The drought recorded in 1970s and 1980s, particularly in the Sahara and Sahel region has greatly affected the population as well as the economies and the eco-systems of this area. In 2007, the African Union launched a...The drought recorded in 1970s and 1980s, particularly in the Sahara and Sahel region has greatly affected the population as well as the economies and the eco-systems of this area. In 2007, the African Union launched a Pan-African program, the Great Green Wall for the Sahara, the Sahel Initiative (GGWSSI) to reverse land degradation and desertification by planting a wall of trees stretching from Dakar to Djibouti. The objective is to improve food security, and support local people to adapt to climate change. This paper aims to evaluate the impacts of the reforestation program in Senegal, fifteen years after it was launched. This study uses a time series of satellite-derived vegetation cover and climatic parameters data to analyze the sustainability of these interventions. Change detection approaches were applied to identify and characterize the drives of the eventual changes. A comparative analysis of reforestation on climatic parameters was explored through the temporal analysis of the vegetation index over the periods 2000-2008 and 2009-2020. An increase in vegetation activity was noted through the NDVI at the interannual (+2% to +8%) and seasonal (+1.5% to 7% for the wet season and 1% to 4% for the dry season) scale and a positive and significant evolution is noted on the trace of the GGW. Also, the period 2009-2020 recorded an increase in rainfall of 2% to 8% of the average value 2000-2020 and 4% to 8% of the rainy season. Soil moisture is the climatic parameter that has increased the most, with an increase of 25% to 54% of the 2000-2020 average, i.e. between 20 mm and 70 mm more. This study shows a significant improvement in the relationship between NDVI and climate parameters after the different reforestation actions of the GGW.展开更多
Introduction: In comparison to anterior wall myocardial infarction, inferior wall myocardial infarction is generally regarded as a low risk event. The aim of this study was to evaluate the prognostic impact of right v...Introduction: In comparison to anterior wall myocardial infarction, inferior wall myocardial infarction is generally regarded as a low risk event. The aim of this study was to evaluate the prognostic impact of right ventricular (RV) myocardial involvement in patients with inferior wall myocardial infarction (IWMI). Methods: This is an observational study of 82 consecutive IWMI patients admitted and treated in Manmohan Cardiothoracic, Vascular and Transplant Center (MCVTC) from May 15 2018 to June 15 2019. The clinical characteristics, risk factors profile, electrocardiographic, echocardiographic, including RV function and angiographic characteristics, complications and in-hospital deaths were analyzed. Results: The mean age of patients presenting with IMWI was 64.8 ± 13.8 years with predominance of male (67%). Right ventricular myocardial infarction was present in 34.1% of patient with RV dysfunction in 25.6% patients. Mean Tricuspid Annular Plane Systolic Excursion (TAPSE), RV tricuspid annulus (S') and RV Fractional area change (FAC) in patients with RV dysfunction vs patients without RV dysfunction were 12.2 ± 3.3 mm vs 22.5 ± 3.5 mm (p < 0.001), 7.54 ± 0.91 cm/s vs. 12.79 ± 2.16 cm/s respectively (p Conclusion: In inferior wall myocardial infarction, RV involvement with RV dysfunction is an independent risk factor for in-hospital mortality along with advanced age, complete atrioventricular block, higher Killip class, delayed hospital presentation, left ventricular ejection fraction < 40% and angiographic evidence of triple vessel disease.展开更多
Background: Ventricular septal rupture (VSR) leading to right ventricular (RV) wall dissection is an extremely rare and life-threatening complication of inferior myocardial infarction (MI) with posterior VSR. Its rare...Background: Ventricular septal rupture (VSR) leading to right ventricular (RV) wall dissection is an extremely rare and life-threatening complication of inferior myocardial infarction (MI) with posterior VSR. Its rare incidence and complex pathology make it difficult to select the appropriate surgical procedures to prevent fatalities. Case Presentation: A 68-year-old woman was transferred to our hospital because of a post-infarction VSR 12 days after symptom onset. Short-axis image obtained using transthoracic echocardiography demonstrated a large posterior VSR. Moreover, the VSR was continuous, with a large echo-free space in the posterior wall of the right ventricle. Color echocardiography showed blood flowing into the echo-free space through the septal defect and blood flowing out into the RV lumen. Coronary angiography revealed complete occlusion of the second segment of the right coronary artery. Thus, dissection of the posterior wall of the right ventricle that continued into the RV lumen was considered to have been caused by the posterior VSR caused by an inferior MI. The patient underwent urgent surgery to repair the VSR using the sandwich double-patch technique by making a posterior RV incision that was repaired using a third patch. No additional procedure was required to block the flow from the cavity of the RV wall dissection into the RV lumen. Postoperative echocardiography and contrast-enhanced computed tomography demonstrated that the VSR was closed securely and the RV wall dissection was almost completely thrombosed. Conclusion: In this case, a patient with a posterior VSR and RV wall dissection was successfully treated using the sandwich double-patch technique with a posterior RV incision. No additional procedure may be needed for RV wall dissection when a secure VSR repair is complete;however, close follow-up is essential to improve the long-term prognosis.展开更多
The severe drought observed in the Sahel during 1970s, 1980s and 1990s has deeply affected the population as well as the economies and the eco-systems of this climatic area. The GGW Initiative spearheaded by Africa Un...The severe drought observed in the Sahel during 1970s, 1980s and 1990s has deeply affected the population as well as the economies and the eco-systems of this climatic area. The GGW Initiative spearheaded by Africa Union in 2007 proposed to combat the land degradation and desertification by planting a wall of trees stretching from Dakar to Djibouti. A reforestation was then conducted in the Senegal’s GGW since 2006 as part as other areas in the Sahel. This paper aims to evaluate the carbon sequestration dynamics in the sites of the Senegal’s GGW over the last three decades. The method consists firstly of analyzing the evolution of land cover and land use dynamics based on ESA-CCI LC satellite data. There is an improvement of the surface areas of tree and shrub savanna of 11.40% (Tessekere), 8.25% (Syer) and 2.70% (Loughere-Thioly). The regreening of the different localities and a positive dynamic observed is explained by the return to normal rainfall and to reforestation actions, agroforestry practices, better management of natural resources undertaken. However, some non-reforested sites showed an opposite trend despite of the normal rainfall. Secondly, the results on land mapping are used as a proxy for the assessment of carbon stocks. The dynamic observed in vegetation cover since the beginning of the reforestation made it possible to sequester 5.8 million tons of carbon representing respectively 2.31% of African GGW. This gain in stored carbon is equivalent to 21.2 million tons of CO<sub>2</sub> captured in the atmosphere. Through this study, it appears that carbon storage becomes significant 8 to 10 years after the start of reforestation. An urbanization without respect for the environmental factors could be a danger for the climate (case of Ballou).展开更多
Introduction: In the last two decades, chest wall perforator flaps (CWPF) have become a versatile tissue replacement technique for partial breast reconstruction following breast-conserving surgery (BCS) in well-select...Introduction: In the last two decades, chest wall perforator flaps (CWPF) have become a versatile tissue replacement technique for partial breast reconstruction following breast-conserving surgery (BCS) in well-selected cases. We present the surgical outcome of 81 patients with chest wall perforator flaps used for breast-conserving surgery. Methods: We recorded the outcomes of three oncoplastic breast surgeons who performed partial breast reconstruction with chest wall perforator flaps from 1<sup>st</sup> January 2018 to 30<sup>th</sup> June 2022 at Sherwood Forest Hospitals NHS Foundation Trust. Data were collected on patient demographics, including age, BMI, smoking status, bra size, previous treatments, type of CWPF procedure, tumor size (measured clinically, via imaging and histologically), biopsy results, specimen weight, margins involvement, re-operation rate, surgical site infection (SSI), flap loss, flap shrinkage, hematoma, and seroma rates. Results: A total of 81 patients were included in this study, with an average age of 55.7 years and a body mass index (BMI) of 26.7 kg/m<sup>2</sup>. The bra size varied between A to FF with A (7.4%), B (28.3%), C (38.2%), D (13.6%), DD (11.1%), and FF (1.2%). 14.8% of the patients had neoadjuvant chemotherapy (NACT). For 45 patients, LICAP (lateral intercostal artery perforator), 16 AICAP (anterior intercostal artery perforator), 13 MICAP (medial intercostal artery perforator), and for seven patients, LTAP (lateral thoracic artery perforator) flaps were used. The average tumor was measured at 15.75 mm clinically, 19.1 mm via imaging, and 19.6 mm histologically. Biopsy showed that 16% of the tumors were ductal carcinoma in situ (DCIS), and 84% were invasive. 16% of patients had involved margins, and re-excision was required in 10 patients, and completion mastectomy was performed in 2 patients. A thirty-day SSI rate was 6.2%, with flap-related complications, including flap loss and shrinkage, at 3.7% and 4.9%, respectively. In addition, 3.7% had a hematoma, and 17.3% had other complications. Conclusion: Partial breast reconstruction with perforator flaps is an excellent volume replacement technique in breast-conserving surgery with acceptable complications in well-selected cases.展开更多
目的探讨自体腘绳肌腱植入治疗重度阴道前壁脱垂的安全性和中期疗效。方法本研究为单臂临床试验,2021年5月开始纳入有症状、要求手术治疗的以阴道前壁重度脱垂为主的盆腔器官脱垂(pelvic organ prolapse,POP)患者,经患者充分知情,自愿...目的探讨自体腘绳肌腱植入治疗重度阴道前壁脱垂的安全性和中期疗效。方法本研究为单臂临床试验,2021年5月开始纳入有症状、要求手术治疗的以阴道前壁重度脱垂为主的盆腔器官脱垂(pelvic organ prolapse,POP)患者,经患者充分知情,自愿选择自体腘绳肌腱添加修补,同时行双侧高位骶韧带悬吊。术后随访盆腔器官脱垂定量分度(pelvic organ prolapse quantification,POP-Q)、盆底不适调查表简表评分(Pelvic Floor Distress Inventory-Short Form 20,PFDI-20)、术后满意度评分、患者整体印象改善评分(Patient Global Impression of Improvement,PGI-I)。观察术后取腱侧下肢功能及术后并发症处理、再手术情况。结果取腱手术时间(19.7±8.3)min,盆底手术时间(122.1±37.8)min,术中出血量中位数70 ml(50~400 ml),无术中副损伤和术后病率。12例随访(26.4±2.5)月。Aa、Ba、C术前分别为3(-1~3)、5(2~10)、4(-1~10),术后24个月分别为-3(-3~3)、-3(-3~3)、-6(-6~3),差异有显著性(P<0.05)。12例术前、术后24个月PFDI-20评分分别为88.0(16.7~204.2)、8.3(0~32.3)分,差异有显著性(Z=-2.803,P=0.005);PGI-I问卷11例术后症状明显改善,1例有改善。术后6、24个月满意度评分分别为(4.8±0.4)分和(4.6±0.7)分。1例术后12个月自感阴道脱出物,阴道前壁及顶端脱垂Ⅲ度,复发率8.3%(1/12)。2例分别术后9 d、2周肺栓塞,Clavien-Dindo外科手术并发症分级分别为Ⅱ、Ⅲ级,分别门诊和住院治疗后痊愈。1例阴道顶端局部筋膜暴露,药物治疗好转。所有患者取腱部位切口愈合良好,肌力、下肢活动均正常。无因复发和筋膜条并发症再次手术。结论自体腘绳肌腱植入治疗重度阴道前壁脱垂手术安全,中期疗效满意。术前需向患者宣教下肢锻炼预防静脉血栓并发症。展开更多
文摘The drought recorded in 1970s and 1980s, particularly in the Sahara and Sahel region has greatly affected the population as well as the economies and the eco-systems of this area. In 2007, the African Union launched a Pan-African program, the Great Green Wall for the Sahara, the Sahel Initiative (GGWSSI) to reverse land degradation and desertification by planting a wall of trees stretching from Dakar to Djibouti. The objective is to improve food security, and support local people to adapt to climate change. This paper aims to evaluate the impacts of the reforestation program in Senegal, fifteen years after it was launched. This study uses a time series of satellite-derived vegetation cover and climatic parameters data to analyze the sustainability of these interventions. Change detection approaches were applied to identify and characterize the drives of the eventual changes. A comparative analysis of reforestation on climatic parameters was explored through the temporal analysis of the vegetation index over the periods 2000-2008 and 2009-2020. An increase in vegetation activity was noted through the NDVI at the interannual (+2% to +8%) and seasonal (+1.5% to 7% for the wet season and 1% to 4% for the dry season) scale and a positive and significant evolution is noted on the trace of the GGW. Also, the period 2009-2020 recorded an increase in rainfall of 2% to 8% of the average value 2000-2020 and 4% to 8% of the rainy season. Soil moisture is the climatic parameter that has increased the most, with an increase of 25% to 54% of the 2000-2020 average, i.e. between 20 mm and 70 mm more. This study shows a significant improvement in the relationship between NDVI and climate parameters after the different reforestation actions of the GGW.
文摘Introduction: In comparison to anterior wall myocardial infarction, inferior wall myocardial infarction is generally regarded as a low risk event. The aim of this study was to evaluate the prognostic impact of right ventricular (RV) myocardial involvement in patients with inferior wall myocardial infarction (IWMI). Methods: This is an observational study of 82 consecutive IWMI patients admitted and treated in Manmohan Cardiothoracic, Vascular and Transplant Center (MCVTC) from May 15 2018 to June 15 2019. The clinical characteristics, risk factors profile, electrocardiographic, echocardiographic, including RV function and angiographic characteristics, complications and in-hospital deaths were analyzed. Results: The mean age of patients presenting with IMWI was 64.8 ± 13.8 years with predominance of male (67%). Right ventricular myocardial infarction was present in 34.1% of patient with RV dysfunction in 25.6% patients. Mean Tricuspid Annular Plane Systolic Excursion (TAPSE), RV tricuspid annulus (S') and RV Fractional area change (FAC) in patients with RV dysfunction vs patients without RV dysfunction were 12.2 ± 3.3 mm vs 22.5 ± 3.5 mm (p < 0.001), 7.54 ± 0.91 cm/s vs. 12.79 ± 2.16 cm/s respectively (p Conclusion: In inferior wall myocardial infarction, RV involvement with RV dysfunction is an independent risk factor for in-hospital mortality along with advanced age, complete atrioventricular block, higher Killip class, delayed hospital presentation, left ventricular ejection fraction < 40% and angiographic evidence of triple vessel disease.
文摘Background: Ventricular septal rupture (VSR) leading to right ventricular (RV) wall dissection is an extremely rare and life-threatening complication of inferior myocardial infarction (MI) with posterior VSR. Its rare incidence and complex pathology make it difficult to select the appropriate surgical procedures to prevent fatalities. Case Presentation: A 68-year-old woman was transferred to our hospital because of a post-infarction VSR 12 days after symptom onset. Short-axis image obtained using transthoracic echocardiography demonstrated a large posterior VSR. Moreover, the VSR was continuous, with a large echo-free space in the posterior wall of the right ventricle. Color echocardiography showed blood flowing into the echo-free space through the septal defect and blood flowing out into the RV lumen. Coronary angiography revealed complete occlusion of the second segment of the right coronary artery. Thus, dissection of the posterior wall of the right ventricle that continued into the RV lumen was considered to have been caused by the posterior VSR caused by an inferior MI. The patient underwent urgent surgery to repair the VSR using the sandwich double-patch technique by making a posterior RV incision that was repaired using a third patch. No additional procedure was required to block the flow from the cavity of the RV wall dissection into the RV lumen. Postoperative echocardiography and contrast-enhanced computed tomography demonstrated that the VSR was closed securely and the RV wall dissection was almost completely thrombosed. Conclusion: In this case, a patient with a posterior VSR and RV wall dissection was successfully treated using the sandwich double-patch technique with a posterior RV incision. No additional procedure may be needed for RV wall dissection when a secure VSR repair is complete;however, close follow-up is essential to improve the long-term prognosis.
文摘The severe drought observed in the Sahel during 1970s, 1980s and 1990s has deeply affected the population as well as the economies and the eco-systems of this climatic area. The GGW Initiative spearheaded by Africa Union in 2007 proposed to combat the land degradation and desertification by planting a wall of trees stretching from Dakar to Djibouti. A reforestation was then conducted in the Senegal’s GGW since 2006 as part as other areas in the Sahel. This paper aims to evaluate the carbon sequestration dynamics in the sites of the Senegal’s GGW over the last three decades. The method consists firstly of analyzing the evolution of land cover and land use dynamics based on ESA-CCI LC satellite data. There is an improvement of the surface areas of tree and shrub savanna of 11.40% (Tessekere), 8.25% (Syer) and 2.70% (Loughere-Thioly). The regreening of the different localities and a positive dynamic observed is explained by the return to normal rainfall and to reforestation actions, agroforestry practices, better management of natural resources undertaken. However, some non-reforested sites showed an opposite trend despite of the normal rainfall. Secondly, the results on land mapping are used as a proxy for the assessment of carbon stocks. The dynamic observed in vegetation cover since the beginning of the reforestation made it possible to sequester 5.8 million tons of carbon representing respectively 2.31% of African GGW. This gain in stored carbon is equivalent to 21.2 million tons of CO<sub>2</sub> captured in the atmosphere. Through this study, it appears that carbon storage becomes significant 8 to 10 years after the start of reforestation. An urbanization without respect for the environmental factors could be a danger for the climate (case of Ballou).
文摘Introduction: In the last two decades, chest wall perforator flaps (CWPF) have become a versatile tissue replacement technique for partial breast reconstruction following breast-conserving surgery (BCS) in well-selected cases. We present the surgical outcome of 81 patients with chest wall perforator flaps used for breast-conserving surgery. Methods: We recorded the outcomes of three oncoplastic breast surgeons who performed partial breast reconstruction with chest wall perforator flaps from 1<sup>st</sup> January 2018 to 30<sup>th</sup> June 2022 at Sherwood Forest Hospitals NHS Foundation Trust. Data were collected on patient demographics, including age, BMI, smoking status, bra size, previous treatments, type of CWPF procedure, tumor size (measured clinically, via imaging and histologically), biopsy results, specimen weight, margins involvement, re-operation rate, surgical site infection (SSI), flap loss, flap shrinkage, hematoma, and seroma rates. Results: A total of 81 patients were included in this study, with an average age of 55.7 years and a body mass index (BMI) of 26.7 kg/m<sup>2</sup>. The bra size varied between A to FF with A (7.4%), B (28.3%), C (38.2%), D (13.6%), DD (11.1%), and FF (1.2%). 14.8% of the patients had neoadjuvant chemotherapy (NACT). For 45 patients, LICAP (lateral intercostal artery perforator), 16 AICAP (anterior intercostal artery perforator), 13 MICAP (medial intercostal artery perforator), and for seven patients, LTAP (lateral thoracic artery perforator) flaps were used. The average tumor was measured at 15.75 mm clinically, 19.1 mm via imaging, and 19.6 mm histologically. Biopsy showed that 16% of the tumors were ductal carcinoma in situ (DCIS), and 84% were invasive. 16% of patients had involved margins, and re-excision was required in 10 patients, and completion mastectomy was performed in 2 patients. A thirty-day SSI rate was 6.2%, with flap-related complications, including flap loss and shrinkage, at 3.7% and 4.9%, respectively. In addition, 3.7% had a hematoma, and 17.3% had other complications. Conclusion: Partial breast reconstruction with perforator flaps is an excellent volume replacement technique in breast-conserving surgery with acceptable complications in well-selected cases.
文摘目的探讨自体腘绳肌腱植入治疗重度阴道前壁脱垂的安全性和中期疗效。方法本研究为单臂临床试验,2021年5月开始纳入有症状、要求手术治疗的以阴道前壁重度脱垂为主的盆腔器官脱垂(pelvic organ prolapse,POP)患者,经患者充分知情,自愿选择自体腘绳肌腱添加修补,同时行双侧高位骶韧带悬吊。术后随访盆腔器官脱垂定量分度(pelvic organ prolapse quantification,POP-Q)、盆底不适调查表简表评分(Pelvic Floor Distress Inventory-Short Form 20,PFDI-20)、术后满意度评分、患者整体印象改善评分(Patient Global Impression of Improvement,PGI-I)。观察术后取腱侧下肢功能及术后并发症处理、再手术情况。结果取腱手术时间(19.7±8.3)min,盆底手术时间(122.1±37.8)min,术中出血量中位数70 ml(50~400 ml),无术中副损伤和术后病率。12例随访(26.4±2.5)月。Aa、Ba、C术前分别为3(-1~3)、5(2~10)、4(-1~10),术后24个月分别为-3(-3~3)、-3(-3~3)、-6(-6~3),差异有显著性(P<0.05)。12例术前、术后24个月PFDI-20评分分别为88.0(16.7~204.2)、8.3(0~32.3)分,差异有显著性(Z=-2.803,P=0.005);PGI-I问卷11例术后症状明显改善,1例有改善。术后6、24个月满意度评分分别为(4.8±0.4)分和(4.6±0.7)分。1例术后12个月自感阴道脱出物,阴道前壁及顶端脱垂Ⅲ度,复发率8.3%(1/12)。2例分别术后9 d、2周肺栓塞,Clavien-Dindo外科手术并发症分级分别为Ⅱ、Ⅲ级,分别门诊和住院治疗后痊愈。1例阴道顶端局部筋膜暴露,药物治疗好转。所有患者取腱部位切口愈合良好,肌力、下肢活动均正常。无因复发和筋膜条并发症再次手术。结论自体腘绳肌腱植入治疗重度阴道前壁脱垂手术安全,中期疗效满意。术前需向患者宣教下肢锻炼预防静脉血栓并发症。
