Oskar Bordeaux
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Resuscitation
No full textINTRODUCTION: Previous studies have described interactions between the success rate of tracheal intubation (TI) and chest compression during resuscitation from cardiac arrest. However, it is not clear if chest compression increases the complexity of TI. The aim of this study was to determine the risk factors for difficulty with tracheal intubation during resuscitation of patients with out-of-hospital cardiac arrest, focusing in particular on the impact of ongoing chest compressions on the success of the first intubation attempt. METHODS: We performed a secondary analysis of data obtained during an observational, prospective multicenter study. After each TI, the operator provided information on both the operator and the patient, and the TI environment. We included only OHCA data. The primary endpoint was failure of the first intubation attempt. RESULTS: Data on a total of 848 OHCA patients were analyzed. A total of 291 first TI attempts failed (34.3%). Multivariate analysis revealed that six variables were associated with an increased risk of failure: an operator who had performed ≤ 50 prior intubations (odds ratio [OR] [95% confidence interval] = 2.0 [1.4-2.9]), male patient gender (OR = 1.5 [1.0-2.3]), a small inter-incisor space (OR = 3.4 [2.2-5.4]), ear, nose, and throat disease (OR = 2.8 [1.8-4.4]), vomiting (OR = 2.1 [1.4-3.2]), and continued chest compression during the TI attempt (OR = 1.6 [1.1-2.3]). CONCLUSION: The first intubation attempt failed in 34% of cases, and ongoing chest compressions during intubation was one of six variables associated with the risk of failure. However, this must be weighed against the need for invasive airway management and the negative effects of interrupting chest compressions
Peau d'âne se défile : les costumes d'un conte de fées et leur influence sur la création de mode contemporaine
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Eur Urol Oncol
Get PDFBACKGROUND AND OBJECTIVE: Renal cancer often requires nephron-sparing surgery for optimal patient outcomes. Despite advances in imaging and robot-assisted surgery, there is a need to enhance surgical precision and renal preservation. This trial evaluates the effectiveness of three-dimensional image-guided robot-assisted partial nephrectomy versus standard methods in improving surgical outcomes. CLINICAL TRIAL DESIGN AND TIMEFRAME: This trial is a prospective, 1:1 randomized, single-blind phase 3 superiority study conducted across 14 centers within the French Network for Research on Kidney Cancer, aiming to enroll 694 patients over 36 mo. ENDPOINTS: The primary endpoint is a composite trifecta score, including negative surgical margins, no complications, and renal function preservation (estimated glomerular filtration rate >90% at 1 mo). The secondary endpoints include oncological outcomes, conversion rates, perioperative parameters, and economic evaluation. DATA SOURCES AND STATISTICAL ANALYSIS PLAN: Data are collected via the UroCCR database. Logistic regression will analyze the primary endpoint, and various regression methods will address the secondary outcomes. Economic evaluations involve incremental cost-utility and cost-effectiveness ratios. STRENGTHS AND LIMITATIONS: Strengths include the multicenter design and robust randomization. Limitations involve variability in surgeons' experience with the new three-dimensional technology and logistical challenges in technology adoption. PATIENT SUMMARY: This clinical trial is designed to evaluate a new surgical technique for treating kidney tumors called three-dimensional (3D) image-guided robot-assisted partial nephrectomy. This study aims to determine whether this new method is more effective and safer than the current standard robot-assisted surgery by improving surgical precision and preserving kidney function. Kidney tumors require precise surgical removal to ensure the best outcomes for patients both during and after surgery. While robotic assistance has improved many surgeries, use of advanced 3D imaging during these procedures might enhance the surgeon's ability to operate with greater accuracy, potentially leading to better patient outcomes and fewer complications. Participants in the trial will undergo surgery using either the conventional robotic-assisted method or the new 3D image-guided technique. The method used for each participant will remain undisclosed to maintain the study's integrity. All participants will receive the highest standard of care, and their progress will be monitored closely throughout the trial. This study hopes to demonstrate that the 3D image-guided method can improve surgical precision and outcomes for patients undergoing kidney tumor removal. If successful, this technique could set a new standard for kidney surgery and improve the overall care patients receive in the future. The addition of 3D reconstruction to the surgery carries very little extra risk. If any technical issues occur, the surgeons can switch back to the regular method without affecting safety. The 3D technology we use, Synapse 3D, is approved and used in hospitals worldwide, ensuring that its safety is well proven by existing evidence
Social robots and autism spectrum disorder: the role of social robots in therapeutic interventions for children with autism spectrum disorder
No full textLe trouble du spectre de l’autisme est un trouble neurodéveloppemental dont les méthodes thérapeutiques font l’objet de progrès constants. Depuis une trentaine d’années, les robots sociaux sont utilisés tant en recherche fondamentale que dans des études interventionnelles. Avec l’avancée technologique actuelle et une diminution de leur coût de fabrication, la recherche s’est intensifiée, le nombre de publications avec des protocoles thérapeutiques novateurs est en hausse ces dernières années. Dans cette thèse, nous nous proposons, d’explorer leur intérêt comme médiateurs thérapeutiques chez les enfants TSA à travers une revue de la littérature narrative de ces dix dernières années. Méthode : nous avons utilisé les bases de recherche : PubMed, Scopus, ScienceDirect, Cochrane, EBSCOhost et Springer avec les mots-clés : trouble du spectre de l’autisme / robot social / enfants. Résultats : nous retenons 36 articles rapportant des essais cliniques sur la population pédiatrique. Nous confirmons l’intérêt des enfants TSA pour les robots et leur efficacité pour stimuler le développement des enfants TSA sur l'apprentissage de compétences sociales et de communication, l’attention conjointe, les dysrégulations émotionnelles et les comportements stéréotypés. En fonction des protocoles, les interventions robotiques peuvent s’avérer moins efficaces, aussi efficaces, plus efficaces que les interventions humaines. Discussion : nous mettons en lumière l’intérêt d’adapter l’aspect du robot et la cible thérapeutique en fonction de l’âge développemental et de la sévérité de l’autisme et de développer des designs d’intervention variés en fonction de ces cibles (interactions dyadiques pour cibler des apprentissages par répétition, interactions triadiques pour stimuler une communication fonctionnelle).Autism spectrum disorder (ASD) is a neurodevelopmental disorder for which therapeutic methods have seen constant progress. Over the past thirty years, social robots have been used in both fundamental research and interventional studies. With current technological advances and a reduction in their cost, research has intensified, and the number of publications featuring innovative therapeutic protocols has increased in recent years. In this thesis, we aim to explore their relevance as therapeutic mediators for children with ASD through a narrative review of the literature from the past ten years. 3 Method: we used the research databases PubMed, Scopus, ScienceDirect, Cochrane, EBSCOhost, and Springer with the keywords: autism spectrum disorder / social robot / children. Results: we identified 36 articles reporting clinical trials on the pediatric population. We confirm the interest of children with ASD in robots and their effectiveness in stimulating the development of social and communication skills (verbal, gestural), joint attention, emotional regulation, and reducing stereotypical behaviors in children with ASD. Depending on the protocols, robotic interventions may be less effective, equally effective, or more effective than human interventions. Discussion: we highlight the importance of adapting the robot appearance and the therapeutic target based on the developmental age and severity of autism. We also emphasize the need to develop varied intervention designs according to these targets (dyadic interactions to foster learning through repetition, triadic interactions to stimulate functional communication)
BMC Nutr
Get PDFBACKGROUND: The Kasai region in the Democratic Republic of Congo suffered a violent conflict in 2016-17 and has been facing high household food insecurity and acute malnutrition (AM) in under 5 children ever since. This study aims to describe food security and feeding practices in a rural health district of this region in which the clinical randomised control trial OptiMA was implemented, and to assess the associated factors of AM among children aged 6 to 59 months in the aftermath of the conflict. METHODS: A community-based matched case-control study was nested in the OptiMA trial. Cases (n = 91) were children aged 6 to 59 months suffering from AM enrolled in the trial. Two neighbourhood controls (n = 181) were randomly selected per case, matched on age. The required sample size, based on the Household Hunger Score (HHS) in the area, was 81 pairs of cases and controls. Of the 282 heads of households interviewed, 272 were included in the analyses. The heads of household and the children's caregivers were interviewed on household, caregiver, and child acute malnutrition risk factors. A conditional logistic regression was used to fit a model of wasting risk factors. RESULTS: A total of 91% of households faced severe food insecurity and 33% severe hunger. Dietary diversity of both children and mothers was low with no mothers and only 5 children in the controls group reaching minimum dietary diversity. The mean diet diversity of mothers and children in both groups was only comprised between 2 and 2.5 out of 10 and 8 food groups, respectively in the classification. The HHS (AOR 2.9, 95% CI 1.6 to 5.6) and both moderate and severe stunting (AOR 10.2, 95% CI 3.2 to 32.2 and AOR 11.0, 95% CI 3.5 to 34.9, respectively) were strongly associated with acute malnutrition in the adjusted model. CONCLUSIONS: The dire food security and hunger described in this study calls for multi-sectoral actions to improve food access and evidence-based preventive actions for all types of undernutrition in the area. TRIAL REGISTRATION: The trial in which this ancillary study is embedded was registered on clinicaltrials.gov under the number NCT03751475 on November, 23rd 2018
Mobilité scolaire quotidienne, empreinte carbone et enjeux sociospatiaux : le cas des collégiens girondins
Get PDFPar ses multiples enjeux, la mobilité scolaire quotidienne fournit une littérature internationale issue de champs divers. Les disciplines médicales alertent du déclin des modes actifs comme un problème majeur de santé publique. Les sciences sociales étudient cette mobilité à l’instar de la place qu’elle tient dans la qualité de vie des enfants et son influence sur les comportements qu’ils auront une fois adulte. Nonobstant, l’étude des externalités environnementales et les disparités sociospatiales de cette mobilité reste limitée, a fortiori dans la littérature française. Cette recherche interroge les moyens d’action pour une mobilité scolaire plus soutenable. Elle s’appuie sur une enquête menée dans le Département de la Gironde auprès des collégiens du secteur public sur leurs déplacements domicile-étude. Nous commençons par calculer les gaz à effet de serre rejetés par ces déplacements. Nous cherchons ensuite à mieux comprendre les liens de ces émissions et des comportements de mobilité au regard des caractéristiques sociales et spatiales de l’enfant, permettant de mieux dessiner les contours d’une action œuvrant pour la réduction des émissions et des inégalités de mobilité.Rising several issues, home-to-school mobility provides an international literature from various fields. Medical disciplines warn of a decline in active travelling as a major public health problem. Social sciences study this mobility with regard to the role it plays in children's quality of life and its influence on the behaviours they will exhibit as adults. Nevertheless, the study of environmental externalities and sociospatial disparities of this mobility remains limited, especially in the French literature. This research relies on a survey conducted in Gironde, a French department, questioning pupils of the French “college” (11 – 15 years old) in the public sector about their home-to-school mobility. We begin by calculating the greenhouse gases emitted by these trips. We then seek to better understand the links between these emissions and mobility patterns in relation to the child's social and spatial attributes, to better formulate actions that address both emission reduction and mobility inequities
BMC Pulm Med
No full textSarcoidosis is a complex multisystemic disease with a wide range of clinical manifestations. Its severity and evolution are highly variable and the prognostic utility of paraclinical markers is debated. We analysed the utility of the CD4/CD8 T-cell ratio (R) in bronchoalveolar lavage (BAL) fluid as a marker of sarcoidosis severity. We conducted an observational, retrospective, monocentric study involving patients with systemic sarcoidosis who underwent BAL for diagnostic purposes between June 2010 and April 2020. Among 62 patients, half had a CD4/CD8 T-cell ratio (R) value ≥ 3.5. Patients with R < 3.5 had more extrapulmonary manifestations, mainly abdominal (32.3% vs. 6.5%, p = 0.01) and tended to have a higher frequency of cardiac/central nervous system involvement (19.4% vs. 6.5%, p = 0.25). They also had more frequent interstitial lung involvement (80.6% vs. 67.7%, p = 0.2) and tended to have more severe respiratory impairment. The activation (p = 0.01) of CD8 + T cells in peripheral blood was significantly higher in patients with R < 3.5. By contrast, patients with R ≥ 3.5 tended to have more frequent musculoskeletal-cutaneous involvement (48.4% vs. 32.3%, p = 0.2). Treatment was initiated more frequently in patients with R < 3.5 (71% vs. 35.5%, p = 0.01), who also more frequently required immunosuppressive agents (54.5% vs. 36.4%, p = 0.02). An R value < 3.5 in BAL fluid has potential as a marker of sarcoidosis severity. Patients with a low R value had a worse prognosis with more severe respiratory impairment and more frequent multisystemic and extra-pulmonary involvement, and more frequently required immunosuppressive agents
Virome Scanning of Pear Germplasm Collections Identifies a New Velarivirus and Extends the Geographical Spread of Three Other Pear Viruses
No full textIn this study, an extensive virome investigation was performed on a germplasm collection of pear trees ( Pyrus communis L.) from the Walloon Agricultural Research Centre (Gembloux, Belgium). In total, 128 pear trees samples were analyzed as pools using high-throughput sequencing techniques and/or tested individually for targeted viruses by reverse transcription PCR (RT-PCR). During the virome survey, a novel velarivirus was identified in several asymptomatic trees, and four known viruses were detected. Bioinformatics tools were used to assemble the genome of the new virus. The pear germplasm collection from Kozjanski Park (Slovenia) and a viral collection from Agroscope (Nyon, Switzerland) were also surveyed for the new pear virus and for three known viruses (citrus virus A [CiVA], apple rubbery wood virus 1 [ARWV-1], and apple rubbery wood virus 2 [ARWV-2]) to study their prevalence and geographic distribution. In Belgium, the new velarivirus was detected by RT-PCR in 6 of the 99 sampled trees (6%) and CiVA in 49 (49%) of them; in Slovenia, four of the six trees sampled (67%) were positive for CiVA; and in Switzerland, four of the nine trees sampled (44%) were positive for CiVA and 1 (11%) for ARWV-1 and -2. This study combined pooled high-throughput sequencing analyses to maximize the amount of germplasm tested and targeted RT-PCR tests on individual samples for accurate detection. It reports and describes a new velarivirus discovered in pear trees and first detections of CiVA in Belgium, Switzerland, and Slovenia, as well as ARWV-1 and -2 in Switzerland. [Formula: see text] Copyright © 2025 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license