Adult renal neuroblastoma is a rare condition, and a few cases have been previously described in the literature. Its prognosis is variable and the treatment suffer the lack of specific guidelines due ...to the low incidence. We report a case of adult renal neuroblastoma managed with nephrectomy and adjuvant chemotherapy. The purpose of this report is to update the knowledge available on this disease.
The design of advanced experimental nuclear reactors consists in integrating safety and operational requirements as well as reaching targets in terms of thermal power and neutron spectrum. In order ...to meet theses constraints, slender structures with little supports and crossing the entire reactor vessel are implemented in the reactor and are subjected to an axial flow that generates flow-induced vibration (FIV). From the industrial point of view, the mastering of the occurrence of FIV and its associated wear in case of contacts is requested. The stationary fluid forces applying on slender tubular structure in response to its motion are of primary interest since they can significantly affect the vibration amplitudes and even the stability of the system, especially in case of confined axial flow with high velocities (typically higher than 10 m/s). In this study it proposed to compare two approaches to estimate the vibration induced by turbulent excitation of an industrial device encountered in a research nuclear reactor. The control-rod guide-tube mock-up of the Jules Horowitz Reactor, previously tested in an hydraulic channel at the Technical Center from Le Creusot in France, is retained for this benchmark. Two models are proposed, one based on derivation of leakage flow theory and the other one was based on potential flow theory with adjusted coefficients given by CFD simulations. The flow induced vibration amplitude is consistent with the experimental data. Also, the calculation and experiment provide similar trends when the boundary conditions are changed.
Infectious conjunctivitis outbreaks remain a public health burden. This study focuses on the pathogen and antimicrobial resistance (AMR) profiles identified in Niger. Sixty-two patients with acute ...infectious conjunctivitis who presented to health posts were enrolled from December 2021 to May 2022. Nasal and conjunctival swabs were obtained from each patient. Unbiased RNA deep sequencing (RNA-seq) was used to identify associated pathogens. A pathogen was identified in 39 patients (63%; 95% CI, 50-74). Of those, an RNA virus was detected in 23 patients (59%; 95% CI, 43-73). RNA viruses were diverse and included human coronaviruses (HCoVs): SARS-CoV-2, HCoV-229E, HCoV-HKU1, and HCoV-OC43. A DNA virus was identified in 11 patients (28%; 95% CI, 17-44). Of those, four patients had a coinfection with an RNA virus and two patients had a coinfection with both an RNA virus and a bacterium. DNA viruses were predominantly human herpesvirus (cytomegalovirus, Epstein-Barr virus, human herpesvirus 8) and human adenovirus species B, C, and F. Eighteen patients (46%; 95% CI, 32-61) had a bacteria-associated infection that included Haemophilus influenza, Haemophilus aegyptius, Staphylococcus aureus, Streptococcus pneumoniae, and Moraxella spp. Antimicrobial resistance determinants were detected in either the conjunctiva or nasal samples of 20 patients (32%; 95% CI, 22-45) and were found to be more diverse in the nose (Shannon alpha diversity, 1.12 95% CI, 1.05-1.26 versus 1.02 95% CI, 1.00-1.05, P = 0.01). These results suggest the potential utility of leveraging RNA-seq to surveil pathogens and AMR for ocular infections.
Cet article revient sur une expérience de collaboration entre des chercheur·se·s et une association malienne spécialisée dans la collecte et la numérisation de savoirs locaux, Donkosira. Cette ...expérience menée depuis 2017 dans des villages excentrés du Mali, du Sénégal et de la Guinée a donné lieu à des reportages réalisés par les communautés grâce à des téléphones portables fournis par le projet, et postés sur internet et les réseaux sociaux. Cet article questionne notamment la valorisation des savoirs locaux et l’écueil de leur essentialisa- tion ; les difficultés de la pratique de la co-production des données ; l’asymétrie de la relation enquêteur·se·s/ enquêté·e·s et ses impensés (post)coloniaux. La valorisation numérique des savoirs locaux contribue à créer des « communautés numériques par le bas », aux contours souples, que cet article s’attache à décrire.
Le diverticule de Meckel (DM) est une persistance du canal omphalo-mésentérique. Généralement bénin et asymptomatique, il est surtout découvert fortuitement. Sa découverte se fait souvent à ...l’occasion de complications. Le but de notre étude est de décrire les aspects épidémiologiques, cliniques, anatomopathologiques et thérapeutiques des complications des DM. Il s’agissait d’une étude rétrospective sur 13 ans (Janvier 2003-Juin 2016) portant sur 15 cas de diverticules de Meckel compliqués pris en charge aux urgences chirurgicales de l’Hôpital Aristide Le Dantec de Dakar. Il s’agissait de 10 hommes et de 5 femmes dont l’âge moyen était de 27,8 ans avec des extrêmes de 1 mois et 73 ans. Les 2 principales circonstances de découverte étaient le syndrome occlusif et l’irritation péritonéale. La laparotomie en urgence avait permis d’affirmer l’implication d’un DM dans le tableau clinique. Dans les cas d’occlusion, le mécanisme était toujours une bride. Dix patients présentaient une nécrose intestinale avec perforation au moment du diagnostic. Tous les 15 patients avaient eu une résection segmentaire du grêle emportant le diverticule. Cette résection était suivie d’une anastomose immédiate dans 12 cas. La morbidité était constituée par 2 cas de fistules et 2 cas de péritonites post opératoires. Un décès par choc septique a été noté. Trois cas d’hétérotopie muqueuse ont été constatés dont une hétérotopie gastrique, une colique et une association d’hétérotopies colique et gastrique chez le même patient. Les complications de DM constituent des urgences digestives nécessitant une prise en charge chirurgicale précoce et adaptée. Cette dernière est greffée d’une morbidité non négligeable.
The metabolomic profile of vaso-occlusive crisis, compared to the basal state of sickle cell disease, has never been reported to our knowledge. Using a standardized targeted metabolomic approach, ...performed on plasma and erythrocyte fractions, we compared these two states of the disease in the same group of 40 patients. Among the 188 metabolites analyzed, 153 were accurately measured in plasma and 143 in red blood cells. Supervised paired partial least squares discriminant analysis (pPLS-DA) showed good predictive performance for test sets with median area under the receiver operating characteristic (AUROC) curves of 99% and mean p-values of 0.0005 and 0.0002 in plasma and erythrocytes, respectively. A total of 63 metabolites allowed discrimination between the two groups in the plasma, whereas 61 allowed discrimination in the erythrocytes. Overall, this signature points to altered arginine and nitric oxide metabolism, pain pathophysiology, hypoxia and energetic crisis, and membrane remodeling of red blood cells. It also revealed the alteration of metabolite concentrations that had not been previously associated with sickle cell disease. Our results demonstrate that the vaso-occlusive crisis has a specific metabolomic signature, distinct from that observed at steady state, which may be potentially helpful for finding predictive biomarkers for this acute life-threatening episode.
Le but de notre étude était d’évaluer les résultats du traitement chirurgicale du plastron appendiculaire après appendicectomie différée ou immédiate. Il s’agit d’une étude rétrospective de type ...descriptif allant de Janvier 2000 au 31 Décembre 2007 portant sur 27 patients reçus et traités pour plastron appendiculaire. Le diagnostic était clinique par la présence d’une masse à la fosse iliaque droite, échographique, ou per opératoire. Tous les patients opérés en urgence ont été classés dans le groupe I et ceux opérés à froid, groupe II. Nous avons noté 18 hommes et 9 femmes avec un sex-ratio homme /femme = 3. L’âge moyen de nos patients était de 33 ans avec des extrêmes de 19 et 57 ans. Les signes cliniques étaient dominés par la douleur à la fosse iliaque droite et la fièvre respectivement 25 (92,6%) et 15 (55,6%) des cas. Dans le groupe I, l’appendicectomie n’a pu être réalisée pour 7 patients (n = 15) dû aux difficultés opératoires. Dans les autres cas, l’appendicectomie était possible au prix de l’élargissement de l’incision de Mac Burney et une durée de séjour plus longue. Le groupe II a concerné 12 patients (n = 12) avec 9 abords laparoscopiques et dans 3 cas, la voie de Mac Burney a été empruntée. Trois cas d’adhérences péritonéales ont été notés lors de la coelioscopie. L’appendicectomie à froid du plastron appendiculaire est un procédé sûr et efficace. Elle permet d’éviter les cicatrices inesthétiques et les fistules digestives iatrogènes. L’appendicectomie immédiate doit être abandonnée chez les patients porteurs de plastron appendiculaire car elle engendre beaucoup de morbidité.
Direct numerical simulations are used to investigate the individual dynamics of large spherical particles suspended in a developed homogeneous turbulent flow. A definition of the direction of the ...particle motion relative to the surrounding flow is introduced and used to construct the mean fluid velocity profile around the particle. This leads to an estimate of the particle slipping velocity and its associated Reynolds number. The flow modifications due to the particle are then studied. The particle is responsible for a shadowing effect that occurs in the wake up to distances of the order of its diameter: the particle calms turbulent fluctuations and reduces the energy dissipation rate compared to its average value in the bulk. Dimensional arguments are presented to draw an analogy between particle effects on turbulence and wall flows. Evidence is obtained for the presence of a logarithmic sublayer at distances between the thickness of the viscous boundary layer and the particle diameter
${D}_{p} $
. Finally, asymptotic arguments are used to relate the viscous sublayer quantities to the particle size and the properties of the outer turbulence. It is shown in particular that the skin-friction Reynolds number behaves as
$R{e}_{\tau } \propto {({D}_{p} / \eta )}^{4/ 3} $
.
Background
Cumulative sum (CUSUM) analysis is a valuable tool for quantifying the learning curve of surgical teams by detecting significant changes in operative length. However, there is limited ...research evaluating the learning curve of laparoscopic techniques in low-resource settings. The objective of this study is to evaluate the learning curve for laparoscopic appendectomy within a single surgical team in Senegal.
Methods
This was a single-center prospective study conducted from May 1, 2018, to August 31, 2023 of patients who underwent laparoscopic appendectomy at a tertiary care institution in West Africa. The AAST classification was used to describe the severity of appendicitis. Parameters studied included age, sex, operative length, conversion rate, and postoperative outcomes. To quantify the learning curve, CUSUM analysis of operative length was performed.
Results
A total of 81 patients were included. The mean age was 26.7 years (range 11–70 years) with a sex ratio of 1.9. Pre-operative severity according to AAST was Grade I in 75.4% (
n
= 61), Grade III in 7.4% (
n
= 6), Grade IV in 6.1% (
n
= 5), and Grade V in 11.1% (
n
= 9). Conversion occurred in 5 cases (6.1%). The average operative length was 76.8 min (range 30–180 min) and the average length of hospitalization was 2.7 days (range 1–13 days). Morbidity was observed in 3.7% (
n
= 3) and there were no deaths. The CUSUM analysis showed that a steady operative length was achieved after 28 procedures, with decreasing operative lengths thereafter.
Conclusion
Surgeons in our setting overcame the learning curve for laparoscopic appendectomy after performing 28 procedures. Moreover, laparoscopic appendectomy is safe and feasible throughout the learning curve. CUSUM analysis should be applied to other laparoscopic procedures and individualized by surgical teams to improve surgical performance and patient outcomes in low-resource settings.
Le volvulus de la vésicule biliaire (VVB) est une affection rare et de diagnostic difficile; le plus souvent per opératoire. Nous rapportons 1 cas de VVB avec gangrène de la vésicule biliaire chez un ...enfant de 10 ans. Le diagnostic a été porté à l'exploration chirurgicale réalisée en urgence pour un syndrome occlusif fébrile. Il s'agissait d'un volvulus total de la vésicule biliaire. A cette occasion, nous rappelons les aspects diagnostiques et thérapeutiques de cette affection.
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