicotomy (in 40% of cases) was associated or not with videothoracoscopy (one case) or thoracotomy (in 20% of cases) and wide-spectrum antibiotherapy. In the postoperative period, an irrigation-suction system was used on the drains in 15 patients. In 1 case a rethoracotomy was necessary to remove a residual right pyothorax, and one patient required a tracheostomy. Twenty-two (88%) patients recovered from their mediastinitis. Death of 3 patients by sepsis multiorgan failure occurred. Postoperative follow-up during one year was uneventful without recurrence., Conclusions: According to our experience, we believe the more aggressive local treatment is, the better are the results., Competing Interests: The authors report no conflict of interest., (Copyright: © 2023 Polish Society of Cardiothoracic Surgeons (Polskie Towarzystwo KardioTorakochirurgów) and the editors of the Polish Journal of Cardio-Thoracic Surgery (Kardiochirurgia i Torakochirurgia Polska).)

Background: The objectives of our study are to evaluate our surgical experience of mediastinal bronchogenic cyst (MBC) and to determine the results of resection by video-assisted thoracic surgery (VATS) and posterolateral thoracotomy (PLT)., Methods: The demographic characteristics, clinical and radiological features intraoperative data, outcomes and fol- low-up information were reviewed and analyzed from 38 patients who underwent resection of a MBC between 2008 and 2019., Results: cystectomy was performed for thirty eight patients included in the present study. Seventeen of them, benefited from VATS cystectomy (VATS group) with 1 conversion to thoracotomy (5.9%) and 21 underwent PLT cystectomy (PLT group). In our series 27 (71.1%) were male. Their average age was 42.6 years. While 09 patients (23.7%) had no symptoms pre-operatively, 29 patients (76.3%) were symptomatic. There were no operative deaths and 3 patients (7.9%) presented postoperative complications. The average duration of hospital stay was 3.2 days for patients who had VATS, but 5.8 days for those who had thoracotomy. Long-term follow-up (range, 1 to 8 years) showed no late complications and no recurrence., Conclusion: VATS and PLT are main approaches for the surgical resection of MBCs VATS is a safe procedure, with less pain and time spent at the hospital. Early surgical procedures of MBCs may be recommended to prevent complications. Surgical adhesions are unfavorable conditions to thoracoscopic treatment.

Competing Interests: The authors report no conflict of interest.

Bilio-bronchial fistulization is a rare complication of neglected liver hydatid cysts ruptured in the thorax by anatomical contiguity. Because of the bronchopulmonary and hepato-biliary lesions that it can cause and in the context of severe infection, the morbi-mortality remains high in these fragile patients. The diagnosis is based on clinical arguments: biliptysis mainly with a hepato-thoracic syndrome, imaging data showing the fistulous path, and especially bronchial and biliary endoscopy. The pretherapeutic stage aims at correcting the hydrolytic, anemic and nutritional defects, but above all at controlling the hepatobronchial infection after removal of the biliary obstruction (endoscopic sphincterotomy) and by broad-spectrum antibiotic therapy as well as active respiratory physiotherapy. This preparatory step may be sufficient, otherwise surgical sanction is necessary in operable patients to establish the hepato-phreno-thoracic disconnection. The choice of the thoracic or abdominal approach depends on the initial and progressive lesion assessment and on the surgical strategy envisaged., Competing Interests: The authors report no conflict of interest., (Copyright: © 2021 Polish Society of Cardiothoracic Surgeons (Polskie Towarzystwo KardioTorakochirurgów) and the editors of the Polish Journal of Cardio-Thoracic Surgery (Kardiochirurgia i Torakochirurgia Polska).)

Competing Interests: The authors report no conflict of interest.

Introduction: Mediastinal parathyroid adenomas are a rare condition., Aim: Analysis of epidemiological data, clinical manifestation of mediastinal parathyroid adenoma (MPA), including imaging modalities, and therapeutic approach to this condition., Material and Methods: A retrospective study of documented cases of mediastinal parathyroid adenoma that were managed at our Department of Thoracic Surgery of the Military Teaching Hospital Mohammed V, between January 2010 and December 2019., Results: During a 9-year period in our department, 21 documented cases of MPA were treated surgically. Patients ranged in age from 20 to 69 years, with a mean age of 45 years, and there was no gender predominance. The most frequently reported manifestations were osteoarticular, with bone pain in 66.6% (14/21), pathological fractures in 28.5% (6/21), and osteoporosis in 23.8% (5/21). Cervical ultrasound, MIBI scintigraphy and cervico-thoracic computed tomography scan were performed respectively in 28.5% ( n = 06/21), in 47.6% ( n = 10/21) and 100% ( n = 21), and allowed positive diagnosis of MPA. All patients benefited from resection surgery, through a classical transverse cervicotomy which was extended in some cases to the manubrium, and in only one case treated with thoracotomy., Conclusions: Management of mediastinal parathyroid adenoma is based on the diagnosis imaging assessment step, usually by MIBI scintigraphy. Surgical ablation is a radical treatment. Peroperative hormonal evaluation is mainly recommended., Competing Interests: The authors report no conflict of interest., (Copyright: © 2021 Polish Society of Cardiothoracic Surgeons (Polskie Towarzystwo KardioTorakochirurgów) and the editors of the Polish Journal of Cardio-Thoracic Surgery (Kardiochirurgia i Torakochirurgia Polska).)

Background: The association of pulmonary and hepatic hydatid cysts is rare. Managing this condition with low mortality and complications is a challenge. The aim of this study is to put forward our experience in managing both sites in single-stage posterolateral thoracotomy. Patients and Methods: A retrospective study of 14 patients who underwent single-stage posterolateral thoracotomy and phrenotomy to treat right lung and liver hydatid cysts between January 2010 and December 2019 were reviewed. Results: Fourteen of 135 patients (10.4%) with double location of hydatid disease were treated in our department for pulmonary hydatid cysts in the same period. There were nine males and five females who were 20 to 72 years old (average age, 42.7 years). Chest computed tomography (CT) and abdominal scan were performed in all cases. The surgical approach was posterolateral thoracotomy and phrenotomy without laparotomy in all cases. Conservation of hepatic and pulmonary parenchymas was possible in 13 patients (92.8%). Average operative time was 122 minutes (range, 95-210 minutes) and the average post-operative hospital stay was 8.7 days. Post-operative complications occurred in two (14.3%) cases, one was atelectasis and the other persistent biliary and air leakage. There was no post-operative mortality. All patients received post-operative medical treatment for three to six months and there was no recurrence after an average follow-up of 26 months. Conclusion: Single-stage thoracotomy is a better option than thoracotomy and laparotomy for the management of double located hydatid cysts. It has a lower complication rate, shorter hospital stay, and rapid resumption of normal activity.

The prevalence rate for childhood asthma and its associated risk factors vary significantly across countries and regions. In the case of Morocco, the scarcity of available medical data makes scientific research on diseases such as asthma very challenging. In this paper, we build machine learning models to predict the occurrence of childhood asthma using data from a prospective study of 202 children with and without asthma. The association between different factors and asthma diagnosis is first assessed using a Chi-squared test. Then, predictive models such as logistic regression analysis, decision trees, random forest and support vector machine are used to explore the relationship between childhood asthma and the various risk factors. First, data were pre-processed using a Chi-squared feature selection, 19 out of the 36 factors were found to be significantly associated ( p -value < 0.05) with childhood asthma; these include: history of atopic diseases in the family, presence of mites, cold air, strong odors and mold in the child's environment, mode of birth, breastfeeding and early life habits and exposures. For asthma prediction, random forest yielded the best predictive performance (accuracy = 84.9%), followed by logistic regression (accuracy = 82.57%), support vector machine (accuracy = 82.5%) and decision trees (accuracy = 75.19%). The decision tree model has the advantage of being easily interpreted. This study identified important maternal and prenatal risk factors for childhood asthma, the majority of which are avoidable. Appropriate steps are needed to raise awareness about the prenatal risk factors.

Introduction: Concomitant lung and liver hydatid cyst is a rare condition. Most surgeons agree that both sites should be resected in one-time surgery., Aim: We present a case series of hepatic and pulmonary hydatid cyst treated in one-stage surgery (OSS) compared with patients who underwent two-stage surgery (TSS)., Material and Methods: This retrospective study included 47 patients separated into two groups (33 TSS and 14 OSS) between 2008 and 2019. Data on clinical symptoms, sites, radiological features, techniques, postoperative complications, mean hospital stay and outcome were analyzed separately for TSS and OSS procedures., Results: A total of 33 patients who underwent TSS (70.2%) were compared to 14 patients operated on by OSS (29.8%). No significant differences were found between groups for age (45.3 vs. 42.7, p = 0.45), sex (male: 57.6% vs. 64.2%) and socio-geographic status (urban: 72.7% vs. 78.6%). But there were more postoperative complications (24.3% vs. 14.3%, p = 0.036) in the TSS group, and operative duration (154 minutes vs. 122 minutes, p = 0.047), postoperative hospital stay (13.8 days vs. 8.7 days, p = 0.022), and interruption of activities and work (56 days vs. 31 days, p = 0.045) were longer in the TSS group. There was no difference in postoperative mortality between the 2 groups., Conclusions: Single-stage surgical management by trans-thoraco-phrenotomy can be recommended to treat dual-seat hepatic and pulmonary hydatid disease with fewer complications and a rapid return to work. This technique is easier and safer for right lung and liver dome hydatid cysts., Competing Interests: The authors report no conflict of interest., (Copyright: © 2021 Polish Society of Cardiothoracic Surgeons (Polskie Towarzystwo KardioTorakochirurgów) and the editors of the Polish Journal of Cardio-Thoracic Surgery (Kardiochirurgia i Torakochirurgia Polska).)

Competing Interests: The authors report no conflict of interest.

Objective: The objective of this study was to describe the role of surgical management of ruptured hydatid cysts into the pleural cavity in children. A review of the management of patients with intrapleural rupture of pulmonary hydatid cysts in children at our center was performed., Materials and Methods: A retrospective chart review was performed on all children who developed intrapleural rupture of a hydatid cyst in the lung. Patients with intrapleural rupture from other locations (liver, mediastinum, diaphragm, kidney) were excluded., Results: In these 19 patients, there were 11 males and 8 females with a mean age of 9.4 years (range 7-16 years). Different clinical symptoms, biological, and imaging data allowed the diagnosis. The surgical approach consisted of a posterolateral thoracotomy and decortication in all patients. In addition, different procedures were needed for the pulmonary lesion according to the degree of lung destruction. Radical resections were required in four cases, including lobectomies (n = 1) and segmentectomies (n = 3). Conservative treatment was possible in 15 patients (simple capitonnage and bronchial fistula closure). Post-operative complications occurred in 2 cases (10.5%), including one pyothorax with a prolonged air leak and one wound infection. There were no postoperative deaths. There was no recurrence of thoracic hydatid disease in postoperative follow-up ranging from 1 to 3 years (mean: 2 years)., Conclusion: Intrapleural hydatid cyst rupture may be prevented by early treatment of simple forms to avoid increased morbidity., Level of Evidence: Level IV., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Introduction: Paraneoplastic Cushing's syndrome is a rare cause of endogenous hypercortisolism attributable to ectopic ACTH secretion by non-pituitary tumors. Imaging and biochemical results are often inconclusive and differential diagnosis with Cushing's disease can then be challenging. Moreover, these tumors may be occult and difficult to find and thus the need of new imaging tools such as (18)FDG-PET scan and (18)DOPA-PET scan., Case Report: We report a 50-year-old man who presented with very aggressive clinical features related to Cushing's syndrome. Biological work-up confirmed the hypercortisolism and was consistent with an ectopic ACTH secretion. Conventional localization techniques failed to show any tumor and bilateral adrenalectomy was performed because of life-threatening complications. Two years later, thoracic computed tomography reveals an 11 mm mass in the left lower pulmonary lobe, (18)FDG-PET scan found a non-specific mild hypermetabolism of the lung nodule, and the (18)DOPA-PET scan confirmed the high uptake of this nodule suggesting an endocrine carcinoma. Histology confirmed a typical carcinoid tumor. The tumor cells stained positive for ACTH, CD56, chromogranin and synaptophysin., Conclusion: This case illustrates the dilemma between the need for morphological diagnosis of the ectopic ACTH source and control of the life-threatening hypercortisolism. (18)FDG-PET scan and (18)DOPA-PET scan should be considered early as a secondary diagnostic tool when conventional imagery fails to show any tumor., (Copyright © 2015 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.)

The aim of our work is to promote the awareness about the development of sarcoidosis after antineoplastic therapy in order to avoid diagnostic errors with FDG-PET/CT findings. We report the observation of three women with breast, cervix and stomach treated cancers who developed a sarcoidosis after the end of anti-neoplastic therapy. The utility of FDG-PET/CT is in pinpointing the organs candidates for diagnostic biopsy and not distinguishing between the malignancy and granulomatous or inflammatory diseases., (Copyright © 2014 SEPAR. Published by Elsevier Espana. All rights reserved.)