[Emergency medicine in the German Maritime Search and Rescue Service-Evaluation of medical emergencies in the North Sea and Baltic Sea over 2 years]. / Notfallmedizin in der Deutschen Gesellschaft zur Rettung Schiffbrüchiger ­ Auswertung medizinischer Notfälle auf der Nord- und Ostsee über 2 Jahre.

BACKGROUND: The logistic peculiarities of an emergency maritime location and the frequent additional threat of accidental hypothermia mean that the treatment of medical emergencies at sea are particularly demanding. This article describes the characteristics of emergency medical missions of the German Maritime Search and Rescue Service (DGzRS) as the main provider of non-helicopter-based medical maritime rescue on the seas off the coasts of Germany. MATERIAL AND METHODS: A retrospective analysis of all missions by the DGzRS in 2017 and 2018 was carried out. The data and times of the missions as well as the severity of the diseases of the patients (graduated using the NACA score) were evaluated and exemplarily compared to those of a medical emergency ambulance service from the City of Lübeck. RESULTS: In a total of 182 medical missions 224 patients were treated. The mission units of the DGzRS needed a mean time of 30 ± 21 min up to arrival and 43 ± 30 min for rescue, treatment and transport. In 63 missions the patients were accompanied by an emergency physician, who was brought in from the ground rescue service in 44 missions. Due to the waiting time for boarding of the additional personnel, the departure in 26 missions was delayed by an average of 18 ± 7 min. The average severity of the disease in the maritime rescue was significantly higher than in the emergency medical service of Lübeck but the number of resuscitations and fatalities were comparable. CONCLUSION: Although the severity of medical emergencies on the seas off the coasts of Germany was high, the emergency physicians frequently arrived with a considerable delay. There is an urgent need for an effective support of the DGzRS by medical personnel specifically trained for maritime missions.

Computed Tomography Radiomics to Differentiate Intrahepatic Cholangiocarcinoma and Hepatocellular Carcinoma.

AIMS: Intrahepatic cholangiocarcinoma (iCCA) and hepatocellular carcinoma (HCC) differ in prognosis and treatment. We aimed to non-invasively differentiate iCCA and HCC by means of radiomics extracted from contrast-enhanced standard-of-care computed tomography (CT). MATERIALS AND METHODS: In total, 94 patients (male, n = 68, mean age 63.3 ± 12.4 years) with histologically confirmed iCCA (n = 47) or HCC (n = 47) who underwent contrast-enhanced abdominal CT between August 2014 and November 2021 were retrospectively included. The enhancing tumour border was manually segmented in a clinically feasible way by defining three three-dimensional volumes of interest per tumour. Radiomics features were extracted. Intraclass correlation analysis and Pearson metrics were used to stratify robust and non-redundant features with further feature reduction by LASSO (least absolute shrinkage and selection operator). Independent training and testing datasets were used to build four different machine learning models. Performance metrics and feature importance values were computed to increase the models' interpretability. RESULTS: The patient population was split into 65 patients for training (iCCA, n = 32) and 29 patients for testing (iCCA, n = 15). A final combined feature set of three radiomics features and the clinical features age and sex revealed a top test model performance of receiver operating characteristic (ROC) area under the curve (AUC) = 0.82 (95% confidence interval =0.66-0.98; train ROC AUC = 0.82) using a logistic regression classifier. The model was well calibrated, and the Youden J Index suggested an optimal cut-off of 0.501 to discriminate between iCCA and HCC with a sensitivity of 0.733 and a specificity of 0.857. CONCLUSIONS: Radiomics-based imaging biomarkers can potentially help to non-invasively discriminate between iCCA and HCC.

[First orthodontic consultation: children or teenagers?]. / Quand adresser un enfant chez l'orthodontiste ?

Orthodontic treatments aim at improving the positions of teeth, the form of dental arches and their reports relations. Determining the age to perform these treatments consists in defining the ideal moment to achieve them in the shortest time possible and with the best stability success. To know when to address the child or the teenager to the orthodontist, it is necessary for the pediatrician to observe the patient, his/her positions, orofacial functions (phonation, swallowing, aeration), his/her face and profile, oral cavity, particularly the way his/her teeth articulate in the three spatial directions. This orthodontic check-up allows the detection of abnormalities, for which two kinds of treatments exist. Firstly, early treatments which start in temporary dentition stage, in order to prevent or intercept abnormalities and, secondly, late treatments performed on permanent dentition, when well-developed bony and alveolar growths make it possible to correct these abnormalities.

Occurrence of 2-ethylhexanoic acid in foods packed in glass jars.

After simultaneous distillation-extraction (SDE) of commercial baby foods (n = 20) and fruit juices (n = 15) (among them 15 and eight products labelled 'organic', respectively) from 11 different suppliers, analyses performed by coupled capillary gas chromatography-mass spectrometry (GC-MS) revealed the presence of 2-ethylhexanoic acid (2-EHA), a known teratogenic compound. 2-EHA was found in 80 and 73% of the baby foods and fruit juices, respectively. Amounts ranged from 0.25 to 3.2 mg kg(-1)(average, 0.55 mg kg(-1)) and from 0.01 to 0.59 mg l(-1) (average, 0.18 mg l(-1)) in baby foods and fruit juices, respectively. GC-MS analysis of the SDE extracts obtained from the plastic gaskets inside the metal lids of the samples under study revealed the gaskets to be the origin of 2-EHA. As shown from the non-contaminated samples under study, obviously technology is available to avoid 2-EHA contamination of glass jar-packed food.