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Objective: To analyse relevant literature and to express an expert point of view concerning the interest of electroencephalography and evoked potentials recordings in the evaluation of severe head trauma in adults in the context of a consensus conference.Material and methods: Scientific databases have been checked on the Internet using key-words.The summaries of 340 papers have checked out. Consequently 94 papers have been thoroughly analysed. Fifty-nine of them are cited in the text of this paper.Results: Electroencephalography (EEG) and evoked potentials (Eps) evaluate the functional status of the brain. They augment the clinical examination. They are non invasive and easy to perform at patient''s bedside. The EEG evaluate globally the functional status of the brain but it is very sensitive to sedative and anaesthetic drugs. It can disclose subclinical or electroclinical epileptic seizures. When reactivity to sensory stimulations can be elicited, this can be considered a prognostic indicator for a good outcome. Evoked potentials are less influenced by sedative drugs. There are several types of evoked potentials, each one with a different localizing value. Brainstem auditory evoked potentials (or short-latency Eps) evaluate the auditory nerve and brainstem. When normal they have no specificity. When abnormal they are an indicator of a poor or bad outcome. Somatosensory and auditory middle-latency Eps evaluate the primary cortex. In coma due to traumatic brain injury the presence of primary cortex components is an indicator of a good outcome and its absence is an indicator of a poor outcome at least when there is no focal brain lesion as to have the primary cortex component to be absent. Event-related potentials evaluate associative brain areas. When they are present in a comatose patient they favor the idea that some cognitive processes are active and they have a high positive predictive value for a return to consciousness. The electrophysiological evaluation can help to identify atypical situations and pathologies close to coma, disclose nonconvulsive seizures and localize certain complications or dysfunctions in atypical cases. [Copyright &y& Elsevier]

The contribution regards a mathematical single-degree-of-freedom model of a slender structure vibrating in an air flow. Based on an experimental investigation, movement of such structures can be expressed by van der PolDuffing-type equations. Several particular configuration parameter settings for a white and non-white Gaussian random excitation together with deterministic harmonic forcing are considered and numerically analysed. The results support recently published analytic formulas.

Systematic low-cycle fatigue (LCF) experiments are carried out on additive manufactured AlSi10Mg specimens for several material conditions with varying layer thickness, heat treatment, building direction and surface quality. The deformation behaviour depends significantly on the heat treatment. It is outlined that the process control and heat treatment can produce fatigue properties comparable with the cast material, whereby an as-built specimen surface leads to a lifetime reduction in all cases. The experiments are accompanied with detailed metallo- and fractographic investigations. For all tested LCF specimens, the defect type and the failure origin defect size are characterized in terms of the √area parameter by using scanning electron microscopy. The failure of the specimen is mostly caused by lack of fusion surface or near-surface defects, whereby the defect size is determined by the SLM process parameters, such as building direction, surface quality and layer thickness. On the basis of the experimental data and the observed defects, a mechanism-based, deterministic lifetime model is developed and adapted to the specific damage mechanisms of the additive manufactured AlSi10Mg alloy.

Abstract: The knotting of an epidural catheter is a rare complication preventing catheter withdrawal. We report two cases of catheter knotting and subsequent impossible withdrawal with moderate repeated traction. Imaging by CT scan allowed visualisation in the epidural space of a loop and a real knot for the first and the second patient respectively. The common risk factor found was an excess in catheter length inserted. A surgical procedure was necessary for both patients. [Copyright &y& Elsevier]

The non-holonomic system represents a model of the ball tuned mass damper (TMD), as used to absorb vibration of selected engineering structures, where conventional absorber types are inapplicable. The device consists of a ball moving within a spherical cavity fixed with the structure. To deduce a governing differential system the Appel-Gibbs formulation has been employed. The non-linear mathematical model includes six degrees of freedom and three non-holonomic constraints. The system has an auto-parametric character. The homogeneous differential system in the normal form is formulated. Its general properties are investigated for various settings of non-homogeneous initial conditions. Several singular solutions are extracted and physically interpreted. In principal, they represent limits separating solution groups of a certain character. The shape and general character of regular solutions within individual domains staked out by these limits are analyzed in order to facilitate a practical application of this theoretical background.

Description of the subject. Alginate beads that release semiochemical compounds are interesting biological control devices used to attract the natural enemies of aphids in infested crops. Little information, however, is available about the impact of climatic factors on the release of semiochemicals from this diffusive system. Objectives. The objective of this scoping study was to investigate the impact of temperature, relative humidity and wind speed, on the release of E-β-caryophyllene from alginate beads. Method. The impact of the three climatic factors on the release of E-β-caryophyllene from alginate beads was evaluated using a Box-Behnken experimental design and a laboratory scale volatile collection system. The influence of relative humidity on bead water content and size, with and without this semiochemical, was also investigated using a gravimetric method and an easy-to-use photographic device, respectively. Results. The results showed that an increase in temperature caused a significant increase in the E-β-caryophyllene release rate. Neither relative humidity nor airflow, however, had a significant effect on the release of this semiochemical when relative humidity and wind speed ranged from 33% to 75% and from 6.61 x 10-4 m·s-1 to 2.05 x 10-2 m·s-1, respectively. The isotherm curves obtained were characteristic of food products and biopolymer materials. The isotherm shapes were not modified by the incorporation of the semiochemical into alginate beads, and showed an important increase in water content when relative humidity values exceeded 85%. Fortunately, this water content increase did not affect bead size, which facilitates the calculation of E-β-caryophyllene release. Conclusions. The present study shows for the first time the impact of the three main climatic factors on the release of E-β-caryophyllene from alginate beads. It allows learning more about how these biological control devices operate in order to optimize future field trials.

Fetal death is defined as the spontaneous cessation of cardiac activity after fourteen weeks of amenorrhea. In France, the prevalence of fetal death after 22 weeks is between 3.2 and 4.4/1000 births. Regarding the prevention of fetal death in the general population, it is not recommended to counsel for rest and not to prescribe vitamin A, vitamin D nor micronutrient supplementation for the sole purpose of reducing the risk of fetal death (Weak recommendations; Low quality of evidence). It is not recommended to prescribe aspirin (Weak recommendation; Very low quality of evidence). It is recommended to offer vaccination against influenza in epidemic periods and against SARS-CoV-2 (Strong recommendations; Low quality of evidence). It is not recommended to systematically look for nuchal cord encirclements during prenatal screening ultrasounds (Strong Recommendation; Low Quality of Evidence) and not to perform systematic antepartum monitoring by cardiotocography (Weak Recommendation; Very Low Quality of Evidence). It is not recommended to ask women to perform an active fetal movement count to reduce the risk of fetal death (Strong Recommendation; High Quality of Evidence). Regarding evaluation in the event of fetal death, it is suggested that an external fetal examination be systematically offered (Expert opinion). It is recommended that a fetopathological and anatomopathological examination of the placenta be carried out to participate in cause identification (Strong Recommendation. Moderate quality of evidence). It is recommended that chromosomal analysis by microarray testing be performed rather than conventional karyotype, in order to be able to identify a potentially causal anomaly more frequently (Strong Recommendation, moderate quality of evidence); to this end, it is suggested that postnatal sampling of the placental fetal surface for genetic purposes be preferred (Expert Opinion). It is suggested to test for antiphospholipid antibodies and systematically perform a Kleihauer test and a test for irregular agglutinins (Expert opinion). It is suggested to offer a summary consultation, with the aim of assessing the physical and psychological status of the parents, reporting the results, discussing the cause and providing information on monitoring for a subsequent pregnancy (Expert opinion). Regarding announcement and support, it is suggested to announce fetal death without ambiguity, using simple words and adapting to each situation, and then to support couples with empathy in the various stages of their care (Expert opinion). Regarding management, it is suggested that, in the absence of a situation at risk of disseminated intravascular coagulation or maternal vitality, the patient's wishes should be taken into account when determining the time between the diagnosis of fetal death and induction of birth. Returning home is possible if it's the patient wish (Expert opinion). In all situations excluding maternal life-threatening emergencies, the preferred mode of delivery is vaginal delivery, regardless the history of cesarean section(s) history (Expert opinion). In the event of fetal death, it is recommended that mifepristone 200mg be prescribed at least 24hours before induction, to reduce the delay between induction and delivery (Low recommendation. Low quality of evidence). There are insufficient data in the literature to make a recommendation regarding the route of administration (vaginal or oral) of misoprostol, neither the type of prostaglandin to reduce induction-delivery time or maternal morbidity. It is suggested that perimedullary analgesia be introduced at the start of induction if the patient asks, regardless of gestational age. It is suggested to prescribe cabergoline immediately in the postpartum period in order to avoid lactation, whatever the gestational age, after discussing the side effects of the treatment with the patient (Expert opinion). The risk of recurrence of fetal death after unexplained fetal death does not appear to be increased in subsequent pregnancies, and data from the literature are insufficient to make a recommendation on the prescription of aspirin. In the event of a history of fetal death due to vascular issues, low-dose aspirin is recommended to reduce perinatal morbidity, and should not be combined with heparin therapy (Low recommendation, very low quality of evidence). It is suggested not to recommend an optimal delay before initiating another pregnancy just because of the history of fetal death. It is suggested that the woman and co-parent be informed of the possibility of psychological support. Fetal heart rate monitoring is not indicated solely because of a history of fetal death. It is suggested that delivery not be systematically induced. However, induction can be considered depending on the context and parental request. The gestational age will be discussed, taking into account the benefits and risks, especially before 39 weeks. If a cause of fetal death is identified, management will be adapted on a case-by-case basis (expert opinion). In the event of fetal death occurring in a twin pregnancy, it is suggested that the surviving twin be evaluated as soon as the diagnosis of fetal death is made. In the case of dichorionic pregnancy, it is suggested to offer ultrasound monitoring on a monthly basis. It is suggested not to deliver prematurely following fetal death of a twin. If fetal death occurs in a monochorionic twin pregnancy, it is suggested to contact the referral competence center, in order to urgently look for signs of acute fetal anemia on ultrasound in the surviving twin, and to carry out weekly ultrasound monitoring for the first month. It is suggested not to induce birth immediately., (Copyright © 2024 The Authors. Published by Elsevier Masson SAS.. All rights reserved.)

Objectives: To define the different stages of spontaneous labour. To determine the indications, modalities of use and the effects of administering synthetic oxytocin. And to describe undesirable maternal and perinatal outcomes associated with the use of synthetic oxytocin., Method: A systematic review was carried out by searching Medline database and websites of obstetrics learned societies until March 2016., Results: The 1st stage of labor is divided in a latence phase and an active phase, which switch at 5cm of cervical dilatation. Rate of cervical dilatation is considered as abnormal below 1cm per 4hour during the first part of the active phase, and below 1cm per 2hours above 7cm of dilatation. During the latent phase of the first stage of labor, i.e. before 5cm of cervical dilatation, it is recommended that an amniotomy not be performed routinely and not to use oxytocin systematically. It is not recommended to expect the active phase of labor to start the epidural analgesia if patient requires it. If early epidural analgesia was performed, the administration of oxytocin must not be systematic. If dystocia during the active phase, an amniotomy is recommended in first-line treatment. In the absence of an improvement within an hour, oxytocin should be administrated. However, in the case of an extension of the second stage beyond 2hours, it is recommended to administer oxytocin to correct a lack of progress of the presentation. If dynamic dystocia, it is recommended to start initial doses of oxytocin at 2mUI/min, to respect at least 30min intervals between increases in oxytocin doses delivered, and to increase oxytocin doses by 2mUI/min intervals without surpassing a maximum IV flow rate of 20mUI/min. The reported maternal adverse effects concern uterine hyperstimulation, uterine rupture and post-partum haemorrhage, and those of neonatal adverse effects concern foetal heart rate anomalies associated with uterine hyperstimulation, neonatal morbidity and mortality, neonatal jaundice, weak suck/poor breastfeeding latch and autism., Conclusion: The widespread use of oxytocin during spontaneous labour must not be considered as simply another inoffensive prescription without any possible deleterious consequences for mother or foetus. Conditions for administering the oxytocin must therefore respect medical protocols. Indications and patient consent have to be report in the medical file., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Frailty in the elderly develops under the combined action of physiological aging, chronic diseases and life context. Malnutrition is often the cause or consequence and engenders physiological alterations due to decreased food consumption, the ability to eat and access to food. The objective of this study is to analyze, in a rehabilitation and treatment center for the elderly, the results of two scores of nutritional risk screening, the Nutritional Risk Screening (NRS) and the Mini Nutritional Assessment Short Form (MNA-SF) validated in the elderly and taking into account the clinical signs of fragility. In this study, the MNA-SF has a higher sensitivity and is the reference tool for routine screening in this population.

Preterm or sick neonates are frequently hampered in establishing a safe and efficient oral feeding. This can delay hospital discharge and impact on parent-child bonding, growth or neurodevelopment. Recent researches identified a pattern of interventions that could allow to reduce these troubles and to shorten hospital stays.

Several preliminary studies suggest that prophylactic administration of probiotics reduces the incidence of necrotizing enterocolitis (NEC) in preterm infants, and several neonatology units have introduced this treatment under strict surveillance. Nonetheless, breast milk feeding remains the mainstay of NEC prevention. The beta-blocker propranolol, known for its effectiveness on cutaneous hemangiomas, is also proving useful for the treatment of subglottic or visceral hemangiomas. Following the decrease in severe bacterial infections thanks to widespread vaccinations, the McCarthy clinical score has regained importance in the prediction of the risk of bacterial infection in febrile infants. It is easy to use, economical, and has a diagnostic value comparable to laboratory tests. The new WHO growth charts have been introduced in Switzerland in 2011 to take into account the increasing regional and ethnic variations in our country. Any significant change in growth velocity should prompt an evaluation of the need of further investigations.

Brainstem auditory evoked potentials (BAEP) monitoring is a useful tool to decrease the danger of hearing loss during pontocerebellar angle surgery, particularly in microvascular decompression (MVD). Critical complications arising during MVD surgery are the stretching of the VIII nerve - the main cause of hearing loss - labyrinthine artery manipulation, direct trauma with instruments, or a nearby coagulation, and at end of the surgery neocompression of the cochlear nerve by the prosthesis positioned between the conflicting vessel(s) and the VIIth-VIIIth nerve complex. All these dangers warrant the use of BEAP monitoring during the surgical team's training period. Based on delay in latency of peak V, we established warning thresholds that can provide useful feedback to the surgeon to modify the surgical strategy: the initial signal at 0.4 ms is considered the safety limit. A second signal threshold at 0.6 ms (warning signal for risk) corresponds to the group of patients without resultant hearing loss. The third threshold characterized by the delay of peak V is at 1 ms (warning signal for a potentially critical situation). BAEP monitoring provides the surgeon with information on the functional state of the auditory pathways and should help avoid or correct manoeuvres that can harm hearing function. BAEP monitoring during VIIth-VIIIth complex surgery, particularly in MVD of facial nerves for HFS is very useful during the learning period.

Background/purpose: Since otoneurosurgical pathologies are being diagnosed increasingly early, the functional prognosis of surgery is gaining in importance. Hearing and cochlear nerve exploration can be carried out using three principal methods: pure-tone and speech audiometry, evoked otoacoustic emissions (EOAEs), and brainstem auditory evoked potentials (BAEPs). The aim of this paper is to present the current knowledge on auditory functional assessment., Materials and Methods: The medical and scientific literature from the Pubmed-Medline database was reviewed. Recently published related books were also included. RESULTS/DATA SYNTHESIS: Preoperative audiological evaluation makes it possible to assess pathology consequences on hearing. Depending on auditory status, conservative surgery, including intraoperative auditory monitoring, can be planned. From this perspective, prognostic factors for hearing preservation - such as the speech intelligibility score, the presence of transient EOAEs, and the presence of the BAEPs wave III - were identified. However, several surgical teams argue for a systematic conservative procedure, particularly when EOAEs are present, whatever the patient's preoperative hearing status. Postoperative audiological evaluation provides the opportunity for monitoring: in the short term, to detect complications early, through BAEPs recorded in the nonoperated ear; in the long term, to detect recurrence of the pathology. Moreover, the consequences of surgery on hearing can be assessed and long-term follow-up of auditory function can be carried out. Finally, the comparison of pre- and postoperative audiological status provides inductive feedback on surgery and electrophysiological monitoring, giving the otoneurosurgeon and neurophysiologist the opportunity to improve the entire procedure., Conclusion: Auditory functional assessment is essential for optimal care of tumor or functional pathologies involving the cochlear nerve and/or the cerebellopontine angle.

The knotting of an epidural catheter is a rare complication preventing catheter withdrawal. We report two cases of catheter knotting and subsequent impossible withdrawal with moderate repeated traction. Imaging by CT scan allowed visualisation in the epidural space of a loop and a real knot for the first and the second patient respectively. The common risk factor found was an excess in catheter length inserted. A surgical procedure was necessary for both patients.