Designing a Massive Open Online Course (MOOC) in face-to-face sessions. A blended design to teach practical histology.

Teaching histology, through virtual microscopy in educational strategies, undeniably moved towards the digitization and distancing of teaching. The setting up of the Massive Open Online Course (MOOC) entitled "Introduction to Histology: exploring the tissues of the human body" made it possible to exploit the potential to share digital resources with a wider audience while being integrated into the teaching on-campus students. This article described the pedagogical choices prevailing during the design of the MOOC and its combination with face-to-face sessions to achieve specific learning outcomes. The pedagogical alignment of learning outcomes described according to their cognitive levels, with online and face-to-face learning activities and evaluation methods has been demonstrated. The impact of such a blended design into an academic program has been ascertained using perception and performance data. Student satisfaction and engagement as well as motivational cues were identified. The level of performance was maintained in the educational strategy implemented and made it possible to achieve the objectives expected by the teachers. The benefits of integrating a MOOC with classroom-based teaching were highlighted, as well as barriers that could hinder the successful implementation.

[Exploration of urethral strictures : place of urethrocystography]. / Comment j'explore les sténoses urétrales : intérêt de l'urétrocystographie.

Stricture of the male urethra is a frequent and regularly iatrogenic pathology in industrialized countries. The urologist's surgical arsenal is wide and the choice of an operative technique is made at the end of an assessment where urethrocystography is the main radiological examination. The conditions to achieve the examination, its different stages, the normal aspects and anatomical variants as well as the limitations to its interpretation, should therefore be known by the urologist and the radiologist, in order to assess correctly this pathology.

La sténose de l'urètre masculin est une pathologie fréquente, régulièrement iatrogène dans les pays industrialisés. L'arsenal chirurgical de l'urologue face à celle-ci est large et le choix d'une technique opératoire est posé au terme d'un bilan dont l'urétrocystographie occupe une place centrale. Les conditions de réalisation de l'examen, ses étapes, les aspects normaux et les quelques variantes anatomiques ainsi que ses limites d'interprétation, doivent donc être connus de l'urologue et du radiologue, de manière à ne pas méconnaître ou, au contraire, surestimer une sténose urétrale.

Urological evaluation before kidney transplantation : recommendations for practice / Comment j'expore. Evaluation urologique des candidats à une transplantation rénale : recommandations pour la pratique.

Candidates for a kidney transplantation must undergo a complete evaluation, including a urological evaluation. This urological assessment should first of all exclude any pathology of the urinary tract likely to contraindicate a transplantation or to evolve under immunosuppression. Moreover, this assessment should evaluate the lower urinary tract that is to receive a kidney graft. It is therefore necessary to detect and possibly treat uro-genital cancers, benign uropathies of the native kidneys or abnormalities of the lower urinary tract. The basic evaluation is rather simple and non-invasive and includes a complete history, general and urogenital physical examination, urinalysis, total serum PSA measurement, urinary tract ultrasound, and uroflowmetry. If necessary, other explorations and testings will be carried out, such as CT scan, MRI, retrograde uretero-pyelography, uretero-renoscopy, cystoscopy, urethro-cystography or urodynamic examination. This article reviews the various pathologies involved, and sets out practical recommendations for explorations to be performed.

Les candidats à une transplantation rénale doivent faire l'objet d'une évaluation complète, y compris urologique. Ce bilan urologique permet, tout d'abord, d'exclure toute pathologie de l'arbre urinaire susceptible de contre-indiquer une greffe rénale ou susceptible de s'aggraver sous immunosuppression. Par ailleurs, ce bilan permet d'évaluer l'aptitude du bas appareil urinaire à recevoir un greffon. Il convient donc de dépister et, éventuellement, de traiter les cancers uro-génitaux, les uropathies bénignes des reins natifs ou les anomalies du bas appareil urinaire. L'évaluation de base est simple et non invasive et comprend une anamnèse complète, un examen clinique général et uro-génital, une analyse d'urine, un dosage de PSA sérique total, une échographie des voies urinaires, et une débitmétrie. Elle sera complétée par d'autres explorations si nécessaire, telles que le scanner, l'IRM, l'urétéro-pyélographie rétrograde, l'urétéro-rénoscopie, la cystoscopie, l'urétro-cystographie rétograde et permictionnelle, ou l'examen urodynamique. Cet article revoit les différentes pathologies urologiques concernées, et définit des recommandations pratiques concernant les explorations à envisager.

[ELECTRONIC LOGBOOK: LEARNING TOOL AND TEACHING AID FOR THE EVALUATION OF LEARNING ACTIVITIES]. / LogBook numérique: un carnet de bord réflexif comme outil d'apprentissage en contexte de stage.

A LogBook is a learning tool and teaching aid I where clinical settings lived during training courses are provided. A LogBook is basically a journal which evidences learning and skills. LogBook provides a means for monitoring student learning, both for the student and for the instructor. It provides a feedback loop for the evaluation of learning activities. This LogBook has been developed for the student's training in psychiatry but it may be extended to all medical disciplines. The authors have developed an electronic logbook to support learning and assessment. In the context of Europe, it has become necessary to set up a LogBook of uniform learning outcomes to assist medical students.

[TRAUMATIC RUPTURE OF THE AORTIC ISTHMUS: MODERN PERSPECTIVES]. / Rupture post-traumatique de l'isthme aortique: perspectives modernes de prise en charge.

Traumatic aortic rupture of the thoracic aorta (usually at the isthmus) is frequently associated with concomitant life-threatening injuries. Historically, the conventional care consisted of surgical repair of the lesion performed as soon as possible. However, in spite of constant technical improvements the morbi-mortality remains high because of these associated lesions. In addition, their management can have priority and delay aortic surgery. The endovascular approach has been shown to be a feasible and efficient technique and currently represents a valuable alternative to open surgery for patients with multiple traumas. We report a patient presenting with a traumatic aortic rupture of the aortic isthmus, which was successfully treated by delayed combined endovascular (thoracic aortic stentgrafting) and open approach (hemiaortic arch debranching).

Surgical treatment of cardiovascular complications in patients with Marfan syndrome: a report of two cases and literature review.

Cardiovascular disease is the main cause of morbidity and mortality in patients with Marfan syndrome. The most life threatening complication is aortic root aneurysms leading to aortic dissection or rupture. It can be prevented by regular aortic follow-up and prophylactic aortic surgery. Modern aortic surgery has led to a substantial increase in the life expectancy of these patients. We report two cases of Marfan syndrome with cardiovascular complications. Their management is discussed according to the most recent literature.

Animal board invited review: OneARK: Strengthening the links between animal production science and animal ecology.

Wild and farmed animals are key elements of natural and managed ecosystems that deliver functions such as pollination, pest control and nutrient cycling within the broader roles they play in contributing to biodiversity and to every category of ecosystem services. They are subjected to global changes with a profound impact on the natural range and viability of animal species, the emergence and spatial distribution of pathogens, land use, ecosystem services and farming sustainability. We urgently need to improve our understanding of how animal populations can respond adaptively and therefore sustainably to these new selective pressures. In this context, we explored the common points between animal production science and animal ecology to identify promising avenues of synergy between communities through the transfer of concepts and/or methodologies, focusing on seven concepts that link both disciplines. Animal adaptability, animal diversity (both within and between species), selection, animal management, animal monitoring, agroecology and viability risks were identified as key concepts that should serve the cross-fertilization of both fields to improve ecosystem resilience and farming sustainability. The need for breaking down interdisciplinary barriers is illustrated by two representative examples: i) the circulation and reassortment of pathogens between wild and domestic animals and ii) the role of animals in nutrient cycles, i.e. recycling nitrogen, phosphorus and carbon through, for example, contribution to soil fertility and carbon sequestration. Our synthesis identifies the need for knowledge integration techniques supported by programmes and policy tools that reverse the fragmentation of animal research toward a unification into a single Animal Research Kinship, OneARK, which sets new objectives for future science policy. At the interface of animal ecology and animal production science, our article promotes an effective application of the agroecology concept to animals and the use of functional diversity to increase resilience in both wild and farmed systems. It also promotes the use of novel monitoring technologies to quantify animal welfare and factors affecting fitness. These measures are needed to evaluate viability risk, predict and potentially increase animal adaptability and improve the management of wild and farmed systems, thereby responding to an increasing demand of society for the development of a sustainable management of systems.

[stent thrombosis : A won battle ? (data from the France PCI registry)]. / Thrombose de stent : une bataille gagnée ? (Données du registre France PCI).

GOAL: The aim of the study is to assess the incidence, risk factors and prognosis of definite stent thrombosis (ST) at 1 year in the France PCI multicenter prospective registry. PATIENTS AND METHODS: Only patients who underwent coronary angioplasty with at least one stent implantation between 1st January 2014 and 31 December 2019 were included. The population was separated into 2 groups: the "ST" group with stent thrombosis and the "control" group without stent thrombosis. RESULTS: 35,435 patients were included. 256 patients (0.72%) presented a ST at 1 year. The rate of ST decreased significantly in acute coronary syndrome (1.5% in 2014 vs. 0.73% in 2019; p = 0.05) but not in chronic coronary syndrome (0.46% in 2014 vs 0.40%; p = 0.98). The risk factors are young age (65.8 years vs 68.2; p = 0.002), clinical context (35.27% vs 16.68%; p = 0.0001), diabetes (35.2 % vs 26.4%; p = 0.002), renal failure (11.7% vs 8%; p = 0.009) and history of coronary angioplasty (28.63% vs 21.86%; p = 0.009) and peripheral arterial disease (14.5% vs 10.1%; p = 0.021), LV dysfunction (37% vs 27.5%; p = 0.003), mean length (39.6 mm vs 31, 7mm; p <0.0001) and the mean number of stents per procedure (1.9 vs 1.6; p <0.0001), a TIMI flow ≤1 pre procedure (21.5% vs 12.4%; p <0.0001) and an intrastent restenosis (11% vs 6%; p <0.0001). The 1-year mortality of the ST group was significantly higher than that of the control group (19.14% vs 5.82%; p <0.0001). CONCLUSION: Since 2014, the incidence of ST at 1 year has been decreasing but remains stuck at a floor level of 0.54% in 2019. The battle for ST seems to have been partly won and its risk factors well identified, but its mortality is still high.

Effect of curvature on C-F bonding in fluorinated carbons: from fullerene and derivatives to graphite.

The effect of the curvature of the carbon lattice is discussed taking into account NMR data on various fluorinated carbons including C(60) fullerenes, single, double and multiwall carbon nanotubes. Graphite fluorides and highly fluorinated fullerenes are used as limit model compounds for planar and spherical geometries, respectively. The curvature results in a weakening of the C-F bonding covalence. First of all, various highly fluorinated fullerenes with increasing F/C molar ratio were prepared by treatment with pure gaseous fluorine. A preliminary study using XRD, EPR and IR spectroscopy confirms that the highest fluorination level can be reached either at 133 or at 300 degrees C. In order to extract the correlation between fluorine and carbon atoms and the C-F bond length, specific sequences such as solid echo, two-dimensional (19)F -->(13)C cross polarization wide-line separation and inverse (19)F -->(13)C cross polarization were also used for fluorinated C(60).

[Thoracic drainage technique for emergencies]. / Drainage thoracique en situation précaire.

The purpose of this report is to describe a simple, reproducible technique for pleural drainage. This technique that requires scant resources should be used only in life-threatening situations calling for pleural drainage. It is not intended to replace conventional techniques.

[The anatomical laboratory: a tool for the trial of the new therapeutic procedures]. / Le laboratoire d'anatomie: un banc d'essai des nouvelles technologies.

Since September 2009, the new anatomical department is located on the CHU building. This modern anatomical laboratory is an effective tool to design the new therapeutic procedures and to teach these procedures to practitioners.

Cost minimization analysis to compare activated prothrombin complex concentrate (APCC) and recombinant factor VIIa for haemophilia patients with inhibitors undergoing major orthopaedic surgeries.

Benefits of bypassing agents for maintaining haemostasis in major surgeries have been described in the literature; however, their use has a substantial economic impact. This study assessed the cost of FEIBA, an activated prothrombin complex concentrate and recombinant factor VIIa (rFVIIa) when used in inhibitor patients undergoing major surgeries. After reviewing published literature, a cost minimization model was developed describing dosing regimens recommended and used during major surgeries for FEIBA (pre-operative: 75-100 U kg(-1); postoperative: 75-100 U kg(-1) q 8-12 h days 1-5 and 75-100 U kg(-1) q 12 h days 6-14) and rFVIIa (pre-operative: 90 microg kg(-1); intra-operative: 90 microg kg(-1) q 2 h; postoperative: 90 microg kg(-1) q 2-4 h days 1-5 and 90 microg kg(-1) q 6 h days 6-14). Using a 75 kg patient and US prices, total drug cost was calculated for three scenarios: use of FEIBA or rFVIIa alone and a third case combining rFVIIa pre- and intra-operative and FEIBA throughout a 14-day postoperative period. Dosage amounts of modelled bypassing agents were similar to cases in the literature. Using FEIBA instead of rFVIIa would decrease total drug cost by >50% and save over $400,000 per surgery. Sequential use of both bypassing agents would increase total drug cost by 9% when compared with FEIBA alone, but would remain >40% lower than rFVIIa alone. Univariate sensitivity analyses confirmed robustness of results. As large amounts of bypassing agents are necessary for patients with inhibitors to undergo major surgeries, cost is a major consideration. Use of FEIBA alone or in combination with rFVIIa has emerged as a cost-saving approach.

Photophysical comparative study of amylose and polyvinyle pyrrolidone/single walled carbon nanotubes complex.

Progressive addition of hydroxypropylated amylose (AmH), from 0.05 wt% to 4.5 wt%, to single-walled carbon nanotubes (SWNTs) in aqueous surfactant suspensions quenches the intrinsic near Infra-Red fluorescence of semiconducting SWNTs while dispersions obtained with a same amount of polyvinylpyrrolidone (PVP) remain luminescent. Near Infra-Red emission spectroscopy (fluorescence and Raman scattering) of the samples is used to characterize the supramolecular organization of these polymer/SWNT complexes. The SWNTs are found to be wrapped by the PVP chains and not by the AmH chains which rather form AmH/surfactant/SWNTs complexes. In PVP/SWNTs dispersion, the fluorescence line position and intensity are affected by dielectric screening. In the case of AmH/surfactant/SWNTs complex, dielectric screening plays also a role but quenching occurs above about 3 wt% of AmH. We attribute the quenching to the formation of a "composite like" microstructure by opposition to stabilized dispersion.

Fortuitous discovery of common bile duct stones: results of a conservative strategy.

OBJECTIVE: The incidence of fortuitously discovered stones in the common bile duct is about 5%. The purpose of this study was to determine the rate of spontaneous clearance of asymptomatic stones in the common bile duct discovered fortuitously during cholecystectomy. PATIENTS AND METHODS: Intraoperative cholangiography was performed in all patients undergoing cholecystectomy for symptomatic gallbladder stones. If a filling defect of the common bile duct was discovered, a transcystic drain was inserted. Surgical or endoscopic extraction was not proposed initially. A control cholangiogram was performed on the second postoperative day then during the sixth postoperative week. If a stone persisted at the sixth week, endoscopic extraction was undertaken. RESULTS: Cholecystectomy was performed in 124 patients with symptomatic gallstones and no signs predictive of stones in the common bile duct. A stone was found fortuitously in the common bile duct in 12 patients. The control cholangiogram was normal in two of these patients on day two (16.7%) and in six others (50%) at the six-week control. All 12 patients remained free of symptoms suggesting the presence of a stone in the common duct. Presence of the drain had no impact on quality-of-life. Endoscopic extraction was finally performed for four patients (33.3%) to remove a stone from the common bile duct. CONCLUSION: Early surgical or endoscopic extraction of stones in the common bile duct should not be undertaken systematically in asymptomatic patients. Spontaneous asymptomatic clearance of the common bile duct is observed in about half of patients.

Isolated common femoral artery injury caused by blunt trauma.

The authors report an isolated common femoral artery injury caused by blunt trauma with dissection and secondary ischaemia. A 21-year-old man was admitted to hospital after being stabbed during acute alcoholic intoxication. He presented with a stab wound on the left leg and blunt trauma in the right groin. The surgical exploration of the left-sided wound did not disclose any vascular injury. After a 12-hour period of observation, the patient was discharged. Six hours later, he came back with severe ischaemia on the right leg caused by a femoral artery dissection. The patient underwent surgical revascularization, and fully recovered. Isolated artery blunt trauma is a rare event. In this observation, the absence of early symptoms resulted in delayed diagnosis.

[Recent injuries to the left diaphragm: value of laparoscopy in Africa and Europe]. / Lésions récentes du diaphragme gauche: intérêt de la laparoscopie, en Afrique comme en Europe.

Management of recent diaphragm injury is challenging. The purpose of this report is to describe two patients who presented injuries to the left diaphrgmatic cupola, i.e., rupture due to blunt trauma in Europe and a stab wound in Africa. The value of laparoscopy for diagnosis and treatment are discussed in these contrasting settings.

[About the discovery of a hepatic subcapsular collection as early complication of transperitoneal laparoscopy. Review of the clinical implications based on the hepatic capsular and retroperitoneal anatomy, its subdivisions and communications]. / Collection sous-capsulaire hépatique survenue dans le décours précoce d'une laparoscopie transpéritonéale: revue de l'anatomie du rétropéritoine et de ses implications cliniques.

We report a case of hepatic subcapsular collection as early complication of transperitoneal laparoscopy. The etiology seems to be a detachment of the hepatic capsule induced by laparoscopic gas. We discuss the anatomic data about the liver capsule, renal fascia and retroperitoneal subdivisions supporting such a mechanism.

[TVT-O, a novel minimally invasive technique for the treatment of female stress urinary incontinence from development to clinical experience]. / Actualités thérapeutiques en urologie. Le TVT-O, nouvelle technique mini-invasive pour le traitement de l'incontinence urinaire d'effort féminine, développements et expérience clinique.

Tension-free sub-urethral tapes have revolutionized the surgical treatment of female stress urinary incontinence for the past decade. The inside-out transobturator approach, developed in our Institution 5 years ago, is currently being utilized worldwide. The technique is simple and reproducible and the incidence of complications is minimized. Stress urinary incontinence cure rates of almost 90% are achieved after a 3-year minimum follow up. These good results have been confirmed in the international literature.