Perforations de l'oesophage (A propos d'une série rétrospective de 37 patients; Résultats)

STRASBOURG-Medecine (674822101) / SudocSudocFranceF

Integrated photovoltaics potential for passenger car : a focus on the sensitivity to electrical architecture losses

International audienceTo reduce greenhouse emissions and improve primary energy saving, vehicle integrated pho-tovoltaics have an ongoing interest. Therefore, we developed a simulation tool of the mileage covered by VIPV. This tool considers various use profiles, different characteristics of the vehicles and of the PV system and all the losses that may decrease energy yield. Focusing on passenger car, simulations show that many parameters influence the outputs of the model, mainly: geo-graphic location, shading losses, thresholds due to extra-consumption to charge the vehicle bat-tery from PV and frequency of recharge with the grid. With projections of the technology in 2030, with 30 % shading losses, VIPV cover up to 1444 km annual mileage. This represents up to 12 % of the total distance. For the best month, it can get up to 14 km/day. For average Europe and worst-case conditions, the VIPV cover only 293 km annual mileage. Life Cycle Assessment (LCA) of solarized passenger car shows negative balance for low-carbon electricity mix. The carbon footprint is up to 489 kg CO2-equivalent avoided emissions on 13 years lifespan in fa-vorable conditions. Beyond km and LCA focus, VIPV could provide useful functions in non-interconnected zones and for resilience in case of climatic catastrophes

Estimation of integrated photovoltaics potential for solar city bus in different climate conditions in Europe

5th International Symposium on Hydrogen Energy and Energy Technologies (HEET 2022) 18/11/2022 - 19/11/2022 Osaka, JapanInternational audienceVehicle integrated photovoltaics have an ongoing interest. Studies on the benefits from vehicle solar roof which take into account all the possible losses and the monthly variation in different climate conditions, are required. Therefore, we developed a software for the simulation of useful PV energy and mileage covered by the PV in vehicles with solar roofs. This software can take into account different use profiles and different characteristics of the vehicles and of the PV system. Focusing on city bus, simulations allow seeing that many parameters can influence the outputs of the model, mainly: the geographic location (first order), the shading losses (second order), the electric architecture (third order) and the battery saturation (fourth order).At mid-life of the vehicle, with the integrated PV (projections of the technology at 2030), a city bus can collect up to 8571 kWh annual useful PV energy, thus up to 9739 km annual mileage covered by VIPV. This represents up to 24 % of the total distance. For the best month, it can get up to 47 km/day. For average Europe case, with high shading losses, a city bus can collect down to 3805 kWh per year and so only 3506 km annual mileage covered by VIPV.The upgrade of the technology from 2022 to 2030 induces an improvement of the useful PV energy and annual mileage covered by VIPV from 32 % to 56 % for city bus depending on the use case.Based on the annual distance covered by VIPV, an evaluation of the different stages of the life cycle analysis of solarized vehicle solutions is possible. The objective is to know the environmental balance of the solutions over the entire life cycle of the vehicles. The carbon footprint of the different solutions is highly variable and depends primarily on the carbon content of the electricity mix in which the vehicle is marketed, but also on the amount of solar irradiance in the considered area. Therefore, there is no simple general trend. Nevertheless, we have drawn some conclusions. With a low carbon module, for a city bus, neutral to very large gains in term of avoided CO2 are expected (up to 28 T CO$_2$ on 20 years lifetime)

Detection and prediction of acute heart transplant rejection with the myocardial T-2 determination provided by a black-blood magnetic resonance imaging sequence

International audienceAbstract: OBJECTIVES This study aimed to determine whether the myocardial T-2 relaxation time, determined using a black-blood magnetic resonance imaging (MRI) sequence, could predict acute heart transplant rejection. BACKGROUND The use of black-blood MRI sequences allows suppression of the confusing influence of blood signal when myocardial T-2 is calculated to detect myocardial edema. METHODS A total of 123 investigations, including cardiac MRI and myocardial biopsy, were performed 8 +/- 11 months after heart transplantation. Myocardial T-2 was determined using an original inversion-recovery/spin-echo sequence. RESULTS A higher than normal T-2 (greater than or equal to 56 ms) allowed an accurate detection of the moderate acute rejections evidenced at baseline biopsy (greater than or equal to International Society for Heart and Lung Transplantation grade 2): sensitivity, 89% and specificity, 70% (p < 0.0001). T-2 was increased in grade 2 (n = 11) compared with grade 0 (n = 49, p < 0.05), grade 1A (n = 34, p < 0.05) and grade 1B (n = 21, p < 0.05); T-2 was further increased in grade 3 (n = 8) compared with grade 2 (p < 0.05). In addition, in patients without rejection equal to or greater than grade 2 at baseline, a T-2 higher than normal (56 ms) was correlated with the subsequent occurrence of equal or greater than grade 2 rejection within the next three months: sensitivity 63% (12/19) and specificity 78% (64/82) (p = 0.001). CONCLUSIONS Myocardial T-2 determined using a black-blood MRI sequence, is sufficiently sensitive to identify most; of the moderate acute rejections documented with biopsy at the same time, but is also a predictor of the subsequent occurrence of such biopsy-defined rejections

Whole-body MR imaging in suspected physical child abuse: comparison with skeletal survey and bone scintigraphy findings from the PEDIMA prospective multicentre study

International audienceObjectives: To assess the contribution of whole-body magnetic resonance imaging (WBMRI) and bone scintigraphy (BS) in addition to skeletal survey (SS) in detecting traumatic bone lesions and soft-tissue injuries in suspected child abuse.Methods: In this prospective, multicentre, diagnostic accuracy study, children less than 3 years of age with suspected physical abuse were recruited. Each child underwent SS, BS and WBMRI. A blinded first review was performed in consensus by five paediatric radiologists and three nuclear medicine physicians. A second review investigated discrepancies reported between the modalities using a consensus result of all modalities as the reference standard. We calculated the sensitivity, specificity and corresponding 95% confidence interval for each imaging modality (SS, WBMRI and BS) and for the combinations [SS + WBMRI] and [SS + BS].Results: One hundred seventy children were included of which sixty-four had at least one lesion. In total, 146 lesions were included. The sensitivity and specificity of each examination were, respectively, as follows: 88.4% [95% CI, 82.0-93.1] and 99.7% [95% CI, 99.5-99.8] for the SS, 69.9% [95% CI, 61.7-77.2] and 99.5% [95% CI, 99.2-99.7] for WBMRI and 54.8% [95% CI, 46.4-63.0] and 99.7% [95% CI, 99.5-99.9] for BS. Sensitivity and specificity were, respectively, 95.9% [95% CI, 91.3-98.5] and 99.2% [95% CI, 98.9-99.4] for the combination SS + WBMRI and 95.2% [95% CI, 90.4-98.1] and 99.4% [95% CI, 99.2-99.6] for the combination SS + BS, with no statistically significant difference between them.Conclusion: SS was the most sensitive independent imaging modality; however, the additional combination of either WBMRI or BS examinations offered an increased accuracy.Key points: • SS in suspected infant abuse was the most sensitive independent imaging modality in this study, especially for detecting metaphyseal and rib lesions, and remains essential for evaluation. • The combination of either SS + BS or SS + WBMRI provides greater accuracy in diagnosing occult and equivocal bone injuries in the difficult setting of child abuse. • WBMRI is a free-radiation technique that allows additional diagnosis of soft-tissue and visceral injuries

Status and trends in the development of clinical diagnostic agents

Contrast agents (CA) are routinely used in clinical practice to improve the diagnosis of diseases and to monitor therapy response. The majority of CA comprises small molecules accumulating at pathological sites due to vascular abnormalities, such as changes in perfusion and permeability. For many diseases, high diagnostic accuracy can be achieved with contrast-enhanced imaging. This means that new CA will only succeed in translation if they either show superior performance with respect to diagnostic accuracy, safety and cost, support a new imaging modality, or are directly linked to the refinement of therapy, e.g., as a companion diagnostic. Unfortunately, these basic demands are often not carefully considered by the scientific community, leading to concepts with low chances of clinical translation. Thus, it is not surprising that, despite steadily increasing numbers of publications, there is quite the opposite trend when it comes to the clinical approval of new diagnostics. As a matter of fact, except for PET tracers, in the last decade, only a handful of CA received FDA or EMA approval. Furthermore, several approved products were discontinued by the manufacturers because of low market potential, a competitive own product, suboptimal clinical performance, or safety concerns. This review article discusses the current status of approved diagnostic probes for clinical imaging modalities, with a focus on new trends in CA development. In this context, molecularly targeted diagnostics or probes for emerging fields, such as image-guided surgery, nanomedicine, or theranostics, will be introduced and discussed with regard to their clinical translation