ETIOLOGIA SÂNGERĂRILOR GASTROINTESTINALE LA COPIL

Obiective. Identifi carea caracterelor clinice, endoscopice, etiologice la copiii diagnosticaţi cu hemoragie digestivă superioară şi inferioară. Material şi metodă. S-a efectuat un studiu retrospectiv descriptiv pe o perioadă de 3 ani (ianuarie 2010- decembrie 2012) pe 107 copiii cu vârsta între 1 şi 18 ani, internaţi pentru hemoragii digestive în Spitalului Clinic de Copii „Sf. Maria“ Iaşi. Lotul de studiu nu cuprinde hemoragii digestive din urgenţe chirurgicale, boli infecţioase, boli intestinale cu mecanism imunologic sau toxic. Analiza retrospectivă individualizată prin studiul foii de observaţie a cuprins date anamnestice, clinice, endoscopice şi histologice orientate pentru diagnosticul etiologic al hemoragiilor digestive. Toţi pacienţii au fost investigaţi prin endoscopie digestivă superioară/colonoscopie după ce procedura a fost explicată şi s-a obţinut consimţământul informat. Rezultate. Din lotul de 107 copii luaţi în studiu 39 (36,4%) au reprezentat hemoragia digestivă superioară (HDS), dintre care 6 cazuri (5,1% ) de cauza variceală iar 33 (94,8%) de cauză non variceală; şi 68 (63,5%) au prezentat hemoragia digestivă inferioară (HDI). În etiologia HDS gastrita erozivă a reprezentat 12 (30,8%) cazuri, esofagita 6 (15,4%), duodenita 6 (15,4%), ulcerul duodenal 4 (10,3%), ulcerul gastric 2 (5,1%), sindrom Mallory Weiss 1 (2,6%), etiologie multiplă 6 (15,4%) cazuri. Principalele aspecte etiologice ale HDI au fost polipul colo-rectal în 28 (41,2%) cazuri, colită ulcerativă 14 (20,6%), leziuni nespecifi ce 12 (17,6%) fi suri anale 9 (13,4%), sindroame de polipoză intestinală 3 (4,4%), malformaţie vasculară 1 (1,5%), diverticul rectal 1 (1,5%) caz. S-au practicat intervenţii endoscopice concomitente în cazul polipilor colo-rectali. Concluzii. Hemoragia digestivă inferioară a fost cea mai frecventă, corelată cu cauze minore: polipi colorectali, fi suri anale, leziuni nespecifi ce. Hemoragia digestivă non-variceală forma cea mai frecventă s-a asociat cu gastrita erozivă, esofagita, duodenita, ulcerul gastric. Endoscopia digestivă s-a dovedit a fi o investigaţie utilă în diagnosticul hemoragiilor digestive şi cu aport terapeutic în anumite cazuri

Blocking representation in the ERA-Interim driven EURO-CORDEX RCMs

While Regional Climate Models (RCMs) have been shown to yield improved simulations compared to General Circulation Model (GCM), their representation of large-scale phenomena like atmospheric blocking has been hardly addressed. Here, we evaluate the ability of RCMs to simulate blocking situations present in their reanalysis driving data and analyse the associated impacts on anomalies and biases of European 2-m air temperature (TAS) and precipitation rate (PR). Five RCM runs stem from the EURO-CORDEX ensemble while three RCMs are WRF models with different nudging realizations, all of them driven by ERA-Interim for the period 1981?2010. The detected blocking systems are allocated to three sectors of the Euro-Atlantic region, allowing for a characterization of distinctive blocking-related TAS and PR anomalies. Our results indicate some misrepresentation of atmospheric blocking over the EURO-CORDEX domain, as compared to the driving reanalysis. Most of the RCMs showed fewer blocks than the driving data, while the blocking misdetection was negligible for RCMs strongly conditioned to the driving data. A higher resolution of the RCMs did not improve the representation of atmospheric blocking. However, all RCMs are able to reproduce the basic anomaly structure of TAS and PR connected to blocking. Moreover, the associated anomalies do not change substantially after correcting for the misrepresentation of blocking in RCMs. The overall model bias is mainly determined by pattern biases in the representations of surface parameters during non-blocking situations. Biases in blocking detections tend to have a secondary influence in the overall bias due to compensatory effects of missed blockings and non-blockings. However, they can lead to measurable effects in the presence of a strong blocking underestimation.This work was funded by the Austrian Science Fund (FWF) under the project: Understanding Contrasts in high Mountain hydrology in Asia (UNCOMUN: I 1295-N29). This research was supported by the Faculty of Environmental, Regional and Educational Sciences (URBI), University of Graz, as well as the Federal Ministry of Science, Research and Economy (BMWFW) by funding the OeAD Grant Marietta Blau. This work was partially supported (JMG and SH) by the project MULTI-SDM (CGL2015-66583- R, MINECO/FEDER). DB was supported by the PALEOSTRAT (CGL2015-69699-R) project funded by the Spanish Ministry of Economy and Competitiveness (MINECO)

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Les deux forums de la colonia Ulpia Traiana Augusta Dacica Sarmizegetusa

From C. Daicoviciu's excavations, a monumental ensemble has been identified as « Augustales Palace », at the crossing of Decumanus Maximus and Cardo Maximus. The authors criticize minutely this identification and propose to acknowledge a basilica closing at the south the place of the civil forum. Bordered by civic and religious premises, it plays the part of a « diaphragm basilica » between civil forum and religious forum, which spreads more in south.Depuis les fouilles de C. Daicoviciu, on a identifié comme Palais des Augustales un ensemble monumental occupant une ìnsula, au croisement du Decunanus Maximus et du Cardo Maximus. Les auteurs soumettent à une critique minutieuse une telle identification et proposent de reconnaître une basilique fermant au sud la place du forum civil. Bordée de locaux civiques et religieux, elle joue le rôle d'une basilique diaphragme entre le forum civil et le forum religieux, qui se déploie plus au sud.Etienne Robert, Piso Ioan, Diaconescu Alexandru. Les deux forums de la colonia Ulpia Traiana Augusta Dacica Sarmizegetusa. In: Revue des Études Anciennes. Tome 92, 1990, n°3-4. pp. 273-296