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Summary: Background: Sialendoscopy is a recently developed minimally invasive diagnostic and therapeutic procedure for the management of obstructive diseases of the salivary glands. This report describes our early experience with this new tool and compares our results with the literature data. Material and methods: This was a retrospective analysis of the 33 first cases treated at a teaching hospital from October 2009 to June 2011. Results: The success rate for diagnostic sialendoscopy was 94%. Sialolithiasis was found in 19 cases and salivary duct stenosis in 11; no canal anomaly was found in two cases. The success rate for stone removal was 79%, while treatment of strictures failed in four cases. Longer surgical experience led to shorter operating times and improved indications as well as better therapeutic outcomes. There were no complications. Conclusion: Sialendoscopy is a safe technique that can easily be learned by surgeons familiar with endoscopic surgery. However, practical experience is needed to reduce operating times, lower failure rates and determine its precise indications. [Copyright &y& Elsevier]

Summary: Introduction: Voice rehabilitation after total laryngectomy is a major socio-economic challenge. Voice rehabilitation can be achieved by voice prostheses, which provide rapid patient satisfaction. Enlarged tracheo-oesophageal puncture is a frequent complication and can be difficult to manage. Material and method: A prospective study was conducted from November 2010 to October 2011 on 28 Blom-Singer large oesophageal and tracheal flange voice prostheses placed in 18 patients with enlarged tracheo-oesophageal puncture causing leakage around the voice prosthesis. Result: Leakage around the voice prosthesis resolved in all patients with a mean prosthesis lifespan of 95 days. The patients considered voice quality to be similar to that obtained with the initial voice prosthesis. Conclusion: The Blom-Singer large oesophageal and tracheal flange voice prosthesis is a useful solution for the management of periprosthetic leakage ensuring similar voice quality and an identical lifespan to that of other voice prostheses. [Copyright &y& Elsevier]

Study objective: Emergency tracheal intubation is reported to be more difficult with single-use plastic than with reusable metal laryngoscope blades in both inhospital and out-of-hospital settings. Single-use metal blades have been developed but have not been compared with conventional metal blades. This controlled trial compares the efficacy and safety of single-use metal blades with reusable metal blades in out-of-hospital emergency tracheal intubation. Methods: This randomized controlled trial was carried out in France with out-of-hospital emergency medical units (Services de Médecine d''Urgence et de Réanimation). This was a multicenter prospective noninferiority randomized controlled trial in adult out-of-hospital patients requiring emergency tracheal intubation. Patients were randomly assigned to either single-use or reusable metal laryngoscope blades and intubated by a senior physician or a nurse anesthetist. The primary outcome was first-pass intubation success. Secondary outcomes were incidence of difficult intubation, need for alternate airway devices, and early intubation-related complications (esophageal intubation, mainstem intubation, vomiting, pulmonary aspiration, dental trauma, bronchospasm or laryngospasm, ventricular tachycardia, arterial desaturation, hypotension, or cardiac arrest). Results: The study included 817 patients, including 409 intubated with single-use blades and 408 with a reusable blade. First-pass intubation success was similar in both groups: 292 (71.4%) for single-use blades, 290 (71.1%) for reusable blades. The 95% confidence interval (CI) for the difference in treatments (0.3%; 95% CI –5.9% to 6.5%) did not include the prespecified inferiority margin of –7%. There was no difference in rate of difficult intubation (difference 3%; 95% CI –7% to 2%), need for alternate airway (difference 4%; 95% CI –8% to 1%), or early complication rate (difference 3%; 95% CI –3% to 8%). Conclusion: First-pass out-of-hospital tracheal intubation success with single-use metal laryngoscopy blades was noninferior to first-pass success with reusable metal laryngoscope blades. [Copyright &y& Elsevier]

Background: Diagnosis of acute coronary artery disease in survivors of out-of-hospital cardiac arrest (OHCA) is difficult. The role of emergency coronary angiography and percutaneous coronary intervention (PCI) in this setting is debated. The objective of this study was to assess the prevalence of coronary lesions on emergency angiography in survivors of OHCA. Methods: Seventy-two consecutive OHCA survivors underwent systematic emergency coronary angiography. Patients with critical stenoses or occlusion underwent ad hoc PCI. Results: Most (63.9%) OHCA survivors had angiographic coronary artery disease (≥1 lesion >50%), but only a minority (37.5%) had clinical or angiographic evidence of an acute coronary syndrome due to either an acute occlusion (16.7%) or an irregular lesion suggestive of ruptured plaque or thrombus (25.0%). A final diagnosis of myocardial infarction was assigned in 27 patients (37.5%). Percutaneous coronary intervention was attempted and successful in 33.3% of the total cohort (n = 24). Hospital survival was 48.6%. By multivariable analysis, use of PCI was not an independent correlate of survival. ST-segment elevation on admission was an independent correlate of acute myocardial infarction (odds ratio 64.2, 95% CI 7.6-544.2, P = .0001), with high positive (82.6%) and negative (83.7%) predictive values. Conclusions: A minority of OHCA patients has angiographic evidence of an acute coronary syndrome and one-third undergo PCI, but PCI is not an independent correlate of survival. The presence of ST elevation on admission was a strong independent correlate of acute myocardial infarction and may be used to triage OHCA patients to emergency angiography with a view to PCI. [Copyright &y& Elsevier]

INTRODUCTION: This study was carried out to estimate the relationship between arterial PCO2 (PaCO2) and end-tidal carbon dioxide (PETCO2) during prehospital controlled ventilation and also to evaluate variation of the gradient between PCO2 and PETCO2 during prehospital transport. METHODS: Measurements of PETCO2 from capnography values and PaCO2 from arterial blood gases were registered at the beginning (T(0)) and at the end (T(end)) of out-of-hospital management. For all patients requiring invasive ventilation, the gradient between PCO2 and PETCO2 was calculated for T(0) and T(end), the PaCO2-PETCO2 variation between T(end) and T(0) was also calculated. RESULTS: One hundred patients were included in this study (mean age, 58.4 +/- 16.4 years; 57 were male). There was no variation of the mean gradient (DeltaPaCO2-PETCO2 ) during transport (8.64 +/- 13.5 mm Hg at T(0) and 7.26 +/- 12.94 mm Hg at T(end)). Thirty-six percent of patients (n = 36) had a gradient above +10 mm Hg, and for 6% of patients (n = 4) the gradient was lower than -10 mm Hg. The PaCO2-PETCO2 gradient was not significantly different according to the pathology, but was significantly higher in hypercapnic patients compared with hypocapnic or normocapnic patients. In patients with severe head injury, the capnia was normalized in 80% of patients at the end of the transport according to the last blood gas result. In this subgroup the DeltaPaCO2-PETCO2 (T(end) - T(0)) gradient was stable between T(0) and T(end) except in 20% of the patients for whom the DeltaPaCO2-PETCO2 was lower than -10 mm Hg. Fifty-four percent of critical care physicians had modified the respiratory setting after the first arterial blood gas results. CONCLUSIONS: The PaCO2 cannot be estimated by the PETCO2 in the prehospital setting. There is wide variation in the gradient between PCO2 and PETCO2 depending on patient condition, and over time, the relationship does not remain constant and thus cannot be useful in prehospital ventilation management. Copyright © 2005 by Elsevier Inc. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: This study was carried out to estimate the relationship between arterial Pco 2 (Paco 2) and end-tidal carbon dioxide (Petco 2) during prehospital controlled ventilation and also to evaluate variation of the gradient between Pco 2 and Petco 2 during prehospital transport. Methods: Measurements of Petco 2 from capnography values and Paco 2 from arterial blood gases were registered at the beginning (T 0) and at the end (T end) of out-of-hospital management. For all patients requiring invasive ventilation, the gradient between Pco 2 and Petco 2 was calculated for T 0 and T end, the Paco 2 − Petco 2 variation between T end and T 0 was also calculated. Results: One hundred patients were included in this study (mean age, 58.4 ± 16.4 years; 57 were male). There was no variation of the mean gradient (ΔPaco 2 − Petco 2) during transport (8.64 ± 13.5 mm Hg at T 0 and 7.26 ± 12.94 mm Hg at T end). Thirty-six percent of patients (n = 36) had a gradient above +10 mm Hg, and for 6% of patients (n = 4) the gradient was lower than −10 mm Hg. The Paco 2 − Petco 2 gradient was not significantly different according to the pathology, but was significantly higher in hypercapnic patients compared with hypocapnic or normocapnic patients. In patients with severe head injury, the capnia was normalized in 80% of patients at the end of the transport according to the last blood gas result. In this subgroup the ΔPaco 2 − Petco 2 (T end − T 0) gradient was stable between T 0 and T end except in 20% of the patients for whom the ΔPaco 2 − Petco 2 was lower than −10 mm Hg. Fifty-four percent of critical care physicians had modified the respiratory setting after the first arterial blood gas results. Conclusions: The Paco 2 cannot be estimated by the Petco 2 in the prehospital setting. There is wide variation in the gradient between Pco 2 and Petco 2 depending on patient condition, and over time, the relationship does not remain constant and thus cannot be useful in prehospital ventilation management. [Copyright &y& Elsevier]

Background The safety of morphine use has been questioned in the management of ST Elevation Myocardial Infarction (STEMI). Are there other analgesics that are at least as effective without adverse effects? Purpose Evaluate the non-inferiority of nitrous oxide/oxygen plus acetaminophen versus morphine in pre-hospital patients with STEMI. Method Multi-center, randomized, non-inferiority cluster study. Thirty-eight mobile intensive care unit centres were randomized. Inclusion criteria: patients with STEMI and pain intensity score ≥ 4 on the numerical rating scale (NRS). Outcome: proportion of patient with NRS ≤ 3, 30 minutes after starting analgesia without adding morphine in the nitrous oxide/oxygen group. Expected or unexpected events were measured at 30 minutes and 1 month. Estimated number of subjects: 684. Per protocol (PP) and intention to treat (ITT) statistical analyses were planned. A non-inferiority margin was specified as an absolute difference of − 10% in proportions. The cluster design of the trial was taken into account through generalised estimating equations. Results A total of 684 patients were included in ITT analysis and 644 in PP analysis. Pain relief was obtained in 73.6% patients in the morphine group versus 51.7% patients in the nitrous oxide/oxygen group in the PP analysis. The absolute risk difference was − 21.7% (95% CI − 29.6 to − 13.8) and was below the non-inferiority margin of − 10%. The incidence of expected and serious adverse events were 10.2% and 3.5% respectively in the morphine group versus 13.2% and 6.2% in the nitrous oxide/oxygen group. Conclusion Oxide/oxygen plus acetaminophen is inferior to morphine analgesia in patients with STEMI. Adverse effects were not different between the groups. [ABSTRACT FROM AUTHOR]

We present the design for the first narrowband filter NB964 for the Dark Energy Camera (DECam), which is operated on the 4m Blanco Telescope at the Cerro Tololo Inter-American Observatory. The NB964 filter profile is essentially defined by maximizing the power of searching for Lyman alpha emitting galaxies (LAEs) in the epoch of reionization, with the consideration of the night sky background in the near-infrared and the DECam quantum efficiency. The NB964 filter was manufactured by Materion in 2015. It has a central wavelength of 964.2 nm and a full width at half maximum (FWHM) of 9.2 nm. An NB964 survey named LAGER (Lyman Alpha Galaxies in the Epoch of Reionization) has been ongoing since December 2015. Here we report results of lab tests, on-site tests and observations with the NB964 filter. The excellent performances of this filter ensure that the LAGER project is able to detect LAEs at z ~ 7 with a high efficiency.

The Gemini Planet Imager is a dedicated facility for directly imaging and spectroscopically characterizing extrasolar planets. It combines a very high-order adaptive optics system, a diffraction-suppressing coronagraph, and an integral field spectrograph with low spectral resolution but high spatial resolution. Every aspect of the Gemini Planet Imager has been tuned for maximum sensitivity to faint planets near bright stars. During first-light observations, we achieved an estimated H band Strehl ratio of 0.89 and a 5-σ contrast of 10(6) at 0.75 arcseconds and 10(5) at 0.35 arcseconds. Observations of Beta Pictoris clearly detect the planet, Beta Pictoris b, in a single 60-s exposure with minimal postprocessing. Beta Pictoris b is observed at a separation of 434 ± 6 milliarcseconds (mas) and position angle 211.8 ± 0.5°. Fitting the Keplerian orbit of Beta Pic b using the new position together with previous astrometry gives a factor of 3 improvement in most parameters over previous solutions. The planet orbits at a semimajor axis of [Formula: see text] near the 3:2 resonance with the previously known 6-AU asteroidal belt and is aligned with the inner warped disk. The observations give a 4% probability of a transit of the planet in late 2017.

An epidemiological study and the simultaneous evaluation of anti-HAV antibody using radio immunoassay (RIA) and immunoadherence hemagglutination assay (IAHA) was performed during three hepatitis A epidemics in the Tours area (France). Fifty-seven sera from 35 subjects with viral hepatitis type A and 16 sera from nine children who did not develop any clinical signs of hepatitis were studied. The more explosive epidemic occurred in an institution for mentally retarded children (attack rate 68%). The two major outbreaks observed were due to the introduction of the institutions of individuals infected with hepatitis A virus. Two out of three of the index cases had a seafood dinner three to four weeks before onset of jaundice. Sera taken one week after jaundice were always found to be anti-HAV positive by both RIA and IAHA, and sera taken more than three days before the appearance of jaundice were negative by both methods. Sera taken at the peak of the transaminase elevation were anti-HAV positive by RIA but only one out of two were positive by IAHA. The anti-HAV titre by RIA increased from the time of the appearance of jaundice and the highest titres, over 1/20000 were seen only after several months. Observations of subjects in close contact with patients who seroconverted without any manifestation of hepatitis, confirmed the existence of clinically mute infections.

A new radioimmunoassay (RIA) procedure using a double-sandwich technique was developed for the detection of hepatitis A antigen (HAV) in crude faecal extracts for patients involved in three outbreaks of type A hepatitis. Stools were obtained from 24 residents suffering from acute hepatitis A and from six children who remained asymptomatic throughout the epidemic. In addition, the HAV detection was performed in sera from 13 patients with hepatitis. HAV was detected in stools as early as five days before and as late as five days after the onset of jaundice. In this procedure, positive activity was only found in stools from patients with type A hepatitis, but not in negative controls. HAV was not detected in acute-phase sera. The double-sandwich RIA test used appears to be a reliable test for the large-scale screening of HAV in stool samples from patients suffering from type A hepatitis.