In this study we investigated and quantified the effects of interscalene block (ISB) on humeral arterial blood flow (HBF). Eleven patients scheduled for shoulder arthroscopic surgery under ISB were ...prospectively studied. A Doppler ultrasound of the humeral artery was performed before, and 30 min after, the ISB. The resistance index and the HBF were measured at the level of the midpoint of the upper arm. The median (interquartile range) of resistance index decreased from 0.98 (0.95–1.00) to 0.81 (0.77–0.91) (P < 0.01). The median HBF increased from 32 (18–46) to 88 (59–98) mL/min (P < 0.01). We conclude that ISB enhances arterial blood flow and decreases arterial resistance.
Pulmonary edema occurring in divers using a self-contained underwater breathing apparatus (scuba) is an uncommon, probably under-reported, but potentially life-threatening and recurrent condition. We ...report six episodes of pulmonary edema in five scuba divers seen during a period of 15 months. The four men and one woman ranged in age from 37 to 56 years and two were treated for hypertension. Symptoms were mostly dyspnea onset at depth, cough, hemoptysis and hypoxemia, which in the recurrent case led to cardiac arrest and death. All cases occurred in rather cold water. Findings on thoracic computed tomography (CT) scanning ranged from pleural effusion to ground-glass opacities restricted to a few areas of the lung. The complex underlying mechanisms that would contribute to a raised transalveolar pressure or to a disruption of the blood-gas barrier are discussed. It is important for emergency care providers to be aware of this syndrome for prompt recognition and optimal treatment.
Objective: In cochlear implant recipients, the threshold of the electrically evoked compound action potential (ECAP) has been shown to correlate with the perceptual detection threshold and maximum ...comfortable loudness levels (respectively,
T- and
C-levels) used for implant programming. Our general objective was to model the relationship between ECAP threshold and
T/
C-levels by taking into account their relative changes within each subject. In particular, we were interested in investigating further the validity of ECAP threshold as a predictor of psychophysical levels, depending on intra-cochlear electrode location and time of testing (from 1 to 18 months post-implantation).
Methods: A total of 370 ECAP thresholds, measured in 49 children, using a Nucleus
® 24 cochlear implant, were compared with the corresponding
T- and
C-levels obtained at the same visit, for the same electrode. Response profiles for the whole group of patients were modeled across four test electrodes spaced equally along the electrode array from base towards apex. A linear regression model was constructed and the quality of the ECAP threshold-based predictions was assessed by testing for correlation between measured and predicted psychophysics. Comparison was made with a more simplistic model (described here as the ‘parallel profiles method’) stipulating, within each subject, a 1 μA increase in psychophysical levels for every 1 μA increase in ECAP threshold.
Results: Offset between ECAP threshold and psychophysics profiles was found to vary significantly along the electrode array for the
T-, but not for the
C-level. In contrast with the parallel profiles method, our regression model predicted, within each subject, an average increase of 0.23
μA (95% confidence interval: 0.18–0.28) in
T-level for every 1 μA increase in ECAP threshold. This correction improved the quality of
T-level prediction when our model was run using measured
T-level and ECAP threshold from a reference electrode (
r=0.77 vs.
r=0.62). The shorter the distance between the electrode for which
T-level was predicted and the one used as reference, the stronger the correlation between measured and predicted
T-levels. In addition, poorer
T-level predictions were obtained at the basal end of the array during the first 3 months post-implantation. In contrast to
T-level, individual changes in
C-level with ECAP threshold exhibited heterogeneous patterns across subjects so that no common coefficient could account for these changes. However, applying the parallel profiles method led to high-quality
C-level prediction.
Conclusions and significance: The results suggest that covariation between ECAP thresholds and psychophysics plays a decisive role in the relationship of ECAP threshold with
T-, but not with
C-level. Therefore, our regression model and the parallel profiles method should both be used for predicting, respectively, the
T- and the
C-levels. Although the predictability of our regression model seems to be better for middle and apical electrodes, its utilization should be extended to basal electrodes after 6 months' implant use.
Mycobacterium avium subspecies paratuberculosis (Map) is the aetiological agent of Johne's disease or paratuberculosis and is included within the Mycobacterium avium complex (MAC). Map strains are of ...two major types often referred to as 'Sheep' or 'S-type' and 'Cattle' or 'C-type'. With the advent of more discriminatory typing techniques it has been possible to further classify the S-type strains into two groups referred to as Type I and Type III. This study was undertaken to genotype a large panel of S-type small ruminant isolates from different hosts and geographical origins and to compare them with a large panel of well documented C-type isolates to assess the genetic diversity of these strain types. Methods used included Mycobacterial Interspersed Repetitive Units - Variable-Number Tandem Repeat analysis (MIRU-VNTR), analysis of Large Sequence Polymorphisms by PCR (LSP analysis), Single Nucleotide Polymorphism (SNP) analysis of gyr genes, Pulsed-Field Gel Electrophoresis (PFGE) and Restriction Fragment Length Polymorphism analysis coupled with hybridization to IS900 (IS900-RFLP) analysis. The presence of LSP.sup.A4 and absence of LSP.sup.A20 was confirmed in all 24 Map S-type strains analysed. SNPs within the gyr genes divided the S-type strains into types I and III. Twenty four PFGE multiplex profiles and eleven different IS900-RFLP profiles were identified among the S-type isolates, some of them not previously published. Both PFGE and IS900-RFLP segregated the S-type strains into types I and III and the results concurred with those of the gyr SNP analysis. Nine MIRU-VNTR genotypes were identified in these isolates. MIRU-VNTR analysis differentiated Map strains from other members of Mycobacterium avium Complex, and Map S-type from C-type but not type I from III. Pigmented Map isolates were found of type I or III. This is the largest panel of S-type strains investigated to date. The S-type strains could be further divided into two subtypes, I and III by some of the typing techniques (IS900-RFLP, PFGE and SNP analysis of the gyr genes). MIRU-VNTR did not divide the strains into the subtypes I and III but did detect genetic differences between isolates within each of the subtypes. Pigmentation is not exclusively associated with type I strains.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
L’émergence de germes résistants et la survenue d’effets secondaires sous traitement conventionnel mènent à une utilisation croissante de molécules hors AMM dans le traitement des IOA. Ces nouvelles ...antibiothérapies sont en contrepartie plus coûteuses, pouvant constituer un frein à la prise en charge en service de soins de suite (SSR), sans qu’il n’existe de données précises en France concernant le volume et le coût de ces prescriptions. L’objectif de cette étude était d’estimer le coût de l’utilisation de ces antibiotiques hors AMM pour les patients pris en charge dans un CRIOAc.
Une étude de cohorte prospective a inclus l’ensemble des patients pris en charge dans un CRIOAc recevant les molécules suivantes en 2014 et 2015 : daptomycine, ertapénème, linézolide, ceftaroline, tigécycline et/ou colimycine. Les caractéristiques des patients, des IOA et les modalités de prescriptions (posologie, durée) ont été recueillies pendant tout le parcours de soins (hospitalisation en chirurgie et/ou médecine au CRIOAc ou dans des hôpitaux périphériques, en SSR et au domicile). Le coût global de ces prescriptions hors AMM a été estimé en tenant compte des variations de prix d’achat facturé au CRIOAc.
Sur les 410 et 473 patients pris en charge au CRIOAc en 2014 et 2015, le nombre ayant reçu une antibiothérapie hors AMM était de 185 (45 %) et 220 (47 % ; p=0,679), respectivement. Cent dix-huit (29 %) patients avaient une infection de prothèse. Toutes les indications ont été validées en réunion de concertation pluridisciplinaire. La répartition des molécules utilisées étaient la suivante : daptomycine (85 46 % en 2014 et 109 50 % en 2015), linézolide (37 20 % et 48 22 %), ertapénème (39 21 % et 38 17 %), colimycine (12 6 % et 12 5 %), tigecycline (11 6 % et 10 5 %) et ceftaroline (1 1 % et 3 1 %). La durée moyenne de dispensation était longue mais stable : 52jours en 2014 et 50jours en 2015. Le coût total de l’antibiothérapie hors AMM était de 1 034 000 € en 2014 et 1 290 000 € en 2015, la daptomycine étant à l’origine de la plus grande part du coût total (610 000 € 59 % du coût global en 2014, 840 000 € 65 % en 2015). Le coût total durant la prise en charge en SSR a diminué de 219 000 € (21 % du coût total des antibiotiques hors AMM) en 2014 à 174 000 € (14 %) en 2015.
L’antibiothérapie hors AMM représente un coût important dans la prise en charge des IOA. La part revenant aux SSR n’est pas majoritaire. Grâce à l’utilisation de génériques, notamment pour le linézolide et prochainement la daptomycine, il devrait drastiquement se réduire dès 2017.
The acute toxicity of fenitrothion was studied in seawater (36 PSU approximately 1060 plus or minus 10 mosmkg super(-1)) in larval, postlarval, and juvenile instars of the shrimp Penaeus stylirostris ...and Penaeus vannamei. The effects of this organophosphorus insecticide on juvenile hypo-osmoregulatory capacity (hypo-OC), i.e., the difference between the osmolality of the haemolymph and that of seawater) and muscle acetylcholinesterase (AChE) activity were then recorded for both species at lethal and sublethal concentrations. In P. stylirostris, 24 and 48 h LC sub(50)s for nauplii were above 500 mu gl super(-1). The 24-h LC sub(50)s ranged from 160 mu gl super(-1) (zoae 2) to 12 and 10 mu gl super(-1) (mysis 3 and postlarval instar 1) and from 11.2 mu gl super(-1) (juveniles of 8 g) to 18.9 mu gl super(-1) (juveniles of 20 g). The 48-h LC sub(50)s ranged from 42 mu gl super(-1) (zoae 1) to 2 mu gl super(-1) (mysis 3) and from 10.5 mu gl super(-1) (juveniles of 8 g) to 16.3 mu gl super(-1) (juveniles of 14 g). In P. vannamei, 24 and 48 h LC sub(50)s for nauplii were above 500 mu gl super(-1).
Les accidents de décompression sévères sont des entités cliniques peu fréquentes. Leur étiologie est le plus souvent identifiable (erreur de procédure, facteur favorisant). Nous rapportons un cas ...d’accident médullaire grave ; sa survenue au décours d’une plongée banale en profondeur et en durée, en dehors de tout facteur favorisant, son caractère réfractaire à un traitement en caisson, 3 heures après la sortie de l’eau, et l’importance des lésions objectivées par l’IRM, nous amènent à souligner la surprenante variabilité dans la survenue et l’évolution de tels accidents…
Severe decompression sickness occurs unfrequently, with, generally an identifying cause (error in decompression protocols, promoting factors…). We report a case of severe spinal cord damage; onset after a common dive, neither deep nor long, without any promoting factor, absence of responsiveness to recompression, three hours post-dive, importance of MRI signal abnormalities, make us to point out the confounding variability of onset and evolution of such illness.
Severe decompression sickness occurs unfrequently, with, generally an identifying cause (error in decompression protocols, promoting factors.). We report a case of severe spinal cord damage; onset ...after a common dive, neither deep nor long, without any promoting factor, absence of responsiveness to recompression, three hours post-dive, importance of MRI signal abnormalities, make us to point out the confounding variability of onset and evolution of such illness.
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