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Birds, like most animals, are expected to adjust their foraging activity in response to biotic and abiotic variations to optimize energy intake and reduce costs associated with finding and ingesting food. This may lead to temporal variation in the exploitation of food resources, which has been investigated for birds of different feeding guilds but remains poorly understood for frugivorous species. Here, we tested whether the frugivory activity of birds on Schinus terebinthifolia trees varies throughout the day during the austral autumn and winter and whether variation is related to weather conditions. For two consecutive years, we quantified frugivory events for 304 h in 19 individuals of S. terebinthifolia observed across four time periods throughout the day. We found that the number of frugivory events was similar irrespective of the time period, both for the entire assemblage (all species pooled together) and for the most common species analyzed individually. We additionally found that frugivory activity was slightly influenced by temperature and wind. The lack of any effect of daytime period on fruit consumption may relate to the high and prolonged levels of fruit availability in S. terebinthifolia and the short photoperiod of the autumn–winter, which favors frequent feeding throughout the day. Such constant removal of fruits by a diverse assemblage of generalist fruit consumers probably enhances seed dispersal and may have important implications for the population dynamics of this abundant plant. Our results also demonstrate that data on avian frugivory in temperate, open-vegetation environments can be quantified throughout the entire daytime during the cold season without temporal bias, which has important methodological implications for studies on bird–plant interactions.

Objective Microprolactinomas are currently treated with dopamine agonists. Outcome information on microprolactinoma patients treated by surgery is limited. This study reports the first large series of consecutive non-invasive microprolactinoma patients treated by pituitary surgery and evaluates the efficiency and safety of this treatment. Design Follow-up of a cohort of consecutive patients treated by surgery. Methods Between January 2008 and October 2020, 114 adult patients with pure microprolactinomas were operated on in a single tertiary expert neurosurgical department, using an endoscopic endonasal transsphenoidal approach. Eligible patients presented with a microprolactinoma with no obvious cavernous invasion on MRI. Prolactin was assayed before and after surgery. Disease-free survival was modeled using Kaplan–Meier representation. A cox regression model was used to predict remission. Results Median follow-up was 18.2 months (range: 2.8–155). In this cohort, 14/114 (12%) patients were not cured by surgery, including ten early surgical failures and four late relapses occurring 37.4 months (33–41.8) after surgery. From Kaplan–Meier estimates, 1-year and 5-year disease free survival was 90.9% (95% CI: 85.6–96.4%) and 81% (95% CI: 71.2–92.1%) respectively. The preoperative prolactinemia was the only significant preoperative predictive factor for remission (P < 0.05). No severe complication was reported, with no anterior pituitary deficiency after surgery, one diabetes insipidus, and one postoperative cerebrospinal fluid leakage properly treated by muscle plasty. Conclusions In well-selected microprolactinoma patients, pituitary surgery performed by an expert neurosurgical team is a valid first-line alternative treatment to dopamine agonists.

International audience; The aim of this review was to update the recommendations for optimal pain management after open and laparoscopic or robotic prostatectomy. Optimal pain management is known to influence postoperative recovery, but patients undergoing open radical prostatectomy typically experience moderate dynamic pain in the immediate postoperative day. Robot-assisted and laparoscopic surgery may be associated with decreased pain levels as opposed to open surgery. We performed a systematic review using Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) with PROcedure SPECific Postoperative Pain ManagemenT (PROSPECT) methodology. Randomised controlled trials (RCTs) published in the English language, from January 2015 until March 2020, assessing postoperative pain, using analgesic, anaesthetic and surgical interventions, were identified from MEDLINE, EMBASE and Cochrane Databases. Of the 1797 studies identified, 35 RCTs and 3 meta-analyses met our inclusion criteria. NSAIDs and COX-2 selective inhibitors proved to lower postoperative pain scores. Continuous intravenous lidocaine reduced postoperative pain scores during open surgery. Local wound infiltration showed positive results in open surgery. Bilateral transversus abdominis plane (TAP) block was performed at the end of surgery and lowered pain scores in robot-assisted procedures, but results were conflicting for open procedures. Basic analgesia for prostatic surgery should include paracetamol and NSAIDs or COX-2 selective inhibitors. TAP block should be recommended as the first-choice regional analgesic technique for laparoscopic/robotic radical prostatectomy. Intravenous lidocaine should be considered for open surgeries.

With approximately 67 million individuals affected worldwide, autism spectrum disorder (ASD) is the fastest growing neurodevelopmental disorder (United Nations, 2011), with a prevalence estimated to be 1/100. In France ASD affects approximately 600,000 individuals (from childhood to adulthood, half of whom are also mentally retarded), who thus have a major handicap in communication and in adapting to daily life, which leads autism to be recognized as a national public health priority. ASD is a neurodevelopmental disorder that affects several domains (i.e., socio-emotional, language, sensori-motor, executive functioning). These disorders are expressed early in life with an age of onset around 18 months. Despite evidence suggesting a strong genetic link with ASD, the genetic determinant remains unclear. The clinical picture is characterized by impairments in social interaction and communication and the presence of restrictive and repetitive behaviors (DSM-5, ICD-10). However, in addition to these two main dimensions there is significant comorbidity between ASD and other neurodevelopmental disorders such as attention deficit hyperactivity disorder or with genetic and medical conditions. One of the diagnostic features of ASD is its early emergence: symptoms must begin in early childhood for a diagnosis to be given. Due to brain plasticity, early interventions are essential to facilitate clinical improvement. Therefore, general practitioners and pediatricians are on the front line to detect early signs of ASD and to guide both medical explorations and early rehabilitation.

Objectif Le debriefing est un element fondamental de l’apprentissage par simulation pleine echelle en sciences de la sante, mais reste un processus complexe et difficile a apprehender. L’objectif de cet article est de definir le debriefing postsimulation, d’en preciser les objectifs et de degager les grands principes du debriefing au regard des donnees de la litterature.

Introduction Les biotherapies anti-TNFα (infliximab et adalimumab, principalement) sont utilisees pour traiter les sarcoidoses severes et/ou refractaires. L’etude STAT a montre une reponse clinique dans 64 % des cas, principalement pour les atteintes neurologiques, cardiaques, cutanees, et ORL [1] . Il n’y a, cependant, pas de donnees concernant le profil et le devenir des patients non repondeurs aux anti-TNFα. Objectif Decrire les patients non repondeurs inclus dans le registre national francais des sarcoidoses traitees par anti-TNFα (STAT). Patients et methodes Etude de cohorte retrospective a partir d’un appel a observations national en juillet 2014. Etaient inclus les patients atteints de sarcoidose histologiquement prouvees et/ou de neurosarcoidose probable selon la classification de Zajicek consideres comme non-repondeurs aux anti-TNFα. Resultats Parmi 132 patients, 14 patients etaient identifies comme refractaires aux anti-TNFα. Cinq patients ont ete exclus (un deces, 3 donnees manquantes, 1 diagnostic final alternatif). L’âge median des 9 patients inclus, (6 femmes) etait de 48 ans (29–70) a l’initiation des anti-TNFα. La maladie atteignait en moyenne 4,2 organes et les patients avaient recu en moyenne 2 traitements immunosuppresseurs (IS) avant les anti-TNFα. Huit patients avaient recus de l’infliximab et un patient avait recu 3 anti-TNFα differents. Quatre patients recevaient un IS en meme temps que les anti-TNFα. La duree mediane de traitement anti-TNFα etait de 7 mois (3–24). Apres un suivi median de 35 mois (19–128) post-traitement anti-TNFα, 2 patients avaient finalement une reponse complete, 5 avaient une reponse partielle et 2 avait une maladie evolutive. Les patients recevaient en moyenne 2 nouvelles lignes de traitements IS. Les traitements de premiere ligne etaient le methotrexate (n = 5) et le cyclophosphamide (n = 2). Dans 6 cas, la reponse clinique etait obtenue avec un traitement IS recu anterieurement par le patient. Conclusion Dans les sarcoidoses refractaires, les immunosuppresseurs conservent leur utilite meme en cas d’echec des anti-TNFα.

Background The application of safety principles from the aviation industry to the operating room has offered hope in reducing surgical complications. This study aimed to assess the impact on major surgical complications of adding an aviation-based team training programme after checklist implementation. Methods A prospective parallel-group cluster trial was undertaken between September 2011 and March 2013. Operating room teams from 31 hospitals were assigned randomly to participate in a team training programme focused on major concepts of crew resource management and checklist utilization. The primary outcome measure was the occurrence of any major adverse event, including death, during the hospital stay within the first 30 days after surgery. Using a difference-in-difference approach, the ratio of the odds ratios (ROR) was estimated to compare changes in surgical outcomes between intervention and control hospitals. Results Some 22 779 patients were enrolled, including 5934 before and 16 845 after team training implementation. The risk of major adverse events fell from 8·8 to 5·5 per cent in 16 intervention hospitals (adjusted odds ratio 0·57, 95 per cent c.i. 0·48 to 0·68; P < 0·001) and from 7·9 to 5·4 per cent in 15 control hospitals (odds ratio 0·64, 0·50 to 0·81; P < 0·001), resulting in the absence of difference between arms (ROR 0·90, 95 per cent c.i. 0·67 to 1·21; P = 0·474). Outcome trends revealed significant improvements among ten institutions, equally distributed across intervention and control hospitals. Conclusion Surgical outcomes improved substantially, with no difference between trial arms. Successful implementation of an aviation-based team training programme appears to require modification and adaptation of its principles in the context of the the surgical milieu. Registration number: NCT01384474 (http://www.clinicaltrials.gov).

The present paper deals with specific safety issues resulting from the coupling of a nuclear reactor (very high temperature reactor, VHTR) with a hydrogen production plant (HYPP). The first part is devoted to the safety approach consisting in taking into account the safety standards and rules dedicated to the nuclear facility as well as those dedicated to the process industry. This approach enabled two main families of events to be distinguished: the so-called internal events taking place in the coupling circuit (transients, breaks in pipes and in heat exchangers) and the external events able to threat the integrity of the various equipments (in particular the VHTR containment and emergency cooling system) that could result from accidents in the HYPP. By considering a hydrogen production by means of the iodine/sulfur (IS) process, the consequences of the both families of events aforementioned have been assessed in order to provide an order of magnitude of the effects of the incidents and accidents and also in order to propose safety provisions to mitigate these effects when it is necessary. The study of transients induced by a failure of a part of the HYPP has shown the possibility to keep the part of the HYPP unaffected by the transient under operation by means of an adapted regulation set. Moreover, the time to react in case of transfer of corrosive products in the VHTR containment has been assessed as well as the thermohydraulic loading that would experience the coupling pipes in case of very fast uncoupling of the facilities aiming at avoiding an excessive pressurization of the VHTR containment. Regarding the external events, by applying a method used in the process industries, the bounding representative scenarios have been identified on the basis of their consequences but also on the basis of their occurrence frequency. The consequences of the selected bounding scenarios, calculated taking into the source-term, the atmospheric dispersion and the pressure and toxic effects induced respectively by a hydrogen unconfined vapour cloud explosion (UVCE) and a sulfur dioxide release have been assessed. The resulting safety distance of about 100 m for the UVCE is fairly acceptable in terms of performance (head loss and thermal loss) of the coupling system. However, the longer safety distance (about 1.5 km) calculated for a SO 2 release implies to foresee a long distance to settle the control room of the site or to foresee provisions able to stop very fast the SO 2 leak.

The aims of the present study were to estimate the prevalence of renal impairment (RI) among HIV-infected adult patients and to investigate the associated factors.A cross-sectional survey was conducted in a French hospital-based cohort. Clearance of creatinine (CC) was calculated using the Cockcroft-Gault formula. Four stages of RI were defined: mild (60-90 mL/min), moderate (30-60), severe (15-30) and end stage (15). Logistic regression models were used to investigate factors associated with RI.The male/female ratio of the 2588 patients enrolled was 3:1 and the median age was 42 years. At the time of assessment of CC, the median CD4 count was 430 cells/microL and HIV plasma viral load (VL) was50 copies/mL in 60%. The overall prevalence of RI was 39.0%: 34.2% mild, 4.4% moderate, 0.3% severe and 0.2% end-stage. Mild RI was associated with female gender [odds ratio (OR)=3.3: 95% CI 2.6-4.3)], age50 years (OR=9.8: 7.4-13.0) and 40-50 years (OR=1.9: 1.5-2.4), body mass index (BMI)22 kg/m(2) (OR=3.3: 2.7-4.3) and tenofovir exposure (OR=1.4: 1.0-1.9 for1 year and OR=1.5: 1.2-2.0 for1 year). Advanced RI (CC60 mL/min) was associated with age50 years (OR=5.6: 2.9-10.9) and 40-50 years (OR=2.2: 1.1-1.4), BMI22 kg/m(2) (OR=1.5: 1.0-2.4), hypertension (OR=2.5: 1.4-2.5) and indinavir (IDV) exposure1 year (OR=2.3: 1.5-3.6).This survey confirms the high prevalence of RI in HIV-infected patients and indicates the importance of the investigation of renal function especially in women, older patients, those with a low BMI or treated with tenofovir or IDV.

A simple strategy for covalently attaching Ta2O5 particles onto functionalized graphitic carbon supports has been developed to fabricate hybrid nanocomposites. In this process, tantalum ethoxide was directly reacted with functional groups on the carbon surface to form covalent bonding, which caused the carbonyl stretches of the carbon supports to be blue-shifted to 50-70 cm-1 after Ta2O5 particle deposition. Homogeneously distributed Ta2O5 particles with smaller than 100 nm have been homogeneously deposited on the carbon supports. X-ray diffraction (XRD), FT-IR spectroscopy, and scanning electron microscopy (SEM) have been used to study the formation of Ta2O5/C hybrid structure.

Background More than 10 years after the introduction of combination antiretroviral therapy (cART), we examined the trend in the proportion of deaths caused by end-stage liver disease (ESLD) in HIV-infected adults in France between 1995 and 2005. Design and methods In 2005, 34 departments prospectively recorded all deaths in HIV-infected patients who were followed in those departments (around 24 000). Results were compared with those of four previous cross-sectional surveys conducted since 1995 using the same methodology. Results Among 287 reported deaths in 2005, 100 (35%) were related to AIDS, and 48 (17%) to ESLD. Three out of four patients who died from ESLD-related causes had chronic hepatitis C. Excessive alcohol consumption was reported in approximately half of the patients (48%). At death, 62% of patients had undetectable HIV viral load and the median CD4 count was 237 cells/μL. From 1995 to 2005, the proportion of deaths caused by ESLD increased from 2 to 17% (P

We present our experience, spanning more than 10 years of teaching a course on ‘ethics and engineering’ for a group of MSc programmes in applied sciences at Delft University of Technology. The course is taught by a team of teachers from the faculty of Applied Sciences and from the department of Philosophy of the Faculty of Technology, Policy and Management, on a basis of complementarity and equality. We call it the Joint Venture teaching model. We conclude that the Joint Venture teaching model, in combination with the contents and teaching methods of the course, are successful. The course is a positively perceived element in the curricula. But we also point to a threat to the Joint Venture teaching model. As it may not be very attractive for staff from a technical faculty to participate in this kind of teaching, the availability of motivated and qualified staff from a technical faculty may be a problem. Mitigation of this threat requires sustained commitment from a technical faculty, and hence this is a n...

The purpose of benchmarking is to settle improvement processes by comparing the activities to quality standards. The proposed methodology is illustrated by benchmark business cases performed inside medical plants on some items like nosocomial diseases or organization of surgery facilities. Moreover, the authors have built a specific graphic tool, enhanced with balance score numbers and mappings, so that the comparison between different anesthesia-reanimation services, which are willing to start an improvement program, is easy and relevant. This ready-made application is even more accurate as far as detailed tariffs of activities are implemented.

The main idea developed in this paper is a novel biconverter structure to supply a doubly fed induction machine (DFIM). Two voltage source inverters (VSIs) feed the stator and rotor windings. The outputs of the two VSIs are combined electromechanically in the machine, and as a result, novel features can be obtained. For example, for high power drive applications, this configuration uses two inverters dimensioned for a half of the DFIM power. A new dual direct torque control is developed with flux model of DFIM. Two switching tables linked to VSI are defined for stator and rotor flux vector control. The satisfactory experimental and simulation results are shown, and they confirm good dynamic behavior in four quadrants of the speed-torque plane. Moreover, experimental results show the correct flux vector control behavior and speed tracking performances.

Resume Objectifs Synthetiser les preuves les plus recentes sur l'utilite et l'innocuite des anti-inflammatoires utilises en perioperatoire. Source des donnees Les references ont ete obtenues par interrogation des bases de donnees electroniques (termes medicaux : AINS, coxibs, steroides, chirurgie, anesthesie) puis completes par une recherche manuelle. Synthese des donnees Les AINS, les coxibs et les steroides utilises seuls ou en association se sont montres efficaces pour traiter la douleur postoperatoire. Cependant, le benefice perioperatoire des anti-inflammatoires peut aller au-dela de l'analgesie postoperatoire. Les anti-inflammatoires se sont reveles efficaces dans certaines situations pour diminuer l'incidence des effets secondaires des morphiniques et des nausees-vomissements postoperatoires ou pour ameliorer la recuperation apres une chirurgie. Toutefois, les AINS ont ete reconnus comme etant un facteur de risque pour la reprise chirurgicale apres certains actes chirurgicaux. A l'inverse, les coxibs sont impliques dans la survenue de thromboses arterielles apres certaines chirurgies.

Les auteurs ont realise une etude multicentrique en ouvert pour evaluer l’efficacite et la tolerance de Gripponyl®, medication phytotherapique a base de quinquina, de saule et de the vert. Le produit est administre par voie orale a des patients atteints de symptomes grippaux.

Polydactyly is the most common congenital limb anomaly occurring both as an isolated defect or as part of a syndrome. However mirror foot is an exceptional abnormality (14 cases reported). The authors describe two sporadic cases of mirror foot. The first case presents a mirror polydactyly of the left foot, an hexadactyly of the right foot and a central polysyndactyly of both hands. The second case presents a mirror polydactyly of both feet. Mirror foot is a very rare defect. Both sporadic and familiar cases have been reported. This malformation can affect one or both feet. Some cases are associated with other congenital anomalies. The definition of mirror foot is warying according to the authors and the review of literature shows an important variability in the patterns of mirror polydactyly. Mirror duplication of hands and feet result of aberrant positioning of the zone of polarizing activity in relation to the apical ectodermal ridge during limb bud development. Different genes encoding limb pattern have been described.

The thermodynamic equilibrium between metallic iron, iron oxides, iron carbides and an hydrocarbon/hydrogen mixture was calculated at 600 °C. On the basis of the metastable Fe-C-O phase diagram, both metallic iron and iron oxides can be directly convertcd into carbides in reducing and carburizing atmosphere. Thermogravimetric (ATG) measurements have been performed in iC 4 H 10 -H 2 -Ar atmosphere at 600 °C on reduced and pre-oxidised iron samples. The kinetic of coke formation was studied on both surface states by sequential exposure experiments. The initial stages of the transformation were characterised by scanning electron microscopy (SEM) observations and X-ray diffraction (XRD) analysis. On a reduced surface, the results are consistent with the mechanism currently proposed to explain catalytic coke formation. Cementite (Fe 3 C) is formed on the iron surface after carbon supersaturation (a c > 1). The graphite deposition on its surface (a c = 1) induces its decomposition. Iron atoms from cementite diffuse through the graphite and agglomerate to small particles that act as catalysts for further carbon deposition. A new mechanism of catalytic particle formation is proposed when an oxide scale initially covers the iron surface. In the carburizing and reducing atmosphere, magnetite (Fe 3 O 4 ) can be directly converted into cementite (Fe 3 C). XPS analysis confirm that, in this process, metallic iron is not an intermediary specie of the oxide/carbide reaction. At the same time, graphite deposition occurs at the metal/oxide interface through the cracks present in the oxide scale. Iron carbide in contact with graphite is partially decomposed and acts as catalyst for graphitic filaments growth.

In France, watr services are under municipal responsibility. They can be managed, either by municipalities themselves, or by private companies through delegation contracts. Whatever the situation is, water management remain under state control. The law of 29 January 1993 known as “Sapin Act” limits the duration of the contracts of delegation and imposes a procedure of publicity and consultation preliminary to their conclusion or their renewal. A study has been led from 1998 by our laboratory on the impact of this competition between private companies on the delegation contracts and their price. The main conclusions are the following:Including water and wastewater contracts, the procedure of competition led to an average fall of 10% of the price paid to the contractor. The most significant falls concern services of more than 20 000 inhabitants;If the global distribution of the contracts between the three major companies in this sector is not basically modified, one notes an increasingly marked presence of independent private operators;The duration of the contracts is in reduction, on average, from 17 to 11 years. Then, it appears that the procedure instituted by the law of 29 January 1993 allowed a better exercise of competition between the private companies. The municipalities, mainly the smallest, encounter difficulties in the course of the procedure, and this is the reason why they expressed strong expectations in regard to the services of consulting. The progressive development of associations of municipalities makes it possible for the municipalities to obtain more favourable contractual conditions. This study makes it possible to follow the evolution of the number of procedures initiated pursuant to the law of 29 January 1993: nearly 300 in 1997, 582 in 1998 and 684 in 1999. In 2005, most of the 12,000 French contracts would have been renegotiated, a figure which shows the economical impact on water services.

Background After cardiac surgery adequate postoperative analgesia is necessary. We assessed analgesia using intrathecal morphine and clonidine. Methods In a double-blind randomized study, 45 patients having coronary artery bypass graft surgery were allocated randomly to receive i.v. patient-controlled analgesia (PCA) morphine (bolus, 1 mg; lock-out interval, 7 min) (control group), either alone or combined with intrathecal morphine 4 μg kg −1 or with both intrathecal morphine 4 μg kg −1 and clonidine 1 μg kg −1 . Intrathecal injections were performed before the induction of general anaesthesia. Pain was measured after surgery using a visual analogue scale (VAS). We recorded i.v. PCA morphine consumption during the 24 h after operation. Results Morphine dosage [median (25th–75th percentiles)] was less in the first 24 h in the patients who were given intrathecal morphine + clonidine [7 (0–37) mg] than in other patients [40.5 (15–61.5) mg in the intrathecal morphine group and 37 (30.5–51) mg in the i.v. morphine group]. VAS scores were lower after intrathecal morphine + clonidine compared with the control group. Time to extubation was less after intrathecal morphine + clonidine compared with the i.v. morphine group [225 (195–330) vs 330 (300–360) min, P Conclusion Intrathecal morphine and clonidine provide effective analgesia after coronary artery bypass graft surgery and allow earlier extubation.

Platinum thin films are suitable candidates as electrodes for high permittivity and ferroelectric oxides. Pt films were prepared by metal organic chemical vapor deposition (MOCVD) using a direct liquid delivery system. This method is based on the oxidative decomposition of (methylcyclopentadienyl)trimethylplatinum (MeCpPtMe3), as a precursor, diluted in cyclohexane solvent. Different deposition conditions were used to grow high purity platinum films on TiO2/SiO2/Si and SiO2 substrates. Adhesion properties of the Pt CVD films on TiO2 were found to be better than directly on SiO2 since TiO2 acts as a 'glue layer'. Platinum films deposited exhibit a roughness ranged from 3.1 to 4.5 nm and a thickness between 60 and 100 nm.

Resume Objectifs : Presenter des questionnaires d’enquete et un logiciel informatique specifique pour le traitement des donnees, permettant la realisation de demarches d’assurance qualite dans le domaine de la prise en charge des douleurs postoperatoires. Type d’etude : Etude descriptive. Methodes : Un comite de pilotage forme de medecins anesthesistes, d’infirmier(e)s et d’epidemiologistes a elabore et teste trois questionnaires d’enquetes pour evaluer la satisfaction des patients, du personnel infirmier et medical. A partir de la version definitive des questionnaires, un logiciel specifique a ete cree, permettant une analyse rapide des points de dysfonctionnements dans l’organisation de la prise en charge des douleurs postoperatoires. Apres cette mise au point, ce materiel a ete employe dans trois etablissements hospitaliers differents (A, B et C). Resultats : Les resultats des enquetes effectuees ont pu etre pris en consideration, quand le taux des repondeurs etaient superieur a 50 %. Les points de dysfonctionnement ont ete classes en 4 niveaux : le point de vue des patients (ex : les douleurs postoperatoires persistaient pour plus de 50 % des patients), le bilan des pratiques (ex : 42 a 72 % des soignants declaraient connaitre les protocoles antalgiques en vigueur dans leur service), le bilan des attitudes (ex : 19 a 34 % des soignants pensaient encore qu’une douleur de base est utile pour la surveillance) et le potentiel du service (ex : 21 a 61 % du personnel infirmier et medical avaient recu une formation specifique sur la prise en charge de la douleur). Les avantages et les inconvenients de ce materiel (questionnaires et logiciel) ont ete discutes et les modalites d’utilisation qui en decoulent ont ete definies. Conclusion : Le materiel expose ici devrait permettre aux equipes soignantes d’evaluer la qualite de l’organisation de la prise en charge des douleurs postoperatoires. Sa validation, qui est en cours, permettra de perfectionner cet outil en gardant les indicateurs les plus performants temoignant d’une prise en charge correcte de la douleur aigue postoperatoire.

The thermodynamic equilibria between metallic iron, iron oxides, iron carbides and a hydrocarbon/hydrogen mixture were calculated at 600°C. On the basis of metastable Fe-C-O phase diagram, iron oxides can be converted directly into carbides in a reducing and carburizing atmosphere. Experimental results on the rate of oxide/carbide conversion are reported. Thermogravimetric measurements have been performed in an iC 4 H 10 -H 2 -Ar atmosphere at 600°C on preoxidized iron samples. The kinetics of the oxide layer transformation were studied by sequential exposure experiments. Scanning electron microscopy observations and x-ray diffraction analysis have been carried out. The results lead to the conclusion that magnetite (Fe 3 O 4 ) is transformed into carbide particles, acting as a catalyst for graphitic filament growth. The initial stages of the oxide/carbide transition were studied by x-ray photoelectron spectroscopy. The results confirm that no metallic iron was formed during the transformation.

In this double-blind randomized study we compared a group of 15 patients undergoing thoracotomy who received a spinal injection of sufentanil 20 μg combined with morphine (200 μg) after induction of general anaesthesia with a control group of the same size. Post-operative pain was rated on a visual analogue scale (VAS) and a verbal rating scale at rest and with a VAS on coughing. In the recovery room, patients received titrated i.v. morphine until the VAS score was

SUMMARY During the last two decades, societal demands on engineering education to provide safe and environmentally benign technology have increased strongly. Delft University of Technology—and the Faculty of Chemical Engineering in particular—has been actively responding to these demands, when necessary by developing radically new educational programmes. The first educational programmes, started in the 1970s, integrated safety, health, the environment and often highly controversial ethical questions; these programmes are continuing. Typical of these programmes is a broadness of approach. Students receive training in the physical-chemical-biological fundamentals of risks posed by engineering, as well as social-philosophical aspects as they study controversial and value-laden contemporary issues, such as biotechnology, energy provision, and possible climate change. The Delft programmes, in many respects still unique and daring even today, have been in use for more than 20 years already and have been applied...

A 72-yr-old patient was to undergo a left lumbar plexus block by the posterior approach to achieve postoperative analgesia after hip replacement. The block failed after three unsuccessful attempts to identify nerve structures and a fascia iliaca compartment block was performed. Postoperatively the patient received enoxaparin and then phenylindanedione for thromboprophylaxis. She was re-admitted 2 weeks after surgery because of a lower limb motor deficit and a left retroperitoneal haematoma requiring blood transfusion. Clinicians need to be aware of this potential complication of lumbar plexus block in patients receiving thrombphylaxis.

The aim of this systematic review was to evaluate the available literature on the management of pain after laparoscopic colorectal surgery.Randomized studies, published in English between January 1995 and July 2011, assessing analgesic and anaesthetic interventions in adults undergoing laparoscopic colorectal surgery, and reporting pain scores, were retrieved from the Embase and MEDLINE databases. The efficacy and adverse effects of the analgesic techniques was assessed. The recommendations were based on procedure-specific evidence from a systematic review and supplementary transferable evidence from other relevant procedures.Of the 170 randomized studies identified, 12 studies were included. Overall, all approaches including ketorolac, methylprednisolone, intraperitoneal instillation of ropivacaine, intravenous lidocaine infusion, intrathecal morphine and epidural analgesia improved pain relief, reduced opioid requirements and improved bowel function. However, there were significant differences in the study designs and the variables evaluated, precluding quantitative analysis. The L'Abbé plots of the data from the epidural analgesia studies included in this review indicate that the pain scores in the nonepidural groups, although higher than those in the epidural groups, were within an acceptable level (i.e. 4/10).Infiltration of surgical incisions with local anaesthetic at the end of surgery, systemic steroids, conventional nonsteroidal anti-inflammatory drugs or cyclooxygenase-2-selective inhibitors in combination with paracetamol with opioid used as rescue are recommended. Intravenous lidocaine infusion is recommended, but not as the first line of therapy. However, neuraxial blocks (i.e. epidural analgesia and spinal morphine) are not necessary based on high risk:benefit ratio.

Extradural clonidine produces analgesia, with sedation, hypotension and bradycardia, in postoperative patients. This study assessed if oral yohimbine would reverse these side effects. We studied 30 ASA I-II patients undergoing orthopaedic surgery. After operation they were allocated randomly to three groups to receive placebo, extradural clonidine 450 micrograms or extradural clonidine 450 micrograms plus oral yohimbine 16 mg. Pain score was measured on a visual analogue scale (VAS); sedation was assessed on a simple scale graded from 0 (awake and alert) to 3 (deeply sedated, awakening after tactile stimulations) and heart rate and arterial pressure were monitored for 5 h. Yohimbine reversed the sedation induced by extradural clonidine, but also shortened the duration of analgesia (31 (SD 15) min, 186 (72) min and 126 (52) min in the placebo, extradural clonidine and extradural clonidine+yohimbine groups, respectively) (P0.05), and did not reduce the hypotension and bradycardia related to clonidine administration. These results suggest that alpha 2 adrenoceptors are mediators of the sedation induced by clonidine and that the haemodynamic effects are not related to stimulation of supraspinal alpha 2 receptors.

In order to explore new types of jet ventilation, we tested a tracheal gas injection tube (TGIT) which included six thin capillaries and provided high pressure injection. The driving pressure was chosen to yield a plateau of inspiratory tracheal pressure of 10 cm H2O. An original controller was built to monitor spirometry and trigger injection in order to deliver both pressure controlled ventilation (PCVTGIT) and a new mode of inspiratory pressure support jet ventilation (IPSTGIT). The PVCTGIT mode maintained the same end-tidal carbon dioxide concentration as conventional ventilation with the same tidal and minute ventilation. We studied 10 patients after abdominal surgery. During spontaneous breathing, the patients were allowed to breathe through the tube, successively with and without IPSTGIT. IPSTGIT, compared with spontaneous breathing increased minute ventilation (from 5.7 (SD 1.6) to 7.1 (1.7) litre min-1) (P less than 0.001). It reduced the total work of breathing (from 0.625 (0.223) to 0.263 (0.151) J litre-1, respectively) (P less than 0.01) and the occlusion pressure (from 2.62 (1.28) to 1.36 (0.74) cm H2O, respectively) (P less than 0.01). It is concluded that this TGIT used with a specific system for sensing and triggering ventilation allows inspiratory pressure support during low frequency jet ventilation.

BackgroundContinuous intravenous administration of lidocaine may decrease the duration of ileus and pain after abdominal surgery.MethodsThree databases (Medline, Embase and the Cochrane Controlled Trials Register) were searched to retrieve randomized controlled trials comparing continuous intravenous lidocaine infusion during and after abdominal surgery with placebo. Study design was scored using the Oxford Quality Score based on randomization, double-blinding and follow-up. Outcome measures were duration of ileus, length of hospital stay, postoperative pain, and incidence of nausea and vomiting.ResultsEight trials were selected. A total of 161 patients received intravenous lidocaine, with 159 controls. Intravenous lidocaine administration decreased the duration of ileus (weighted mean difference (WMD) − 8·36 h; P < 0·001), length of hospital stay (WMD − 0·84 days; P = 0·002), postoperative pain intensity at 24 h after operation on a 0–100-mm visual analogue scale (WMD − 5·93 mm; P = 0·002), and the incidence of nausea and vomiting (odds ratio 0·39; P = 0·006).ConclusionContinuous intravenous administration of lidocaine during and after abdominal surgery improves patient rehabilitation and shortens hospital stay.