Le reflux gastro-oesophagien de l'enfant: indications chirurgicales, techniques et suivi.

Contexte: Présent sous forme physiologique chez environ 60% des nourrissons normaux de moins de quatre mois, le reflux gastro-oesophagien (RGO) n'est symptomatique que chez 10% d'entre eux. Il est également plus fréquent chez les enfants atteints de troubles neurologiques quelque soit leur âge. Non traité, il peut avoir des conséquences graves (oesophagite, sténose peptique, endobrachyoesophage (Barrett) puis adénocarcinome de l'oesophage). Il s'agit donc d'un problème qu'il faut savoir détecter et traiter précocement. Les signes et symptômes du RGO sont multiples et varient en fonction de l'âge. Ils ne se limitent pas au seul vomissement. Le traitement initial du RGO chez l'enfant est médical. En cas d'échec de celui-ci ou dans certaines indications (comme les RGO récidivants, les malformations congénitales, les anomalies morphologiques ou les pathologies neurologiques) un traitement chirurgical est nécessaire. L'évolution des traitements conservateurs et des techniques chirurgicales lors de ces dernières années en font un bon sujet pour une étude rétrospective. Objectif: Le but de cette étude est de mettre en évidence dans une population d'enfants ayant bénéficié d'une cure chirurgicale anti-reflux la fréquence relative des symptômes selon la pathologie initiale de l'enfant, puis de préciser le choix de traitement et sa durée. Nous analyserons également les risques d'échec qui s'y rapportent. Ces conclusions devraient nous permettre de proposer un algorithme décisionnel de prise en charge du RGO de l'enfant en pré et post-opératoire. Méthodologie: Étude rétrospective sur 9 ans se basant sur les dossiers médicaux-chirurgicaux de 132 enfants opérés d'un reflux gastro-oesophagien dans le Service de Chirurgie Pédiatrique du Centre Hospitalier Universitaire Vaudois (CHUV) par le Professeur Olivier Reinberg et son équipe entre le 1er janvier 2003 et le 31 décembre 2012. Résultats: Sur les 132 enfants, 93 ont bénéficié d'une fundoplicature selon Toupet, 34 selon Nissen et 5 selon Dor. 57% des enfants présentant un déficit neurologique ont été opérés selon la technique de Nissen contre 7% des enfants "sains". Les taux de démontage et de récidive sont respectivement 5.4% et 3.5 % pour la technique selon Toupet et 2.9% et 0% pour la technique de Nissen. Le taux de démontage global de la fundoplicature est de 4.6% (N=6) Conclusions: La fundoplicature est une méthode de choix pour les enfants chez qui tous les autres traitements ont échoué ou chez qui la présence concomitante du RGO et des comorbidités est délétère à une croissance harmonieuse. Grâce à la chirurgie, la qualité de vie d'au moins 95% des enfants est grandement améliorée après la disparition de symptômes quotidiens et qui peuvent donner lieu à des complications graves

Madagascan day geckos (Phelsuma spp.) exhibit differing responses along a gradient of land-use change

Madagascar is a key priority for global conservation efforts, as much of its diverse and highly endemic biota is threatened by deforestation. Despite this threat, there are limited data on the responses and tolerances of herpetofaunal species to landscape change. This study investigated the response of Madagascan day geckos (Phelsuma spp.) to deforestation in Nosy Be, Madagascar. We selected six sites along a gradient of land-use change: two in Sambirano rainforest (“Forest”), two in secondary, fragmented forest (“Fragment”), and two in agricultural plantations (“Orchard” and “Cropland”). We conducted a series of time-constrained searches at each site. The mean encounter rate of Phelsuma geckos (geckos detected per person/hour) was greater in agricultural sites than Forest sites, but no difference was detected between Forest and Fragment or Fragment and agricultural areas. Three species were encountered more frequently in agricultural land than forested sites, but this was not true for Phelsuma seippi, an endangered species on the IUCN Red List. These results suggest that adaptive, generalist species may benefit from anthropogenic land-use change, whereas specialist species will suffer. Our study emphasizes the importance of extending research beyond the borders of protected forests to include anthropogenically disturbed areas

UDRIVE: the European naturalistic driving study

UDRIVE is the first large-scale European Naturalistic Driving Study on cars, trucks and powered two wheelers. The acronym stands for “European naturalistic Driving and Riding for Infrastructure & Vehicle safety and Environment”. Naturalistic driving can be defined as a study undertaken to provide insight into driver behaviour during every day trips by recording details of the driver, the vehicle and the surroundings through unobtrusive data gathering equipment and without experimental control. Data collection will take place in seven EU Member States. Road User Behaviour will be studied with a focus on both safety and environment. The UDRIVE project follows the steps of the FESTA-V methodology, which was originally designed for Field Operational Tests. Defining research questions forms the basis of the study design and the specification of the recording equipment. Both will be described. Although the project has yet to start collecting data from drivers, we consider the process of designing the study as a major result which may help other initiatives to set up similar studies

Souffrons-nous toutes et tous d’un syndrome d’imposture? [Do we all suffer from imposter syndrome?]

Imposture syndrome is widespread among physicians and medical students. It is defined as a psychological experience in which people doubt their own skills and achievements despite proven successes and thus have an unfounded fear of being found out. This can have serious consequences, such as anxiety and/or depressive disorders, and can lead to burn-out. The Clance scale is a self-assessment tool used to measure the level of imposture experienced and, when appropriate, to assess the suffering caused. The aim of this article is to help recognise this syndrome, which is one way of preventing it

Multifrequency Radar Observations Collected in Southern France during HyMeX-SOP1

International audienceThe radar network deployed in Southern France during the first Special Observing Period (SOP1) of the Hydrometeorological Cycle in the Mediterranean Experiment (HyMeX) was designed to precisely document the 3-D structure of moist upstream flow impinging on complex terrain as a function of time, height and along-barrier distance as well as surface rainfall patterns associated with orographic precipitation events. This deployment represents one of the most ambitious field experiments yet endeavoring to collect high quality observations of thunderstorms and precipitation systems developing over and in the vicinity of a major mountain chain. Radar observations collected during HyMeX represent a valuable, and potentially unique, dataset that will be used to improve our knowledge of physical processes at play within coastal orographic heavy precipitating systems as well as to develop, and evaluate, novel radar-based products for research and operational activities. This article provides a concise description of this radar network and discusses innovative research ideas based upon preliminary analyses of radar observations collected during this field project with emphasis on the synergetic use of dual-polarimetric radar measurements collected at multiple frequencies