Riverine litter in a small urban river in Marseille, France: Plastic load and management challenges.

Small urban rivers are thought to be major sources of riverine litter, especially macroplastics, into the ocean. In well-developed countries, waste management infrastructures and recovery systems are sometimes implemented to prevent their emission into the sea meeting environmental and economic goals. The Huveaune River in Marseille, South of France, is a typical case study showing a non-negligible and uncontrolled leakage of riverine litter remains, despite all recovery systems implemented. Giant bar screens are settled over the river to collect riverine litter from the whole water column before water is released into the Sea. In this paper, screened material was characterized during a dry, wet and heavy rainfall period and annual macroplastic mass flows were estimated. The plastic fraction represented 83% by count of the 3147 items sorted and counted. Mass flow of plastic debris ranged between 1.1 and 5.8 mt/yr (equivalent to 2.1-11.4 g/cap/yr), in which 0.4-2.1 mt/yr (equivalent to 0.8-4.1 g/cap/yr) are bypassed to the sea during heavy rainfall periods. Giant bar screens across the Huveaune River prevent 65% of the mass flow to reach the sea annually, but 35% remain uncontrolled. When compared to the Seine River and other European Rivers, macroplastic leakage into the ocean per capita may range between 1 and 10 g/cap/yr. This suggests that end-of-pipe solutions are not enough and further supports urgent regulations of the plastic production on local to global scales to tackle the plastic pollution at its source.

Daily multidisciplinary COVID-19 meeting: Experiences from a French university hospital.

OBJECTIVES: In March 2020, the World Health Organization declared the coronavirus disease 2019 (COVID-19) a pandemic. In absence of official recommendations, implementing daily multidisciplinary team (MDT) COVID-19 meetings was urgently needed. Our aim was to describe our initial institutional standard operating procedures for implementing these meetings, and their impact on daily practice. METHODS: All consecutive patients who were hospitalized in our institution due to COVID 19, from March 31 to April 15, 2020, were included. Criteria to be presented at MDT meetings were defined as a proven COVID-19 by PCR or strongly suspected on CT scan, requiring hospitalization and treatment not included in the standard of care. Three investigators identified the patients who met the predefined criteria and compared the treatment and outcomes of patients with predefined criteria that were presented during MDT meeting with those not presented during MDT meeting. COVID-19 MDT meeting implementation and adhesion were also assessed by a hospital medical staff survey. RESULTS: In all, 318 patients with confirmed or suspected COVID-19 were examined in our hospital. Of these, 230 (87%) were hospitalized in a COVID-19 unit, 91 (40%) of whom met predefined MDT meeting criteria. Fifty (55%) patients were presented at a MDT meeting versus 41 (45%) were not. Complementary exploration and inclusion in the CorImmuno cohort were higher in MDT meeting group (respectively 35 vs. 15%, P=0.03 and 80 versus 49%, P=0.0007). Prescription of hydrocortisone hemisuccinate was higher in group of patients not presented during MDT meeting (24 vs. 51%, P=0.007). Almost half of the patients fulfilling the inclusion criteria were not presented at MDT meeting, which can be partly explained by technical software issues. CONCLUSIONS: Multidisciplinary COVID-19 meetings helped implementing a single standard of care, avoided using treatments that were untested or currently being tested, and facilitated the inclusion of patients in prospective cohorts and therapeutic trials.

Compression bandages: influence of techniques of use on their clinical efficiency and tolerance.

AIM: A bandage is characterized by its components and by its properties evaluated in vitro: stretch theoretical pressures calculated with a dynamometer. A bandage is also characterized by properties evaluated in vivo: interface pressures at rest and during contraction. The aims of this study were to evaluate interface pressures and stiffness of medium stretch bandages and to vary the techniques of bandage in order to obtain a bandage with the lowest possible resting pressure and the highest possible working pressure. METHODS: The interface pressures of Biflex 16 bandages of 7 mx8 cm and of Biflex 17 of 5 mx8 cm were measured with the Kikuhime device. Five techniques to make a bandage were used: two with an overlap of 50% and 75% respectively and a stretch of 30%, two with a superimposition of 2 bandages used in the same conditions as above, and one in spica (in turns of 8-technique). RESULTS: The achieved pressures are related to the technique of making a bandage and the number of layers at the measurement points. The best result is obtained with the Biflex 16 with an use in spica without stretch: the resting pressure is low and the working pressure is high. The stiffness index and the low resting pressure are sufficient to give a good clinical efficacy. CONCLUSION: This technique of use should be appropriate for the treatment of trophic disorders with a satisfactory effect of auto-massage and a maximum of safety even in a patient confined to bed or with a decreased ankle-brachial index (between 0.6 and 0.9).

Water reuse for urban landscape irrigation: aspersion and health related regulations.

The Mediterranean seaside resort of Le Grau du Roi includes 40 hectares of landscaped areas spray irrigated with river water supplied through a separate network. Wastewater collected from several municipalities is treated in an activated sludge wastewater treatment plant (WWTP) and polished in waste stabilization ponds (WSPs). Planned substitution of treated wastewater for river water is hindered by spray irrigation prohibition within a 100 m distance from houses and recreational areas. WWTP and WSP effluents were monitored for pathogens with a particular attention to Legionella in Spring and Summer 2006. Helminth eggs, salmonellae and enteroviruses were never detected neither in WWTP effluent nor in the ponds. Legionella spp content was slightly higher or of the order of magnitude of river water contents. Regarding Legionella pneumophila contents, WSP effluent did not significantly differ from the river water. E.coli and enterococci contents in WSP effluents complied with the "excellent quality" criteria of the European Directive for coastal bathing waters. Therefore, substituting WSP effluents to river water is unlikely to alter health risks related to spray irrigation and, in this case, the buffer zone required by the French water reuse guidelines appears being short of support.

Relationship between medical compression and intramuscular pressure as an explanation of a compression paradox.

BACKGROUND: Using standing magnetic resonance imaging (MRI), we recently showed that medical compression, providing an interface pressure (IP) of 22 mmHg, significantly compressed the deep veins of the leg but not, paradoxically, superficial varicose veins. OBJECTIVE: To provide an explanation for this compression paradox by studying the correlation between the IP exerted by medical compression and intramuscular pressure (IMP). MATERIAL AND METHODS: In 10 legs of five healthy subjects, we studied the effects of different IPs on the IMP of the medial gastrocnemius muscle. The IP produced by a cuff manometer was verified by a Picopress® device. The IMP was measured with a 21G needle connected to a manometer. Pressure data were recorded in the prone and standing positions with cuff manometer pressures from 0 to 50 mmHg. RESULTS: In the prone position, an IP of less than 20 did not significantly change the IMP. On the contrary, a perfect linear correlation with the IMP (r = 0.99) was observed with an IP from 20 to 50 mmHg. We found the same correlation in the standing position. CONCLUSION: We found that an IP of 22 mmHg produced a significant IMP increase from 32 to 54 mmHg, in the standing position. At the same time, the subcutaneous pressure is only provided by the compression device, on healthy subjects. In other words, the subcutaneous pressure plus the IP is only a little higher than 22 mmHg-a pressure which is too low to reduce the caliber of the superficial veins. This is in accordance with our standing MRI 3D anatomical study which showed that, paradoxically, when applying low pressures (IP), the deep veins are compressed while the superficial veins are not.

[Procedure to follow with a resistant venous ulcer of the ankle]. / Conduite à tenir devant l'ulcère rebelle veineux de la cheville.

In this study the authors present details of the clinical and paraclinical examination, in particular, examination of vascular function, which enable identification of the reasons why a venous ulcer on the lower leg fails to heal or recurs despite the usual treatment. Two important possibilities are stressed: 1. Progressive aggravation of the causal venous insufficiency, in which incompetence of calf perforators plays a fundamental role in both varicose veins and phlebitis. 2. Combination of venous insufficiency with a loco-regional or general factor, which contributes to trophic tissue deterioration. It is, thus, at a loco-regional level that ankle stiffness, major sub-ulcer sclerosis with possibility of formation of calcified plaques, lymphatic stasis and exceptionally malignant degeneration should be systematically investigated. It is necessary to act effectively on the various associated factors in order that treatment of the venous insufficiency responsible for the ulcer may succeed in spontaneous healing or allow successful grafting. However, the most important occurrence in the event of resistant ulceration is due to a combination, in patients over 60 years, of arterial insufficiency and venous insufficiency of variable duration. This is the context of mixed ulceration, in which treatment of both etiological factors must be modulated as a function of good identification of concomitant venous and arterial lesions.

[Intra-uterine device and nulliparous women]. / Dispositif intra-utérin et nulliparité.

Intra-uterine device (IUD) is one of the birth control methods, which is available for nulliparous women, even though misconceptions still remain in medical or popular opinion. Only 1.3 % of nulliparous have a IUD as contraception in France while it is the second methods used by all women, after pill. The best contraception is the one chosen by women; however, the choice for a nulliparous of an IUD may be really difficult, despite the increasing number of women wishing to use it. Long-acting reversible contraceptives utilization, including IUD, is probably one of the issues to decrease the unintended pregnancies. An exhaustive and clear information about IUD is necessary to allow an informed and real choice. This prescription must consider contraindications and medical conditions for safe insertion, especially to avoid infection by screening STD (Chlamydia trachomatis and Nesseria gonorrhoeae) in nulliparous women<25 years old. Insertion must be effected with usual precautions and short or SL IUD preferred. Even if side effects such as expulsion, pelvic pains or dysmenorrhea are more frequent by nulliparous, IUD is a first intention choice for contraception to be consider, that women could obtain easily, including in emergency contraception situation.

[Chronic compartmental syndrome. a review of 234 patients]. / Le syndrome chronique des loges. À propos d'une série de 234 patients opérés.

OBJECTIVE: Diagnosis of chronic compartment syndrome of the lower leg, which occurs in a young and athletic population, is often delayed. We studied postoperative outcomes after fasciotomy in patients with compartment syndrome in order to identify specific postoperative complications. Long-term functional outcomes were also evaluated. METHODS: All patients with a diagnosis of chronic exercise-related compartment syndrome of the lower leg who underwent surgery from January 1985 to August 2009 were studied prospectively. The type of compartment and whether surgery was uni or bilateral was recorded. One year after surgery, patients completed a questionnaire to evaluate their functional outcome. RESULTS: Two hundred and thirty-six compartment procedures were performed in 234 patients. Only one compartment (constantly the superficial posterior compartment) was treated in 56/236 (23.7%) procedures. Two compartments (anterior and lateral) were involved in 90/236 procedures (38.1%). Three compartments (anterolateral and superficial posterior) were noted in 74/236 procedures (31.4%) and four compartments (anterolateral and superficial and deep posterior) were described in 6.8%. Involvement of the deep posterior compartment was always associated with another compartment. Surgery was bilateral in 70% of patients. The questionnaire response rate was 65%. The success rate of fasciotomy was 68.4% and a significant improvement was reported by 23.9% of responders; outcome was unsatisfactory for 7.7%. CONCLUSIONS: The diagnostic criteria used to confirm chronic exercise-related compartment syndrome of the lower leg were based on the compartment pressure measurement after exercise. In this study, all patients underwent fasciotomy. The surgical technique was standardized. Outcomes have been satisfactory with few surgical complications.