Dynamical footprints of hurricanes in the tropical dynamics.

Hurricanes-and more broadly tropical cyclones-are high-impact weather phenomena whose adverse socio-economic and ecosystem impacts affect a considerable part of the global population. Despite our reasonably robust meteorological understanding of tropical cyclones, we still face outstanding challenges for their numerical simulations. Consequently, future changes in the frequency of occurrence and intensity of tropical cyclones are still debated. Here, we diagnose possible reasons for the poor representation of tropical cyclones in numerical models, by considering the cyclones as chaotic dynamical systems. We follow 197 tropical cyclones which occurred between 2010 and 2020 in the North Atlantic using the HURDAT2 and ERA5 data sets. We measure the cyclones instantaneous number of active degrees of freedom (local dimension) and the persistence of their sea-level pressure and potential vorticity fields. During the most intense phases of the cyclones, and specifically when cyclones reach hurricane strength, there is a collapse of degrees of freedom and an increase in persistence. The large dependence of hurricanes dynamical characteristics on intensity suggests the need for adaptive parametrization schemes which take into account the dependence of the cyclone's phase, in analogy with high-dissipation intermittent events in turbulent flows.

Experiments and numerical simulations on hovering three-dimensional flexible flapping wings.

In this paper, the applicability and accuracy of high-fidelity experimental and numerical approaches in the analysis of three-dimensional flapping (revolving and pitching) wings operating under hovering flight conditions, i.e. where unsteady and three-dimensional rotational effects are strong, are assessed. Numerical simulations are then used to explore the role of mass and frequency ratios on aerodynamic performance, wing dynamics and flow physics. It is shown that time-averaged lift increases with frequency ratio, up to a certain limit that depends on mass ratio and beyond which upward wing bending and flexibility induced phase lag between revolving an pitching motions at stroke reversal become strong and contribute to phases of negative lift that counterbalances the initial lift increase. This wing dynamics, which is dominated by spanwise bending, also affects wing-wake interactions and, in turn, leading edge vortex formation.

Impact of mothers' IPV-PTSD on their capacity to predict their child's emotional comprehension and its relationship to their child's psychopathology.

Background: Previous studies demonstrated that when the violence-exposed child becomes a mother and interacts with her own child during early sensitive periods for social-emotional development, she may have difficulties providing sensitive responsiveness to the child's emotional communication. Such difficulties place the child's development of emotional comprehension (EC) and related self-regulation at risk. The aim of this study was to examine how mothers' interpersonal violence-related posttraumatic disorder (IPV-PTSD) would affect their children's EC and their own ability to predict their children's EC. We also investigated how mothers' predictive ability would correlate with child psychopathology. Methods: Sixty-one mother-child dyads (36 with IPV-PTSD) participated in this study. Children's (mean age = 7.0 years, SD = 1.1) EC was assessed with the Test of Emotion Comprehension (child TEC) and their psychopathology as reported by the mother was assessed with the Child Behaviour Checklist (CBCL) and as evaluated by a clinician using selected modules of the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS). Mothers were measured for IPV-PTSD with the Clinician Administered PTSD Scale (CAPS) and for their capacity to predict their child's emotional comprehension (mother-responding-as-child TEC; mTEC). Results: We found no significant between-group differences in children's level of EC. Maternal PTSD was associated with lower scores on the mTEC, however. Reduced maternal scores on the mTEC were significantly associated with maternal report of increased aggressive child behaviour and with depression symptoms on the K-SADS. Further, scores on the mTEC interacted with maternal report of child aggression on child oppositional defiant disorder (ODD) symptoms on the K-SADS. Conclusion: These findings support that improving maternal emotional comprehension may help reduce child risk for psychiatric morbidity in this population.

Antecedentes: Los estudios previos demostraron que cuando la niña expuesta a violencia llega a ser madre e interactúa con su propio hijo durante periodos críticos tempranos para el desarrollo socioemocional, ella podría tener dificultades para brindar una respuesta sensible a la comunicación emocional del niño. Tales dificultades podrían poner en riesgo el desarrollo de la comprensión emocional del niño (CE) y la autorregulación asociada a ella. El objetivo de este estudio fue evaluar cómo el trastorno de estrés postraumático por violencia interpersonal de las madres (TEPT-VIF) podría afectar tanto la CE de sus hijos como su propia capacidad de predecir la CE en sus hijos. También investigamos cómo la capacidad predictiva de las madres podría correlacionarse con psicopatología infantil.Métodos: En este estudio participaron sesenta y una diadas madre-hijo (36 con TEPT-VIF). La CE de los niños (edad media = 7.0 años, DE = 1.1) fue evaluada mediante la prueba de Comprensión Emocional (TEC en sus siglas en inglés) del niño. Asimismo, la psicopatología del niño, según lo reportado por la madre, fue evaluada con la Lista de Chequeo Conductual del Niño (CBCL en sus siglas en inglés) y según la evaluación de un médico utilizando módulos seleccionados de la Escala Infantil para Trastornos Afectivos y Esquizofrenia (K-SADS por sus siglas en inglés). En las madres, se midió tanto el TEPT-VIF mediante la Escala para el Trastorno de Estrés Postraumático Administrada por el Clínico (CAPS en sus siglas en ingles) como su capacidad de predecir la comprensión emocional del niño mediante la prueba de Comprensión Emocional en la que la madre responde como el niño (mTEC en sus siglas en inglés).Resultados: No encontramos diferencias significativas entre los grupos en los niveles de CE de los niños. Sin embargo, el trastorno de estrés postraumático materno estuvo asociado a puntajes más bajos en el mTEC. Los puntajes maternos bajos en el mTEC estuvieron significativamente asociados en la K-SADS a un reporte materno de un aumento de la conducta agresiva del niño y a síntomas depresivos. Adicionalmente, los puntajes en el mTEC estuvieron relacionados en la K-SADS con un reporte materno de agresión del niño dentro de los síntomas del trastorno oposicionista desafiante (TOD).Conclusión: Estos hallazgos respaldan que el mejorar la comprensión emocional materna podría ayudar a disminuir el riesgo infantil de morbilidad psiquiátrica en esta población.

Acute Myocarditis after COVID-19 vaccination: A case report.

INTRODUCTION: The etiology of myocarditis often remains undetermined. A large variety of infectious agents, systemic diseases, drugs, and toxins can cause the disease. We report the case of a 19-year-old man who developed myocarditis three days after Pfizer-BioNTech COVID-19 booster vaccination. CASE REPORT: A 19-year-old man, presenting with troponin-positive acute chest pain, was referred to our department. He had received the Pfizer-BioNTech COVID-19 vaccine three days prior to his admission. The diagnosis of acute myocarditis was confirmed by cardiovascular magnetic resonance imaging. Patient hemodynamic status remained stable during hospitalization. The left ventricular ejection fraction was preserved during hospital stay and at one-month follow-up. We found no evidence for another infectious or autoimmune etiology. CONCLUSION: Although imputability of the vaccine cannot be formally established on the basis of this case report, the findings raise the possibility of an association between mRNA COVID-19 vaccination and acute myocarditis.

Radiodiagnóstico y Medicina Nuclear: caminos encontrados / Radiology's and nuclear medicine's paths converge

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[Particularities of African descent patient's electrocardiogram]. / Particularités de l'électrocardiogramme du patient d'origine Africaine.

Particularities of African descent patient's electrocardiogram have been described for many years. Variations such as higher QRS voltage, early repolarization pattern, precordial T-wave inversion and anterior ST segment elevation associated with T-wave inversion are more frequently observed. Ignorance of these variations can lead to misdiagnosis or therapeutic negligence. We present the electrocardiographic particularities attributed to the patient of African origin.

[Acute autoimmune myocarditis secondary to Graves' disease: a case report]. / Myocardite aiguë auto-immune secondaire à une maladie de Basedow : à propos d'un cas.

INTRODUCTION: Interactions between heart and thyroid are strong. Main cardiac complications of Graves' disease are supra-ventricular tachycardia or high output cardiac failure, without real myocardial involvement. OBSERVATION: A 40-year-old man with history of refractory Graves' disease was hospitalized for an acute chest pain with elevated cardiac biomarkers and normal coronarography. Acute myocarditis was confirmed by cardiac MRI. We found no evidence for an infectious etiology. We retained the hypothesis of acute autoimmune myocarditis in the context of active Graves' disease. CONCLUSION: Acute myocarditis is an exceptional complication of Graves' disease, with most likely an autoimmune mechanism. Possible occurrence of fulminant rhythmic or hemodynamic complications justify minimal cardiological check-up before introducing beta blockers.

[Cardiovascular complications of doping products]. / Complications cardiovasculaires des produits dopants.

Doping is the use of a substance that artificially increases an individual's physical ability for competition purpose. Products and methods used in doping are not without risk, especially at cardiovascular level. Here we review the most common doping substances in sport and their cardiovascular consequences.

[Inferior myocardial infarction complicated by complete heart block and cardiac arrest following a gadolinium injection: A case of Kounis syndrome]. / Infarctus du myocarde inférieur compliqué de bloc auriculo-ventriculaire complet et d'arrêt cardiocirculatoire dans les suites d'une injection de gadolinium : à propos d'une observation de syndrome de Kounis.

Kounis syndrome is an allergic acute coronary syndrome. It occurs on healthy or pathological arteries. Its complications, although often benign, can lead to cardiac arrest and death. Its triggering factors are multiple and include contrast products used in diagnostic imaging. We report the case of an 81 years old patient affected by hepatocellular carcinoma, who presented a type 2 Kounis syndrome with inferior myocardial infarction, complicated by cardiac arrest related to complete heart block following a gadoteric acid injection.

[Initial management of ST-elevation myocardial infarction in 2014: From guidelines to practices, survey of 176 French interventional cardiologists]. / Prise en charge initiale du syndrome coronaire aigu avec sus-décalage du segment ST en 2014 : des recommandations à la pratique, enquête auprès de 176 cardiologues interventionnels français.

BACKGROUND: Real life management of myocardial infarction has not recently been evaluated in France. AIMS: To describe ST-elevation myocardial infarction management in France in 2014 and to compare it with current guidelines. METHODS: A multicentre study was performed. An e-mail questionnaire was sent to French interventional cardiologists. Demographic data of interventional cardiologists, procedural aspects of percutaneous coronary intervention, antithrombotic treatments and patient rehabilitation have been investigated. RESULTS: One hundred and seventy-six answers were analysed. Most of centres realized more than 600 annual angioplasties. An average of 209 myocardial infarctions were managed per centre in 2014, more often in academic than in general or private centres (respectively 51, 32 and 17% of infarctions). Anti-GPIIbIIIa (34% of the cases) and thromboaspiration were not systematic but depend on patient's characteristics, according to guidelines. Radial access was favoured in 85% of the cases and increased for the last decade. Drug eluting stents were used in 62% of cases. Unfractionated heparin and enoxaparine accounted for more than 80% of anticoagulants treatments. Overall, use of clopidogrel was as high as that of prasugrel or ticagrelor although clopidogrel is recommended in second-line. Cardiovascular rehabilitation was proposed to more than 50% of patients. CONCLUSION: In spite of heterogeneity of ST-elevation myocardial infarction management in 2014, real-life practices generally comply with current guidelines.

18F-FDG PET/CT and sentinel lymph node biopsy in the staging of patients with cervical and endometrial cancer. Role of dual-time-point imaging / PET/TC con 18F-FDG y biopsia del ganglio centinela en la estadificación de pacientes con cáncer de cérvix y endometrio. Utilidad de la imagen dual-time-point

Objective. Definitive staging for cervical (CC) and endometrial cancer (EC) takes place once surgery is performed. The aim of this study was to evaluate the role of PET/CT in detecting lymphatic metastasis in patients with CC and EC using dual-time-point imaging (DPI), taking the histopathological results of sentinel lymph node (SLN) and lymphadenectomy as the reference. Material and methods. A prospective study was conducted on 17 patients with early CC, and 13 patients with high-risk EC. The patients had a pre-operative PET/CT, MRI, SLN detection, and lymphadenectomy, when indicated. PET/CT findings were compared with histopathological results. Results. In the pathology study, 4 patients with CC and 4 patients with EC had lymphatic metastasis. PET/CT showed hypermetabolic nodes in 1 patient with CC, and 5 with EC. Four of these had metastasis, one detected in the SLN biopsy. Four patients who had negative PET/CT had micrometastasis in the SLN biopsy, 1 patient with additional lymph nodes involvement. The overall patient-based sensitivity, specificity, positive and negative predictive values, and accuracy of PET/CT to detect lymphatic metastasis was 20.0%, 100.0%, 100.0%, 87.9%, and 88.2%, respectively, in CC, and 57.1%, 88.9%, 66.7%, 84.2% and 80.0%, respectively, in EC. DPI showed higher retention index in malignant than in inflammatory nodes, although no statistically significant differences were found. Conclusions. PET/CT has low sensitivity in lymph node staging of CC and EC, owing to the lack of detection of micrometastasis. Thus, PET/CT cannot replace SLN biopsy. Although no statistically significant differences were found, DPI may help to differentiate between inflammatory and malignant nodes (AU)

Objetivo. La estadificación definitiva del cáncer de cérvix (CC) y de endometrio (CE) tiene lugar tras la cirugía. Nuestro objetivo fue evaluar la utilidad de la PET/TC para la detección de metástasis ganglionares en el CC y en el CE con imagen dual-time-point (DPI), considerando como gold standard la histopatología del ganglio centinela (GC) y la linfadenectomía. Material y métodos. Diecisiete pacientes con CC inicial y 13 con CE de alto riesgo fueron incluidas prospectivamente. Preoperatoriamente se realizó una PET/TC, RM, detección del GC y linfadenectomía en los casos indicados. Se comparó la PET/TC con la histopatología. Resultados. En el estudio anatomopatológico, 4 pacientes con CC y 4 con CE tuvieron metástasis ganglionares. La PET/TC mostró ganglios hipermetabólicos en una paciente con CC y en 5 con CE. Cuatro de ellas tenían metástasis, una detectada en el GC. Cuatro pacientes con PET/TC negativa presentaron micrometástasis en el GC, una paciente con ganglios adicionales infiltrados. La sensibilidad, especificidad, valor predictivo positivo y negativo y la exactitud diagnóstica de la PET/TC para detectar metástasis ganglionares fueron 20,0; 100,0; 100,0; 87,9 y 88,2% para el CC, y 57,1; 88,9; 66,7; 84,2 y 80,0% para el CE. La DPI mostró un índice de retención superior en ganglios infiltrados respecto a los inflamatorios, sin hallar diferencias estadísticamente significativas. Conclusiones. La PET/TC tiene baja sensibilidad para estadificar el CC y CE por la incapacidad de detectar micrometástasis y, por tanto, no sustituye la detección del GC. Aunque no hubo diferencias estadísticamente significativas, la DPI podría ayudar a diferenciar ganglios inflamatorios de tumorales (AU)

[Infective endocarditis: Clinical features and prognosis between 2004 and 2014 in a non-teaching hospital]. / Endocardite infectieuse : caractéristiques cliniques et pronostic entre 2004 et 2014 dans un hôpital non universitaire.

AIMS: Despite diagnostic and therapeutic advances, infective endocarditis (IE) remains a severe disease. The aim of the study was to describe clinical features and prognosis of patients with IE in a non-teaching hospital and compare them with current data and a similar study conducted 10 years earlier in the same center. METHODS: We performed a single institution retrospective study including all patients with Duke-Li definite IE between 2004 and 2014. RESULTS: Ninety-four patients were included. Results are consistent with current French and international data, including in-hospital death rate of 16%. In accordance with literature, we report on an increase in Staphylococcus and health care-associated IE and endocarditis on pacemaker leads, but without significant difference compared to our previous study. In univariate analyses, renal failure, age over 77 years and Staphylococcus aureus IE were associated with in-hospital mortality. In multivariate analyses, predictors of in-hospital death were renal failure and lack of surgery. There was a non-significant trend of excess mortality in Staphylococcus endocarditis and in patients with heart failure. CONCLUSION: IE remains a severe disease and S. aureus is more often involved. IE seems to be safely managed in a peripheral hospital provided that there is a partnership with a reference hospital.

18F-FDG PET/CT and sentinel lymph node biopsy in the staging of patients with cervical and endometrial cancer. Role of dual-time-point imaging.

OBJECTIVE: Definitive staging for cervical (CC) and endometrial cancer (EC) takes place once surgery is performed. The aim of this study was to evaluate the role of PET/CT in detecting lymphatic metastasis in patients with CC and EC using dual-time-point imaging (DPI), taking the histopathological results of sentinel lymph node (SLN) and lymphadenectomy as the reference. MATERIAL AND METHODS: A prospective study was conducted on 17 patients with early CC, and 13 patients with high-risk EC. The patients had a pre-operative PET/CT, MRI, SLN detection, and lymphadenectomy, when indicated. PET/CT findings were compared with histopathological results. RESULTS: In the pathology study, 4 patients with CC and 4 patients with EC had lymphatic metastasis. PET/CT showed hypermetabolic nodes in 1 patient with CC, and 5 with EC. Four of these had metastasis, one detected in the SLN biopsy. Four patients who had negative PET/CT had micrometastasis in the SLN biopsy, 1 patient with additional lymph nodes involvement. The overall patient-based sensitivity, specificity, positive and negative predictive values, and accuracy of PET/CT to detect lymphatic metastasis was 20.0%, 100.0%, 100.0%, 87.9%, and 88.2%, respectively, in CC, and 57.1%, 88.9%, 66.7%, 84.2% and 80.0%, respectively, in EC. DPI showed higher retention index in malignant than in inflammatory nodes, although no statistically significant differences were found. CONCLUSIONS: PET/CT has low sensitivity in lymph node staging of CC and EC, owing to the lack of detection of micrometastasis. Thus, PET/CT cannot replace SLN biopsy. Although no statistically significant differences were found, DPI may help to differentiate between inflammatory and malignant nodes.

Pitch perception deficits in nonverbal learning disability.

The nonverbal learning disability (NLD) is a neurological dysfunction that affects cognitive functions predominantly related to the right hemisphere such as spatial and abstract reasoning. Previous evidence in healthy adults suggests that acoustic pitch (i.e., the relative difference in frequency between sounds) is, under certain conditions, encoded in specific areas of the right hemisphere that also encode the spatial elevation of external objects (e.g., high vs. low position). Taking this evidence into account, we explored the perception of pitch in preadolescents and adolescents with NLD and in a group of healthy participants matched by age, gender, musical knowledge and handedness. Participants performed four speeded tests: a stimulus detection test and three perceptual categorization tests based on colour, spatial position and pitch. Results revealed that both groups were equally fast at detecting visual targets and categorizing visual stimuli according to their colour. In contrast, the NLD group showed slower responses than the control group when categorizing space (direction of a visual object) and pitch (direction of a change in sound frequency). This pattern of results suggests the presence of a subtle deficit at judging pitch in NLD along with the traditionally-described difficulties in spatial processing.

Prognostic value of 18F-FDG PET/CT volumetric parameters in recurrent epithelial ovarian cancer / Valor pronóstico de los parámetros volumétricos de la 18F-FDG PET/TC en el cáncer epitelial de ovario recurrente

Objective. Metabolic tumour volume (MTV) and total lesion glycolysis (TLG) from 18F-FDG PET/CT are emerging prognostic biomarkers in various solid neoplasms. These volumetric parameters and the SUVmax have shown to be useful criteria for disease prognostication in preoperative and post-treatment epithelial ovarian cancer (EOC) patients. The purpose of this study was to evaluate the utility of 18F-FDG PET/CT measurements to predict survival in patients with recurrent EOC. Material and methods. Twenty-six patients with EOC who underwent a total of 31 18F-FDG PET/CT studies for suspected recurrence were retrospectively included. SUVmax and volumetric parameters whole-body MTV (wbMTV) and whole-body TLG (wbTLG) with a threshold of 40% and 50% of the SUVmax were obtained. Correlation between PET parameters and progression-free survival (PFS) and the survival analysis of prognostic factors were calculated. Results. Serous cancer was the most common histological subtype (76.9%). The median PFS was 12.5 months (range 10.7-20.6 months). Volumetric parameters showed moderate inverse correlation with PFS but there was no significant correlation in the case of SUVmax. The correlation was stronger for first recurrences. By Kaplan-Meier analysis and log-rank test, wbMTV 40%, wbMTV 50% and wbTLG 50% correlated with PFS. However, SUVmax and wbTLG 40% were not statistically significant predictors for PFS. Conclusion. Volumetric parameters wbMTV and wbTLG 50% measured by 18F-FDG PET/CT appear to be useful prognostic predictors of outcome and may provide valuable information to individualize treatment strategies in patients with recurrent EOC (AU)

Objetivo. El metabolic tumour volume (MTV) y la total lesion glycolysis (TLG) obtenidos de la 18F-FDG PET/TC son biomarcadores pronósticos emergentes en varias neoplasias. Estos parámetros volumétricos junto con el SUVmax son útiles para determinar el pronóstico preoperatorio y post-tratamiento de las pacientes con cáncer epitelial de ovario (CEO). El objetivo fue determinar la utilidad de los parámetros de la 18F-FDG PET/TC para predecir la supervivenvia de las pacientes con CEO recurrente. Material y métodos. Se incluyeron retrospectivamente 26 pacientes con CEO a las que se les realizó 31 estudios 18F-FDG PET/TC por sospecha de recidiva. Se obtuvo el valor del SUVmax, whole-body MTV (wbMTV) y whole-body TLG (wbTLG) con un umbral del 40% y 50% del SUVmax. Se estimó la correlación entre los parámetros PET y el intervalo libre de progresión (ILP) y se realizó análisis de supervivencia segun factores pronósticos. Resultados. El subtipo histológico más frecuente fue cáncer seroso (76,9%). La mediana del ILP fue 12,5 meses (rango 10,7-20,6 meses). Se observó correlación inversa moderada entre los parámetros volumétricos e ILP, sin evidenciar correlación significativa con SUVmax. La correlación fue más fuerte para primeras recidivas. Las curvas de supervivencia mostraron correlación entre wbMTV 40%, wbMTV 50% y wbTLG 50% con ILP. SUVmax y wbTLG 40% no fueron predictores de ILP de forma estadísticamente significativa. Conclusión. Los parámetros wbMTV y wbTLG 50% de la 18F-FDG PET/TC podrían utilizarse como factores pronósticos ofreciendo una valiosa información para individualizar el tratamiento de las pacientes con CEO recurrente (AU)

Prognostic value of (18)F-FDG PET/CT volumetric parameters in recurrent epithelial ovarian cancer.

OBJECTIVE: Metabolic tumour volume (MTV) and total lesion glycolysis (TLG) from (18)F-FDG PET/CT are emerging prognostic biomarkers in various solid neoplasms. These volumetric parameters and the SUVmax have shown to be useful criteria for disease prognostication in preoperative and post-treatment epithelial ovarian cancer (EOC) patients. The purpose of this study was to evaluate the utility of (18)F-FDG PET/CT measurements to predict survival in patients with recurrent EOC. MATERIAL AND METHODS: Twenty-six patients with EOC who underwent a total of 31 (18)F-FDG PET/CT studies for suspected recurrence were retrospectively included. SUVmax and volumetric parameters whole-body MTV (wbMTV) and whole-body TLG (wbTLG) with a threshold of 40% and 50% of the SUVmax were obtained. Correlation between PET parameters and progression-free survival (PFS) and the survival analysis of prognostic factors were calculated. RESULTS: Serous cancer was the most common histological subtype (76.9%). The median PFS was 12.5 months (range 10.7-20.6 months). Volumetric parameters showed moderate inverse correlation with PFS but there was no significant correlation in the case of SUVmax. The correlation was stronger for first recurrences. By Kaplan-Meier analysis and log-rank test, wbMTV 40%, wbMTV 50% and wbTLG 50% correlated with PFS. However, SUVmax and wbTLG 40% were not statistically significant predictors for PFS. CONCLUSION: Volumetric parameters wbMTV and wbTLG 50% measured by (18)F-FDG PET/CT appear to be useful prognostic predictors of outcome and may provide valuable information to individualize treatment strategies in patients with recurrent EOC.

[Acute anterior myocardial infarction as presenting feature of antiphospholipid syndrome related lupus arthritis]. / Infarctus du myocarde antérieur inaugural révélateur d'un syndrome des antiphospholipides dans le cadre d'une polyarthrite lupique.

INTRODUCTION: Antiphospholipid syndrome is an autoimmune disorder causing venous and arterial thrombosis. Acute coronary complications are rare but potentially dramatic. CASE REPORT: We report a 39-year-old woman who presented with an acute anterior myocardial infarction after intravenous corticosteroids as part of the treatment of lupus arthritis and revealing antiphospholipid syndrome. Emergency coronary angiography was performed with drug-eluting stent angioplasty despite the need for anticoagulation and dual antiplatelet therapy. CONCLUSION: Antiplatelet and anticoagulant therapy management is pivotal in patients with antiphospholipid syndrome and acute coronary syndrome to prevent thrombosis recurrence.

The French Advanced Course for Deployment Surgery (ACDS) called Cours Avancé de Chirurgie en Mission Extérieure (CACHIRMEX): history of its development and future prospects.

INTRODUCTION: The composition of a French Forward Surgical Team (FST) has remained constant since its creation in the early 1950s: 12 personnel, including a general and an orthopaedic surgeon. The training of military surgeons, however, has had to evolve to adapt to the growing complexities of modern warfare injuries in the context of increasing subspecialisation within surgery. The Advanced Course for Deployment Surgery (ACDS)-called Cours Avancé de Chirurgie en Mission Extérieure (CACHIRMEX)-has been designed to extend, reinforce and adapt the surgical skill set of the FST that will be deployed. METHODS: Created in 2007 by the French Military Health Service Academy (Ecole du Val-de-Grâce), this annual course is composed of five modules. The surgical knowledge and skills necessary to manage complex military trauma and give medical support to populations during deployment are provided through a combination of didactic lectures, deployment experience reports and hands-on workshops. RESULTS: The course is now a compulsory component of initial surgical training for junior military surgeons and part of the Continuous Medical Education programme for senior military surgeons. From 2012, the standardised content of the ACDS paved the way for the development of two more team-training courses: the FST and the Special Operation Surgical Team training. The content of this French military original war surgery course is described, emphasising its practical implications and future prospects. CONCLUSION: The military surgical training needs to be regularly assessed to deliver the best quality of care in an context of evolving modern warfare casualties.