In this paper, we describe the investigations and actions taken to reduce risk and prevent casualties from a catastrophic 210,000 m
3
rockslope failure, which occurred near the village of Preonzo in ...the Swiss Alps on May 15, 2012. We describe the geological predisposition and displacement history before and during the accelerated creep stage as well as the development and operation of an efficient early warning system. The failure of May 15, 2012, occurred from a large and retrogressive instability in gneisses and amphibolites with a total volume of about 350,000 m
3
, which formed an alpine meadow 1250 m above the valley floor. About 140,000 m
3
of unstable rock mass remained in place and might collapse partially or completely in the future. The instability showed clearly visible signs of movements along a tension crack since 1989 and accelerated creep with significant hydromechanical forcing since about 2006. Because the active rockslide at Preonzo threatened a large industrial facility and important transport routes located directly at the toe of the slope, an early warning system was installed in 2010. The thresholds for prealarm, general public alarm, and evacuation were derived from crack meter and total station monitoring data covering a period of about 10 years, supplemented with information from past failure events with similar predisposition. These thresholds were successfully applied to evacuate the industrial facility and to close important roads a few days before the catastrophic slope failure of May 15, 2012. The rock slope failure occurred in two events, exposing a compound rupture plane dipping 42° and generating deposits in the midslope portion with a travel angle of 39°. Three hours after the second rockslide, the fresh deposits became reactivated in a devastating debris avalanche that reached the foot of the slope but did not destroy any infrastructure. The final run-out distance of this combined rock collapse–debris avalanche corresponded to the predictions made in the year 2004.
Large catastrophic rock slope failures are difficult to predict because the underlying mechanisms causing slope accelerations are difficult to study under in-situ conditions. For slope failures with ...compound basal rupture planes, not only fracture propagation and slip in the basal rupture surface, but also within the landslide body control the displacement evolution and time-to-failure. The Preonzo instability complex in southern Switzerland failed several times since 2002 and offers a unique opportunity to study these mechanisms under in-situ conditions. The largest failure at Preonzo occurred in May 2012 and was conditioned by large slope parallel (NNE-SSW) fracture zones, which are intersected by NE and SW and E-W striking faults creating diverging lateral boundaries. Whereas in the head scarp region oblique and flexural toppling along pre-existing fracture sets is the prevailing mechanism, sliding of either planar or wedge type is the preferred kinematic mode facilitated by the new discontinuities developed within the basal rupture surfaces. These dominating mechanisms, leading to a classical rock slope collapse, could only be revealed in retrospect. We compare fracture patterns in stable ground (tectonic and unloading fractures) with new fractures related to rock slope failure observed on basal rupture surfaces and in the head scarp. Simplified mechanical and kinematic analyses show that old pre-existing tectonic fractures cannot accommodate substantial deformations under the in-situ stress conditions and propagate/connect through curved wing cracks forming at high angles. This situation favors the development of new nearly slope parallel fractures, which are interpreted as synthetic P-shears along localized shear zones. Fractographic markings on these fractures indicate a continuous and relatively fast formation, which presumably has taken place during a period of about 60 years prior to catastrophic failure. This detailed description of the multi-stage evolution of slope failure at Preonzo represents a unique data set for future numerical studies of progressive failure in crystalline rocks.
•Structural evolution of retrogressive failures with fracture orientation change•Interplay of pre-existing fractures and progressive failure in basal rupture planes•Multi-stage kinematic analyses reveal change in kinematics of a retrogressive slope•Possible analogies of tectonic shear zones with fracture reactivation + propagation
During a mine-by experiment performed at the Mont Terri Underground Research Laboratory located at the transition between the sandy and the shaly facies of the Opalinus Clay formation, excavation ...induced micro-acoustic events were recorded in the so-called Gallery 08 (the EZ-G experiment). A first cluster of events occurred in the vicinity of the eastern sidewall of Gallery 08, and a second cluster was observed ahead of the advancing tunnel face. For each recorded micro-acoustic event (AE), all located in the sandy facies of the Opalinus Clay formation, the total stresses associated with the onset of inelastic deformations were estimated using a three-dimensional numerical model. The numerical analysis is based on the assumption that the rock mass behavior in the vicinity of the excavation is essentially elastic before the stress redistribution causes damage evidenced by the triggered AE activity. For the cluster located at the tunnel sidewall, the source mechanism analysis reveals the predominance of extensional failure (tensile) events. The numerical analysis of each individual micro-acoustic event suggests that the differential stresses at the onset of damage range between 3 and 10 MPa. These values are in reasonable agreement with crack initiation thresholds obtained in the laboratory from samples of the various sub-facies types of the sandy facies in the Opalinus Clay formation, which range between 2 and 18 MPa. For the cluster located ahead of the tunnel face, the source mechanism analysis indicates the predominance of local shear failure events. This is consistent with observed shear dislocations on bedding planes within weak beds in the sandy facies that have similar strength properties as the shaly facies. Thus, the modelled shear and total normal stresses acting across the average bedding plane orientation at each event location were modelled and used to estimate the in situ shear strength along the bedding planes. The model suggests a friction angle of 33.4° and a cohesion of 0.43 MPa. The results are overall consistent with the bedding plane strength obtained through undrained direct shear tests on specimens of the shaly facies, suggesting that the observed weak beds with a strength similar to the shaly facies govern the behavior at the tunnel face.
Face recognition is of major social importance and involves highly selective brain regions thought to be organized in a distributed functional network. However, the exact architecture of ...interconnections between these regions remains unknown. We used functional magnetic resonance imaging to identify face-responsive regions in 22 participants and then employed diffusion tensor imaging with probabilistic tractography to establish the white-matter pathways between these functionally defined regions. We identified strong white-matter connections between the occipital face area (OFA) and fusiform face area (FFA), with a significant right-hemisphere predominance. We found no evidence for direct anatomical connections between FFA and superior temporal sulcus (STS) or between OFA and STS, contrary to predictions based on current cognitive models. Instead, our findings point to segregated processing along a ventral extrastriate visual pathway to OFA-FFA and another more dorsal system connected to STS and frontoparietal areas. In addition, early occipital areas were found to have direct connections to the amygdala, which might underlie a rapid recruitment of limbic brain areas by visual inputs bypassing more elaborate extrastriate cortical processing. These results unveil the structural neural architecture of the human face recognition system and provide new insights on how distributed face-responsive areas may work together.
•Endoscopic submucosal dissection with countertraction for laterally spreading lesions is more cost effective than a selective ESD or a piece-meal EMR strategy.•Endoscopic submucosal dissection for ...all laterally spreading lesions is the cheapest strategy and avoids the greatest number of surgeries.•CONECCT classification is the best classification to select high risk lesions for endoscopic submucosal dissection.•Depending to the reimbursement scheme, a selective endoscopic submucosal strategy according to CONECCT optical diagnosis classification could be the most cost effective.
Endoscopic management is preferred to surgical management for large superficial colorectal lesions. However, the optimal endoscopic resection strategy (piecemeal endoscopic mucosal resection pEMR or endoscopic submucosal dissection ESD) is still debated from an economical point of view. To date, in France, there is no Health Insurance reimbursement rate for the hospital stays related to ESD. We searched to estimate the global cost of colorectal ESD and to define the most cost-effectiveness endoscopic strategy.
A model was created to compare the cost-effectiveness of ESD and pEMR according to optical diagnosis (Japan NBI Expert Team JNET, laterally spreading tumour LST, CONECCT). We distinguished three groups from the same multicentre ESD cohort and compared the medical and economic outcomes: real-life ESD data (Universal-ESD or U-ESD) compared to modelled selective ESD (S-ESD JNET; S-ESD LST; S-ESD CONECCT) and exclusive pEMR strategies (Universal-EMR or U-EMR).
The en-bloc, R0, and curative resection rates were 97.5%, 86.5%, and 82.6%, respectively in the real life French ESD cohort of 833 colorectal lesions. U-ESD was the least-expensive strategy, with a global cost of 2,858,048.17 €, i.e. 3,431.03 €/patient and was also the most effective strategy because it avoided 774 surgeries, which was more than any other strategy. It outperformed S-ESD CONNECT (global cost = 2,951,411.44 €, and 3,543.11 €/patient, 765 surgeries avoided, S-ESD LST (global cost = 3,055,951.53 €, and 3,668.61 €/patient, 749 surgeries avoided), and S-ESD JNET (global cost = 3,547,426.97 € and 4,258.62 €/patient, 704 surgeries avoided) and U-EMR (global cost = 4,060,547.62 € and 4,874.61 €/patient, 620 surgeries avoided). Even though a model which optimized pEMR results (0% technical failure, 0% primary surgery), U-EMR strategy remained the most expansive strategy and the one that avoided the least surgeries.
ESD for all LSTs upper than 20 mm is more cost-effective than pEMR, and S-ESD.
•First infective endocarditis by Thalassospira, a marine bacterium.•The patient is a fisherman who likely acquired the bacterium via extensive time spend in marine waters.•The strain could be ...cultured and identified by DNA sequencing methods, but not by routine mass spectrometry.
We report a case of an infective endocarditis caused by a Thalassospira sp. in a 53-year-old man with pre-existing valvular lesions and living in French Polynesia as a fisherman. The strain was identified with DNA-sequecing methods while it was not by mass spectrometry.
MAD2L1BP-encoded p31comet mediates Trip13-dependent disassembly of Mad2- and Rev7-containing complexes and, through this antagonism, promotes timely spindle assembly checkpoint (SAC) silencing, ...faithful chromosome segregation, insulin signaling, and homology-directed repair (HDR) of DNA double-strand breaks. We identified a homozygous MAD2L1BP nonsense variant, R253*, in 2 siblings with microcephaly, epileptic encephalopathy, and juvenile granulosa cell tumors of ovary and testis. Patient-derived cells exhibited high-grade mosaic variegated aneuploidy, slowed-down proliferation, and instability of truncated p31comet mRNA and protein. Corresponding recombinant p31comet was defective in Trip13, Mad2, and Rev7 binding and unable to support SAC silencing or HDR. Furthermore, C-terminal truncation abrogated an identified interaction of p31comet with tp53. Another homozygous truncation, R227*, detected in an early-deceased patient with low-level aneuploidy, severe epileptic encephalopathy, and frequent blood glucose elevations, likely corresponds to complete loss of function, as in Mad2l1bp-/- mice. Thus, human mutations of p31comet are linked to aneuploidy and tumor predisposition.
Abstract
Background
The composition of the digestive microbiota may be associated with outcome and infections in patients admitted to the intensive care unit (ICU). The dominance by opportunistic ...pathogens (such
as Enterococcus
) has been associated with death. However, whether this association remains all throughout the hospitalization are lacking.
Methods
We performed a single-center observational prospective cohort study in critically ill patients admitted with severe SARS-CoV-2 infection. Oropharyngeal and rectal swabs were collected at admission and then twice weekly until discharge or death. Quantitative cultures for opportunistic pathogens were performed on oropharyngeal and rectal swabs. The composition of the intestinal microbiota was assessed by 16S rDNA sequencing. Oropharyngeal and intestinal concentrations of opportunistic pathogens, intestinal richness and diversity were entered into a multivariable Cox model as time-dependent covariates. The primary outcome was death at day 90.
Results
From March to September 2020, 95 patients (765 samples) were included. The Simplified Acute Physiology Score 2
(
SAPS 2) at admission was 33 24; 50 and a Sequential Organ Failure Assessment score (SOFA score) at 6 4; 8. Day 90 all-cause mortality was 44.2% (42/95). We observed that the oropharyngeal and rectal concentrations of
Enterococcus
spp.,
Staphylococcus aureus
and
Candida
spp. were associated with a higher risk of death. This association remained significant after adjustment for prognostic covariates (age, chronic disease, daily antimicrobial agent use and daily SOFA score). A one-log increase in
Enterococcus
spp
.
,
S. aureus
and
Candida
spp. in oropharyngeal or rectal swabs was associated with a 17% or greater increase in the risk of death.
Conclusion
We found that elevated oropharyngeal/intestinal
Enterococcus
spp.
S. aureus
and
Candida
spp. concentrations, assessed by culture, are associated with mortality, independent of age, organ failure, and antibiotic therapy, opening prospects for simple and inexpensive microbiota-based markers for the prognosis of critically ill SARS-CoV-2 patients.
Efficient perceptual identification of emotionally-relevant stimuli requires optimized neural coding. Because sleep contributes to neural plasticity mechanisms, we asked whether the perceptual ...representation of emotionally-relevant stimuli within sensory cortices is modified after a period of sleep. We show combined effects of sleep and aversive conditioning on subsequent discrimination of face identity information, with parallel plasticity in the amygdala and visual cortex. After one night of sleep (but neither immediately nor after an equal waking interval), a fear-conditioned face was better detected when morphed with another identity. This behavioral change was accompanied by increased selectivity of the amygdala and face-responsive fusiform regions. Overnight neural changes can thus sharpen the representation of threat-related stimuli in cortical sensory areas, in order to improve detection in impoverished or ambiguous situations. These findings reveal an important role of sleep in shaping cortical selectivity to emotionally-relevant cues and thus promoting adaptive responses to new dangers.
•Sleep enhances the perceptual discrimination of conditioned stimuli.•Amygdala selectivity to emotionally-significant visual stimuli increases overnight.•Amygdala coupling with sensory cortices is strengthened after sleep.•Coding of threat-related cues is sharpened and upgraded along visual hierarchy.
Le syndrome de résistance aux hormones thyroïdiennes (SRHT) est une pathologie rare, de prévalence 1/40 000. Il se caractérise par une élévation des hormones thyroïdiennes (HT) en regard d’une TSH ...inappropriée. Le déroulement de la grossesse des patientes porteuses d’un SRHT est mal connu et peu décrit dans la littérature. Nous rapportons le cas d’une patiente avec une mutation du gène TRβ, diagnostiquée devant un bilan thyroïdien perturbé (T4L à 21,6 pg/mL en regard d’une TSH à 5,7 μUi/mL) associé à un goitre et une tachycardie (traitée par bêtabloquants) ayant eu deux grossesses (G2P2). Une première grossesse, à l’âge de 23 ans, alors que le SHRT n’était pas diagnostiqué. Elle a accouché à 41 semaines d’aménorrhée par césarienne, pour altération du rythme cardiaque fœtal avec oligoamnios et HTA gravidique. À la naissance, cet enfant de sexe féminin (Apgar normal) pesait 2730 g pour 46 cm soit un retard de croissance intra-utérin. En période néonatale, la TSH était augmentée à 7,8 μUi/mL en regard d’une T4L normale, cette anomalie a été spontanément résolutive en quinze jours. L’enfant aujourd’hui âgée de 10 ans, n’est pas atteinte du SRHT, mais présente un retard statural sans étiologie à ce jour. La patiente a mené une seconde grossesse sous bêtabloquants à l’âge de 31 ans, elle a accouché à 36 SA par voie basse d’un enfant de sexe féminin de poids normal, sans problème de santé. Pendant cette grossesse, la patiente a bénéficié d’un bilan thyroïdien mensuel sans modification majeure. Lors du SRHT, le risque de fausses couches serait de 23 %. Au cours de la grossesse, les HT peuvent augmenter et entraîner une hyperthyroïdie chez le fœtus non muté. En période néonatale les enfants mutés peuvent présenter des valeurs de TSH élevées évoquant à tort une hypothyroïdie ; ces grossesses nécessitent une étroite surveillance.
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