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Impact of endoscopic ultrasound-guided biliary drainage on the management of difficult biliary cannulation in patients with distal malignant biliary obstruction
No full textInternational audienceAbstract Biliary drainage in patients with distal malignant biliary obstruction (DMBO) carries a higher risk of difficult biliary cannulation (DBC) during endoscopic retrograde cholangiopancreatography (ERCP). After the failure of standard cannulation, endoscopists may proceed with advanced cannulation techniques and/or with endoscopic ultrasound-guided biliary drainage (EUS-BD). This was a retrospective study of consecutive patients with DMBO and a dilated common bile duct (CBD; >12 mm) who underwent ERCP for endoscopic biliary drainage in four European centers. The rates of DBC, technical and clinical success, and procedure-related adverse events (AEs) were assessed. The predictive factors for AEs were also investigated through regression analysis. The EUS-BD approach was considered either as the first option after standard cannulation failure or as the final option after advanced cannulation failure. 1016 patients with DMBO were included in the study, with 524 (51.6%) matching the definition of DBC. Clinical success was achieved in 956 patients (94.1%). Procedure-related AEs were experienced by 167 patients (16.4%). Patients with DBC had a higher risk of AEs (P=0.003); however, patients undergoing “early” EUS-BD showed a risk of AEs comparable with those managed with standard cannulation (P=0.38). An attempt at any advanced cannulation technique was independently associated with the occurrence of AEs (P=0.001). The risk of AEs is higher in patients with DMBO and DBC, this appears to be mainly related to the advanced cannulation techniques. In patients with a dilated CBD (>12 mm), “early” EUS-BD may minimize the risk of AEs
Come sta cambiando l’orientamento universitario? Processi, contesti e attori
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“Rejeito a ingenuidade na história da matemática”: considerações metodológicas
No full textInternational audienceThe history of mathematics is far more than a mere sequence of discoveries; it is deeply intertwined with social, cultural, and institutional contexts. This article examines how to approach its study, questioning the very definition of mathematics, the diversity of its practitioners, and the evolution of its methods. It advocates for a critical engagement with historical sources, balancing mathematical and historiographical perspectives to mitigate the risk of anachronism. Moving beyond a linear, (and often Eurocentric) narrative, it emphasizes the circulation and cross-fertilization of mathematical knowledge across different times and places. By renewing historiographical perspectives, it encourages a richer and more nuanced understanding of the discipline.L’histoire des mathématiques ne se résume pas à une suite de découvertes, mais s’inscrit dans des contextes sociaux, culturels et institutionnels. Cet article explore comment écrire cette histoire en questionnant la définition des mathématiques, la diversité de ses acteurs et l’évolution de ses pratiques. Il plaide pour une approche critique des sources, intégrant lectures mathématicienne et historienne afin d’éviter les anachronismes. Loin d’une vision linéaire (et souvent occidentalo-centrée), il met en avant les circulations et interactions des savoirs à travers le temps. En renouvelant les perspectives historiographiques, il invite à une compréhension plus riche et nuancée de la discipline.A história da matemática é muito mais do que uma simples sucessão de descobertas; ela está profundamente interligada a contextos sociais, culturais e institucionais. Este artigo investiga como abordar seu estudo, questionando a própria definição de matemática, a diversidade de seus praticantes e a evolução de seus métodos. Defende uma abordagem crítica das fontes históricas, equilibrando perspectivas matemáticas e historiográficas para evitar anacronismos. Ao romper com uma narrativa linear (e algo eurocêntrica), destaca a circulação e o intercâmbio de conhecimentos matemáticos ao longo do tempo e em diferentes contextos. Ao renovar as perspectivas historiográficas, promove uma compreensão mais ampla e aprofundada da disciplina
Clinical outcomes of patients with unsuccessful mechanical thrombectomy versus best medical management of medium vessel occlusion stroke in the middle cerebral artery territory
No full textInternational audienceBackground Current randomized controlled trials are investigating the efficacy and safety of mechanical thrombectomy (MT) in patients with medium vessel occlusion (MeVO) stroke. Whether best medical management (MM) is more efficient than unsuccessful vessel recanalization during MT remains unknown. Methods This was a retrospective cohort study using data from 37 academic centers across North America, Asia, and Europe between September 2017 and July 2021. Only patients with occlusion of the distal branches (M2 and M3) of the middle cerebral artery territory were included. Unsuccessful MT was defined as a modified Thrombolysis in Cerebral Infarction score of 0–2a. Propensity score matching was used to control for confounders. The primary outcome was functional independence, defined as a modified Rankin Scale (mRS) score of 0–2 at 90 days after treatment. Multivariable regression analysis was used to assess factors associated with the primary outcome. Results Of 2903 patients screened for eligibility, 532 patients were analyzed (266 per group) after propensity score matching. The MM group had superior functional outcomes, with 32% achieving mRS 0–1 at 90 days compared with 21% in the MT group (P=0.011). Patients in the MM group also had significantly lower rates of symptomatic intracranial hemorrhage (sICH) (3.4% vs 16%, P<0.001) and any hemorrhage (18% vs 48%, P<0.001). On multivariable regression, unsuccessful MT was associated with reduced odds of functional independence (OR 0.50, 95% CI 0.29 to 0.85, P=0.011) and increased odds of sICH (OR 4.32, 95% CI 1.84 to 10.10, P<0.001). Mortality rates were similar between groups (27% in MM vs 29% in MT, P=0.73). Conclusion Unsuccessful MT for MeVO was linked to worse outcomes than best MM. These findings highlight the risks of prolonged attempts and emphasize the importance of efficient procedural decision-making to reduce complications and improve patient outcomes
Article 11 - Droit à la liberté de réunion pacifique – La condamnation des entraves méchantes à la circulation routière
No full textInternational audience(CEDH 16 janv. 2025, no 35834/22, Bodson et a. c/ Belgique, AJDA 2025. 120
Telemedicine for the management of neuropsychiatric symptoms in patients with dementia living in long term care facilities: secondary and exploratory analyses from the DETECT interventional pilot study.
No full textInternational audienceObjectiveThis study aimed to compare the effects of telemedicine use in management of neuropsychiatric symptoms (NPS) in patients with dementia in long-term care facilities (LTCFs) versus usual care.DesignDETECT is a prospective randomized controlled cluster pilot study with two arms: "usual care" and "intervention arm" utilizing telemedicine for NPS management. Our study includes secondary and exploratory analyses from the DETECT study (primary analyses were the subject of a separate publication).SettingNineteen LTCFs participated. Patient outcomes included total hospitalizations including emergency room admittance, psychotropic drug prescriptions, NPS based on NPI-NH, quality of life based on QolAD, and functional status based on Activity Daily Living (ADL).MeasurementsAnalyses were conducted on a modified intention-to-treat population. Mixed models were used for outcome measures, considering data correlation over time and intra-LTCF correlation.ResultsOne hundred forty-one patients were included: 65 in the control group and 76 in the intervention group, 99 women (70.2%) with a mean age of 86.8 years ± 6.6 (SD). No difference was identified regarding hospitalizations and psychotropic drug prescriptions in the intervention group. During exploratory analyses, telemedicine showed significant improvement in the intervention group for NPI frequency × severity score (p = 0.001), NPI distress score (p = 0.03), ADL (p = 0.006), and several quality-of-life items compared to usual care.ConclusionsSecondary analyses form DETECT study show no difference in the use of telemedicine on management of NPS in patients with dementia in LTCFs, in terms of hospitalizations and psychotropic drug prescription. However, some exploratory analyses indicated a positive effect of Telemedicine, including severity, frequency, distress, and functional autonomy compared to usual care
Assessment of Residual Stiffness Modulus of Asphalt Mixes from In-Service Pavement by Ultrasonic Testing: Anisotropy and Traffic Load Effects
No full textInternational audienceThis study aims to assess the residual mechanical properties of asphalt concrete (AC) using ultrasonic pulse velocity tests with P- and S-waves on field-extracted plates. In order to evaluate the impact of traffic load on the residual mechanical properties, the plates are extracted from both trafficked and untrafficked areas. S-wave measurements were particularly challenging because of high attenuation of the material, addressed by using piezoelectric transducers operating in shear mode and advanced signal processing. Three methods for the time of flight determination are proposed, taking into account the signal-to-noise ratio effects. The C-scan measurements are presented in the form of spatial cartographies, followed by statistical analysis to assess the homogeneity of the plates across the spatial distribution. The ageing and heavy vehicle traffic degrade the material’s residual mechanical properties, leading to reduced wave velocities, particularly in the base layer’s materials. Comparing with traditional two-point bending test the high-frequency dynamic modulus calculated from US measurements matched well with traditional complex modulus test results and viscoelastic rheological modeling. Ultrasonic pulse velocity measurements indicate that aged AC can be considered as an orthotropic material with transverse isotropy
Collaboration en recherche clinique : exemple de PsyMotDep une étude sur le suivi en psychomotricité de patients avec une dépression
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Plasma-Assisted Partial Methane Oxidation. Part I: One-Dimensional Statistical Modeling of a Dielectric Barrier Discharge Reactor
No full textInternational audienceThis paper presents an original one-dimensional statistical model designed to complement experimental data from a practical DBD reactor. The experimental setup consists of a plasma-assisted reactor with gas injection composed solely of CH4 and O2. The numerical procedure uses electrical measurements to provide a realistic description of the power consumption and the current flowing through the gas, in a complex scenario where approximately one hundred current peaks are measured per electrical half-period. A plasma kinetic model is then used to analyse the chemistry and characteristic times of both isolated discharges and a representative train of discharges occurring within the reactor. These times are used to optimise the computational costs and to select the most appropriate kinetic schemes for the gas phase, whether in a plasma or quasi-thermodynamic equilibrium state. This approach also allows the separation of fast transformations (plasma) occurring at constant volume, from slower transformations occurring at constant pressure. The statistical approach, based on a Monte Carlo method, clearly identifies the assumptions required to reduce the real complexity of the DBD reactor to a 1D flow model. The combination of chromatographic measurements at the reactor outlet and numerical simulations provides the heterogeneity factor of the discharges, which is identified as a key parameter in the model. Although the flow can be considered stationary on average, the obtained value reveals a highly heterogeneous spatial distribution of the discharges within the reactor. Thus, the numerical results suggest that the gases passing through the reactor are rarely in a plasma state