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L’épuration extrarénale (EER) fait partie des soins les plus complexes pour un(e) infirmier(e) (IDE) en réanimation, quelle que soit la technique utilisée. Elle concerne en effet des patients parmi les plus fragiles et nécessite de nombreuses connaissances théoriques et pratiques. Elle est par ailleurs, probablement, très consommatrice de temps. Or, l’EER n’est que rarement ou mal enseignée dans les instituts de formation en soins infirmiers. Cela conduit à un apprentissage, le plus souvent imparfait, par compagnonnage, avec pour conséquences la génération de « stress », une hétérogénéité des pratiques, une éventuelle augmentation du temps dédié à ce soin, voire une surconsommation de consommables. Finalement, il peut en résulter une mauvaise qualité d’épuration, ce qui est le plus dommageable pour le patient. Nous rapportons les résultats préliminaires de l’expérience d’un centre hospitalier général visant à améliorer ce soin. Celle-ci est originale, car fondée sur le ressenti des infirmier(e)s et aboutissant à une démarche d’amélioration des pratiques professionnelles fondée sur l’élaboration d’un livret de poche permettant de répondre à toutes les questions que pourraient se poser les IDE de réanimation lors de la réalisation de ce soin. Renal replacement therapies (RRT) are treatments requiring the most complex nursing care in the intensive care unit (ICU), regardless of the technique used. It involves some of the most fragile patients and requires a great deal of theoretical and practical knowledge. It is generally thought to be time-consuming. Moreover, it is rarely or poorly taught in nurse training institutes. This leads to an apprenticeship, most often imperfect, by companionship, the generation of “stress,” an heterogeneity of practices, possibly an increase in time dedicated to this care or even overconsumption of consumables, and finally, which is the most damaging for the patient, poor quality of purification. We report the preliminary original experience of a general hospital to improve this care. It is based on the nurses’ feeling regarding RRT and has led to an improvement policy on professional practices based on the development of a pocket booklet likely to answer all questions about RRT practical issues asked by ICU nurses.

Strokes have especially devastating implications if they occur early in life; however, only limited information exists on the characteristics of acute cerebrovascular disease in young adults. Although risk factors and manifestation of atherosclerosis are commonly associated with stroke in the elderly, recent data suggests different causes for stroke in the young. We initiated the prospective, multinational European study Stroke in Young Fabry Patients (sifap) to characterize a cohort of young stroke patients.

In this work EBIT measurements in the spectral range of 4-7 nm with electron energies from 0.7 keV to 4 keV are compared in detail with tokamak spectra from ASDEX Upgrade. The energy and temperature dependence of spectral lines and features are investigated and an identification of the charge states W39+-W45+for spectral lines between 4.5 nm and 6.5 nm is possible by taking cross sections from atomic data produced by plane-wave Born calculations via the Cowan code. In the range 12-14 nm the identification of spectral lines emitted by tungsten is improved even though no EBIT measurements are available, as special tokamak discharges have provided ideal possibilities for analysis. These discharges show spectra which are dominated by the emissions from a small region with a narrow electron temperature range. Therefore, only very few ion states contribute to the emission in contrast to the usual case where in the tokamak spectra the emissions of a larger number of ion states are superimposed. Tokamak spectra for varying electron temperature are also used to investigate the correlation to EBIT spectra for the quasicontinuum feature at 5 nm which is emitted by ion states W27+-W35+. We conclude that the narrower features in the EBIT spectra at a certain electron beam energy result from the smaller number of coexisting ion states.

We have measured secondary electron emission from thin, clean foils of C, Al, Ti, Ni, and Cu bombarded with H+, C+, and O+, at energies between 0.3 and 1.2 MeV/amu for protons and 20 to 80 keV/amu for the heavy projectiles. We observe in some but not all cases a proportionality between the secondary electron yield and the stopping power, but such a proportionality seems to break down at the lower projectile energies used by us. The yields emitted in forward direction are generally somewhat larger than those emitted backwards. The results are discussed in the frame of an extended Sternglass model.

The electron-ion recombination rates of Ne10+ and D+ have been measured as a function of relative energy and electron density. We found a strong enhancement of e-Ne10+ recombination over expected radiative recombination rates below 1 meV relative energies, reaching a factor of 4 close to zero relative energy. Remarkably, the measured rate coefficients decrease as a function of electron density for both systems. Studies of recombination of D+ indicate that this density dependence may be due to temperature variations of the electron beam with the electron density.

Tissue polypeptide antigen (TPA) and prostatic acid phosphatase were both detected by radioimmunoassay in the sera of a male population (age>45 years) consulting the clinic for urological problems or check-up on treatment. Increased concentrations of TPA were associated mostly with advanced stages of prostatic carcinomas, parallel to PAP. Some enhanced TPA concentrations were detected with haematuria and adenomas of the prostate.

Retinoids influence the proliferation and differentiation of epithelial tissues. Preliminary results of a double-blind randomized trial in the prevention of recurrent superficial bladder tumors are promising. Patients treated with an oral etretinate tend to have less tumor recurrences and transurethral resections. The number of multifocal recurrences after 12 months of treatment is significantly lower (p less than 0.02). There also are less dropouts owing to inefficacy of treatment (p less than 0.036).