Portail HAL de l'Université Picardie Jules Verne
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Anatomía y fisiología del oído externo
No full textInternational audienceEl oído externo está formado por el pabellón auricular (oreja) y el conducto auditivo externo. La morfología de la oreja es muy variable de una persona a otra (e incluso de una oreja a otra en una misma persona), de modo que la oreja y sus diversas características constitucionales podrían ser una herramienta de identificación comparable a los dermatoglifos. El aspecto de la oreja tiene una gran importancia estética, lo que explica la existencia de muchas técnicas quirúrgicas reparadoras y/o estéticas para sus malformaciones y algunas de sus variaciones anatómicas. Desde un punto de vista fisiológico, el oído externo interviene en la localización, la amplificación (para algunas frecuencias) y la transmisión hacia el oído medio de las ondas mecánicas sonoras. Esto es particularmente importante para muchas especies del reino animal, predadores o presas. El papel fisiológico del oído externo en el ser humano suele considerarse accesorio (e incluso nulo), pero posiblemente esto sea erróneo
Disproportionate Left Ventricular Enlargement in Mitral Valve Prolapse: Prevalence, Predictors, and Association With Outcomes
No full textInternational audienceLeft ventricular (LV) end‐systolic enlargement in severe degenerative mitral‐regurgitation (MR) is a class I surgical trigger. Whether it occurs disproportionately to less‐than‐severe MR due to mitral valve prolapse and is associated with mortality are unknown. We aimed to analyze prevalence and association with survival of disproportionate LV enlargement in less‐than‐severe MR. Methods A multicenter cohort international study enrolled 2848 consecutive patients (52% women, 69±16 years) with degenerative MR prospectively quantified and graded mild or moderate. Primary end point was survival under medical management. Secondary outcome was survival throughout follow‐up stratified by performance of early mitral surgery within 3 months postdiagnosis. Results Among LV remodeling parameters (abnormal end‐diastolic diameter, LV end‐systolic diameter [LVESD] absolute and indexed), LVESD ≥40 mm (present in 12.4%) was the sole independent associate of reduced survival (5‐year 70±3 versus 76±9%; P =0.009). LVESD ≥40 mm was independently linked to larger body surface area, effective regurgitant orifice, and left atrium, and to male sex and diabetes. With multivariable comprehensive adjustment, LVESD ≥40 mm (adjusted hazard ratio [aHR], 1.25 [95% CI, 1.005–1.53]; P =0.04) remained associated with excess mortality under medical management, even after adjustment for lowered ejection fraction (aHR, 1.49 [95% CI, 1.13–1.95]; P =0.004) and in all patient subsets. Among patients with moderate degenerative MR and LVESD ≥40 mm, 22% underwent mitral surgery within 3 months, which was associated with superior survival, even after comprehensive adjustment (aHR, 0.11 [95% CI, 0.005–0.51]; P =0.002). Conclusions Disproportionate LV enlargement in patients with less‐than‐severe degenerative MR is common, particularly with larger bodies, regurgitation, and overall cardiac remodeling. LVESD ≥40 mm is associated with worse survival independent of all baseline characteristics, even lowered ejection fraction, and represents a marker for risk stratification of patients who are generally not yet considered for medical or surgical/interventional treatment
Synthesis of Na3SbS4 solid electrolyte from dimethyl sulfoxide solvent
No full textInternational audienceAs a more effective and scalable substitute for conventional solid-state syntheses, solution synthesis of electrolytes for all solid-state batteries attracts a lot of attention. Sodium tetrathioantimonate Na3SbS4 is a promising solid electrolyte (SE) for all-solid-state sodium ion batteries. Dimethyl sulfoxide solvent was used for the first time as a reaction medium. The Na3SbS4 powder is made of agglomerated irregular particles, and exhibits a Na-ionic conductivity at room temperature of 2.74·10−4 S/cm coupled with a low activation energy of 0.26 eV. The current route using dimethyl sulfoxide solvent would be an alternative approach for the production of high-performance solid electrolytes
Hartmann’s procedure versus primary anastomosis for Hinchey III or IV sigmoid diverticulitis: a propensity score analysis of a retrospective national cohort study
No full textInternational audienceIntroduction: Primary anastomosis with a diverting stoma (PA) has been evaluated relative to Hartmann's procedure (HP) for Hinchey III/IV peritonitis in four randomized trials, all of which lacked power. We aimed to evaluate the safety of PA for this indication in real-life settings.Patients and methods: Patients who underwent surgery for Hinchey III/IV diverticulitis at 43 French centers from 2010 to 2021 were included in this retrospective multicenter study. The primary endpoint was the rate of severe complications at 90 days (Clavien-Dindo III-V). Secondary endpoints included the overall complication rate and stoma-free survival at one year. Two groups of patients (PA vs. HP) were created by propensity score matching (PSM).Results: In total, 651 patients were included (112 with PA and 539 with HP). We matched 102 of the patients with PA with 102 patients who underwent HP. On day 90, there was no difference in the rate of severe complications (31% vs. 29%, p = 0.75) between these groups in subgroup analyses for Hinchey III (p = 0.99) or Hinchey IV (p = 0.35) diverticulitis. The percentages of patients with Hinchey III or IV diverticulitis did not differ significantly between the groups (SMD = 0.03). After inverse probability treatment weighting, mortality was significantly higher in the HP group than in the PA group (6% vs. 1%, p = 0.019). Stoma-free survival at one year was higher in the PA group (85% vs. 73%, p = 0.03). The reoperation rate at 90 days was higher in the PA group than in the HP group (unadjusted: 21% vs. 13%, p = 0.028; PSM: 21% vs. 7%, p = 0.007, respectively).Conclusion: PA did not increase the overall rate of complications. Conversely, it decreased mortality and the rate of definitive stomas in a large cohort of patients with Hinchey III/IV sigmoid diverticulitis
Evaluation of the efficacy and tolerance of pamidronate in complex regional pain syndrom type 1
No full textInternational audienceThis study aimed to determine whether the delay between symptom onset and treatment initiation, the dose of pamidronate, and bone mineral density (BMD) influence the response to pamidronate treatment in complex regional pain syndrome type 1 (CRPS 1). A retrospective observational study included patients treated with pamidronate between 2013 and 2023. Treatment response was assessed based on symptom regression according to the Budapest criteria at one (M1) and four months (M4) post-treatment. Multivariate logistic regression identified factors associated with response. Among the 255 patients included, 14.5% responded at M1 and 67% at M4. Multivariate analysis showed that post-traumatic (OR 2.75, 95% CI [1.36-5.7], P = 0.0053) or idiopathic etiology (OR 5.47, 95% CI [1.86-18.92], P = 0.0037) compared to post-surgical etiology, and the presence of initial edema (OR 2.39, 95% CI [1.26-4.62], P = 0.0082), were associated with a better response at M4. BMD, treatment delay, and pamidronate dosage were not significantly associated with treatment response. These findings suggest that initial edema is a predictive factor for response to pamidronate in CRPS 1, with syndrome etiology also influencing outcomes. Increasing pamidronate dosage or infusion frequency does not seem to improve therapeutic efficacy
Bilan des émissions de gaz à effet de serre moyen des accouchements du CHU Amiens Picardie en 2023 : analyse de cycle de vie du parcours de soins des parturientes
No full textIntroduction : le réchauffement climatique impacte la santé de toutes les populations autour du globe. Les hôpitaux et blocs opératoires contribuent fortement à ce réchauffement en raison de leurs émissions de gaz à effet de serre (GES). Comme tous les secteurs fortement polluants, la santé doit diminuer ses émissions. Les connaître est nécessaire pour agir efficacement. Les accouchements sont parmi les actes apparentés à la chirurgie les plus pratiqués mais aucune étude n’a encore étudié leurs émissions. Notre objectif est de chiffrer les émissions moyennes d’un accouchement au CHU AP, en kg éq.CO2, puis esquisser des propositions pour diminuer notre impact. Matériel et méthode : nous avons réalisé l’analyse du cycle de vie globale des accouchements ayant eu lieu à la maternité du CHU d’Amiens en 2023 grâce à une étude monocentrique et rétrospective. Résultats : la maternité du CHU AP a émis, pour 2526 parturientes, 1 204 678 kg éq. CO2 soit 471 kg éq. CO2 par accouchement. Les postes les plus émetteurs sont les dispositifs médicaux (DM) et les médicaments (34 % des émissions totales), les déplacements des couples et visiteurs (18%), les trajets domicile-travail (13%) et les émissions directes, c’est-à-dire le chauffage au gaz (10%). Discussion : nos résultats semblent cohérents avec le reste de la littérature. Nos suggestions, pour réduire nos émissions, ciblent les prescriptions et l’utilisation des DM, invitent à former le personnel et à agir à tous les échelons. Conclusions : notre activité est émettrice de GES mais des améliorations sont possibles et une lecture écologique de nos pratiques n’est pas en contradiction avec le bien de nos patientes
Altérités médiévales. Chanson de Roland, Rolandslied et manuscrit de Heidelberg, UB, Cpg 112
No full textInternational audienceCette contribution explore l’altérité de la littérature médiévale et les représentations médiévales de l’altérité au prisme de deux textes : la Chanson de Roland, dans sa version anglo-normande datée vers 1100, et le Rolandslied, son adaptation en langue allemande composée par le clerc Konrad entre 1170 et 1185. Elle compare les représentations que les deux œuvres donnent de l’Autre, c’est-à-dire de ceux qu’elles nomment les « païens », et elle analyse dans cette perspective les illustrations de l’unique manuscrit complet qui transmette le Rolandslied, celui de Heidelberg, UB, Cpg 112. L’analyse montre comment les représentations, textuelles et visuelles, données de l’altérité opposent l’Autre à un « nous » dans un processus de construction d’une identité collective de la communauté franque et chrétienne qui repose sur l’exclusion, l’amalgame et la diffamation de l’Autre. L’étude suggère aussi ce que nous enseigne l’altérité de la littérature médiévale : non seulement son mode de transmission nous incite à ne pas dissocier l’étude littéraire des contextes manuscrits, mais la circulation des textes propre à cette époque nous invite à adopter, dans notre approche, une perspective transnationale et transculturelle
The impact of doping with (M = Zn2+, Ca2+, Mg2+) on the microstructure and electrical properties of Na2.2Al0.8M0.2Ti(PO4)3 NASICON glass-ceramics
No full textInternational audienceA series of glasses and glass-ceramics with the composition 26.19Na2O-9.52Al2O3-4.76MO-23.81TiO2-35.72P2O5 (M = Ca, Zn, Mg), corresponding to the formula Na2.2Al0.8M0.2Ti(PO4)3, were prepared using melt quenching and crystallization techniques. This study investigates the influence of dopant elements (Ca, Zn, Mg) on structural, microstructural, and electrical properties to develop solid materials for sodium-ion conduction. DSC analysis revealed a three-dimensional crystallization process and significant thermal stability. Structural and electrical characterization, including XRD, IR, and Raman spectroscopy, confirmed NASICON phase formation. SEM demonstrated a dense morphology, while EIS showed GC-Mg had the highest conductivity of 7.29 × 10−5 (Ω−1 cm−1) at 300 °C with an activation energy of 0.22 eV. DC polarization confirmed predominantly ionic conduction. These findings highlight GC-Mg as a promising Na-ion conductor for energy storage applications
Photophysical modulation of D205 dye in acetonitrile-butanol mixtures: Interplay of solvent polarity, hydrogen bonding, and conformational dynamics
No full textInternational audienceUnderstanding how local solvent environments influence dye photophysics is essential for improving the performance of dye-sensitized systems. In complex ionic liquid (IL)/molecular solvent mixtures, non-linear trends have been observed, raising questions about the underlying mechanisms. In this work, we investigate whether similar microenvironment-dependent behavior can be observed in conventional molecular solvent mixtures, using the indoline dye D205 in a binary 1-butanol (BuOH)/acetonitrile (ACN) system. This mixture allows systematic tuning of key solvent properties such as polarity, hydrogen-bonding, and viscosity, while preserving simpler and more interpretable solvent–solvent interactions. Combining Raman spectroscopy, steady-state UV–Vis and fluorescence spectroscopy, time-correlated single photon counting (TCSPC), femtosecond transient absorption spectroscopy (TAS), and TD-DFT calculations, we show that D205's excited-state dynamics are highly sensitive to changes in solvent composition. Increasing the BuOH fraction leads to blue shifts in emission, decreased Stokes shift, reduced quantum yield, and shorter fluorescence lifetimes at intermediate compositions. TD-DFT reveals solvent-dependent conformational changes and subtle (~1 %) variations in donor–acceptor charge transfer character. However, these changes do not dominate excited-state deactivation pathways, suggesting that hydrogen bonding and local polarity fluctuations play a more decisive role. This study demonstrates that even in conventional binary solvents, local microheterogeneity can strongly modulate dye photophysics. Finally, our findings suggest that the effect of the mixture on the D205 photophysics observed trends is not exclusive to the IL/molecular solvent microenvironments but can also manifest in conventional binary solvent systems such as BuOH/ACN mixtures