Comportement en flexion de poutres en béton armé renforcées par des armatures en PRF encastrées près de la surface

As we move into the twenty-first century, the renewal of our lifelines or deterioration of infrastructure becomes a topic of critical importance. The structures may have to carry larger loads, require change in building use, suffer steel corrosion problems, or errors made during the design or construction phases so that the structure may need to be repaired or strengthened before it can be used. The use of fiber reinforced polymers (FRP) in the last few years in various engineering application, forums and configuration offers an alternative design approach for the construction of new concrete structures and the rehabilitation of existing ones. The use of FRP materials for external strengthening of reinforced concrete (RC) structures has emerged as one of the most exciting and promising technologies in material and structural engineering. Externally bonded FRP reinforcement is relatively unprotected against impact, vandalism or severe environmental conditions. Their structural performance can be greatly affected by these drawbacks. But if the composite material is placed in slots inside the concrete cover some of these drawbacks can be overcome. This method is designated by Near Surface Mounted (NSM) method. Therefore, the presented work is carried out using this advantageous strengthening technique utilizing the non-corrodible FRP materials. My research involved both experimental and analytical investigations on the use of FRP systems for strengthening concrete structures using NSM techniques. The main objectives of my research were to (1) develop/utilize an NSM system composed of FRP bars and adhesives, (2) investigate the bond performance for the proposed NSM system, (3) investigate the effect of freeze and thaw cycles on the of the new proposed system, (4) study the flexural behaviour of RC beams strengthened with NSM FRP bars, (5) develop an analytical model using non-linear finite element analysis (ADINA) taking into consideration the interfacial behaviour between the concrete and FRP bars and (6) establish design recommendations for the use of FRP bars for the NSM method. To achieve these objectives, the research program was divided into two parts. The first part included the experimental work while the second part included the analytical work. The first part consisted of two phases. The first phase included the pullout testing of 76 C-shape concrete blocks including 16 conditioned blocks. The second phase included testing 20 flexural strengthened concrete beams using the NSM method. The second part included developing an analytical model to be used in a non-linear finite element program and to analyze and predict the behaviour of concrete beams strengthened for flexure using NSM FRP bars. The efficiency and accuracy of the model was verified by comparing its results to the experimental results. The developed analytical model was used to study the effect of different parameters. Test results are presented in terms of deflection, strain in the concrete, steel and FRP and modes of failure. Test results showed the superior performance of the proposed NSM FRP/adhesive system. The NSM system is able to increase both the stiffness and flexural capacity of concrete beams by approximately 100% over the unstrengthened one. The FEM was able to predict of the behaviour of the strengthened beams in flexure with NSM. Based on the experimental and analytical study, useful conclusions and recommendations for flexural strengthening with NSM FRP were provided.||Alors que nous entrons dans le XXIème siècle, la dégradation des infrastructures devient un sujet d'une importance cruciale. Les structures doivent supporter des charges plus grandes et subir des changements d'utilisation. En plus de cela s'ajoute les problèmes de corrosion de l'acier, des erreurs de conception et de construction, ce qui souvent nécessitent que la structure soit réparée ou renforcée, des fois même avant sa mise en service. L'utilisation de polymères renforcés de fibres (PRF) dans les dernières années dans divers domaines d'ingénierie a permis une avancée technologique, et leur utilisation dans la construction de nouvelles structures en béton ainsi que la réhabilitation des anciennes. L'utilisation de matériaux en PRF pour le renforcement externe des structures en béton armé est une technologie des plus prometteuses dans l'ingénierie structurale ou de matériaux. Cependant le renforcement par collage externe de PRF n'offre pas une bonne protection contre les chocs, le vandalisme ou les conditions environnementales sévères, ce qui pourraient affecter les performances structurales des éléments réhabilités. Ces inconvénients peuvent être surmontés si le PRF est inséré dans des rainures réalisées dans le recouvrement de béton. Cette méthode est appelée « mise en place d'Armatures Encastrées Près de la surface (AEPS)». Le présent travail s'articule autours de cette technique de renforcement utilisant des matériaux non corrodables. Mes travaux de recherches se focalisent sur l'utilisation des AEPS en PRF pour le renforcement des structures, et cela d'un point de vue expérimental et analytique. Les principaux objectifs de mes recherches sont: (1) développer/utiliser un système d'AEPS composé de barres en PRF et d'adhésif, (2) étudier les performance d'adhérence du système proposé, (3) étudier l'effet des cycles gel-dégel sur le système proposé, (4) l'étude du comportement en flexion de poutres en béton armé, renforcées avec des barres d'AEPS en PRF, (5) développer un modèle analytique utilisant des méthodes non-linéaires d'analyse par éléments finis (logiciel ADINA) en tenant compte du comportement de l'interface béton-barres en PRF, et (6) mettre en place des recommandations de calcul pour l'utilisation des barres en PRF comme AEPS. Pour atteindre ces objectifs, le programme de recherche a été divisé en deux parties. La première partie comprenait les travaux expérimentaux tandis que la deuxième comprenait des travaux d'analyse. La première partie elle même était constituée de deux phases. La première phase comprenait des essais d'arrachement direct de blocs de béton en forme de «C», dont 16 blocs conditionnés dans une chambre environnementale. Alors que la deuxième phase comportait des essais de flexion 20 poutres en béton armé, renforcés par des AEPS en PRF. La deuxième partie a consisté au développement d'un modèle analytique non-linéaire par éléments finis de façon à pouvoir analyser et prédire le comportement en flexion de poutres en béton armé, renforcées par des AEPS en PRF. L'efficacité et la précision du modèle ont été vérifiées en comparant ses résultats analytiques aux résultats expérimentaux. Le modèle analytique développé a été utilisé pour étudier l'effet de différents paramètres. Les résultats des tests sont présentés en termes de déflexion, de contraintes dans le béton, l'acier et le PRF et les modes de rupture. Les résultats des essais ont démontré les bonnes performances du système armatures PRF/adhésif proposé, ce dernier a permit d'augmenter à la fois la rigidité en flexion et la résistance des poutres en béton d'environ 100% par rapport à la poutre non renforcée. L'analyse par éléments finis a été en mesure de prédire le comportement en flexion des poutres renforcées avec des AEPS en PRF. Basé sur ces travaux, des conclusions et des recommandations utiles concernant le renforcement en flexion avec des AEPS en PRF ont été fournis

Clinical phenotypes and constipation severity in Parkinson’s disease: Relation to Prevotella species

Background: The gut microbiome is speculated to play a crucial role in its pathogenesis of Parkinson’s disease as a triggering factor. Recent hypotheses suggested that Prevotella species regulate gut permeability, exert a neuroprotective effect, and interestingly, has been suspected to be deficient in PD patients, and so may play a role in this disease. Aim: This study was designed to compare between PD patients and their healthy controls as regards relative Prevotella abundance, prevalence of Prevotella-dominant Enterotype, and constipation severity. Also, to correlate Prevotella changes with the clinical phenotypes and  severity of motor and non-motor symptoms of PD. Methods: Twenty-five PD cases were enrolled in this study and cross-matched to 25 healthy subjects representing the control group. Overall NMS severity was assessed using the Non-Motor Symptoms Scale (NMSS). Quantitative SYBR green Real Time PCR was performed for the identification and quantitation of Prevotella in stool. Results: Prevotella relative abundance was 4-fold decreased in cases when compared to controls with PIGD phenotype showing the lowest abundance, however the difference was not statistically significance. Prevotella-dominant Enterotype was less presented in cases compared to controls, the result was statistically significant. Severe and very severe constipation grades presented 64% of cases group Vs 12% of control group. There was statistically significant positive correlation between total constipation score and UPDRS total score and motor symptoms phenotypes. Conclusion: Relative low Prevotella abundance in PD patients appears to be related to severe phenotypes of the disease; PIGD and mixed phenotypes. Severe constipation was more presented in PD cases which may be considered  as a preclinical biomarker for PD

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research