Les prothèses totales de genou (étude comparative expérimentale, clinique et radiographique, à propos de 376 prothèses Wallaby 1® et de 128 prothèses H.L.S.)

MONTPELLIER-BU Médecine UPM (341722108) / SudocPARIS-BIUM (751062103) / SudocMONTPELLIER-BU Médecine (341722104) / SudocSudocFranceF

Chapitre 16. Consommer et produire durablement

Les crises énergétiques, alimentaires, financières et économiques se succèdent, le climat continue à se réchauffer, et de nombreuses ressources naturelles se dégradent et se raréfient. Ces dérèglements, d’une ampleur sans précédent, creusent les inégalités et amènent leur cortège d’inquiétudes et d’instabilités sociales et politiques. Optimiser l’efficacité de la production de biens et services comme celle des usages ne sera pas suffisant : une évolution plus fondamentale de nos modes de vie est nécessaire. L’Objectif de développement durable 12 nous y invite, mais il a été livré sans mode d’emploi. Comment faire, alors que les enjeux sont extrêmement complexes et imbriqués, et que la notion de durabilité est elle-même bien difficile à saisir ? La construction de nouvelles utopies collectives semble devenue aussi indispensable qu’urgente pour concilier actions locales et objectifs globaux

Retinal cell type expression specificity of HIV-1-derived gene transfer vectors upon subretinal injection in the adult rat: influence of pseudotyping and promoter

International audienc

Stenosis of the colorectal anastomosis after surgery for diverticulitis: A national retrospective cohort study

International audienceAim The aim of this work was to investigate the association between early postoperative anastomotic leakage or pelvic abscess (AL/PA) and symptomatic anastomotic stenosis (SAS) in patients after surgery for left colonic diverticulitis. Method This is a retrospective study based on a national cohort of diverticulitis surgery patients carried out by the Association Française de Chirurgie . The assessment was performed using path analyses. The database included 7053 patients operated on for colonic diverticulitis, with surgery performed electively or in an emergency, by open access or laparoscopically. Patients were excluded from the study analysis where there was (i) right‐sided diverticulitis (the initial database included all consecutive patients operated on for colonic diverticulitis), (ii) no anastomosis was performed during the first procedure or (iii) missing information about stenosis, postoperative abscess or anastomotic leakage. Results Of the 4441 patients who were included in the final analysis, AL/PA occurred in 327 (4.6%) and SAS occurred in 82 (1.8%). AL/PA was a significant independent factor associated with a risk for occurrence of SAS (OR = 3.41, 95% CI = 1.75–6.66), as was the case for diverting stoma for ≥100 days (OR = 2.77, 95% CI = 1.32–5.82), while central vessel ligation proximal to the inferior mesenteric artery was associated with a reduced risk (OR = 0.41; 95% CI = 0.19–0.88). Diverting stoma created for <100 days or ≥100 days was also a factor associated with a risk for AL/PA (OR = 3.08, 95% CI = 2–4.75 and OR = 12.95, 95% CI = 9.11–18.50). Interestingly, no significant association between radiological drainage or surgical management of AL/PA and SAS could be highlighted. Conclusion AL/PA was an independent factor associated with the risk for SAS. The treatment of AL/PA was not associated with the occurrence of anastomotic stenosis. Diverting stoma was associated with an increased risk of both AL/PA and SAS, especially if it was left for ≥100 days. Physicians must be aware of this information in order to decide on the best course of action when creating a stoma during elective or emergency surgery

Un défi pour la planète

« Transformer les vies tout en préservant la planète », telle est l'ambition des 17 Objectifs de développement durable (ODD), cadre d'action à l'échelle planétaire adopté par tous les pays membres de l'ONU en septembre 2015. Universels, les ODD s'adressent autant aux pays du Nord qu'aux pays du Sud et concernent à la fois l'économie, le développement des sociétés et la protection de l'environnement. Lutte contre la pauvreté, égalité entre les sexes, accès de tous à une énergie propre et à une éducation de qualité, bonne santé et bien-être, villes durables, consommation et production responsables… c'est à un profond changement de modèle que nous invitent les ODD. Cette transformation passe par un dialogue renouvelé entre science, société et politique, et entraîne des mutations majeures dans les rapports Nord-Sud. Proposant une analyse critique de chacun des 17 Objectifs, de leurs interactions et des contradictions dont ils sont aussi porteurs, cet ouvrage réunit une soixantaine d'auteurs d'horizons divers : responsables d'institutions scientifiques, chercheurs, experts, acteurs du développement… Cette approche plurielle offre différentes clés de lecture et met en avant l'importance de la recherche pour comprendre les enjeux des ODD, mesurer l'avancement de leur mise en œuvre et concevoir, en lien avec la société, des solutions innovantes. Accessible à un large public, il apporte un éclairage inédit, à la fois critique et documenté, sur les grands défis de l'Agenda 2030 pour le développement durable

Risk factors for emergency surgery for diverticulitis: A retrospective multicentric French study at 41 hospitals

International audienceBackgroundThe observed increase in the incidence of complicated diverticulitis may lead to the performance of more emergency surgeries. This study aimed to assess the rate and risk factors of emergency surgery for sigmoid diverticulitis.MethodThe primary outcomes were the rate of emergency surgery for sigmoid diverticulitis and its associated risk factors. The urgent or elective nature of the surgical intervention was provided by the surgeon and in accordance with the indication for surgical treatment. A mixed logistic regression with a random intercept after multiple imputations by the chained equation was performed to consider the influence of missing data on the results.ResultsBetween 2010 and 2021, 6,867 patients underwent surgery for sigmoid diverticulitis in the participating centers, of which one-third (n = 2317) were emergency cases. In multivariate regression analysis with multiple imputation by chained equation, increasing age, body mass index <18.5 kg/m2, neurologic and pulmonary comorbidities, use of anticoagulant drugs, immunocompromised status, and first attack of sigmoid diverticulitis were independent risk factors for emergency surgery. The likelihood of emergency surgery was significantly more frequent after national guidelines, which were implemented in 2017, only in patients with a history of sigmoid diverticulitis attacks.ConclusionThe present study highlights a high rate (33%) of emergency surgery for sigmoid diverticulitis in France, which was significantly associated with patient features and the first attack of diverticulitis

Impact of the first wave of COVID-19 epidemy on the surgical management of sigmoid diverticular disease in France: National French retrospective study

International audienceObjective: To analyze the surgical management of sigmoid diverticular disease (SDD) before, during, and after the first containment rules (CR) for the first wave of COVID-19.Methods: From the French Surgical Association multicenter series, this study included all patients operated on between January 2018 and September 2021. Three groups were compared: A (before CR period: 01/01/18-03/16/20), B (CR period: 03/17/20-05/03/20), and C (post CR period: 05/04/20-09/30/21).Results: A total of 1965 patients (A n = 1517, B n = 52, C n = 396) were included. The A group had significantly more previous SDD compared to the two other groups (p = 0.007), especially complicated (p = 0.0004). The rate of peritonitis was significantly higher in the B (46.1%) and C (38.4%) groups compared to the A group (31.7%) (p = 0.034 and p = 0.014). As regards surgical treatment, Hartmann's procedure was more often performed in the B group (44.2%, vs A 25.5% and C 26.8%, p = 0.01). Mortality at 90 days was significantly higher in the B group (9.6%, vs A 4% and C 6.3%, p = 0.034). This difference was also significant between the A and B groups (p = 0.048), as well as between the A and C groups (p = 0.05). There was no significant difference between the three groups in terms of postoperative morbidity.Conclusion: This study shows that the management of SDD was impacted by COVID-19 at CR, but also after and until September 2021, both on the initial clinical presentation and on postoperative mortality