Goodbye Hartmann trial: a prospective, international, multicenter, observational study on the current use of a surgical procedure developed a century ago

Background: Literature suggests colonic resection and primary anastomosis (RPA) instead of Hartmann's procedure (HP) for the treatment of left-sided colonic emergencies. We aim to evaluate the surgical options globally used to treat patients with acute left-sided colonic emergencies and the factors that leading to the choice of treatment, comparing HP and RPA. Methods: This is a prospective, international, multicenter, observational study registered on ClinicalTrials.gov. A total 1215 patients with left-sided colonic emergencies who required surgery were included from 204 centers during the period of March 1, 2020, to May 31, 2020. with a 1-year follow-up. Results: 564 patients (43.1%) were females. The mean age was 65.9 ± 15.6 years. HP was performed in 697 (57.3%) patients and RPA in 384 (31.6%) cases. Complicated acute diverticulitis was the most common cause of left-sided colonic emergencies (40.2%), followed by colorectal malignancy (36.6%). Severe complications (Clavien-Dindo ≥ 3b) were higher in the HP group (P < 0.001). 30-day mortality was higher in HP patients (13.7%), especially in case of bowel perforation and diffused peritonitis. 1-year follow-up showed no differences on ostomy reversal rate between HP and RPA. (P = 0.127). A backward likelihood logistic regression model showed that RPA was preferred in younger patients, having low ASA score (≤ 3), in case of large bowel obstruction, absence of colonic ischemia, longer time from admission to surgery, operating early at the day working hours, by a surgeon who performed more than 50 colorectal resections. Conclusions: After 100 years since the first Hartmann's procedure, HP remains the most common treatment for left-sided colorectal emergencies. Treatment's choice depends on patient characteristics, the time of surgery and the experience of the surgeon. RPA should be considered as the gold standard for surgery, with HP being an exception

Function and length scale integration study in emerging MST-based products

International audienceThis paper discusses the issues typically occurring when integrating, into a single product, functions that can only be realised by employing different length scale features (macro, meso, micro and down to nano). Following the responses of a survey performed on European research projects, a trend for replacing assembly steps with multi-scale processing of single components is highlighted. Two main issues emerging from the implementation of such approach are then discussed. The first one relates to the concurrent design of materials properties and manufacturing processes. The second focuses on the need for new production approaches and organisational models applied by companies

A methodology for evaluating the technological maturity of micro and nano fabrication processes

International audienceGiven that Micro and Nano Technologies (MNTs) is still an emerging field, it is important to adopt a tool for evaluating the maturity of MNT-based products and the production processes enabling their manufacture. In particular, as a risk assessment tool, it could help both the pace of technological adoption and the successful exploitation of these technologies. In this context, the objective of the research presented is to describe a methodology for assessing the maturity of MNTs. The paper also demonstrates the implementation of this methodology for a set of micro and nano manufacturing processes employed for tooling and replication. It could also be easily implemented to evaluate the maturity of other production processes for MNT-based products such as micro assembly technologies. The reported study was conducted in collaboration with two networks funded through the Sixth Framework Programme (FP6) of the European Commission (EC), namely the Multi-Material Micro Manufacture (4M) Network of Excellence (NoE) and the μ SAPIENT Coordination Action (CA). By analysing data from R&D projects carried out in the field of MNTs by partner organisations in these two consortia, the maturity phases targeted by each project could be evaluated and as a result, the maturity profiles for given technologies could be extracted. An important output of this study is to help inform the industry, the global research community and policy makers about the current level of maturity reached by the MNTs which are developed in R&D projects carried out at European level and in particular, within the 4M NoE and the μ SAPIENT CA