Facteurs predictifs d’atteinte ganglionnaire centrale dans les cancers differencies de la thyroïde. Analyses univariée et multivariée

Les cancers papillaires et vésiculaires de la thyroïde sont les cancers endocriniens les plus fréquents. L’envahissement ganglionnaire semble peu influencer la survie globale, mais majore les risques de récidive locorégionale et de métastases à distance. Cet envahissement est une complication fréquente des cancers papillaires de la thyroïde, moins rapporté dans les cancers vésiculaires. il implique un évidement ganglionnaire qui n’est pas sans risques. Pour déterminer les moyens de limiter les curages ganglionnaires, nous avons tenté de déterminer les critères per opératoires prédictifs de métastase ganglionnaire centrale et ainsi identifier les patients qui doivent bénéficier de cette procédure. Notre étude est une étude rétrospective portant sur 71 patients (49 femmes et 22 hommes) traités entre 2000 et 2011d’un cancer différencié de la thyroïde de type papillaire ou vésiculaire. Après analyse des critères épidémiologiques, cliniques et anatomopathologiques, nous avons trouvé une association significative entre l’envahissement extra capsulaire, l’envahissement ganglionnaire latéral, la bilatéralité et l’envahissement ganglionnaire central. un évidemment ganglionnaire central prophylactique doit donc être particulièrement considéré chez ces patients.Mots clés : carcinome thyroïdien, évidement ganglionnaire, métastase ganglionnaire.Papillary and follicular thyroid carcinomas are the most common form of endocrine carcinomas. Lymph node involvement seems to be a low risk factor for death, but it increases the risk for loco-regional recurrences and distant metastasis. Lymph node involvement is a common complication of papillary thyroid carcinoma, less reported in vesicular carcinoma. il involves node dissection and its resulting morbidity. To determine means of limiting lymph node dissections, we attempted to determine intra-operative criteria predictive of node metastasis and soidentify the patients likely to benefit from this procedure. Our study is a retrospective study of 71 patients (49 women and 22 men) treated between 2000 and 2011 from differentiated thyroid cancer (papillary or follicular).After analyses of the demographic, clinical and anatomopathological factors, we found a significant association among extra capsular invasion, lateral lymphnode metastasis, bilaterality, and central compartment lymph node metastasis. A prophylactic neck dissection of the central compartment should be considered particularly in these patients.Keyswords : thyroid carcinoma, lymph node dissection, lymph node metastases

Evaluation des facteurs pronostiques pouvant influencer les resultats d’une septoplastie

Introduction :Une des principales étiologies de l’obstruction nasale est la déviation septale, dont le traitement chirurgical est la septoplastie. mais d’autres étiologies peuvent être à l’origine d’une obstruction nasale, notamment une hypertrophie des cornets, des végétations adénoïdes hypertrophiques, une polypose nasale, etc. Les critères de sélection sur lesquels se base un chirurgien pour décider de pratiquer une septoplastie, sont essentiellement basés sur l’évaluation clinique. Le but de nôtre travail est d’évaluer ces critères cliniques ainsi que les critères dermographiques pouvant influencer les résultats de la septoplastie.Patients et méthodes : On a évalué tous les patients qui ont eu une septoplastie dans les 2 à 10 dernières années. Les données cliniques ont été revues afin de préciser le siège de la déformation septale initiale, sa sévérité dictée par le chirurgien et les résultats fonctionnels de la septoplastie.Résultats et : les patients ayant une déviation septale antérieure ont rapporté le plus d’amélioration après septoplastie. Toutefois il ressort de notre étude qu’une sélection des patients basée uniquement sur l’évaluation clinique par le chirurgien de l’importance de la déviation septale est à l’origine d’un taux important d’insatisfaction des patientsObjective : a common etiology of nasal obstruction is deviation of the nasal septum, for witch septoplasty is the definitive treatment. But nasal obstruction can be caused by other conditions, such as turbinate hypertrophy, adenoid hypertrophy, and nasal polyposis. The surgeons’ selection criteria for septoplasty largely rely on clinical judgment alone. The aim of our study was to evaluate if this clinical criteria and the demographics ones could influence the results of septoplasty.Patients and methods :We evaluate all patients who underwent septoplasty in the past 2 to 10 years. Clinical files were reviewed to establish the initial type of septal deformity, its severity dictated by the surgeon and the functional results of septoplasty.Results and Conclusion : Subjects with anterior septal deformities were shown to benefit the most from septoplasty. However, selection of patients based on clinical evaluation alone does carry a considerable risk of patient dissatisfaction with end results

Osteomyelite atypique ou centrale de la base du crane d’origine sinusienne

Introduction : L’ostéomyélitede la base du crâne esttypiquement secondaire à une otite externe nécrosante chez des patients âgés, diabétiques. Elle atteint l’os temporal et est habituellement due au pseudomonasaeruginosa. Dans sa forme atypique, l’ostéomyélite atteint les os sphénoïdal ou occipital sans otite externe associéeet est beaucoup moins fréquente. Le but de cette étude est d’analyser les caractéristiques cliniques et de déterminer les modalités thérapeutiques de l’ostéomyélite nonotologique de la base du crâne.Méthodes : Nous avons revu rétrospectivement deux casd’ostéomyélite atypique de la base du crâne.Résultats : Les deux patients se sont présentés dans un tableau d’altération de l’état général, une asthénie, des céphalées et de la fièvre. Les signes rhinologiques étaient discrets. Aucun des deux patients n’avait de déficit neurologique. L’imagerie avait montré une destruction osseuse, la biologie a objectivé un syndrome infectieux et une biopsie osseuse trans sphénoïdale a confirmé le diagnostic d’ostéomyélite. Un traitement antibiotique prolongé a été instauré et les deux patients ont été guéris sans récidive moyennant un recul de 12 mois.Conclusion : l’atteinte ostéomyélitique centrale de la base du crâne est une affection rare dont la prise en charge passe par un prélèvement osseux précoce et un traitement approprié afin de prévenir ou limiter d’autres complications telles qu’une extension endocrânienne, un empyème, ou la mort.Mots Clés: Ostéomyélite; Base du crâne; sphenoïdite; IRMIntroduction : Skull base osteomyelitis typically arises as a complication of ear infection in older diabetic patients, involves the temporal bone, and has Pseudomonas aeruginosaas the usual pathogen. Atypical skull base osteomyelitis arising from the sphenoid or occipital bones without associated external otitis occurs much less frequently. The purpose of this study was to review the clinical featuresand determine efficacy of treatment for nonotologic osteomyelitis of the skull base.Methods : We retrospectively reviewed two cases of central or atypical skull base osteomyelitis.Results : The two patients presented with asthenia, headache, and fever. No patient presented with neurologic deficits. Contrary to malignant otitis externa, our cases were not preceded by immediate external infections and had normal external ear examinations. One patient had an underlying immunocompromising condition. Imaging demonstrated bone destruction, subsequent microbiological analysis diagnosed infection and a biopsy proved diagnosis of osteomyelitis, a prolonged antibiotic treatment was instored. The two patients were cured with no recurrence of skull base infection over 12-month follow-up period.Conclusion : Central skull base osteomyelitis is a rare disease whose treatment requires an early bone biopsy and appropriate treatment to prevent or limit other complications such as intracranial extension, empyema, or dead.Key Words : Osteomyelitis; Skull base; sphenoïditis; MR

Evapotranspiration and evaporation/transpiration partitioning with dual source energy balance models in agricultural lands

EvapoTranspiration (ET) is an important component of the water cycle, especially in semi-arid lands. Its quantification is crucial for a sustainable management of scarce water resources. A way to quantify ET is to exploit the available surface temperature data from remote sensing as a signature of the surface energy balance, including the latent heat flux. Remotely sensed energy balance models enable to estimate stress levels and, in turn, the water status of most continental surfaces. The evaporation and transpiration components of ET are also just as important in agricultural water management and ecosystem health monitoring. Single temperatures can be used with dual source energy balance models but rely on specific assumptions on raw levels of plant water stress to get both components out of a single source of information. Additional information from remote sensing data are thus required, either something specifically related to evaporation (such as surface water content) or transpiration (such as PRI or fluorescence). This works evaluates the SPARSE dual source energy balance model ability to compute not only total ET, but also water stress and transpiration/evaporation components. First, the theoretical limits of the ET component retrieval are assessed through a simulation experiment using both retrieval and prescribed modes of SPARSE with the sole surface temperature. A similar work is performed with an additional constraint, the topsoil surface soil moisture level, showing the significant improvement on the retrieval. Then, a flux dataset acquired over rainfed wheat is used to check the robustness of both stress levels and ET retrievals. In particular, retrieval of the evaporation and transpiration components is assessed in both conditions (forcing by the sole temperature or the combination of temperature and soil moisture). In our example, there is no significant difference in the performance of the total ET retrieval, since the evaporation rate retrieved from the sole surface temperature is already fairly close to the one we can reconstruct from observed surface soil moisture time series, but current work is underway to test it over other plots.</p

Harnessing inter-disciplinary collaboration to improve emergency care in low- and middle-income countries (LMICs): results of research prioritisation setting exercise

Background More than half of deaths in low- and middle-income countries (LMICs) result from conditions that could be treated with emergency care - an integral component of universal health coverage (UHC) - through timely access to lifesaving interventions. Methods The World Health Organization (WHO) aims to extend UHC to a further 1 billion people by 2023, yet evidence supporting improved emergency care coverage is lacking. In this article, we explore four phases of a research prioritisation setting (RPS) exercise conducted by researchers and stakeholders from South Africa, Egypt, Nepal, Jamaica, Tanzania, Trinidad and Tobago, Tunisia, Colombia, Ethiopia, Iran, Jordan, Malaysia, South Korea and Phillipines, USA and UK as a key step in gathering evidence required by policy makers and practitioners for the strengthening of emergency care systems in limited-resource settings. Results The RPS proposed seven priority research questions addressing: identification of context-relevant emergency care indicators, barriers to effective emergency care; accuracy and impact of triage tools; potential quality improvement via registries; characteristics of people seeking emergency care; best practices for staff training and retention; and cost effectiveness of critical care – all within LMICs. Conclusions Convened by WHO and facilitated by the University of Sheffield, the Global Emergency Care Research Network project (GEM-CARN) brought together a coalition of 16 countries to identify research priorities for strengthening emergency care in LMICs. Our article further assesses the quality of the RPS exercise and reviews the current evidence supporting the identified priorities

Harnessing inter-disciplinary collaboration to improve emergency care in low- and middle-income countries (LMICs): results of research prioritisation setting exercise

Background More than half of deaths in low- and middle-income countries (LMICs) result from conditions that could be treated with emergency care - an integral component of universal health coverage (UHC) - through timely access to lifesaving interventions. Methods The World Health Organization (WHO) aims to extend UHC to a further 1 billion people by 2023, yet evidence supporting improved emergency care coverage is lacking. In this article, we explore four phases of a research prioritisation setting (RPS) exercise conducted by researchers and stakeholders from South Africa, Egypt, Nepal, Jamaica, Tanzania, Trinidad and Tobago, Tunisia, Colombia, Ethiopia, Iran, Jordan, Malaysia, South Korea and Phillipines, USA and UK as a key step in gathering evidence required by policy makers and practitioners for the strengthening of emergency care systems in limited-resource settings. Results The RPS proposed seven priority research questions addressing: identification of context-relevant emergency care indicators, barriers to effective emergency care; accuracy and impact of triage tools; potential quality improvement via registries; characteristics of people seeking emergency care; best practices for staff training and retention; and cost effectiveness of critical care – all within LMICs. Conclusions Convened by WHO and facilitated by the University of Sheffield, the Global Emergency Care Research Network project (GEM-CARN) brought together a coalition of 16 countries to identify research priorities for strengthening emergency care in LMICs. Our article further assesses the quality of the RPS exercise and reviews the current evidence supporting the identified priorities

Effects of Precursor Concentration and Acidic Sulfate in Aqueous Glyoxal−OH Radical Oxidation and Implications for Secondary Organic Aerosol

Previous experiments demonstrated that aqueous OH radical oxidation of glyoxal yields low-volatility compounds. When this chemistry takes place in clouds and fogs, followed by droplet evaporation (or if it occurs in aerosol water), the products are expected to remain partially in the particle phase, forming secondary organic aerosol (SOA). Acidic sulfate exists ubiquitously in atmospheric water and has been shown to enhance SOA formation through aerosol phase reactions. In this work, we investigate how starting concentrations of glyoxal (30−3000 μM) and the presence of acidic sulfate (0−840 μM) affect product formation in the aqueous reaction between glyoxal and OH radical. The oxalic acid yield decreased with increasing precursor concentrations, and the presence of sulfuric acid did not alter oxalic acid concentrations significantly. A dilute aqueous chemistry model successfully reproduced oxalic acid concentrations, when the experiment was performed at cloud-relevant concentrations (glyoxal <300 μM), but predictions deviated from measurements at increasing concentrations. Results elucidate similarities and differences in aqueous glyoxal chemistry in clouds and in wet aerosols. They validate for the first time the accuracy of model predictions at cloud-relevant concentrations. These results suggest that cloud processing of glyoxal could be an important source of SOA