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To close or not to close after colorectal endoscopic submucosal dissection: that is the question!
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Flushing ensures vessel presealing in underwater third-space endoscopy
No full textInternational audienceAbstract Background Stent misdeployment (SMD) is a feared and poorly characterized technical challenge of endoscopic ultrasound (EUS)-guided choledochoduodenostomy (CDS) using lumen-apposing stents. We aimed to ascertain the rate of stent misdeployment in EUS-CDS for malignant distal biliary obstruction (MDBO) and describe its outcomes while identifying variables associated with its occurrence. Method This was a post hoc analysis of two randomized controlled trials comparing EUS-CDS vs. endoscopic retrograde cholangiopancreatography in MDBO. The primary end point was rate of SMD, classified as misdeployment of the distal flange (type I), proximal flange (type II), contralateral bile duct wall injury (type III), or double mucosal puncture (type IV). Multivariable analysis was performed to identify variables associated with SMD and/or technical failure, and with clinical failure or stent dysfunction. Results 152 patients were included. Technical success was 93.4 %. SMD occurred in 11 patients (7.2 %; 95 %CI 3.1 %–11.4 %): 8 type I, 1 type II, and 2 type III. Endoscopic salvage of SMD was successful in 81.8 %. Misdeployment led to adverse events in four patients (two mild, two moderate), giving an overall SMD-related adverse event rate of 2.6 % (95 %CI 0.7 %–6.6 %). On multivariable analysis, extrahepatic bile duct diameter of ≤ 15 mm was associated with increased odds of SMD and/or technical failure. Conclusion SMD was relatively common in EUS-CDS and was associated with an extrahepatic bile duct diameter of ≤ 15 mm. The majority of misdeployments could be rescued endoscopically with low risk for adverse events
TTR Gene Screening Since the Advent of Biotherapies in France: A Nationwide Retrospective Survey Between 2018 and 2023
No full textInternational audienceBackground Hereditary transthyretin amyloidosis (ATTRv) is a rare genetic disorder caused by mutations in the TTR gene. Associated with various clinical phenotypes like polyneuropathy and cardiomyopathy, ATTRv has historically had poor outcomes. Recent advances in biotherapies have significantly improved these outcomes. This study aimed to assess the evolution in genetic TTR variant screening since the advent of biotherapies in France in 2018. Methods This nationwide retrospective study analyzed data and genetic results from patients who underwent TTR gene sequencing from 2018 to 2023. Results 16,640 patients were tested during the period studied. There was a 108% increase in the number of TTR gene sequencing performed annually between 2018 and 2023. Positive rates remained stable despite increased testing (7.09% over time). During this 6‐year period, 1,179 patients were diagnosed with a pathogenic variant of TTR . Conclusions The study shows a substantial rise in TTR genetic testing in France, likely linked to the deployment of biotherapies. These findings underscore the necessity of integrating TTR gene sequencing into standard diagnostic procedures, especially given the effectiveness of treatments and the stability of positive rates
Arc Blanc: a real time ocean simulation framework
No full textInternational audienceThe oceans cover the vast majority of the Earth. Therefore, their simulation has many scientific, industrial and military interests, including computer graphics domain. By fully exploiting the multi-threading power of GPU and CPU, current state-of-the-art tools can achieve real-time ocean simulation, even if it is sometimes needed to reduce the physical realism for large scenes. Although most of the building blocks for implementing an ocean simulator are described in the literature, a clear explanation of how they interconnect is lacking. Hence, this paper proposes to bring all these components together, detailing all their interactions, in a comprehensive and fully described real-time framework that simulates the free ocean surface and the coupling between solids and fluid. This article also presents several improvements to enhance the physical realism of our model. The two main ones are: calculating the real-time velocity of ocean fluids at any depth; computing the input of the solid to fluid coupling algorithm.Les océans couvrent la grande majorité de la Terre. Leur simulation présente donc de nombreux intérêts scientifiques, industriels et militaires, y compris dans le domaine de l'informatique graphique. En exploitant pleinement la puissance du multithreading sur les GPU et les CPU, les outils actuels peuvent réaliser une simulation des océans en temps réel, même s'il est parfois nécessaire de réduire le réalisme physique pour les scènes de grande taille. Bien que la plupart des éléments constitutifs de la mise en œuvre d'un simulateur d'océan soient décrites dans la littérature, il n'existe pas d'explication claire sur la manière dont ils sont interconnectés. Cet article propose donc de rassembler tous ces composants, en détaillant toutes leurs interactions, dans un framework en temps réel qui simule la surface libre de l'océan et le couplage entre les solides et les fluides. Cet article présente également plusieurs améliorations visant à renforcer le réalisme physique de notre modèle. Les deux principales sont : le calcul en temps réel de la vitesse des fluides océaniques à n'importe quelle profondeur ; le calcul de l'entrée de l'algorithme de couplage du solide vers le fluide
Imaging follow-up of unruptured intracranial aneurysms treated with flow diverter: Insights from a French collaborative survey
No full textInternational audiencePurposeThe absence of standardized guidelines for imaging follow-up of unruptured intracranial aneurysms treated with flow diverters (FD) results in significant variability across centers. This survey aims to provide a comprehensive overview of current imaging follow-up practices in French academic centers.MethodsIn April 2024, a 49-question survey was distributed to interventional neuroradiology centers in France through the trainee-led research collaborative network, Jeunes En Neuroradiologie Interventionnelle-Research Collaborative (JENI-RC). The survey covered follow-up protocols for digital subtraction angiography (DSA), magnetic resonance imaging (MRI), and computed tomography (CT), as well as potential modifications for specific cases.ResultsTwenty interventional neuroradiology centers responded to the survey. Most centers (n = 14, 70 %), conducted a single systematic DSA either at 6 or 12 months post-procedure. In most centers (n = 13, 65 %), a second DSA was scheduled only based on the results of the first, specifically in cases of non-occluded aneurysm, intimal hyperplasia, or in-stent stenosis. MRI follow-up varied, with most centers (n = 12, 60 %) performing three MRIs over five years. Only two centers included CT scans in their protocols.ConclusionThis survey highlights the substantial heterogeneity in imaging follow-up protocols for FD-treated unruptured intracranial aneurysms among French academic centers. The findings underscore the urgent need for standardized guidelines to harmonize practices, optimize patient outcomes, and improve resource utilization. Additionally, innovations in FD technology, advancements in MRI sequences, and the advent of photon-counting CT will likely influence follow-up practices in the near future
Les interfaces de la colère. Obstacles et conditions du bien-être dans l’industrie vidéoludique
No full textInternational audienceThe video game industry is known for the harmful nature of its working conditions, with the use of crunch being one of the main indicators. Initially documented by the press and then by research, which is increasingly focused on these issues, in a context of major upheaval for both itself and its workers. With constant growth and record profits during the successive lockdowns related to the Covid-19 pandemic, it now appears to be in crisis, given the colossal number of layoffs recorded in recent years. In this context, this article aims to question the conditions of possibility for well-being – and, by extension, its antonyms – within the video game industry, focusing on a polysemous device: interface. This study thus discusses the specificities of video game development, explores the diversity of production interfaces, and questions the potentially conflicting dimension of the latter.L’industrie vidéoludique est désormais réputée pour la nocivité de ses conditions de travail, dont le recours au crunch est l’un des principaux indicateurs : d’abord documentées par la presse, puis par la recherche, qui s’intéresse de plus en plus à ces questions, dans un contexte de bousculements majeurs pour l’industrie vidéoludique et ses travailleur·ses. Forte d’une croissance en constante augmentation et de profits records réalisés à l’occasion des confinements successifs liés à la pandémie de Covid-19, elle semble aujourd’hui être entrée en crise, comme en témoignent les dizaines de milliers de licenciements enregistrés ces dernières années. Dans ce contexte, cet article vise ainsi à interroger les conditions de possibilité du bien-être – et de fait, de ses antonymes – au sein de l’industrie vidéoludique, en s’intéressant à un dispositif polysémique : l’interface. Cette étude évoque ainsi les spécificités du développement de jeux vidéo, explore la diversité des interfaces de production et questionne leur dimension possiblement conflictuelle
Multiscale thermal and thermomechanical analysis of a SiP using Fan Out Wafer LevelPackaging (FO-WLP) technology
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Introduction
No full textInternational audienceL’important, avant de se lancer dans la lecture de cet ouvrage, est de comprendre que le handicap est une notion récente à l’échelle de l’histoire mais qu’elle est l’héritière de lois et de représentations séculaires qui n’ont eu de cesse de classer des populations singulières et d’en définir la place plus ou moins restreinte à laquelle elles pouvaient prétendre au sein des différentes sociétés qui se sont succédé. Cette longue histoire n’a pu que générer de multiples idées reçues dont certaines persistent encore aujourd’hui
