Law enforcement at sea (AEM) is an administrative and operational organization to guarantee French state interests at sea while optimizing its capabilities. Each administration is responsible for its ...mission but it also ensures other missions on request of the « Préfet maritime ». The French Navy has dispatched naval and aerial capabilities in each of the maritime areas in order to enable the State, together with other governments, to monitor areas under our jurisdiction and to intervene if necessary. The Navy is more specialized in missions in the High Sea or requiring a high level of military involvement or sophistication of the capabilities. The French maritime organization is a model that is looked after. Its main challenge now lies in the intervention capabilities the State would implement to carry out its sovereign functions at sea.
La thérapie écosystémique des troubles de la communication des patients Alzheimer s’adresse au malade et à son entourage familial et/ou professionnel 1. L’objectif des recherches présentées est ...d’évaluer l’efficacité de cette thérapie auprès des malades et de leur entourage. Plusieurs études ont été réalisées à des moments différents sur des cas uniques et multiples notamment dans des études longitudinales de patients vivant à domicile et en institution. L’efficacité a été évaluée en fonction de différentes variables : capacités de communication, fonctions cognitives, comportement des malades, prescription de neuroleptiques 2 et aussi degré de satisfaction de l’entourage. Les résultats de ces recherches 3 ont montré l’efficacité de la thérapie écosystémique sur la communication des patients, sur leurs capacités cognitives et sur la communication des aidants avec les malades. En conclusion, il convient de prendre en compte les difficultés méthodologiques car les échantillonnages des différentes études sont souvent limités et elles ne peuvent pas être menées en aveugle. La modélisation de l’approche thérapeutique est également difficile, de même que le contrôle de toutes les variables. Malgré ces difficultés méthodologiques, les résultats sont très encourageants et suffisamment significatifs pour confirmer l’intérêt d’une prise en charge orthophonique de type écosystémique.
Prostate cancer (PCa) pelvic radiotherapy fields are defined by guidelines that do not consider individual variations in lymphatic drainage. We examined the feasibility of personalized sentinel lymph ...node (SLN)-based pelvic irradiation in PCa. Among a SLN study of 202 patients, we retrospectively selected 57 patients with a high risk of lymph node involvement. Each single SLN clinical target volume (CTV) was individually segmented and pelvic CTVs were contoured according to Radiation Therapy Oncology Group (RTOG) guidelines. We simulated a radiotherapy plan delivering 46 Gy and calculated the dose received by each SLN. Among a total of 332 abdominal SLNs, 305 pelvic SLNs (beyond the aortic bifurcation) were contoured (mean 5.4/patient). Based on standard guidelines, CTV missed 67 SLNs (22%), mostly at the common iliac level (40 SLNs). The mean distance between iliac vessels and the SLN was 11mm, and despite a 15mm margin around the iliac vessels, 9% of SLNs were not encompassed by the CTV. Moreover, 42 SLNs (63%) did not receive 95% of the prescribed dose. Despite a consensus on contouring guidelines, a significant proportion of SLNs were not included in the pelvic CTV and did not receive the prescribed dose. A tailored approach based on individual SLN detection would avoid underdosing pelvic lymph nodes that potentially contain tumor cells.
Ergonomics and prevention of musculoskeletal disorders in obstetric sonography is a subject seldom discussed. However, 80% of sonographers describe pain when performing these examinations. The ...consequences of these disorders can range from impaired quality of life to the complete cessation of professional activity. Some diseases may even require surgical treatments such as carpal tunnel syndrome and shoulder rotator cuff injuries. After joint disorders mainly affecting the upper limbs and neck, deterioration of visual acuity is the second most commonly reported condition. A literature review can identify risk factors, particularly arm abduction greater than 30°, repeated isometric maneuvers without compensatory rest, the level of force applied to the probe, abdominal scanning approaches, examination times longer than 25 minutes, and more than 100 sonographic examinations per month. The ergonomics of the operator's workstation and posture are essential to prevent these disorders. Machine, probe, chair, and examination bed designs are already subject to industrial consensus, but sonographers are responsible for configuring their ideal workstations to preserve their professional and physical potential. Therefore, this article proposes rules of good practice and illustrates recommended positions and those to avoid.
Les profils cognitifs des patients Alzheimer sont hétérogènes ainsi que leurs capacités de communication notamment en fonction de multiples facteurs. L’objectif de ces recherches est d’évaluer les ...liens entre les dysfonctionnements cognitifs et les troubles de la communication chez les malades-Alzheimer. Une étude 1 a évalué la communication avec la GECCO de 152 patients Alzheimer et leurs capacités cognitives afin de tester une corrélation entre le type d’actes de langage utilisés et le profil de l’atteinte neurocognitive. Plus spécifiquement, une autre étude 2 a été réalisée auprès de 16 patients pour mesurer la corrélation entre les capacités de communication et les fonctions exécutives évaluées avec la batterie rapide d’évaluation frontale. La première étude a montré l’influence multifactorielle sur les troubles de la communication et une corrélation entre le type d’acte de langage utilisé et le profil de l’atteinte cognitive. La seconde étude démontre que les troubles de l’inhibition sont corrélés au manque de cohérence globale du discours des patients ainsi qu’à l’absence de feed-back à l’interlocuteur. Il apparaît également que l’absence de progression rhématique et de feed-back à la situation est liée à un déficit de la flexibilité mentale. Le profil de l’atteinte cognitive est un facteur important dans la communication des patients-Alzheimer. La prise en charge orthophonique doit en tenir compte, par exemple une prise en charge précoce des troubles des capacités exécutives pourrait permettre de retarder l’apparition des troubles communicationnels.
The aim of this study was to develop an improved technique for DNA extraction from 1 ml of uncultured AF from patients with a gestational age less than 16 weeks and to allow the use of array-CGH ...without DNA amplification. The DNA extraction protocol was tested in a series of 90 samples including 41 of uncultured AF at less than 16 weeks of gestation. Statistical analyses were performed using linear regression. To evaluate the sensitivity and the specificity of array-CGH on 1 ml of uncultured AF, five samples with an abnormal karyotype (three with aneuploidy, two with structural abnormalities) and five with a normal karyotype were studied. This protocol was reproducible and we were able to show a great improvement with higher yield of DNA obtained from all patients, including those with a gestational age less than 16 weeks (p = 0.003). All chromosomal abnormalities were detected and characterized by array-CGH and normal samples showed normal profiles. This new DNA extraction protocol associated with array-CGH analysis could be used in prenatal testing even when gestational age is less than 16 weeks, especially in cases with abnormal ultrasound findings.
•Bacillus velezensis QST713 strongly protects Agaricus bisporus crops against Trichoderma aggressivum in France.•The complete genome of this commercial biofungicide was sequenced and described.•It ...encodes at least 15 secondary metabolite gene clusters including two potential new antimicrobials.•It forms robust and highly complex 3D structured biofilm.•The availability of the genome data provides information for further exploration and understanding of biocontrol mechanisms.
Bacillus subtilis QST713 is extensively used as a biological control agent in agricultural fields including in the button mushroom culture, Agaricus bisporus. This last use exploits its inhibitory activity against microbial pathogens such as Trichoderma aggressivum f. europaeum, the main button mushroom green mould competitor. Here, we report the complete genome sequence of this bacterium with a genome size of 4 233 757 bp, 4263 predicted genes and an average GC content of 45.9%. Based on phylogenomic analyses, strain QST713 is finally designated as Bacillus velezensis. Genomic analyses revealed two clusters encoding potential new antimicrobials with NRPS and TransATPKS synthetase. B. velezensis QST713 genome also harbours several genes previously described as being involved in surface colonization and biofilm formation. This strain shows a strong ability to form in vitro spatially organized biofilm and to antagonize T. aggressivum. The availability of this genome sequence could bring new elements to understand the interactions with micro or/and macroorganisms in crops.
Our aim was to prospectively evaluate the diagnostic accuracy of sentinel lymph node biopsy-guided lymph node dissection compared to extended pelvic lymph node dissection in patients with ...intermediate- or high-risk prostate cancer.
We conducted a prospective, single-arm, multicenter study at 3 tertiary centers in France between February 2012 and May 2019. Eligible patients had clinically localized intermediate- or high-risk prostate cancer. After intraprostatic injection of (99m)Tc-nanocolloid, the locations of the sentinel lymph nodes were defined by preoperative lymphoscintigraphy. Surgical excision of the sentinel lymph nodes was performed using intraoperative gamma probe guidance. After resection of the sentinel lymph nodes, extended pelvic lymph node dissection was performed in all patients. We assessed the diagnostic accuracy of the sentinel lymph node biopsy method using extended pelvic lymph node dissection as the reference standard. This trial was registered in ClinicalTrials.gov (NCT02732392).
A total of 162 men cN0M0 (CT scan and bone scan) were enrolled: 106 (65.4%) and 56 (34.6%) patients had intermediate- and high-risk prostate cancer, respectively. The median number of nodes retrieved was 14 (mean 16, IQR 10-21) per patient. At final pathological analysis, 22 patients (13.6%) were pN+. Sensitivity, specificity, negative predictive value, and positive predictive value of sentinel lymph node biopsy method in detecting patients with at least 1 lymph node metastasis were 95.4% (95% CI, 75.1-99.7), 100% (95% CI, 96.6-100), 99.2% (95% CI, 95.5-99.9), and 100% (95% CI, 80.7-100), respectively.
Our multicenter prospective study supports that sentinel lymph node biopsy is a very effective and sensitive method for pelvic lymph node staging in patients with intermediate- or high-risk localized prostate cancer.
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