Giant splenic cysts discovered incidentally after early abortion

Splenic cysts are rare tumors, grouped into parasitic and non-parasitic cysts, no-parasitic cysts are further classified into primary and secondary cysts depending on the mucous membrane of the cyst, radiological imaging allows the diagnosis to be made but confirmation of the diagnosis is based on an atom-o-pathological examination of the part. surgical treatment is the cornerstone of symptomatic and complicated splenic cysts. The conservative treatment is a reference for splenic cysts. We report the case of a young woman who was presented with a simple cyst of the spleen

Pacifica: Poetry International: Revolutions in Tunisian Poetry

A collection of contemporary poetry from Tunisia, including poems in translation with their French and Arabic original texts

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Optimisation robuste multi-niveaux et multi-objectif de structures mécaniques complexes

Cet article présente une nouvelle approche d’optimisation multi-objectifs robuste, et multi-niveaux, pour la conception des structures mécaniques complexes. Cette optimisation est à deux niveaux : système et élément. Le problème multi-objectifs robuste, au niveau système, à résoudre est à quatre fonctions coût : d’une part la minimisation de la masse globale et le déplacement en un point fixé de la structure mécanique étudiée, d’autre part la maximisation des robustesses respectivement de la masse et du déplacement alors que le problème multi-objectifs robuste au niveau élément est à deux fonctions coût : la minimisation de la masse de l’élément et la maximisation de sa robustesse. Contrairement aux formulations existantes, cette nouvelle approche tient compte des incertitudes sur les paramètres de conception tant au niveau système qu’au niveau élément. De plus, elle répond au partage des tâches pratiqué dans l’industrie

Composite beam identification using a variant of the inhomogeneous wave correlation method in presence of uncertainties

International audiencePurpose: This paper aims to propose numerical-based and experiment-based identification processes, accounting for uncertainties to identify structural parameters, in a wave propagation framework.Design/methodology/approach: A variant of the inhomogeneous wave correlation (IWC) method is proposed. It consists on identifying the propagation parameters, such as the wavenumber and the wave attenuation, from the frequency response functions. The latters can be computed numerically or experimentally. The identification process is thus called numerical-based or experiment-based, respectively. The proposed variant of the IWC method is then combined with the Latin hypercube sampling method for uncertainty propagation. Stochastic processes are consequently proposed allowing more realistic identification.Findings: The proposed variant of the IWC method permits to identify accurately the propagation parameters of isotropic and composite beams, whatever the type of the identification process in which it is included: numerical-based or experiment-based. Its efficiency is proved with respect to an analytical model and the Mc Daniel method, considered as reference. The application of the stochastic identification processes shows good agreement between simulation and experiment-based results and that all identified parameters are affected by uncertainties, except damping.Originality/value: The proposed variant of the IWC method is an accurate alternative for structural identification on wide frequency ranges. Numerical-based identification process can reduce experiments’ cost without significant loss of accuracy. Statistical investigations of the randomness of identified parameters illustrate the robustness of identification against uncertainties

Model reduction methods for viscoelastic sandwich structures in frequency and time domains

International audienceThis paper deals with modeling and model reduction methods intended to sandwich structures with viscoelastic materials. The modeling step is carried out by combining the First order shear deformation theory (FSDT) with the Golla–Hughes–Mc Tavish (GHM) model. The GHM model introduces auxiliary coordinates to take into account the frequency dependence of viscoelastic materials which, combined with the finite element method (FEM), leads to large order models. This paper focuses on the use of model reduction methods. The reduced models compared to the full model are illustrated by three numerical examples in order to outline the performance, the practical interest of these methods and their validity domains