Chirurgie hépatique mineure par laparoscopie en ambulatoire : étude rétrospective observationnelle

RésuméAu cours de la dernière décennie, la chirurgie hépatique laparoscopique (CHL) a connu un essor dans le monde entier. Parallèlement, la chirurgie ambulatoire a été développée afin d’améliorer le confort des patients et de réduire les dépenses de santé. L’objectif de cette étude est de rapporter notre expérience préliminaire de la CHL en ambulatoire. Entre 1999 et 2014, 172 patients ont été opérés dans notre institution d’une CHL, incluant 151 résections hépatiques et 21 fenestrations de kystes hépatiques. Tous les patients consécutifs, hautement sélectionnés, opérés d’une CHL en ambulatoire ont été inclus. Vingt patients ont été opérés d’une CHL en ambulatoire. Les indications étaient des kystes hépatiques dans 10 cas, un angiome hépatique dans 3 cas, une hyperplasie nodulaire focale dans 3 cas, et une métastase hépatique de cancer colorectal dans 4 cas. La durée opératoire médiane était de 92minutes (dispersion : 50–240minutes). La perte sanguine médiane était de 35mL (dispersion : 20–150mL). Il n’a pas été observé de complication ni de réhospitalisation. Tous les patients étaient hospitalisés en postopératoire dans notre unité de chirurgie ambulatoire, et ont pu quitter l’établissement 5 à 7heures après la fin de la chirurgie. Le score médian de douleur postopératoire à la sortie était de 3 (échelle visuelle analogique à 10 niveaux ; dispersion : 0–4). Le score médian de qualité de vie à la première consultation postopératoire était de 8 (dispersion : 6–10), et le score médian de satisfaction esthétique était de 8 (dispersion : 7–10). Cette série montre que la CHL ambulatoire est faisable et sûre et chez des patients sélectionnés pour des interventions mineures.SummaryOver the last decade, laparoscopic hepatic surgery (LHS) has been increasingly performed throughout the world. Meanwhile, ambulatory surgery has been developed and implemented with the aims of improving patient satisfaction and reducing health care costs. The objective of this study was to report our preliminary experience with ambulatory minimally-invasive LHS. Between 1999 and 2014, 172 patients underwent LHS at our institution, including 151 liver resections and 21 fenestrations of hepatic cysts. The consecutive series of highly selected patients who underwent ambulatory LHS were included in this study. Twenty patients underwent ambulatory LHS. The indications were liver cysts in 10 cases, liver angioma in 3 cases, focal nodular hyperplasia in 3 cases, and colorectal hepatic metastasis in 4 cases. The median operative time was 92minutes (range: 50–240minutes). The median blood loss was 35mL (range: 20–150mL). There were no postoperative complications or re-hospitalizations. All patients were hospitalized after surgery in our ambulatory surgery unit, and were discharged 5–7hours after surgery. The median postoperative pain score at the time of discharge was 3 (visual analogue scale 0–10; range: 0–4). The median quality-of-life score at the first postoperative visit was 8 (range: 6–10) and the median cosmetic satisfaction score was 8 (range: 7–10). This series shows that, in selected patients, ambulatory LHS is feasible and safe for minor hepatic procedures

A 2 GHz Bandpass Analog to Digital Delta-sigma Modulator for CDMA Receivers with 79 DB Dynamic Range in 1.23 MHz Bandwidth

This paper presents the design of a second-order single-bit analog-to-digital continuous-time delta-sigma modulator that can be used in wireless CDMA receivers. The continuous-time delta-sigma modulator samples at 2 GHz, consumes 18 mW at 1.8 V and has a 79-dB signal-to-noise ratio (SNR) over a 1.23-MHz bandwidth. The continuous-time delta-sigma modulator was fabricated in a 0.18- m 1-poly 6-metal, CMOS technology and has an active area of approximately 0.892 mm2 . The delta-sigma modulator\u27s critical performance specifications are derived from the CDMA receiver specifications

Simulation Study of the Variations in Driving Pressure and Frequency on Microbubbles Contras Agents Behavior

The difference between the density of the gas core of microbubbles and the surrounding media causes the behavior of microbubbles contrast agents in an ultrasound field to be nonlinear and intricate. In addition, many factors affect the radial oscillations of these microbubbles. Some of these factors are related with the bubble structure and its shell material such as the initial radius of the bubble, shell thickness, viscosity of the shell material and its elasticity. Other factors are related with the incident acoustic wave such as the driving frequency and driving pressure amplitude. In this simulation study the effects of pressure and frequency as influential factors on the stability of the microbubble were studied in wide range (frequencies are extend from f<fr to f≈3 fr, pressure extends from 0.05 to 1.5 MPa.), and analyzed using the bifurcation theory to visualize and characterize the effect of these factors on the microbubbles behavior. The study expounded theoretically that the generation the higher order of subharmonic oscillations is possible to result at high driving frequencies with low and appropriate driving pressures

An MDA approach for developing Secure OLAP applications: metamodels and transformations

Decision makers query enterprise information stored in Data Warehouses (DW) by using tools (such as On-Line Analytical Processing (OLAP) tools) which employ specific views or cubes from the corporate DW or Data Marts, based on multidimensional modelling. Since the information managed is critical, security constraints have to be correctly established in order to avoid unauthorized access. In previous work we defined a Model-Driven based approach for developing a secure DW repository by following a relational approach. Nevertheless, it is also important to define security constraints in the metadata layer that connects the DW repository with the OLAP tools; that is, over the same multidimensional structures that end users manage. This paper incorporates a proposal for developing secure OLAP applications within our previous approach: it improves a UML profile for conceptual modelling; it defines a logical metamodel for OLAP applications; and it defines and implements transformations from conceptual to logical models, as well as from logical models to secure implementation in a specific OLAP tool (SQL Server Analysis Services).This research is part of the following projects: SIGMA-CC (TIN2012-36904), GEODAS-BC (TIN2012-37493-C01) and GEODAS-BI (TIN2012-37493-C03) funded by the Ministerio de Economía y Competitividad and Fondo Europeo de Desarrollo Regional FEDER. SERENIDAD (PEII11-037-7035) and MOTERO (PEII11- 0399-9449) funded by the Consejería de Educación, Ciencia y Cultura de la Junta de Comunidades de Castilla La Mancha, and Fondo Europeo de Desarrollo Regional FEDER

Francisella tularensis Transmission by Solid Organ Transplantation, 20171.

In July 2017, fever and sepsis developed in 3 recipients of solid organs (1 heart and 2 kidneys) from a common donor in the United States; 1 of the kidney recipients died. Tularemia was suspected only after blood cultures from the surviving kidney recipient grew Francisella species. The organ donor, a middle-aged man from the southwestern United States, had been hospitalized for acute alcohol withdrawal syndrome, pneumonia, and multiorgan failure. F. tularensis subsp. tularensis (clade A2) was cultured from archived spleen tissue from the donor and blood from both kidney recipients. Whole-genome multilocus sequence typing indicated that the isolated strains were indistinguishable. The heart recipient remained seronegative with negative blood cultures but had been receiving antimicrobial drugs for a medical device infection before transplant. Two lagomorph carcasses collected near the donor's residence were positive by PCR for F. tularensis subsp. tularensis (clade A2). This investigation documents F. tularensis transmission by solid organ transplantation

Submucosal Tunnel Endoscopic Resection of Gastric Lesion Before Obesity Surgery: a Case Series

Background: Submucosal tumors (SMTs) of the gastrointestinal tract are a rare pathological entity comprising a wide variety of neoplastic and non-neoplastic lesions. Even if most SMTs are benign tumors (e.g., leiomyomas), a smaller portion may have a malignant potential (e.g., gastrointestinal stromal tumor (GIST)). Preoperative diagnosis of SMT in bariatric patients may arise challenging clinical dilemmas. Long-term surveillance may be difficult after bariatric surgery. Moreover, according to SMT location, its presence may interfere with planned surgery. Submucosal tunneling endoscopic resection (STER) has emerged as an effective approach for minimally invasive en bloc excision of SMTs. This is the first case series of STER for SMTs before bariatric surgery. Methods: Seven female patients underwent STER for removal of SMTs before bariatric surgery. All lesions were incidentally diagnosed at preoperative endoscopy. STER procedural steps comprised mucosal incision, submucosal tunneling, lesion enucleation, and closure of mucosal defect. Results: En bloc removal of SMT was achieved in all cases. Mean procedural time was of 45 min (SD 18.6). No adverse event occurred. Mean size of the lesions was 20.6 mm (SD 5.8). Histological diagnoses were 5 leyomiomas, 1 lipoma, and 1 low grade GIST. Bariatric procedure was performed after a mean period of 4.1 months (SD 1.6) from endoscopic resection. Conclusion: STER is a safe and effective treatment for the management of SMT even in bariatric patients awaiting surgery. Preoperative endoscopic resection of SMTs has the advantages of reducing the need for surveillance and removing lesions that could interfere with planned surgery. STER did not altered accomplishment of bariatric procedures

Genome-wide footprints in the carob tree (Ceratonia siliqua) unveil a new domestication pattern of a fruit tree in the Mediterranean

Intense research efforts over the last two decades have renewed our understanding of plant phylogeography and domestication in the Mediterranean basin. Here we aim to investigate the evolutionary history and the origin of domestication of the carob tree (Ceratonia siliqua), which has been cultivated for millennia for food and fodder. We used >1000 microsatellite genotypes to delimit seven carob evolutionary units (CEUs). We investigated genome-wide diversity and evolutionary patterns of the CEUs with 3557 single nucleotide polymorphisms generated by restriction-site associated DNA sequencing (RADseq). To address the complex wild vs. cultivated status of sampled trees, we classified 56 sampled populations across the Mediterranean basin as wild, seminatural or cultivated. Nuclear and cytoplasmic loci were identified from RADseq data and separated for analyses. Phylogenetic analyses of these genomic-wide data allowed us to resolve west-to-east expansions from a single long-term refugium probably located in the foothills of the High Atlas Mountains near the Atlantic coast. Our findings support multiple origins of domestication with a low impact on the genetic diversity at range-wide level. The carob was mostly domesticated from locally selected wild genotypes and scattered long-distance westward dispersals of domesticated varieties by humans, concomitant with major historical migrations by Romans, Greeks and Arabs. Ex situ efforts to preserve carob genetic resources should prioritize accessions from both western and eastern populations, with emphasis on the most differentiated CEUs situated in southwest Morocco, south Spain and eastern Mediterranean. Our study highlights the relevance of wild and seminatural habitats in the conservation of genetic resources for cultivated trees

Investigating the genetic and environmental basis of head micromovements during MRI

Introduction Head motion during magnetic resonance imaging is heritable. Further, it shares phenotypical and genetic variance with body mass index (BMI) and impulsivity. Yet, to what extent this trait is related to single genetic variants and physiological or behavioral features is unknown. We investigated the genetic basis of head motion in a meta-analysis of genome-wide association studies. Further, we tested whether physiological or psychological measures, such as respiratory rate or impulsivity, mediated the relationship between BMI and head motion.Methods We conducted a genome-wide association meta-analysis for mean and maximal framewise head displacement (FD) in seven population neuroimaging cohorts (UK Biobank, LIFE-Adult, Rotterdam Study cohort 1-3, Austrian Stroke Prevention Family Study, Study of Health in Pomerania; total N = 35.109). We performed a pre-registered analysis to test whether respiratory rate, respiratory volume, self-reported impulsivity and heart rate mediated the relationship between BMI and mean FD in LIFE-Adult.Results No variant reached genome-wide significance for neither mean nor maximal FD. Neither physiological nor psychological measures mediated the relationship between BMI and head motion.Conclusion Based on these findings from a large meta-GWAS and pre-registered follow-up study, we conclude that the previously reported genetic correlation between BMI and head motion relies on polygenic variation, and that neither psychological nor simple physiological parameters explain a substantial amount of variance in the association of BMI and head motion. Future imaging studies should thus rigorously control for head motion at acquisition and during preprocessing