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Introduction In elderly patients, goal-directed haemodynamic therapy (GDHT), depth of anaesthesia monitoring and lung-protective ventilation have been shown to improve postoperative outcomes. The aim of this study was to evaluate current practices concerning strategies of anaesthesia optimisation in patients aged ≥ 75 years. Patients and methods A multicentre observational study was performed from February to May 2015 in 23 French academic centres. On 30 consecutive days in each centre, patients ≥ 75 years with at least one major comorbidity undergoing elective or emergency procedures (femoral-neck fractures surgery, intraperitoneal abdominal surgery or vascular surgery) were included. Patient characteristics and data related to GHDT, management of hypotension, monitoring of temperature and depth of anaesthesia, lung ventilation, point of care haemoglobin testing were collected. Results In total, 807 patients were included. Only 2% of patients [95% CI: 1–3] received GHDT in full accordance with guidelines. Depth of anaesthesia monitoring was largely performed (53% [95% CI: 50–56]). The multifaceted strategy of lung-protective ventilation combining low tidal volumes (6–8 mL/kg), PEEP of 5–8 cm cmH2O, and repeated recruitment manoeuvres, was performed in only 4% [95% CI: 3–5] of patients. A centre effect was a major determinant of variation concerning implementation of these strategies. Discussion In patients’ ≥ 75 years, strategies of anaesthesia optimisation are not in accordance with eligible guidelines. Implementation of these techniques varies independently of factors related to the patient or the type of surgery and may be dependent on the generated constraints.

This study was designed to evaluate patient self-reported outcome of the Malone antegrade continent enema at a single institution in patients suffering from severe defecatory disorders.A total of 18 patients (15 females; median age, 31 (range, 12-63) years) underwent a Malone antegrade continent enema (August 1999 to September 2004). The Malone antegrade continent enema technique has been previously described; however, in this series emphasis was placed on method appendix tunneling. Patients' charts were reviewed and follow-up telephone interviews were conducted. Indications for Malone antegrade continent enema were chronic constipation (n = 12), intractable fecal incontinence (n = 5), or both (n = 1). The underlying pathology included neurogenic (n = 2), congenital (n = 4), postsurgery-related (n = 4), irritable bowel syndrome (n = 6), and megarectum (n = 2). The appendix (n = 17) or cecum (n = 1) was used as a conduit.The mean follow-up was 18.5 (range, 3-67) months. Fourteen patients (78 percent) still use the Malone antegrade continent enema routinely and report good functional outcome. Three patients (20 percent) required stoma creation as subsequent alternate treatment. A total of 10 patients experienced 12 complications: 3 perioperative (infections) and 9 postoperative Malone antegrade continent enema use/nonuse complications (4 stomal orifice strictures, 2 fecal impactions, 2 appendiceal perforations, and 1 irrigation catheter knot). No patient experienced leakage from the appendiceal stoma. During the follow-up interval, one patient underwent proctectomy for megarectum. No failures occurred in patients with congenital or neurogenic disorders.Malone antegrade continent enema is a reasonable option for the treatment of select patients with severe defecation disorders. Good functional patient self-reported outcome was achieved by 78 percent of patients. The social inconvenience of stoma leakage is avoided with appropriate surgical technique. Malone antegrade continent enema is one option that provides a less invasive surgical alternative than colectomy or ileostomy for severe defecation disorders.

The aim of the study was to investigate peak anaerobic power during all-out exercise in patients with COPD. Twenty patients (ten women, ten men) [FEV1 = 50.5 (7.6)% of predicted] and 11 healthy subjects (six women, five men) performed: (1) three maximal sprints on a cycle ergometer to measure peak anaerobic power (Pmax) and optimal velocity (Vopt), (2) assessment of whole-body composition by dual-energy X-ray absorptiometry (DEXA) and (3) assessment of mean habitual daily energy expenditure (MHDEE). Pmax was 30% lower in COPD than in healthy subjects [22.9 (7.1) vs. 32.8 (5.6) W kg−1legs FFM, P < 0.001]. Nevertheless, Vopt was similar in both series. In COPD, Pmax was lower in women than in men [21.4 (7.7) vs. 23.8(6.4) W kg−1legs FFM, P < 0.05]. Vopt was lower in women than in COPD men [72.6 (11.3) vs. 89.3 (13.8) rpm, P < 0.05]. MHDEE was lower in COPD than in healthy subjects [8019 (1254) vs. 9093 (1660) kJ day−1]. In COPD, MHDEE was lower in women than in men (P < 0.001). This study demonstrates that in COPD patients, the decrease in peak anaerobic power could play a role in their specific muscular dysfunction. Considerable differences were observed in peripheral muscle function, body composition and MHDEE between women and men. The skeletal muscle of women and men may therefore adapt to COPD in different ways.

The educational literature generally suggests that supplemental instruction (SI) is effective in improving academic performance in traditionally difficult courses. A pilot program of peer teaching based on the SI model was implemented for an undergraduate course in human anatomy. Students in the course were stratified into three groups based on the number of peer teaching sessions they attended: nonattendees (0 sessions), infrequently attended (1‐3 sessions), and frequently attended (≥ 4 sessions). After controlling for academic preparedness [i.e., admission grade point average (AGPA)] using an analysis of covariance, the final grades of frequent attendees were significantly higher than those of nonattendees (P = 0.025) and infrequent attendees (P = 0.015). A multiple regression analysis was performed to estimate the relative independent contribution of several variables in predicting the final grade. The results suggest that frequent attendance (β = 0.245, P = 0.007) and AGPA (β = 0.555, P

The compounds 2,2'-exo-epidithio-1,1',7,7,7',7'-hexamethyl-3,3'-bibicyclo[2.2.1]hept-2-ene, C 20 H 30 S 2 , (2), and 2-endo,2'-exo-epidithio-1,1,1',7,7,7',7'-hexamethyl-3,3'-bibicyclo[2.2.1]heptanylidene, C 20 H 30 S 2 , (3), were prepared as potential antiviral agents and their structures were determined by X-ray diffraction. It has been shown previously that there is a relationship between the strain energy of a C-S-S-C group, as measured by its planarity and S-S bond length, and the antiviral activity of the compound containing this group. In general, the activity increases with the planarity of the group and as the disulfide bond distorts from a 'normal' length. The values of the C-S-S-C torsion angle and S-S bond length for compounds (2) and (3) are 56.1 (1)° and 2.056 (1) A, and 44.9 (2)° and 2.019 (2) A, respectively. (1R,1R')-2'-exo-Mercapto-1,1',7,7,7',7'-hexamethyl-3-exo,3'-exo-bibicydo[2.2.1]heptane-2-thione, C 20 H 32 S 2 , (1), is the intermediate compound necessary to obtain compound (2). The absolute configuration of each of the title compounds was determined from the X-ray studies.

Sulfur amino acids [cysteine (Cys) and methionine (Met)] play two major roles during animal development: protein synthesis for growth and glutathione synthesis for defense. For caterpillars, the levels of sulfur amino acids found in foliar protein can be especially low relative to their nutritional needs. Previous work has measured concentrations of glutathione (GSH; containing Cys) in specific animal tissues, but has not examined whole-body levels to ascertain the costliness of this defense in terms of Cys allocation. This study examined whether the production of GSH varies between species and within individuals in accordance with an insect's need for antioxidant defense. Secondly, we quantified the allocation of total Cys (peptide-bound plus free Cys) to GSH in caterpillars as an estimate of its cost. Two contrasting species were compared: Lymantria dispar (Lymantriidae), a species that is highly defended, and Malacosoma disstria (Lasiocampidae), a species that is less defended. As expected, GSH levels were significantly higher in L. dispar than in M. disstria. Consistent with the function of the midgut as a first line of defense against ingested toxins, GSH levels were significantly higher in these tissues than in the whole bodies of both species. A major finding in this study was that a large fraction of total Cys is used to produce GSH: GSH in the midguts of L. dispar and M. disstria contained 23 and 21%, respectively, of the total Cys in these tissues, and the GSH in their remaining body tissues contained 19 and 17% of the total Cys in these tissues. Levels of total Cys in caterpillar tissues followed the same pattern of distribution as did GSH, producing a strong association between GSH and total Cys (R(2) = 0.794). We conclude that GSH is a costly defense, especially in generalist tree-feeding species such as L. dispar. These results further suggest that the large allocation of Cys to GSH in highly defended species might produce a tradeoff by limiting the amount of Cys available for rapid growth.

Introduction Les infections representent une cause de morbi-mortalite importante en reanimation. Chez le patient brule, ce risque infectieux est majore par la rupture de la barriere cutanee. Les principaux germes en cause sont Staphylococcus aureus et Pseudomonas aeruginosa (PA). Ce dernier colonise les brulures en 10 jours avec une incidence en baisse ces dernieres annees (25–45 %). La colonisation ou l’infection cutanee par PA retarde la cicatrisation, compromet la greffe de peau, et prolonge la duree d’hospitalisation. La balneotherapie et le nettoyage des plaies au lit avec des antiseptiques sont les deux techniques les plus employees. Suite a l’arret de la balneotherapie dans notre centre, nous avons voulu etablir un bilan epidemiologique du PA. Materiel et methodes Etude retrospective monocentrique dont l’objectif primaire etait d’evaluer l’incidence du PA en 2013. Les objectifs secondaires etaient de decrire le delai de survenue et les facteurs de risque. Cette etude est basee sur les dossiers medicaux des patients admis plus de 24 heures avec au moins un prelevement microbiologique (PM) puis on s’est focalisee sur les biopsies cutanees (BC). Seuls les patients presentant au moins un PM positif a PA ont ete analyses, et classes en trois groupes (infection ou colonisation cutanee a PA, et un groupe avec PM positif a PA autre qu’une BC). L’ « infection cutanee » etait definie sur l’aspect clinique et une BC ≥ 105 CFU ; on parlait de colonisation si Resultats Cent deux dossiers sur un an ont ete analyses avec 8549 PM, dont 103 (1,2 %) avec PA en culture (32 patients [31,4 %]). La duree mediane de sejour etait de 50 jours [25–77] et de ventilation mecanique de 30 jours [21–43]. Ces PM comprenaient 2034 biopsies cutanees, dont 82 (4 %) a PA. Quatorze patients ont presente une infection cutanee et 9 une colonisation a PA. Les trois groupes etaient comparables en dehors d’un IMC plus faible, une surface brulee totale et des scores de gravite plus eleves chez les patients infectes. L’infection cutanee a PA etaient associees a une duree de sejour superieure en reanimation par rapport au groupe controle (21 j [10–39] vs 73 [59–97], p Fig. 1 ). Discussion L’incidence du PA dans notre unite est comparable a celle des unites de reanimation mais trois fois le delai decrit dans la litterature chez les brules. La colonisation et l’infection a PA sont associees de maniere significative a une augmentation de la duree de sejour en reanimation. Le profil de resistance souligne l’importance d’une reevaluation reguliere de l’epidemiologie locale pour adapter les protocoles d’antibiotherapie probabiliste. Ces donnees renforcent la necessite de comparer ces resultats a ceux d’une cohorte historique avec utilisation de la balneotherapie.

Two potassium fulleride phases, metallic K3C60 and nonmetallic K6C60, are formed when potassium is incorporated into thin C60 films under ultrahigh vacuum conditions. Phase separation is observed for intermediate stoichiometries. Results obtained for the C60-K3C60 heterostructure demonstrate that it is stable against potassium migration from the K3C60 phase. In contrast, the C60-K6C60 interface is not stable and K3C60 is formed.

Publisher Summary This chapter provides an introduction of fullerenes by comparing gas phase and solid state properties, examining thin film and bulk crystal growth, and doping with alkali metals and other atoms. The fullerenes are all-carbon molecules with a closed-cage structure and nearly spherical appearance. These cages are derived from 12 pentagons and an appropriate number of hexagons. The chapter also discusses the electronic structure of correlated-electron systems in fullerenes, relating the electronic properties and vibrational properties to superconductivity. Early descriptions of fullerene formation suggested that small carbon chains would grow by the sequential addition of carbon radicals. Finally, the chapter discusses the latest additions to the fullerene family—namely, endofullerenes, tubes, and the buckyonions.

The compounds 2,2'-exo-epidithio-1,1',7,7,7',7'-hexamethyl-3,3'-bibicyclo[2.2.1]hept-2-ene, C 20 H 30 S 2 , (2), and 2-endo,2'-exo-epidithio-1,1,1',7,7,7',7'-hexamethyl-3,3'-bibicyclo[2.2.1]heptanylidene, C 20 H 30 S 2 , (3), were prepared as potential antiviral agents and their structures were determined by X-ray diffraction. It has been shown previously that there is a relationship between the strain energy of a C-S-S-C group, as measured by its planarity and S-S bond length, and the antiviral activity of the compound containing this group. In general, the activity increases with the planarity of the group and as the disulfide bond distorts from a 'normal' length. The values of the C-S-S-C torsion angle and S-S bond length for compounds (2) and (3) are 56.1 (1)° and 2.056 (1) A, and 44.9 (2)° and 2.019 (2) A, respectively. (1R,1R')-2'-exo-Mercapto-1,1',7,7,7',7'-hexamethyl-3-exo,3'-exo-bibicydo[2.2.1]heptane-2-thione, C 20 H 32 S 2 , (1), is the intermediate compound necessary to obtain compound (2). The absolute configuration of each of the title compounds was determined from the X-ray studies.

Investing in effective prevention and early intervention programs will reduce human costs of victimization and also save tax dollars in the short and long terms.

Introduction La gestion des antivitamines K (AVK) est un enjeu sanitaire d’interet national. Les AVK sont sources de iatrogenie majeure et leur maniement en phase peri operatoire expose aux risques thrombotique et hemorragique. Malgre l’existence de recommandations elaborees par la Haute Autorite de sante (HAS) et publiees en 2008, le suivi de celles-ci apparait insuffisant dans la seule etude realisee a ce jour a l’echelon national par le College francais des anesthesistes et reanimateurs (CFAR). L’objectif de notre etude a ete de determiner l’impact d’une evaluation des pratiques professionnelles (EPP) a l’echelon local sur le suivi de ces recommandations apres mise en place de mesures correctrices. Materiel et methodes Nous avons realise une EPP de type audit clinique, monocentrique sur l’hopital de la Conception a Marseille. L’etude retrospective a concerne 40 dossiers de patients sous AVK prevus en chirurgie programmee, toute specialite confondue, avant et apres mise en place de mesures correctrices. Les criteres analyses principaux ont ete : l’arret justifie des AVK, la realisation justifiee ou non d’un relais, le delai d’arret des AVK, la conformite de la molecule de relais utilisee, l’emploi de doses curatives, avec, pour referentiel, les recommandations HAS de 2008. Un taux de conformite « ultime » ou total a ete calcule selon l’ensemble des recommandations concernant l’algorithme de prise en charge des patients sous AVK ait ete satisfait. Les mesures correctrices ont ete presentees a l’ensemble des acteurs du service d’anesthesie reanimation. Elles ont consiste en la creation d’une fiche AVK synthetique individuelle, la diffusion de protocoles d’arret et de relais AVK, et de la mise a disposition d’ordonnances de relais et d’INR type en salle de consultation d’anesthesie. Resultats Le suivi des recommandations a ete augmente de maniere significative avec un taux de conformite « ultime » multiplie par 4. Les taux de conformite « ultimes » sont restes cependant insuffisants au premier tour d’audit (7,5 %) et au deuxieme tour d’audit (32,5 %). Il existait des disparites dans le suivi des recommandations concernant les differents criteres analyses, comme le montre les pourcentages de taux de conformite resumes sur la Fig. 1 . Discussion L’amelioration significative du suivi des recommandations apres mise en place de mesures correctrices incite a une reconduite de cette EPP a l’echelon local et national. Les taux de conformite a l’echelon local revelent une grande variabilite dans l’application des recommandations, comme le soulignait deja le registre AVK-CFAR au niveau national, liee au manque de sensibilisation et a la complexite de la gestion des AVK. L’EPP de type audit clinique apparait comme une methode efficace d’evaluation des bonnes pratiques et s’integre parfaitement dans une politique d’amelioration de la qualite et de la securite de la prise ne charge des patients sous AVK.

A two-choice feeding bioassay was used to investigate the intra-specific repellency of the larval oral exudate of eastern and western spruce budworms,Choristoneura fumiferana (Clem.) andC. occidentalis Free., respectively. Results of the bioassay indicated that feeding behavior on artificial diet-drop feeding stations was modified in the presence of exudate, with feeding stations treated with conspecific exudate being avoided when an untreated station was available 3 cm away. Feeding was suppressed when a single, exudate-treated station was provided, or when the treated and untreated stations were separated by only 1 cm. The repellent effect functioned both inter- and intraspecifically. When induced to produce exudate,C. occidentalis larvae were not immediately repelled by either their own or other individuals' exudate. However, 24 hr after induction, test larvae were repelled by exudate from either source. In both species, larval oral exudate probably functions to repel conspecific competitors.

The kinetics of isomerization of D-glucose to D-fructose catalyzed by immobilized glucose isomerase from Bacillus coagulans were studied at 50, 60 and 70°C in a continuous stirred tank reactor. Initial substrate concentrations of 5 to 25% (W/V) were used with 0,043 kg of immobilized enzyme per liter of reactor. From preliminary studies on the reactor, it was found that at a stirring speed of 2,25 r/s and a glucose residence time under 3 330s, diffusional interferences were negligible. Different rate models were tested, but only the Michaelis-Menten expression without inhibition adequately described the kinetic data. Non-linear estimations of Km and Vmax were determined at 50, 60 and 70°C respectively. The apparent activation energy obtained had a value of 46 kJ/mol.

Type I osteogenesis imperfecta (OI) is characterized clinically by a moderate fracture frequency with minimal bone deformity and dominant inheritance. Previous studies of the collagenous proteins synthesized by dermal fibroblasts obtained from unrelated patients with this form of OI suggested that the biochemical basis of the disease was reduced production of type I collagen. This study was designed to determine if this biochemical finding segregated with the disease within an individual family. Dermal fibroblast strains were established from three generations of a family having the typical features of type I OI. Analysis of the collagenous proteins made in culture revealed an elevated alpha 1(III) to alpha 1(I) collagen type ratio and an elevated alpha 1(I) to alpha 2(I) collagen chain ratio. The procollagen that accumulated in the medium reflected these ratios to the same degree. Total collagen synthesis was significantly reduced in affected family members. Therefore, the most striking abnormality in affected members was a 50-75% reduction of type I collagen production. Furthermore, the ratio of the alpha 1(I)/alpha 2(I) collagen messenger RNA (mRNA), measured by dot hybridization, was one-half of the value of uninvolved family members and unrelated controls. Since the reduction in the production of type I collagen and the altered alpha 1(I)/alpha 2(I) mRNA ratio clearly segregated with affected individuals within this family, these biochemical measurements may be a useful genetic marker for type I OI.

L'action du brome suivie du traitement basique d'enamines heterocycliques ayant la double liaison endo conduit a une contraction de cycle; lorsque la double liaison est exo, il y a agrandissement de cycle

Reaction of trimethylsilyliodide (generated in situ from trimethylsilylchoride and sodium iodide) in the presence of triethylamine in acetonitrile with α-chloroketones yields the vinylic halide isomer of chlorotrimethylsilyl enol ethers.

(1884). On a new type of the class Hirudineae. Annals and Magazine of Natural History: Vol. 14, No. 80, pp. 149-151.