Management of adhesive small bowel obstruction: the results of a large retrospective study.

BACKGROUND: Postoperative adhesive small bowel obstruction (SBO) is a frequent cause of hospital admission in a surgical department. Emergency surgery is needed in a majority of patients with bowel ischemia or peritonitis; most adhesive SBO can be managed nonoperatively. Many studies have investigated benefits of using oral water-soluble contrast to manage adhesive SBO. Treatment recommendations are still controversial. METHODS: We conducted an observational retrospective monocentric study to test our protocol of management of SBO using Gastrografin®, enrolling 661 patients from January 2008 to December 2021. An emergency surgery was performed in patients with abdominal tenderness, peritonitis, hemodynamic instability, major acute abdominal pain despite gastric decompression, or CT scan findings of small bowel ischemia. Nonoperative management was proposed to patients who did not need emergency surgery. A gastric decompression with a nasogastric tube was immediately performed in the emergency room for four hours, then the nasogastric tube was clamped and 100 ml of nondiluted oral Gastrografin® was administered. The nasogastric tube remained clamped for eight hours and an abdominal plain radiograph was taken after that period. Emergency surgery was then performed in patients who had persistent abdominal pain, onset of abdominal tenderness or vomiting during the clamping test, or if the abdominal plain radiograph did not show contrast product in the colon or the rectum. In other cases, the nasogastric tube was removed and a progressive refeeding was introduced, starting with liquid diet. RESULTS: Seventy-eight percent of patients with SBO were managed nonoperatively, including 183 (36.0%) who finally required surgery. Delayed surgery showed a complete small bowel obstruction in all patients who failed the conservative treatment, and a small bowel resection was necessary in 19 patients (10.0%): among them, only 5 had intestinal ischemia. CONCLUSIONS: Our protocol is safe, and it is a valuable strategy in order to accelerate the decision-making process for management of adhesive SBO, with a percentage of risk of late small bowel resection for ischemia esteemed at 0.9%.

A questionnaire survey for the assessment of wild-domestic pig interactions in a context oedema disease outbreaks among wild boars (Sus scrofa) in South-Eastern France.

Pig outdoor farming is gaining popularity and commercial success in the European Union, and its expansion, together with an increasing wild boar population, facilitates interactions between domestic and wild suids. In the Southern French Department of Ardèche, several episodes of mass mortalities due to infection with an enteropathogenic strain of Escherichia coli causing oedema disease (OD) were reported in wild boar populations between 2013 and 2016. In order to investigate a potential link between those events and the frequency of interactions between wild boar and domestic pig, we analyzed regional vegetation and hunting bag data and implemented a semi-structured questionnaire survey among a total of 30 outdoor pig farmers and 30 hunters distributed inside and outside the identified area of OD emergence. One third of interviewed farmers (11/30) had experienced intrusions of wild boars in domestic pig premises during the previous year. Similarly, 23% of interviewed hunters reported interactions between wild boar and feral free-ranging pigs in recent years, and 60% reported the observation of free-ranging pigs with a phenotypic feature of Vietnamese pot-bellied pigs (55%). Our analysis identified that in the OD emergence area, several factors could facilitate the transmission of pathogens between wild and domestic suids including a predominance of forested vegetation, a higher estimated wild boar density, weaker levels of farm biosecurity, a higher level of reported wild boar intrusions in pig farms and several reports of feral pot-bellied pig presence. Although our sample was limited, our study suggested a widespread occurrence of situations facilitating the transmission of pathogens between wild and domestic suids. Similar studies in other rural regions in the European Union are recommended, in order to promote preparedness for the emergence and circulation of shared swine pathogens.

Link Between Anhedonia and Depression During Early Alcohol Abstinence: Gender Matters.

AIMS: The aim of the present study was to evaluate the relation between anhedonia and depression in alcohol use disorders (AUD) during detoxification: Is trait anhedonia measured at the beginning of detoxification predictive of depressive symptoms observed at the end? Does state anhedonia recover during detoxification as depression does? Gender differences that have been previously observed for depression in AUD were also explored. METHODS: 81 AUD inpatients were tested at T1 (day 1) and T2 (day 14-18) of withdrawal with the trait Physical Anhedonia Scale, the state anhedonia Snaith-Hamilton Pleasure Scale, the Beck depression inventory and the Spielberger State Anxiety Inventory and compared to 34 control participants, matched for age and gender. RESULTS: AUD patients scored significantly higher than controls on depression, anxiety and state and trait anhedonia when they just entered the detoxification unit. Depression, anxiety and state anhedonia decreased between T1 and T2 in AUD patients. In women, state anhedonia at T1 was predictive of depressive symptoms at T2 over and above anxiety and depression at T1. CONCLUSION: In AUD, state anhedonia recovers during detoxification, concurrently to other affective-related symptoms. However, in women, trait anhedonia predicts the level of depression at the end of detoxification, above and beyond anxiety. This finding stresses the importance of addressing anhedonia in the treatment of AUD and emphasizes the need for targeted interventions within clinical settings in this gender. Clinical consequences are discussed.

The Mobile Analyzer of Radioactive Gases OuTflows (MARGOT): A promising environmental xenon radionuclides detection system.

An ultra-compact and unshielded spectrometer for analysis of atmospheric xenon radionuclides has been developed: the MARGOT system. This system works at ambient temperature and high pressure, and has a 54.3 cm3 inner active volume. Atmospheric xenon radionuclide activities are determined with the electron-photon coincidence technique using both NaI(Tl) detectors and large pixellized Si-PIN detectors. The MARGOT system integrates an enhanced version of the PIPSBox™, Geant4 simulation and first calibration results are discussed.

Introducing the MARGOT prototype: An ultra-compact and mobile gas detection system for nuclear explosion monitoring.

An ultra-compact and unshielded spectrometer for analysis of atmospheric radioxenons has been developed. This system works at ambient temperature and has a 58 cm3 inner active volume. Atmospheric radioxenons activities are determined with electron/photon coincidence technique using both NaI(Tl) detector and large pixellized Si-PIN detector. The performances of the detection system without shielding in terms of Minimal Detectable Activities are below 65 mBq for a 12 h acquisition, for all radioxenons of interest. An enhanced version of the prototype presented here is already under development: the Mobile Analyzer for Radioactive Gases OuTflows (MARGOT) system.

Quantifying in situ phenotypic variability in the hydraulic properties of four tree species across their distribution range in Europe.

Many studies have reported that hydraulic properties vary considerably between tree species, but little is known about their intraspecific variation and, therefore, their capacity to adapt to a warmer and drier climate. Here, we quantify phenotypic divergence and clinal variation for embolism resistance, hydraulic conductivity and branch growth, in four tree species, two angiosperms (Betula pendula, Populus tremula) and two conifers (Picea abies, Pinus sylvestris), across their latitudinal distribution in Europe. Growth and hydraulic efficiency varied widely within species and between populations. The variability of embolism resistance was in general weaker than that of growth and hydraulic efficiency, and very low for all species but Populus tremula. In addition, no and weak support for a safety vs. efficiency trade-off was observed for the angiosperm and conifer species, respectively. The limited variability of embolism resistance observed here for all species except Populus tremula, suggests that forest populations will unlikely be able to adapt hydraulically to drier conditions through the evolution of embolism resistance.

EEG Dynamics and Neural Generators in Implicit Navigational Image Processing in Adults with ADHD.

In contrast to childhood ADHD that is characterized by inattention, impulsivity and hyperactivity, most adults with ADHD predominantly exhibit inattention. We used a new oddball paradigm using implicit navigational images and analyzed EEG dynamics with swLORETA inverse modeling of the evoked potential generators to study cortical processing in adults with ADHD and age-matched controls. In passive observation, we demonstrated that P350 amplitude, alpha-beta oscillation event-related synchronization (ERS) anticipation, and beta event-related desynchronization (ERD) were significantly smaller in ADHD. In the active condition, P100 duration was reduced and N140 amplitude increased for both deviant and frequent conditions in the ADHD. Alpha ERS and delta-theta ERS were reduced in the ADHD in the deviant condition. The left somatosensory area (BA2) and the right parietal lobe (BA31, BA40) contributed more to the P100 generators in the control than in the ADHD group, while the left frontal lobe (BA10) contributed more to the P100 generators in the ADHD. The left inferior parietal lobe (BA40) contributed more to the N140 generators in the control than the ADHD group while the right posterior cingulate (BA30) contributed more to the N140 generators in the ADHD. These findings reinforce the notion that earlier cortical stages of visual processing are compromised in adult ADHD by inducing the emergence of different even-related potential generators and EEG dynamics in ADHD. Considering that classical approaches for ADHD diagnosis are based on qualitative clinical investigation possibly biased by subjectivity, EEG analysis is another objective tool that might contribute to diagnosis, future neurofeedback or brain stimulation therapies.

Low-level laboratory measurement of xenon radionuclides: Electron-photon versus photon measurements.

Radioactive xenon (mainly 131mXe, 133Xe, 133mXe and 135Xe) are tracked as markers of nuclear weapons testing. The CEA has developed the PIPSBox, a measurement cell able to detect electrons emitted by xenon nuclides. Combined with an ultra-low background γ spectrometer, electron detection capacities allow reaching minimum detectable activities (MDA) for a 3-day long measurement of about 0.5mBq for the four xenon radionuclides. Compared to a classical measurement cell, MDAs are improved by a factor of 2-4.

SPALAX NG: A breakthrough in radioxenon field measurement.

Lessons-learned from 10 years of noble gas stations operation and dedicated R&D allowed the design of a New Generation of station. In order to produce 60m3 air equivalent Xenon samples every 8h, it implements: (i) larger sampler unit for Xenon extraction (2 compressors and 8 nitrogen membranes), (ii) new noble gas adsorbent (Ag@ZSM5), (iii) hardened components and (iv) new high resolution coincidence low background spectrometer (HPGe/PIPSBox). Station expected radioxenon sensitivity is lower than 0.3mBq/m3.

Ground surface ultralow background spectrometer: Active shielding improvements and coincidence measurements for the Gamma3 spectrometer.

The ultralow background versatile spectrometer GAMMA3 has been optimized with the following shielding improvements: (i) optimized nitrogen injection flux of 300Lh-1, and (ii) cosmic veto configuration with 9 scintillating plates. These improvements allow a reduction of 39% of the normalized integral background count rate down to 2.7±0.2min-1kgGe-1 (40-2500keV energy range). Minimum Detectable Activities when performing direct γ-ray spectrometry or γ-γ coincidence spectrometry are compared.

Growing teratoma syndrome of the ovary presenting with liver metastasis: report of a case.

Growing teratoma syndrome (GTS) is a rare condition among patients with non-seminomatous germ cell tumors who present with enlarging metastatic masses during appropriate systemic chemotherapy in the context of normalized serum markers. This is an infrequent event in the progression of testicular tumors, and is even less common in the case of ovarian germ cell tumors. The pathogenesis of GTS is not completely understood and diagnosis can only be made with certainty after complete pathologic examination. Although histologically benign, GTS may present an enveloping growth with aggressive local expansion, which can be related to substantial morbidity and mortality. Surgery is the only recommended treatment and early recognition of this syndrome is essential as it offers hope for curative resection and avoids the use of ineffective chemotherapy. The authors present a brief review of the literature, along with the case report of a 37-year-old woman presenting GTS with liver involvement who was successfully treated by debulking surgery followed by major liver resection. This report demonstrates that complete surgical resection results in excellent disease control. More importantly, it highlights that clinicians need to be aware of the possible development of GTS when monitoring their patients with non-seminomatous germ cell tumors. These patients require coordinated care between oncologist, gynecologists, and general surgeons to obtain the best possible outcomes.

Spalax™ new generation: A sensitive and selective noble gas system for nuclear explosion monitoring.

In the context of the verification regime of the Comprehensive nuclear Test ban Treaty (CTBT), CEA is developing a new generation (NG) of SPALAX™ system for atmospheric radioxenon monitoring. These systems are able to extract more than 6cm(3) of pure xenon from air samples each 12h and to measure the four relevant xenon radioactive isotopes using a high resolution detection system operating in electron-photon coincidence mode. This paper presents the performances of the SPALAX™ NG prototype in operation at Bruyères-le-Châtel CEA centre, integrating the most recent CEA developments. It especially focuses on an innovative detection system made up of a gas cell equipped with two face-to-face silicon detectors associated to one or two germanium detectors. Minimum Detectable activity Concentrations (MDCs) of environmental samples were calculated to be approximately 0.1 mBq/m(3) for the isotopes (131m)Xe, (133m)Xe, (133)Xe and 0.4 mBq/m(3) for (135)Xe (single germanium configuration). The detection system might be used to simultaneously measure particulate and noble gas samples from the CTBT International Monitoring System (IMS). That possibility could lead to new capacities for particulate measurements by allowing electron-photon coincidence detection of certain fission products.

An introduction to γ(3) a new versatile ultralow background gamma spectrometer. Background description and analysis.

The γ(3) setup has been designed as a versatile, high sensitivity spectrometry platform. State-of-the art techniques have been implemented to reduce its background to minimum level even though the system is installed at ground level. The shield design and background performance of the setup are presented. The spectrometer is composed of three identical HPGe detectors for high detection efficiency or coincidence measurement and can accommodate several sample geometries. Its shield includes three layers of increasing purity lead, a cosmic veto, an inner borated polyethylene layer, and a radon-free gas injection system. The spectrometer normalized background count rate is 4.4 counts per minutekgGe(-1) (in the 40-2500keV energy range). Its background characteristics, cosmic veto efficiency, and radon-free gas injection performances are discussed.

On the use of (127)Xe standards for the quality control of CTBTO noble gas stations and support laboratories.

(127)Xe has a longer half-life than (131m)Xe, it can be easily purely produced and it is present in the environment at very low level. For these reasons, (127)Xe is supposed to be a convenient quality control radionuclide for remote noble gas stations of the International Monitoring System (IMS) network. As CEA/DAM has recently developed two new photon/electron setups for low-level detection of (131m)Xe, (133m)Xe, (133)Xe and (135)Xe, we took the opportunity to test these setups for the measurement of a (127)Xe standard. The results and a detailed description of these measurements are presented in this paper. They illustrate the complexity of (127)Xe decay, emitting simultaneously several γ, X-rays, conversion electrons and Auger electrons; this results in highly summated coincidence spectra. The measurements performed provide precise electron energy calibration of the setups. The count rate of electrons in coincidence with iodine Kα X-rays was found to be surprisingly low, leading to the study of electron-gated photon spectrum. Finally, a comparison of three photon/electron coincidence spectra obtained with three different setups is given. The use of (127)Xe as a standard for energy calibration of IMS noble gas station is possible, but it appears to be quite complicated for efficiency check of noble gas station equipped with ß/γ detectors.

Long-term performances of the 95ZR/95Nb chronometer for nuclear events dating.

The present work reports on a long-term analysis of the performances of the (95)Zr/(95)Nb chronometer for dating a nuclear event. Taking benefit of a recent Profiency Test Exercise, a sample containing a standardized mixture of fission products has been measured repeatedly with a low background HPGe spectrometer during a period extending up to one year with the aim of assessing the accuracy of the various zero-time determinations. Evaluation of the uncertainties associated to these evaluations was performed using a Monte Carlo approach. Input parameters sensitivity has been investigated, especially the influence of the (95m)Nb decay branch. The (95)Zr/(95)Nb chronometer was found to be accurate for zero-time determination within one day and one week for a decay of 3 months and 10 months respectively. Sub-day uncertainties are achievable for a two months old sample whereas sub-week uncertainties are reached after a decay of six months. Limitations of the technique for dating a real event are investigated.

Improvements of low-level radioxenon detection sensitivity by a state-of-the art coincidence setup.

The ability to quantify isotopic ratios of 135, 133 m, 133 and 131 m radioxenon is essential for the verification of the Comprehensive Nuclear-Test Ban Treaty (CTBT). In order to improve detection limits, CEA has developed a new on-site setup using photon/electron coincidence (Le Petit et al., 2013. J. Radioanal. Nucl. Chem., DOI : 10.1007/s 10697-013-2525-8.). Alternatively, the electron detection cell equipped with large silicon chips (PIPS) can be used with HPGe detector for laboratory analysis purpose. This setup allows the measurement of ß/γ coincidences for the detection of (133)Xe and (135)Xe; and K-shell Conversion Electrons (K-CE)/X-ray coincidences for the detection of (131m)Xe, (133m)Xe and (133)Xe as well. Good energy resolution of 11 keV at 130 keV and low energy threshold of 29 keV for the electron detection were obtained. This provides direct discrimination between K-CE from (133)Xe, (133m)Xe and (131m)Xe. Estimation of Minimum Detectable Activity (MDA) for (131m)Xe is in the order of 1mBq over a 4 day measurement. An analysis of an environmental radioxenon sample using this method is shown.