Bloc de la ligne blanche au secours de la chirurgie herniaire

Une hernie de la ligne blanche est une hernie située sur la ligne médiane entre les muscles grands droits de l'abdomen. Le diagnostic repose généralement sur un examen clinique. Plus rarement, il nécessite une échographie, voire un scanner.L'intervention pour soigner une hernie de la ligne blanche est le plus souvent réalisée en ambulatoire et sous anesthésie générale. Elle est réalisée par laparotomie, laparoscopie ou assistance robotique. Le choix de la technique dépend de l'épaisseur du tissu, de la taille de la hernie et de la présence d'interventions abdominales antérieures. L'intervention consiste à remettre l'intestin dans sa position initiale et à refermer le trou par lequel il est passé. Si le trou de la hernie est supérieur à 1 cm, un treillis est placé pour renforcer l'espace fermé par la chirurgie et prévenir les récidives.La diversité des pathologies et des antécédents des patients a nécessité une diversité de techniques anesthésiques plus adaptées d'où l'anesthésie locorégionale et lesblocs de la paroi abdominal

Tropical water vapour in the lower stratosphere and its relationship to tropical/extratropical dynamical processes in ERA5

Stratospheric water vapour (SWV), in spite of its low concentration in the stratosphere as compared to the troposphere, contributes significantly to the surface energy budget and can have an influence on the surface climate. This study investigates the dynamical processes that determine SWV on interannual to decadal time‐scales. First, we evaluate two SWV reanalysis products and show that SWV is better represented in a new‐generation reanalysis product, ERA5, than in its predecessor, ERA‐Interim. In particular, it is shown that SWV in ERA5 is highly consistent with observational data obtained from the SPARC Data Initiative Multi‐Instrument Mean (SDI MIM). Second, we investigate the variability of tropical SWV and its relationship to dynamical stratospheric variables. The analyses show that the interannual variability in the tropical lower‐stratospheric water vapour is closely linked to the tropical Quasi‐Biennial Oscillation (QBO). When westerlies occupy the middle stratosphere and easterlies the lower stratosphere, a decrease is observed in lower‐stratospheric water vapour due to a colder tropical tropopause and a QBO‐induced enhanced residual circulation. On decadal time‐scales, the composite analysis of the boreal winter in two typical periods shows that less SWV is related to a warm anomaly in the North Atlantic sea‐surface temperature, which leads to stronger upward propagation of planetary wave activity at high latitudes, a weaker polar vortex and an enhanced residual circulation. The opposite occurs during periods with higher concentrations of SWV

α5β1-Integrin promotes tension-dependent mammary epithelial cell invasion by engaging the fibronectin synergy site.

Tumors are fibrotic and characterized by abundant, remodeled, and cross-linked collagen that stiffens the extracellular matrix stroma. The stiffened collagenous stroma fosters malignant transformation of the tissue by increasing tumor cell tension to promote focal adhesion formation and potentiate growth factor receptor signaling through kinase. Importantly, collagen cross-linking requires fibronectin (FN). Fibrotic tumors contain abundant FN, and tumor cells frequently up-regulate the FN receptor α5β1 integrin. Using transgenic and xenograft models and tunable two- and three-dimensional substrates, we show that FN-bound α5β1 integrin promotes tension-dependent malignant transformation through engagement of the synergy site that enhances integrin adhesion force. We determined that ligation of the synergy site of FN permits tumor cells to engage a zyxin-stabilized, vinculin-linked scaffold that facilitates nucleation of phosphatidylinositol (3,4,5)-triphosphate at the plasma membrane to enhance phosphoinositide 3-kinase (PI3K)-dependent tumor cell invasion. The data explain why rigid collagen fibrils potentiate PI3K activation to promote malignancy and offer a perspective regarding the consistent up-regulation of α5β1 integrin and FN in many tumors and their correlation with cancer aggression

Les goitres plongeants : particularites cliniques, radiologiques et therapeutiques

Introduction: Les goitres plongeants, devenus rares de nos jours, posent des problèmes diagnostiques et chirurgicaux particuliers. Leur prise en charge est facilitée par l’apport de la tomodensitometrie permettant de planifier l’attitude thérapeutique.Le but de ce travail est de préciser les modalités d’exploration et de prise en charge chirurgicale des goitres plongeants.Matériels et méthodes : Nous rapportons une étude rétrospective portant sur42 cas de goitre plongeant colligés sur une période de 11 ans entre 2001 et 2011.Résultats : L’âge moyen de nos patients était de 56,9 ans (36-86 ans). Le sex-ratio était de 0,13. La tuméfaction basi-cervicale était le motif de consultation le plus fréquent, rapportée dans 74 % des cas associée à des signes de compression oesotrachéale dans 45% des cas.Une paralysie récurrentielle unilatérale a été objectivée dans 3 cas.Une radiographie de thorax a montré un élargissement médiastinal dans 23% des cas avec déviation trachéale chez63 % des malades. Une TDM cervico-thoracique pratiquée dans 85% des cas a confirmé le diagnostic. Le traitement chirurgical était mené par voie cervicale exclusive chez tous les patients. Une paralysie récurentielle a été observée dans 3 cas. Aucune hypoparathyroïdie définitive n’a été rapportée avec un reculmoyen de 24mois.Conclusion : Les goitres plongeants devenus rares du fait de la prise en charge plus précoce des nodules thyroïdiens. Ils posent actuellement moins de difficultés thérapeutiques. L’indication chirurgicale est toujours formelle devant le risque vital qu’ils posent.Mots clés : goitre cervicothoracique, thyroïdectomie, paralysie récurrentielle, hypoparathyroïdie.Introduction: Substernal goiters, becoming rare, present diagnositic and therapeutic problems.Their management is facilitated by the contribution of computed tomography for planning the therapeutic approach. The aim of this study is to specify the procedures for exploration and surgical management of substernal goiters.Materials and Methods: We report a retrospective study of 42 cases of substernalgoiters collaged over a period of 11 years between 2001 and 2011.Results: The mean age was 56,9 years (36- 86 years). The sex ratio was 0,13. Cervical swelling was the most common reason for consultation, reported in 74% of cases associated with signs of oesotrachealcompression in 45% of cases. Unilateral laryngeal palsy has been objectified in 3 cases. Chest-x-Ray showed widening of mediastinal shadowwith tracheal deviation in 63% of patients. A cervico-thoracic CT performed in 85% of cases confirmed the diagnosis of substernal goiters. The cervical approach has been used in all cases. Laryngeal nerve palsy was observed in 3 cases. No definitive hypoparathyroidism have been reported with a mean of 24 months.Conclusion: Substernal goiters become rare due to the earlier diagnosis of thyroid nodules. They currently present fewer therapeutic difficulties, and must be managed surgically because of vital risk.Key words: substernal goiter, thyroidectomy, laryngeal nerve palsy, hypoparathoidism

Evaluation of the Radiation-Protective Properties of Bi (Pb)–Sr–Ca–Cu–O Ceramic Prepared at Different Temperatures with Silver Inclusion

The influences of the sintering process and AgNO3 addition on the phase formation and radiation shielding characteristics of Bi1.6Pb0.4Sr2Ca2Cu3O10 were studied. Three ceramics (code: C0, C1, and C2) were prepared as follows: C0 was obtained after calcination and only one sintering step, C1 was obtained after calcination and two sintering cycles, and C2 was prepared after the addition of AgNO3 at the beginning of the final sintering stage. C2 displayed the maximum volume fraction of the Bi-2223 phase (76.4 vol%), the greatest crystallite size, and high density. The linear mass attenuation coefficient (µ) has been simulated using the Monte Carlo simulation. The µ values are high at 15 keV (257.2 cm−1 for C0, 417.57 cm−1 for C1, and 421.16 cm−1 for C2), and these values dropped and became 72.58, 117.83 and 133.19 cm−1 at 30 keV. The µ value for the ceramics after sintering is much higher than the ceramic before sintering. In addition, the µ value for C2 is higher than that of C1, suggesting that the AgNO3 improves the radiation attenuation performance for the fabricated ceramics. It was demonstrated that the sintering and AgNO3 addition have a considerable influence on the ceramic thickness required to attenuate the radiation. © 2022 by the authors. Licensee MDPI, Basel, Switzerland.The authors express their gratitude to Princess Nourah bint Abdulrahman University Researchers Supporting Project (PNURSP2022R2), Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia

Relative spins and excitation energies of superdeformed bands in 190Hg: Further evidence for octupole vibration

An experiment using the Eurogam Phase II gamma-ray spectrometer confirms the existence of an excited superdeformed (SD) band in 190Hg and its very unusual decay into the lowest SD band over 3-4 transitions. The energies and dipole character of the transitions linking the two SD bands have been firmly established. Comparisons with RPA calculations indicate that the excited SD band can be interpreted as an octupole-vibrational structure.Comment: 12 pages, latex, 4 figures available via WWW at http://www.phy.anl.gov/bgo/bc/hg190_nucl_ex.htm

Multi-decadal modulations in the Aleutian-Icelandic Low seesaw and the axial symmetry of the Arctic Oscillation signature, as revealed in the 20th century reanalysis

Seesaw relationship in intensity between the surface Aleutian and Icelandic Lows (AIS) is a manifestation of atmospheric teleconnection that bridges the interannual variability over the Pacific and Atlantic in particular winter months. Analysis of the 20th Century Reanalysis data reveals that the strength and timing of AIS have undergone multi-decadal modulations in conjunction with those in structure of the Arctic Oscillation (AO) signature, extracted in the leading mode of interannual sea-level pressure (SLP) variability over the extratropical Northern Hemisphere. Specifically, events of what may be called ‘pure AO’, in which SLP anomalies exhibit a high degree of axial symmetry in association with in-phase SLP variability between the midlatitude Atlantic and Pacific, tended to occur during multi-decadal periods in which the inter-basin teleconnection through AIS was active under the enhanced interannual variability of the Aleutian Low. In contrast, the axial symmetry of the AO pattern was apparently reduced during a multi-decadal period in which the AIS teleconnection was inactive under the weakened interannual variability of the Aleutian Low. In this period, the leading mode of interannual SLP variability represented a meridional seesaw between the Atlantic and Arctic, which resembles SLP anomaly pattern associated with the cold-ocean/warm-land (COWL) temperature pattern. These multi-decadal modulations in interannual AIS signal and the axial symmetry of the interannual AO pattern occurred under multi-decadal changes in the background state that also represented the polarity changes of the COWL-like anomaly pattern

Effects of Natural and Anthropogenic Stressors on Fucalean Brown Seaweeds Across Different Spatial Scales in the Mediterranean Sea

Algal habitat-forming forests composed of fucalean brown seaweeds (Cystoseira, Ericaria, and Gongolaria) have severely declined along the Mediterranean coasts, endangering the maintenance of essential ecosystem services. Numerous factors determine the loss of these assemblages and operate at different spatial scales, which must be identified to plan conservation and restoration actions. To explore the critical stressors (natural and anthropogenic) that may cause habitat degradation, we investigated (a) the patterns of variability of fucalean forests in percentage cover (abundance) at three spatial scales (location, forest, transect) by visual estimates and or photographic sampling to identify relevant spatial scales of variation, (b) the correlation between semi-quantitative anthropogenic stressors, individually or cumulatively (MA-LUSI index), including natural stressors (confinement, sea urchin grazing), and percentage cover of functional groups (perennial, semi-perennial) at forest spatial scale. The results showed that impacts from mariculture and urbanization seem to be the main stressors affecting habitat-forming species. In particular, while mariculture, urbanization, and cumulative anthropogenic stress negatively correlated with the percentage cover of perennial fucalean species, the same stressors were positively correlated with the percentage cover of the semi-perennial Cystoseira compressa and C. compressa subsp. pustulata. Our results indicate that human impacts can determine spatial patterns in these fragmented and heterogeneous marine habitats, thus stressing the need of carefully considering scale-dependent ecological processes to support conservation and restoration