L’automutilation génitale : intérêt d’un avis psychiatrique dans la prise en charge urologique

Les automutilations sont des conduites fréquentes, souvent associées à une morbidité psychiatrique. Les auteurs rapportent trois observations de sujets admis dans le service d’urologie du CHU de Cocody d’Abidjan, pour des automutilations génitales. Au cours de la prise en charge chirurgicale, l’avis psychiatrique demandé chez ces patients a conclu au diagnostic de schizophrénie paranoïde. Les frustrations survenues dans l’accomplissement de leur sexualité ontconstitué les motifs évoqués par les patients pour réaliser l’automutilation génitale. La blessure auto-infligée a eu pour fonctions de communiquer à l’entourage la souffrance psychique, exprimerla dissociation psychique caractéristique de la schizophrénie. Le traitement chirurgical débuté avant la prise en charge psychiatrique ou de façon concomitante, a consisté en une suture des corps caverneux chez le 3ème patient; suture des corps caverneux et urétrorraphie chez le 2ème, puis à une urétrostomie définitive chez le premier. Ces observations soulignent l’intérêt de la collaboration entre chirurgiens et psychiatres dans la prise en charge des automutilations

L’apport de l’imagerie dans le diagnostic de la tuberculose uro-génitale (TUG): Une analyse de 4 observations et revue de la littérature

La tuberculose uro-génitale (TUG) est une localisation secondaire de la maladie. Son diagnostic est bactériologique, mais la probabilité de mettre en évidence le bacille de Koch (BK) dans les urines est faible. D’où le concours de l’imagerie dans le diagnostic et la mise en route du traitement médical. Nous rapportons 4 observations de patients atteints de TUG, dont les images radiologiques associées aux contextes clinique et épidémiologique ont fait évoquer une tuberculose urinaire et génitale. Dans un cas seulement l’uroculture s’est révélée positive au BK. Chez les trois autres patients où la culture urinaire a été négative, les résultats anatomopathologiques des pièces opératoires ont été en faveur d’une lésion tuberculeuse. D’où l’intérêt de la radiologie dans le diagnostic précoce et la prise en charge de la TUG.Mots clés : Tuberculose uro-génitale, bacille de Koch, imageri

A chemically etched corrugated feedhorn array for D-band CMB observations

We present the design, manufacturing, and testing of a 37-element array of corrugated feedhorns for Cosmic Microwave Background CMB) measurements between 140 and 170 GHz. The array was designed to be coupled to Kinetic Inductance Detector arrays, either directly (for total power measurements) or through an orthomode transducer (for polarization measurements). We manufactured the array in platelets by chemically etching aluminum plates of 0.3 mm and 0.4 mm thickness. The process is fast, low-cost, scalable, and yields high-performance antennas compared to other techniques in the same frequency range. Room temperature electromagnetic measurements show excellent repeatability with an average cross polarization level about − 20 dB, return loss about − 25 dB, first sidelobes below − 25 dB and far sidelobes below − 35 dB. Our results qualify this process as a valid candidate for state-of-the-art CMB experiments, where large detector arrays with high sensitivity and polarization purity are of paramount importance in the quest for the discovery of CMB polarization B-modes

An early European experience with transapical off-pump mitral valve repair with NeoChord implantation

OBJECTIVES: Transapical off-pump NeoChord repair is a novel minimally invasive surgical procedure to treat degenerative mitral valve regurgitation. The aim was to evaluate 1-year clinical results of the NeoChord procedure in a consecutive cohort of patients. METHODS: Between February 2013 and July 2016, 213 patients were enrolled in the NeoChord Independent International Registry. All patients presented severe mitral regurgitation due to flail/prolapse of 1 or both leaflets, and they all completed postoperative echocardiographic assessment up to 1 year. We identified the primary end point as composed of procedural success, freedom from mortality, stroke, reintervention, recurrence of severe mitral regurgitation, rehospitalization and decrease of at least 1 New York Heart Association functional class at 1-year follow-up. We also compared outcomes according to the anatomical classification (Type A: isolated central posterior leaflet disease; Type B: posterior multisegment disease; Type C: anterior, bileaflet, paracommissural disease with/without leaflet/annular calcifications). RESULTS: The median age was 68 years (interquartile range 56-77), and the median EuroSCORE II was 1.05% (interquartile range 0.67-1.76). The number of Type A, B and C patients was 82 (38.5%), 98 (46%) and 33 (15.5%), respectively. Procedural success was achieved in 206 (96.7%) patients. At 1-year follow-up, overall survival was 98 ± 1%. Composite end point was achieved in 84 ± 2.5% for the overall population and 94 ± 2.6%, 82.6 ± 3.8% and 63.6 ± 8.4% in Type A, Type B and Type C patients, respectively (P < 0.0001). CONCLUSIONS: These results demonstrate that the NeoChord procedure is safe, effective and reproducible. Clinical and echocardiographic efficacy is maintained up to 1 year with significant differences among the anatomical groups. Specific anatomical selection criteria are necessary to achieve stable results

Measuring CMB spectral distortions from Antarctica with COSMO: blackbody calibrator design and performance forecast

COSMO is a ground-based instrument to measure the spectral distortions (SD) of the Cosmic Microwave Background (CMB). In this paper, we present preliminary results of electromagnetic simulations of its reference blackbody calibrator. HFSS simulations provide a calibrator reflection coefficient of R∼ 10 - 6, corresponding to an emissivity ϵ= 1 - R= 0.999999. We also provide a forecast for the instrument performance by using an ILC-based simulation. We show that COSMO can extract the isotropic Comptonization parameter (modeled as | y| = 1.77 · 10 - 6) as | y| = (1.79 ± 0.19) · 10 - 6, in the presence of the main Galactic foreground (thermal dust) and of CMB anisotropies, and assuming perfect atmospheric emission removal

Chronic obstructive pulmonary disease (COPD) in elderly subjects: impact on functional status and quality of life

AbstractChronic obstructive pulmonary disease (COPD) is an important cause of morbidity and disability. Many studies have investigated factors influencing quality of life (QoL) in middle-aged COPD sufferers, but little attention has been given to elderly COPD. The aim of the present study was to investigate the impact of COPD on QoL and functional status in the elderly. Sixty COPD patients and 58 healthy controls over 65 years old were administered Pulmonary Function Tests, 6min Walking Test (6MWD) for exercise tolerance, the Barthel Index and Mini Mental State Examination (MMSE) for functional status, the Geriatric Depression Scale (GDS) for mood, and the Saint George Respiratory Questionnaire (SGRQ) for QoL. FEV1 and P aO2 were reduced in COPD patients. Also the distance walked during 6MWD was significantly shorter for patients than controls (282.5±89.5 vs. 332.9±95.2m; P<0.01). Moreover, COPD patients had significantly worse outcomes for the Barthel Index, GDS and SGRQ. The logistic regression model demonstrated that a decrease in FEV1 is the factor most strictly related to the deterioration of QoL in COPD patients. Mood was also an independent factor influencing QoL. In conclusion, elderly COPD patients show a substantial impairment in QoL depending on the severity of airway obstruction; symptoms related to the disease may be exaggerated by mood deflection

Identifying frequency decorrelated dust residuals in B-mode maps by exploiting the spectral capability of bolometric interferometry

Astrophysical polarized foregrounds represent the most critical challenge in Cosmic Microwave Background (CMB) B-mode experiments. Multi-frequency observations can be used to constrain astrophysical foregrounds to isolate the CMB contribution. However, recent observations indicate that foreground emission may be more complex than anticipated. We investigate how the increased spectral resolution provided by band splitting in Bolometric Interferometry (BI) through a technique called spectral imaging can help control the foreground contamination in the case of unaccounted Galactic dust frequency decorrelation along the line-of-sight. We focus on the next generation ground-based CMB experiment CMB-S4, and compare its anticipated sensitivities, frequency and sky coverage with a hypothetical version of the same experiment based on BI. We perform a Monte-Carlo analysis based on parametric component separation methods (FGBuster and Commander) and compute the likelihood on the recovered tensor-to-scalar ratio. The main result of this analysis is that spectral imaging allows us to detect systematic uncertainties on r from frequency decorrelation when this effect is not accounted for in component separation. Conversely, an imager would detect a biased value of r and would be unable to spot the presence of a systematic effect. We find a similar result in the reconstruction of the dust spectral index, where we show that with BI we can measure more precisely the dust spectral index also when frequency decorrelation is present. The in-band frequency resolution provided by BI allows us to identify dust LOS frequency decorrelation residuals where an imager of similar performance would fail. This opens the prospect to exploit this potential in the context of future CMB polarization experiments that will be challenged by complex foregrounds in their quest for B-modes detection.Comment: 13 Pages, 15 figures, 4 tables. Submitted to A&

Time course of risk factors associated with mortality of 1260 critically ill patients with COVID-19 admitted to 24 Italian intensive care units

94noopenPurpose: To evaluate the daily values and trends over time of relevant clinical, ventilatory and laboratory parameters during the intensive care unit (ICU) stay and their association with outcome in critically ill patients with coronavirus disease 19 (COVID-19). Methods: In this retrospective–prospective multicentric study, we enrolled COVID-19 patients admitted to Italian ICUs from February 22 to May 31, 2020. Clinical data were daily recorded. The time course of 18 clinical parameters was evaluated by a polynomial maximum likelihood multilevel linear regression model, while a full joint modeling was fit to study the association with ICU outcome. Results: 1260 consecutive critically ill patients with COVID-19 admitted in 24 ICUs were enrolled. 78% were male with a median age of 63 [55–69] years. At ICU admission, the median ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2) was 122 [89–175] mmHg. 79% of patients underwent invasive mechanical ventilation. The overall mortality was 34%. Both the daily values and trends of respiratory system compliance, PaO2/FiO2, driving pressure, arterial carbon dioxide partial pressure, creatinine, C-reactive protein, ferritin, neutrophil, neutrophil–lymphocyte ratio, and platelets were associated with survival, while for lactate, pH, bilirubin, lymphocyte, and urea only the daily values were associated with survival. The trends of PaO2/FiO2, respiratory system compliance, driving pressure, creatinine, ferritin, and C-reactive protein showed a higher association with survival compared to the daily values. Conclusion: Daily values or trends over time of parameters associated with acute organ dysfunction, acid–base derangement, coagulation impairment, or systemic inflammation were associated with patient survival.openZanella A.; Florio G.; Antonelli M.; Bellani G.; Berselli A.; Bove T.; Cabrini L.; Carlesso E.; Castelli G.P.; Cecconi M.; Citerio G.; Coloretti I.; Corti D.; Dalla Corte F.; De Robertis E.; Foti G.; Fumagalli R.; Girardis M.; Giudici R.; Guiotto L.; Langer T.; Mirabella L.; Pasero D.; Protti A.; Ranieri M.V.; Rona R.; Scudeller L.; Severgnini P.; Spadaro S.; Stocchetti N.; Vigano M.; Pesenti A.; Grasselli G.; Aspesi M.; Baccanelli F.; Bassi F.; Bet A.; Biagioni E.; Biondo A.; Bonenti C.; Bottino N.; Brazzi L.; Buquicchio I.; Busani S.; Calini A.; Calligaro P.; Cantatore L.P.; Carelli S.; Carsetti A.; Cavallini S.; Cimicchi G.; Coppadoro A.; Dall'Ara L.; Di Gravio V.; Erba M.; Evasi G.; Facchini A.; Fanelli V.; Feliciotti G.; Fusarini C.F.; Ferraro G.; Gagliardi G.; Garberi R.; Gay H.; Giacche L.; Grieco D.; Guzzardella A.; Longhini F.; Manzan A.; Maraggia D.; Milani A.; Mischi A.; Montalto C.; Mormina S.; Noseda V.; Paleari C.; Pedeferri M.; Pezzi A.; Pizzilli G.; Pozzi M.; Properzi P.; Rauseo M.; Russotto V.; Saccarelli L.; Servillo G.; Spano S.; Tagliabue P.; Tonetti T.; Tullo L.; Vetrugno L.; Vivona L.; Volta C.A.; Zambelli V.; Zanoni A.Zanella, A.; Florio, G.; Antonelli, M.; Bellani, G.; Berselli, A.; Bove, T.; Cabrini, L.; Carlesso, E.; Castelli, G. P.; Cecconi, M.; Citerio, G.; Coloretti, I.; Corti, D.; Dalla Corte, F.; De Robertis, E.; Foti, G.; Fumagalli, R.; Girardis, M.; Giudici, R.; Guiotto, L.; Langer, T.; Mirabella, L.; Pasero, D.; Protti, A.; Ranieri, M. V.; Rona, R.; Scudeller, L.; Severgnini, P.; Spadaro, S.; Stocchetti, N.; Vigano, M.; Pesenti, A.; Grasselli, G.; Aspesi, M.; Baccanelli, F.; Bassi, F.; Bet, A.; Biagioni, E.; Biondo, A.; Bonenti, C.; Bottino, N.; Brazzi, L.; Buquicchio, I.; Busani, S.; Calini, A.; Calligaro, P.; Cantatore, L. P.; Carelli, S.; Carsetti, A.; Cavallini, S.; Cimicchi, G.; Coppadoro, A.; Dall'Ara, L.; Di Gravio, V.; Erba, M.; Evasi, G.; Facchini, A.; Fanelli, V.; Feliciotti, G.; Fusarini, C. F.; Ferraro, G.; Gagliardi, G.; Garberi, R.; Gay, H.; Giacche, L.; Grieco, D.; Guzzardella, A.; Longhini, F.; Manzan, A.; Maraggia, D.; Milani, A.; Mischi, A.; Montalto, C.; Mormina, S.; Noseda, V.; Paleari, C.; Pedeferri, M.; Pezzi, A.; Pizzilli, G.; Pozzi, M.; Properzi, P.; Rauseo, M.; Russotto, V.; Saccarelli, L.; Servillo, G.; Spano, S.; Tagliabue, P.; Tonetti, T.; Tullo, L.; Vetrugno, L.; Vivona, L.; Volta, C. A.; Zambelli, V.; Zanoni, A