New neutron detector based on Micromegas technology for ADS projects

A new neutron detector based on Micromegas technology has been developed for the measurement of the simulated neutron spectrum in the ADS project. After the presentation of simulated neutron spectra obtained in the interaction of 140 MeV protons with the spallation target inside the TRIGA core, a full description of the new detector configuration is given. The advantage of this detector compared to conventional neutron flux detectors and the results obtained with the first prototype at the CELINA 14 MeV neutron source facility at CEA-Cadarache are presented. The future developments of operational Piccolo-Micromegas for fast neutron reactors are also described

The ANTENATAL multicentre study to predict postnatal renal outcome in fetuses with posterior urethral valves: objectives and design

Abstract Background Posterior urethral valves (PUV) account for 17% of paediatric end-stage renal disease. A major issue in the management of PUV is prenatal prediction of postnatal renal function. Fetal ultrasound and fetal urine biochemistry are currently employed for this prediction, but clearly lack precision. We previously developed a fetal urine peptide signature that predicted in utero with high precision postnatal renal function in fetuses with PUV. We describe here the objectives and design of the prospective international multicentre ANTENATAL (multicentre validation of a fetal urine peptidome-based classifier to predict postnatal renal function in posterior urethral valves) study, set up to validate this fetal urine peptide signature. Methods Participants will be PUV pregnancies enrolled from 2017 to 2021 and followed up until 2023 in >30 European centres endorsed and supported by European reference networks for rare urological disorders (ERN eUROGEN) and rare kidney diseases (ERN ERKNet). The endpoint will be renal/patient survival at 2 years postnatally. Assuming α = 0.05, 1–β = 0.8 and a mean prevalence of severe renal outcome in PUV individuals of 0.35, 400 patients need to be enrolled to validate the previously reported sensitivity and specificity of the peptide signature. Results In this largest multicentre study of antenatally detected PUV, we anticipate bringing a novel tool to the clinic. Based on urinary peptides and potentially amended in the future with additional omics traits, this tool will be able to precisely quantify postnatal renal survival in PUV pregnancies. The main limitation of the employed approach is the need for specialized equipment. Conclusions Accurate risk assessment in the prenatal period should strongly improve the management of fetuses with PUV

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Posterior urethral injuries associated with motorcycle pelvic injuries in adolescent. : Computerized finite element model of pelvic and urethra and medical applications

La population adulte jeune masculine est une population très concernée par les accidents de la voie publique en 2 roues. Ce type d'accident peut engendrer des traumatismes de l'urètre postérieur synchrones de traumatismes du bassin. Les traumatismes de l'urètre postérieurs sont des lésions graves responsables d'une morbidité élevée à court et long terme. Les patients présentant ce type de traumatisme de la voie publique sont le plus souvent des patients polytraumatisés justifiant d'une prise en charge en réanimation. La problématique des traumatismes de l'urètre postérieur repose sur leur méconnaissance diagnostique fréquente à la phase initiale du traumatisme et le risque d'aggravation de ceux-ci par un geste de cathétérisme urétral. A ce jour peu d'éléments anatomo-cliniques permettent d'établir une corrélation entre la survenue d'un traumatisme de l'anneau pelvien et le risque d'apparition d'une lésion de l'urètre postérieur associée, à fortiori avant la constatation d'une lésion osseuse radiologique. Méthode : En se basant sur l'expérience en modélisation en accidentologie routière, un modèle numérique éléments finis de 255000 éléments a été conçu. Ce modèle a été élaboré à partir d'un scanner d'adolescent. Les structures anatomiques concernées dans les traumatismes de l'urètre et de l'anneau pelvien ont été isolées, puis mises en trois dimensions et dotées de propriétés biomécaniques. Le modèle a été vérifié selon les expérimentations disponibles sur les traumatismes de l'anneau pelvien.Adolescent males involved in motorcycle accidents are particularly at risk for pelvic injuries. This traumatic situation may provoke a posterior urethral injury. Posterior urethral injuries remain problematic because their diagnosis may be missed, and during the initial treatment response the urethral injury can be worsened by urethral catheterization. Few anatomical and clinical tools exist that establish a correlation between injuries and fractures of the pelvic ring and the risk of posterior urethral injury, for instance prior to the appearance of a bony fracture. Method : Based on experience with traffic accident modelling, a computerized finite element model was conceived integrating the specific anatomic structures concerned. This model was extrapolated from a CAT scan of a 14 years old boy. The anatomic structures concerned in urethral and pelvic ring trauma where isolated, placed in 3D and given biomechanical properties. The model was verified according to available experiments on pelvic ring trauma. Results :To apply the model, we recreated three impact mechanisms on the pelvic ring. Stretching between the prostatic and membranous portions of the urethra (before and after visualization of a pelvic fracture) as well as timing of injury were studied. We analyzed lateral impact, antero-posterior impact and a real car-motorcycle accident situation (postero-lateral impact). In all the three situations, a stretching of the posterior urethra was identified prior to bony fracture visualization

Qualité de vie et suivi à moyen et long terme des patients pris en charge dans la région PACA Est pour une atrésie de l'œsophage

NICE-BU Médecine Odontologie (060882102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Evaluation des déformations thoraciques après thoracotomie et thoracoscopie chez l'anfant

NICE-BU Médecine Odontologie (060882102) / SudocSudocFranceF

Intérêt du dépistage anténatal des anomalies de la vesicule biliaire et des voies biliaires (série de 23 cas)

NICE-BU Médecine Odontologie (060882102) / SudocSudocFranceF

Résultats à long terme de la cure du reflux gastro-oesophagien par voie coelioscopique chez l'enfant pris en charge dans la région PACA-est

NICE-BU Médecine Odontologie (060882102) / SudocSudocFranceF