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Nos recherches servent-elles réellement à quelque chose dans la pratique ? Et que pouvons-nous y faire ?
No full textCausalité : Des études qui répondent à quelles questions ? Généralisation : Un problème de passage à l’échelle ? Mise en œuvre : Passer d’un constat à une recommandation
The learning curve of V-NOTES hysterectomy: a single-surgeon experience
No full textPurpose: Vaginal natural orifice transluminal endoscopic surgery (V-NOTES) has emerged as an innovative surgical approach that combines the advantages of endoscopic surgery with those of the vaginal approach. This article presents the initial experience of a single institution in implementing the V-NOTES technique for hysterectomy procedures. Methods: This retrospective cohort study assessed the first 139 V-NOTES hysterectomies performed by a single surgeon at 000 from 2021 to 2024. Preoperative, intraoperative, and postoperative data were recorded. Operative time (OT) served as an indicator of surgical proficiency. The learning curve was analyzed using the cumulative sum method of operative time (CUSUMot). Results: The mean OT was 59.32 ± 21.13 min. No patient required conversion to laparotomy or conventional laparoscopy. The CUSUMot analysis demonstrated four phases in the learning curve: initiation (12 patients; mean OT, 66.17 ± 12.84 min), consolidation (41 patients; mean OT, 54.32 ± 13.96 min), complexification (54 patients; mean OT, 64.46 ± 25.48 min), and mastery (32 patients; mean OT, 54.5 ± 21.11 min). Additionally, the study identified a history of cesarean section and the absence of vaginal delivery as two risk factors for bladder injury. Conclusion: This study identifies a four-phase learning curve for V-NOTES hysterectomy, with initial competency achieved after 12 cases and sufficient mastery reached after 53 cases for an experienced surgeon
Timeline misalignment in the CAP: why ex-post evaluations currently fall short of informing next policy cycles
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Motivation du licenciement : les travailleurs du secteur privé et du secteur public sont-ils à présents sur un pied d’égalité ?
No full textLa motivation du licenciement est une question sensible en droit social dans la mesure où elle justifie très régulièrement l’introduction d’une procédure devant les juridictions du travail
Standardized reporting of spine and sacroiliac joints in axial spondyloarthritis MRI: from the ESSR-Arthritis Subcommittee.
No full textOBJECTIVES: The revised European Society of Musculoskeletal Radiology (ESSR) consensus guidelines on soft tissue tumor imaging represent an update of 2015 after technical advancements, further insights into specific entities, and revised World Health Organization (2020) and AJCC (2017) classifications. This second of three papers covers algorithms once histology is confirmed: (1) standardized whole-body staging, (2) special algorithms for non-malignant entities, and (3) multiplicity, genetic tumor syndromes, and pitfalls. MATERIALS AND METHODS: A validated Delphi method based on peer-reviewed literature was used to derive consensus among a panel of 46 specialized musculoskeletal radiologists from 12 European countries. Statements that had undergone interdisciplinary revision were scored online by the level of agreement (0 to 10) during two iterative rounds, that could result in 'group consensus', 'group agreement', or 'lack of agreement'. RESULTS: The three sections contain 24 statements with comments. Group consensus was reached in 95.8% and group agreement in 4.2%. For whole-body staging, pulmonary MDCT should be performed in all high-grade sarcomas. Whole-body MRI is preferred for staging bone metastasis, with [18F]FDG-PET/CT as an alternative modality in PET-avid tumors. Patients with alveolar soft part sarcoma, clear cell sarcoma, and angiosarcoma should be screened for brain metastases. Special algorithms are recommended for entities such as rhabdomyosarcoma, extraskeletal Ewing sarcoma, myxoid liposarcoma, and neurofibromatosis type 1 associated malignant peripheral nerve sheath tumors. Satisfaction of search should be avoided in potential multiplicity. CONCLUSION: Standardized whole-body staging includes pulmonary MDCT in all high-grade sarcomas; entity-dependent modifications and specific algorithms are recommended for sarcomas and non-malignant soft tissue tumors. CLINICAL RELEVANCE STATEMENT: These updated ESSR soft tissue tumor imaging guidelines aim to provide support in decision-making, helping to avoid common pitfalls, by providing general and entity-specific algorithms, techniques, and reporting recommendations for whole-body staging in sarcoma and non-malignant soft tissue tumors. KEY POINTS: An early, accurate, diagnosis is crucial for the prognosis of patients with soft tissue tumors. These updated guidelines provide best practice expert consensus for standardized imaging algorithms, techniques, and reporting. Standardization can improve the comparability examinations and provide databases for large data analysis
Association Between Reactive Strength Index and Metabolic Cost of Running in Male Master Athletes
No full textPurpose: To examine the association between reactive strength index (RSI) and metabolic cost of running (MCr) in master athletes. We hypothesized that individuals with a higher RSI would exhibit a lower MCr, that both variables would be associated, and that age would moderate this relationship. Methods: Forty-five male master athletes participated to this study. A median split was performed to constitute 2 age groups (group 1, 47.7 [1.7] y old; group 2, 56.3 [4.6] y old). Participants underwent a single 45-minute session during which RSI was assessed with drop jumps, and MCr, during a continuous exercise of submaximal intensity performed on a treadmill. Results: A small negative association was found between net MCr and RSI in the overall sample (RSI mean r = −.38, P 0.82) than group 2. However, the association between the 2 measures was verified specifically in group 2 (RSI from a 20-cm drop jump, r = −.53, P < .01; RSI mean, r = −.50, P < .05; RSI maximum, r = −.57, P < .01). Conclusions: RSI is associated with net MCR in master athletes, particularly in older participants. Additional intervention studies are now required to further explore this association
Resonance as a Conceptual Lever for Transforming Educational Practices and Institutions
No full textThis article offers a preliminary analysis of how Hartmut Rosa's concept of resonance might meaningfully participate in the transformation of educational practices and institutions, through an exploration of its operational potential. The paper begins by briefly framing the issue of relational vs. individualized educational goals and addressing the complicated relationship between resonance and skill development. Two hypotheses that open up avenues for further research are then explored. The first hypothesis addressed the relationship between resonance theory and moral education through a confrontation with recent literature in education sciences on the development of responsibility, following the idea that, for educational policy to shift away from the skills approach that gels uncomfortably with resonance pedagogy, the latter would need to articulate its capacity to effectively promote a wide range of desirable outcomes beyond the theoretically indigenous aim of dispositional resonance. The second hypothesis posits two ways that resonance theory might affect decision-making processes within educational institutions, examining the role that teachers might play in securing the institutional conditions of resonant pedagogical relationships and proposing a preliminary practical interpretation of Rosa's idea of a resonance compass. The paper closes with a short reflection on the practical distinction between resonance and responsiveness as conceptual levers for educational change, examining what sets resonance pedagogy apart from other relational approaches
SYNTHESIS OF CARBON-BASED BIFUNCTIONAL LEWIS/BRØNSTED ACID CATALYSTS FOR 5-HMF PRODUCTION FROM CELLOBIOSE
No full textLignocellulosic biomass has been recognized as a promising renewable resource for the production of a number of key commodity chemicals. Among the possible products that can be obtained by upgrading its cellulose component, 5-hydroxymethylfurfural (5-HMF) is a high added-value platform chemical that can be valorized. Transforming cellulose into 5-HMF requires three steps involving hydrolysis of the biomass, isomerization of the attained glucose into fructose, and the subsequent dehydration of the latter into 5-HMF [1] (Figure 1). Therefore, there is a strong interest in developing bifunctional catalysts presenting both Brønsted and Lewis acid sites for favoring this multi-step transformation in one pot. In addition, the use of a carbon solid support can provide superior mechanical and chemical resistance to the water and O-rich media provided by such a feedstock, along with tunable textural and surface properties. In the present work, mesoporous aluminosilicate patches [2-3] have been grafted on the surface of a carbon support (activated carbon powder, fraction < 50μm) together with benzyl sulfonic moieties [4] to provide both Lewis and Brønsted acid sites, respectively, to the same solid. To study the elemental composition and microstructural features achieved, SEM/EDX, TEM (Figure 1), and XPS analyses have been performed. Nitrogen physisorption was used to confirm the mesoporous nature of the catalysts, while Boehm titration and 31P MAS NMR with PMe3 probe were applied to investigate their acidity and confirm the presence of both Brønsted and Lewis sites in the final material. The activity of the synthesized bifunctional catalysts and that of their corresponding monofunctional counterparts (sulfonated carbon and aluminosilicate patched carbons) was compared for the upgrading of cellobiose to 5-HMF. A proximity effect was found when the two acidic sites are combined onto the same substrate, facilitating the overall conversion of the sugars involved. A maximal yield of 37% of 5-HMF was attained after 23 h with catalyst I4@BATEOS/SO3H in a THF:mQ water system at 423 K. No significant traces of side products were observed after 23 hours, indicating the high selectivity of the catalyst for the targeted transformations