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Over the last few years, ADNOC has systematically investigated a new polymer-based EOR scheme to improve sweep efficiency in high temperature and high salinity (HTHS) carbonate reservoirs in Abu Dhabi (Masalmeh et al., 2014). Consequently, ADNOC has developed a thorough de-risking program for the new EOR concept in these carbonate reservoirs. The de-risking program includes extensive laboratory experimental studies and field injectivity tests to ensure that the selected polymer can be propagated in the target reservoirs.A new polymer with high 2-acrylamido-tertiary-butyl sulfonic acid (ATBS) content was identified, based on extensive laboratory studies (Masalmeh, et al., 2019, Dupuis, et al., 2017, Jouenne 2020), and an initial polymer injectivity test (PIT) was conducted in 2019 at 250°F and salinity >200,000 ppm, with low H2S content (Rachapudi, et al., 2020, Leon and Masalmeh, 2021). The next step for ADNOC was to extend polymer application to harsher field conditions, including higher H2S content. Accordingly, a PIT was designed in preparation for a multi-well pilotThis paper presents ADNOC's follow-up PIT, which expands the envelope of polymer flooding to dissolve H2S concentrations of 20 - 40 ppm to confirm injectivity at representative field conditions and in situ polymer performance. The PIT was executed over five months, from February 2021 to July 2021, followed by a chase water flood that will run until December 2021. A total of 108,392 barrels of polymer solution were successfully injected during the PIT. The extensive dataset acquired was used to assess injectivity and in-depth mobility reduction associated with the new polymer.Preliminary results from the PIT suggest that all key performance indicators have been achieved, with a predictable viscosity yield and good injectivity at target rates, consistent with the laboratory data. The use of a down-hole shut-in tool (DHSIT) to acquire pressure fall-off (PFO) data clarified the near-wellbore behaviour of the polymer and allowed optimisation of the PIT programme.This paper assesses the importance of water quality on polymer solution preparation and injection performance and reviews operational data acquired during the testing period.Polymer properties determined during the PIT will be used to optimise field and sector models and will facilitate the evaluation of polymer EOR in other giant, heterogeneous carbonate reservoirs, leading to improved recovery in ADNOC and Middle East reservoirs.

Resume La doxylamine (Donormyl®, Lidene®, Generiques) est couramment delivree par les pharmaciens a l’officine comme somnifere. En France il n’est prescrit aujourd’hui que pour traiter les insomnies occasionnelles chez l’adulte. Au vu des avancees sur le role des medicaments agonistes inverses du recepteur H1 de l’histamine dans le traitement de l’insomnie, et specifiquement la doxepine a faible dose (3 mg et 6 mg) commercialisee aux Etats-Unis et au Canada (Silenor®), nous suggerons que l’emploi de la doxylamine pourrait etre utile essentiellement pour traiter des insomnies du dernier tiers de la nuit. Une meilleure information du pharmacien sur le maniement de cet hypnotique anti-H1 serait benefique pour la patientele.

Resume On parle de plus en plus de qualite de vie au travail (QVT) comme approche alternative ou complementaire a celle des risques psychosociaux. Cependant, le flou du concept de QVT est peu propice a son utilisation pour la prevention de l’epuisement professionnel. Cet article presente un modele theorique permettant une definition operationnelle de la QVT de meme que l’instrument qui en decoule : l’Inventaire systemique de qualite de vie au travail. Les resultats obtenus dans un echantillon de travailleurs communautaires, revelent que, lorsque le score global de QVT se situe sous le 25e centile (population de reference de 3500 travailleurs), le risque d’epuisement emotionnel est 4,06 fois plus eleve et celui du desengagement 5,86 fois plus eleve.

Summary Chemical EOR is one of the more attractive methods to improve oil recovery. Numerous successful projects including injectivity tests, pilots and full-field developments have been executed without major injectivity issues or decline. Nevertheless, this topic remains a concern among operators. Polymer Flooding has seen more interest from the industry, and more challenging reservoirs (low permeability formations) are considered—thus raising concerns about injectivity. Filter ratio is routinely used as an injectivity screening criteria, but does it correlate with polymer injectivity and propagation during coreflood experiments, especially in the presence of crude oil? This paper provides new insights on polymer injectivity in cores considering polymer molecular weight, chemistry, rock permeability and mineralogy. The results are obtained from dedicated experiments and examination of several extensive data bases (including the literature). State of the art commercial polymers of varying chemistry with molecular weight ranging from 5 to 27+ MDa were injected into different sandstone cores having permeabilities between 10 to 200 mD with a range of clay content. Filter ratio was also determined and compared to injectivity in cores. All the data comes from field project case studies using reservoir cores and representative outcrop cores. For HPAM, injectivity was not a concern. It was possible to propagate up to 27+ MDa HPAM in a 100–200 mD core without significant pressure build-up. Concerning ATBS polymers, injectivity initially appeared to be constrained by the ATBS content; a 15 MDa polymer with a medium-high ATBS content poorly propagated below 200 mD. However, optimization based on molecular weight for similar ATBS content showed stable propagation in representative porous media. Finally, the filter ratio test did not always correlate to injectivity. Indeed, it was observed that several 1.2 µm FR tests (performed on high Mw polymers) failed despite successful transport in cores having permeability below 200 mD. In addition, acrylamide-based terpolymers allowed improvement in transport of ATBS polymers - a 20 MDa polymer containing medium level of ATBS was able to propagate in less than 100-mD cores. These observations are applicable to cores having clay content below 5%. For higher clay content, injectivity should be assessed case by case using reservoir core and crude oil. This paper establishes new references in terms of polymer transport behavior in porous media and highlights the importance of appropriate selection of polymer, polymer quality and experimental protocols to properly assess polymer injectivity in cores. Significance of the proposed paper: 1. Extensively examines the lower limits of permeability for injection of synthetic polymers, especially as a function of polymer molecular weight, polymer composition, rock mineralogy, and the presence of residual oil. 2. Better characterizes the relations between filter ratio, permeability and polymer injectivity in low-permeability rock.

Summary Reducing the carbon footprint during crude oil extraction is a growing challenge among operators and regulatory institutions. Sustainable solutions need to be implemented for reaching the net-zero production emission target by 2050. Besides the climate challenges, the industry is facing one of the worse crisis of its history. Maximizing production and reserves of existing assets in a sustainable and cost-efficient way are therefore paramount. Polymer flooding, with more than 300 projects worldwide, is a proven and cost-efficient technique to recover more oil in a shorter timeframe; but can the technology also aid in reducing greenhouse gas emissions? This article addresses this question by comparing the GHG emissions associated with standard waterflooding operations and polymer EOR processes Our approach is based on the determination of energy consumption related to different elements of the oil production cycle assisted by water or polymer injection. The total calculation includes water treatment, chemicals manufacturing, transport, polymer injection unit, injection pumps, artificial lift, produced fluids separation, oil heating and oilfield chemicals consumption. GHG emissions associated with oil transport, refinery, water disposal, and gas processing were not included in the study and will simply require updating the model with more data inputs. The emission factors of a series of industrial polymers (including partially hydrolyzed polyacrylamides, sulfonated polyacrylamides, and HT/HS polymers in both powder and emulsion forms) were calculated considering the contributions of the raw materials and energy spent during the polymerization and the conditioning processes. The methodology was applied to different field cases available in the literature to determine the reduction of GHG emissions associated with the reduction of water cut. The results indicated that polymer flooding was able to reduce the carbon intensity of conventional oil production by a factor of 2 to 6 compared to standard waterflooding operations, thus helping save up to 80% of water use. The results are promising for an emission free future in oil and gas industry. The model presented in this paper can complement any reservoir simulation package and can give an estimation of reduction of CO2 emissions and water consumption compared to water injection. As an illustration, the model was applied to a pilot simulation using DOE Polymer Flooding software to compare CO2 footprint of waterflooding vs polymer flooding.

Summary Diadema Oil Field is located in the San Jorge Gulf Basin in Southern Argentina. The field is operated by CAPSA, an Argentinean oil producer company; it has around 500 producer and 300 injector wells (well spacing is around 250 m). The company has been developing water flooding during more than 25 years (today this technique represents +65% of oil production), polymer flooding during more than 10 years and (+15% of oil production); produces about 1,850 m3/d of oil and 45,000 m3/d of gross production (96% water cut) with 43,000 m3/d of water injection. The main reservoir under secondary recovery is characterized by high permeability (500 md average), high heterogeneity (10 to 5000 md), high porosity (30%), very stratified sand-stone layers (4 to 12 m of net thickness) with poor lateral continuity (fluvial origin) and 20 °API oil (100 cp at reservoir conditions, 50 °C). Due to such reservoir conditions, injectors and producers are subject to channeling problems. Polymer gels have been extensively used to tackle such conformance issues. The criteria of success do not only depend on the quality of the technical solution but also on economics. Generally, gels are formulated using polymers under powder form requiring the mobilization of a dissolution unit, a maturation tank and one to several dilution tanks. On the opposite the utilization of polymers under reverse emulsion form only requires the use of a single skid including a static mixer for the inversion of the emulsion and one or two static mixers for polymer dilution and homogenization with the crosslinker, reducing both the footprint of the equipment (important for offshore) and the cost of the treatment. Two gel formulations using Chromium (III) acetate as crosslinker and partially hydrolyzed polyacrylamide either under its powder or its reverse emulsion version were developed to fit field conditions targeting a gel D category according to Sydansk classification and a gel time below 36 hours. A cost analysis comparison of both formulations was performed to select the more efficient solutions. Gels C to D were achieved for both formulations, 15 hours gel time and good stability over 3 months. The economical evaluation showed that the cost saving associated to the use of a single skid did not compensate the extra price of the reverse emulsion compared to the powder. The formulation using HPAM as a powder was selected and 20+ injection wells were treated without facing any operational issue.

Summary Polymer flooding has proven to be an effective technique to improve oil recovery from mature reservoirs. The selection of polymer, focusing mainly on its temperature tolerance properties and its ability to propagate in porous media, is key to achieve a successful EOR job. This selection also depends on brine injection compositions that covers a large range of salinities and hardness worldwide. A screening of viscosity behavior with different polymers in different brine conditions is obviously helpful in order to select the most cost effective chemistry. The impact of different acrylamide based polymer chemistries is evaluated through viscosity measurement over a wide range of salinities and hardness. A parameter called R+, corresponding to the molar ratio of divalent cations divided by the total mole number of cations in the brine is introduced. Salt tolerance and hardness tolerance of polymers in solutions are evaluated for brine considering either constant Total Dissolved Salt (TDS) with different R+ either the impact of different total salinities for constant R+. This parameter is as well considered to compare shear stability of the different polymers. At least, the impact of the type of divalent cations on viscosity is reported. Polymers from the study are all anionic and acrylamide based. The introduction of different amounts of sulfonated monomer (ATBS) was performed and its impact on hardness and shear tolerance was assessed. For all the polymers, a threshold beyond which viscosity remains constant is reached for R+> 0,5. Interestingly, this threshold is obtained for lower value of R+ for polymers containing ATBS since they provide better calcium tolerance. Calcium provides a higher impact on viscosity compared to magnesium for all the polymers studied. Increasing the amount of ATBS leads to higher tolerance to divalent cations. It also provides better stability to shear degradation. A minimum amount of sulfonated monomer is required to improve stability. The objective of this paper is to complete guidelines in the selection of industrial polymers considering a wide range of salinities and hardness. The screening of brine and polymers selected for this study is wide enough to represent worldwide injection brine conditions and helps selecting the most appropriate chemistry for each reservoir condition.

Annales Francaises d'Oto-Rhino-Laryngologie et de pathologie cervico-faciale - Vol. 130 - N° 1 - p. 47-52

Foam injection has been proven to be an efficient technique for EOR applications, stimulation operations and profile control. However, foam is known to have low stability and poor oil tolerance but adding polymer is reported to be an efficient way to improve such foam stability. An extensive study has been undertaken with different surfactants (foaming agents) and polymers to screen out the surfactant/polymer combinations providing the highest foam stability. We performed a systematic study consisting of static tests (foamability, stability) from which we selected two surfactants (nonionic and anionic) and two polymers (nonionic and associative polymer) expected to highly improve foam performances. Core-flood experiments were performed in high-permeability sandpacks in successive sequences starting with foam propagation, followed by a water flow and then an oil backflow. The Resistance Factor (RF) has been measured for each flow sequence. Based on our experiments, polymer-enhanced foams is shown to be a promising way for profile control during waterflood and recommendation of use of an associative polymer instead of a classical nonionic polymer is discussed.

SMG Microgels are pre-gelled polymers having a narrow size distribution and behaving like large polymer molecules whose stability is strongly enhanced by internal crosslinks. The largest species have a size of around 2 μm, which makes them suitable for Water Shutoff and Conformance Control applications in matrix reservoirs. SMG Microgels have been firstly used as water shutoff agents in gas storage wells and showed high efficiency to reduce water production while enhancing gas production. This paper reports a Conformance project which has been recently deployed in a heterogeneous sandstone reservoir. The pilot pattern consisted of one central injector, surrounded by 7 offset producers, with a spacing between 150 and 450 m. Reservoir permeability ranges between 10 and 1,000 mD with an average of 125 mD. Reservoir temperature is 48°C and salinity is 8,000 ppm TDS. Soft SMG with size around 2 μm was chosen regarding reservoir conditions. Microgel size prevented invasion of lowest permeability zones and created flow resistance in highest permeability zones by adsorption on the rock. Microgel slug corresponded to 0.1 Pore Volume and was 10,000 m3. Microgel injection proceeded over a period of 3 months. WHP remained below max pressure authorized of 1,500 psi. Closest producers responded within 3 months after microgel injection, with noticeable increase in oil rate along with a reduction of a few points of water cut. After one year 6 offset producers upon 7 were responding to the treatment. Three producers showed strong increase and sustained oil production, three had low response and one well lost both water and oil, showing diversion to the other wells. The trend remains steadily established in the pattern. After one year, 10,000 bbl of additional oil has been produced, along with a reduction of water production of 125,000 bbl.

An original polymer technology, successfully used in Underground Gas Storage (UGS) wells, has been recently applied in offshore gas producing wells. Many gas wells in this area are facing combined water and sand problems due to reservoir depletion, water entries and clayey formation. To avoid critical problems connected to water/sand production, the most common action has been so far to reduce gas production by choking down the wells. The new technique consists of bullhead injection of water soluble polymers with the main objective to form an adsorbed polymer layer on the surface of the rock, thus providing stabilization. In addition, the products have RPM properties (Relative Permeability Modifiers). They have little impact on gas permeability while strongly reducing water permeability. The combination of both effects will result in a reduction of water and sand production. Laboratory studies were performed to optimize polymer formulation and evaluate flow properties in reservoir cores. Because of the low reservoir rock permeability (around 10-20 mD), high focus was put on polymer injectivity and RPM effects. Since 2013, nine offshore gas wells have been treated with polymers. Treatments have shown positive results combining gas rate increase up to 100% and water reduction around 50% while stopping the sand. Details regarding well and polymer selection, job design, execution and production data are provided.

Resume La catatonie de l’enfant et de l’adolescent est peu etudiee dans la litterature internationale. Il n’existe toujours pas de criteriologie diagnostique, de conduite therapeutique definie, ni d’etiopathogenie clarifiee. Le sujet de cet article est l’etude d’un episode de catatonie severe d’etiopathogenie complexe chez une adolescente de 14 ans. Dans la phase aigue, un traitement par clonazepam et un protocole de reanimation ont permis une amelioration au bout de trois semaines sans necessite de recours a la sismotherapie. Dans un second temps, une monotherapie par carbamazepine a ete instauree a la posologie de 400 mg/j et maintenue pendant cinq ans. Dix ans apres, la patiente n’a jamais rechute, ni presente d’autres troubles psychopathologiques. Ce cas pose des questions diagnostiques, etiopathogeniques et therapeutiques qui font l’objet d’une discussion.

RADIOLOGIE ET IMAGERIE MEDICALE : Musculosquelettique - Neurologique - Maxillofaciale - 31-010-A-10

Resume Objectifs Le but de cet article est de presenter les principaux resultats et des observations cliniques issues de deux etudes prospectives a six mois et a un an sur les hallucinations auditives chez l’enfant. Methode Des consultants de pedopsychiatrie âges de 5 a 12 ans ont ete inclus de facon consecutive, puis evalues sur des periodes d’un an et six mois. La K-SADS questionnaire heteroevaluation a ete utilisee pour le diagnostic categoriel DSM-IV et un questionnaire sur les hallucinations auditives pour l’evaluation clinique. Resultats Sur les 151 patients evalues, 28 ont ete inclus dans les etudes. Pour 13 enfants, les consultations therapeutiques ont permis une disparition des symptomes hallucinatoires apres trois mois de suivi. Ces enfants souffraient dans la plupart des cas d’anxiete de separation. Pour six patients, les troubles ont persiste pendant toute la periode d’investigation. Ces patients presentaient majoritairement un trouble des conduites (5/6). Parmi eux, quatre ont beneficie d’un suivi preventif au-dela de l’etude. Deux ont montre respectivement a 14 et 15 ans un diagnostic de schizophrenie et/ou de trouble schizoaffectif. Deux cas suivis a trois ans sont discutes en fonction de leur evolution. Conclusions Les hallucinations auditives de l’enfant sont un symptome plus frequent que ce qui est reconnu actuellement. Son reperage rapide est important. Dans la majorite des cas, il advient dans un contexte anxieux et il est rapidement resolutif sans necessite de prescription de psychotrope. Cependant, pour quelques enfants, son existence peut etre un point d’appel vers une schizophrenie.

RADIOLOGIE ET IMAGERIE MEDICALE : Musculosquelettique - Neurologique - Maxillofaciale - 31-030-E-10

RADIOLOGIE ET IMAGERIE MEDICALE : Musculosquelettique - Neurologique - Maxillofaciale - 31-030-G-10

A novel technology has been developed for in-depth profile control based on thermo-gelling polymers (refers as THR). This technology differs from the ones currently used through different aspects. Thermo-gels polymers spontaneously gel when they reach a threshold temperature. Below this temperature, the product behaves as low-viscosity fluid, with good injectivity in reservoir rock. The system is single-component, and does not require any additive, contrary to classical gel systems which need to mix a polymer with a cross-linker (and often additives) to control gelation time. It is thus of easy control and does not face the drawbacks of two- or multi-component gel systems. Moreover this family of products is bio-sourced, thus environmentally friendly (some are CEFAS approved). Different THRs have been developed whose gel temperature varies between 25 and 85°C. The present work details laboratory evaluation of different THRs, including rheological properties, gel kinetics, gel strength, long-term stability and coreflood experiments. Main results are as follows: i) gel temperature can be optimized by varying brine salinity and THR type and/or concentration; ii) gel kinetics is very rapid once the gel temperature is reached, iii) THRs remain stable over period of time superior to one year in reservoir conditions; iv) coreflooding experiments in sandstone rocks show moderate adsorption (around 50 μg/g), good injectivity below gel temperature and strong pressure build-up once gel temperature is reached. Gel strength can be as high as 35 bar/m.

Fibre-optics diffuse reflectance spectroscopy (FORS) was used to characterise pigment mixtures in paints used in art. Measurements are non invasive, without any contact with the sample. The experimental device is portable, therefore measurements can be performed in situ, without moving the work of art under investigation from its conservation place. The protocol was validated thanks to modern gouache paints: 10 pure gouaches were used as references and 27 binary mixtures of these pure gouaches were studied. Reflectance spectra are processed using the Kubelka–Munk theory in order to get scattering and absorption coefficients of the references. Assuming a linear dependance of these optical properties with the pigment volume concentration (PVC) of the components of paint layers, the protocol enables qualitative as well as quantitative interpretation of the reflectance spectra measured on binary mixtures of references. Indeed, for most cases, numerical processing of FORS-measurements performed on a mixture leads to the identification of its components. Besides, once the components are identified, it is possible to compute their respective proportions with an accuracy of 5%.

Fibre-optics diffuse-reflectance spectroscopy was used to evaluate pigment quantity in art glazes. Measurements are non-invasive, without any contact, and can be performed in situ, without moving the work of art under investigation from its conservation place. Reflectance spectra are processed using Kubelka–Munk theory in order to obtain scattering and absorption parameters of the samples. Assuming a linear dependance of these optical properties with the pigment volume concentration of the paint layers, we were able to evaluate pigment quantities in the samples from reflectance measurements. Results are in excellent agreement with those obtained by X-ray diffraction and micro-X-ray fluorescence.

Introduction: Recruitment and retention of healthcare staff are difficult in rural communities. Poor quality of work life (QWL) may be an underling factor as rural healthcare professionals are often isolated and work with limited resources. However, QWL data on rural emergency (ED) staff is limited. We assessed QWL among nurses and physicians as part of an ongoing study on ED care in Québec. Methods: We selected EDs offering 24/7 medical coverage, with hospitalization beds, in rural or small towns (Stats Canada definition). Of Québec’s 26 rural EDs, 23 (88%) agreed to participate. The online Quality of Work Life Systemic Inventory (QWLSI, with 1 item per 34 “life domains”), was sent to all non-locum ED nurses and physicians (about 500 potential participants). The QWLSI is used for comparing QWL scores to those of a large international database. We present overall and subscale QWL scores as percentiles (PCTL) of scores in the large database, and comparisons of nurses’ and physicians’ scores (t test). Results: Thirty-three physicians and 84 nurses participated. Mean age was 39.8 years (SD=10.1): physicians=37 (7.7) and nurses=40.9 (10.7). Overall QWL scores for all were in the 32nd PCTL, i.e. low. Nurses were in the 28th PCTL and physicians in the 44nd (p>0.05). For both groups, QWL was below the 25th PCTL i.e. very low, for “sharing workload during absence of an employee”, “working equipment”, “flexibility of work schedule”, “impact of working hours on health”, “possibility of being absent for familial reasons”, “relations with employees”. The groups differed (pConclusion: Overall QWL among rural ED staff is poor. Groups had similar QWL scores except on career path, with physicians perceiving better long-term prospects. Given difficulties in rural recruitment and retention, these findings suggest that QWL should be assessed in rural and urban EDs nationwide.

Introduction: Trauma remains the primary cause of death in people under 40 in Québec. Although trauma care has dramatically improved in the last decade, no empirical data on the effectiveness of trauma care in rural Québec are available. This study aims to establish a portrait of trauma and trauma-related mortality in rural versus urban pre-hospital and hospital settings. Methods: Data for all trauma victims treated in the 26 rural hospitals and 32 Level-1 and Level-2 urban trauma centres was obtained from Québec’s trauma registry (2009-2013). Rural hospitals were located in rural small towns (Statistics Canada definition), provided 24/7 physician coverage and admission capabilities. Study population was trauma patients who accessed eligible hospitals. Transferred patients were excluded. Descriptive statistics were used to compare rural with urban trauma case frequency, severity and mortality and descriptive data collected on emergency department (ED) characteristics. Using logistic regression analysis we compared rural to urban in-hospital mortality (pre-admission and during ED stay), adjusting for age, sex, severity (ISS), injury type and mode of transport. Results: Rural hospitals (N=26) received on average 490 000 ED visits per year and urban trauma centres (N=32), 1 550 000. Most rural hospitals had 24/7 coverage and diagnostic equipment e.g. CT scanners (74 %), intensive care units (78 %) and general surgical services (78 %), but little access to other consultants. About 40% of rural hospitals were more than 300 km from a Level-1 or Level-2 trauma centre. Of the 72 699 trauma cases, 4703 (6.5%) were treated in rural and 67 996 (93.5%) in urban hospitals. Rural versus urban case severity was similar: ISS rural: 8.6 (7.1), ISS urban: 7.2 (7.2). Trauma mortality was higher in rural than urban pre-hospital settings: 7.5% vs 2.6%. Reliable pre-hospital times were available for only a third of eligible cases. Rural mortality was significantly higher than urban mortality during ED stays (OR (95% IC): 2.14 (1.61-2.85)) but not after admission (OR (95% IC): 0.87 (0.74-1.02)). Conclusion: Rural hospitals treat equally severe trauma cases as do urban trauma centres but with fewer resources. The higher pre-hospital and in-ED mortality is of grave concern. Longer rural transport times may be a factor. Lack of reliable pre-hospital times precluded further analysis.

The response of T cells in relation to the cell cycle has not been extensively studied. We have attempted to address this question using Jurkat T cells treated with cytostatic drugs known to arrest cells at various transition points of their cycle. We tested several concentrations of drugs that act at G1/S (hydroxyurea, lovastatin, thymidine), early S (aphidicolin, cyclosporin A, rapamycin) or G2+M (colchicine, nocodazole) in 24 h cultures. Cytofluorimetric analyses showed that cycling Jurkat cells were equally distributed between the G1 (44.9 +/- 6.5%) and S (42.3 +/- 8.0%) phases. Cell distribution in G2+M was 12.7 +/- 2.8%. Hydroxyurea but not lovastatin increased the percentage of cells in S phase to approximately 60-70% and both drugs decreased it to approximately 30% in G1. Thymidine had no effects. Aphidicolin increased the distribution in S phase to approximately 70% with a decrease in G1 to approximately 30%. Cyclosporin A and rapamycin increased the percentage of the cells in G1 to approximately 70% and decreased it to approximately 25% in S phase. Nocodazole increased cell distribution in G2+M to approximately 60% and induced a decrease in G1 to approximately 10%. The effects of the drugs were not related to their toxicity and their limited efficiency raised the possibility that Jurkat cells possessed an intrinsic resistance to these xenobiotics. Time-course analysis showed (scanning electron microscopy) that the early morphological changes induced by colchicine were reversible. Drug efflux experiments (vinblastine) suggested that an ATP-dependent process could be involved. However, Northern blot analyses showed a weak signal for MDR1 (P-glycoprotein). In contrast, a probe for MRP (P-190) showed a strong signal in Jurkat and peripheral lymphocytes. The presence of drugs (cyclosporin A, nocodazole, thymidine) (24 h) did not upregulate its message and cell treatment with DL-butathione (S,R)-sulfoximine only moderately affected the efficiency of the glutathione S-conjugate MRP transporter. Our data suggest that the intrinsic multidrug resistance of leukemic Jurkat T cells does not appear to involve the MDR1 and MRP members of the ABC family of reverse drug transporters and these observations raise the possibility of the involvement of multifaceted mechanisms.

Injections of polymer solutions have been used to improve oil recovery in heavy oil reservoirs (Zaitoun et al. 1998). Most of those polymer flood experiences refer to conditions where the polymer solution propagates through the porous media under low shear rate and exhibits mostly a Newtonian behaviour. On the other hand recent publications indicate injection of polymer solutions at concentration larger than conventional polymer flooding can result in higher recovery at field scale. Typically oil recovery of more than 20% OOIP compared to waterflooding has been reported for light oil (Wang et al; 2011). However injectivity issues have to be considered when injecting concentrated polymer solutions. This study examines whether non polymeric elastic fluids derived from surfactant solutions can represent an alternative approach to elastic polymer floods. The technology we have developed matches the rheological properties of polymer solutions in a broad range of reservoir conditions (temperature & salinity). Bulk flow properties as well as rheology in a confined geometry have been used to compare flow properties of surfactant and high molecular weight polymer solutions. The elastic properties of both fluids have been characterized in terms of Weissenberg numbers. The data indicate the surfactant solution as opposed to the polymer one is highly elastic at low shear rates even in the presence of brine. Those results are confirmed by comparative experiments made using a Particle Image Velocimetry (PIV) technique. Injectivity of concentrated surfactant solutions has been tested in single-phase conditions and indicated a good in depth propagation of the fluid. A series of core-flood experiments has been performed using heavy oil reservoir cores. The surfactant slug has been combined with a conventional low-concentration polymer flooding to benefit from surfactant elasticity and improve oil recovery.

Cytotoxic activity of monocytes may be mediated by their production of TNF-alpha, and IL-2 has been shown to induce TNF-alpha production in monocytes and alveolar macrophages. Unstimulated human monocytes constitutively express the beta-chain of the IL-2R (IL-2R beta), but little or no IL-2R alpha. When monocytes were pretreated with leukotriene (LT) B4, they responded to IL-2 with both enhanced production of TNF-alpha (two- to threefold) and, more strikingly, with augmented sensitivity (1000-fold) to IL-2. Treatment of monocytes with LTB4 induced IL-2R alpha gene transcription at 30 min and augmented expression of IL-2R alpha gene transcripts by 3 h, maximal at 10(-8) M LTB4. LTB4 induced increased shedding of the IL-2R alpha in the culture supernatants and a modest induction of IL-2R alpha protein expression on monocytes. On the other hand, although LTB4 could stimulate the cell membrane expression of IL-2R beta and the accumulation of IL-2R beta mRNA, LTB4 did not significantly affect IL-2R beta gene transcription. The augmented expression of IL-2R on monocytes was associated with augmented binding of 125I-labeled IL-2 to LTB4-pretreated monocytes. Our data present direct evidence that the inflammatory lipid mediator LTB4 can induce the expression of IL-2R alpha in human monocytes by activating IL-2R alpha gene transcription; it can also stimulate the expression of IL-2R beta, through post-transcriptional regulation; this augmented expression of both alpha- and beta-chains of the IL-2R is associated with enhanced sensitivity of monocytes to IL-2 in terms of TNF-alpha production and may be relevant to the proinflammatory actions of LTB4.

Child and adolescent catatonia has been poorly investigated. Moreover, diagnosis criteria only exist for adult psychiatry, and there are no therapeutic guidelines. The aim of this paper is to describe the case of a 14-year-old girl presenting an overlap between psychogenic and neuroleptic induced catatonia, acute treatment and ten year's follow-up.A 14-year-old Caucasian French girl, Elsa, was admitted in February 1998 to a University adolescent mental health center with an acute psychotic disorder. She showed agitation, impulsivity (sudden engagement in inappropriate behaviour), paranoid delusions, visual and auditory hallucinations, diurnal and nocturnal urinary incontinence, lack of self-care, inadequate food intake because of fear of poisoning, and vomiting after meals leading to rapid weight loss of 5 kg. Clinical examination, laboratory tests, EEG and RMI were normal. Toxicological tests were negative. Her IQ, assessed six months before admission, was in the dull average range (70-75). Elsa was treated with loxapine 150 mg per day for one week without improvement and this was then replaced by haloperidol 30 mg per day. One week after the start of haloperidol her agitation, impulsivity, and hallucinatory symptoms decreased. Twenty four days after loxapine introduction and 17 days after the haloperidol, her condition deteriorated rapidly over less than 48 hours. She exhibited immobility, minimal response to stimuli, staring and catalepsy with waxy flexibility. The diagnosis of catatonia was established. Examination revealed tremulous extremities, tachychardia (110 pm) and apyrexia. Creatine phosphokinase levels were 106 UI/l (normal range 0-250). Human immunodeficiency virus, hepatitis, listeria and Lyme serology were negative. Cerebrospinal fluid analysis was normal. Haloperidol was stopped and intravenous clonazepam 5mg/kg was begun. It was not possible to obtain signed consent from the two parents for Electroconvulsive therapy. The patient was transferred to a pediatric intensive care unit. The treatment was standard parenteral nutrition, nursing, intravenous clonazepam 0.05 mg/kg, with regular attendance by a child psychiatrist. Elsa stayed three weeks in this condition. She then began to notice the child psychiatrist, and a few days later she was able to carry out simple requests. Elsa was transferred to an adolescent psychiatric unit. As soon as she could eat by herself again, carbamazepine 400mg per day was begun. Her agitation reduced at a carbamazepine level of 7 mg/l. One month later her condition was stable. However, language difficulties persisted for a further six months. One year after the episode she scored 66 on a repeat IQ test and her RMI was normal. She exhibited no significant residual symptoms except some cognitive impairment. She integrated into a special education facility. These attempts to stop the carbamazepine were followed by depressed mood, aggressiveness and impulsivity; carbamazepine was finally stopped successfully after seven years. Ten years later, Elsa is the mother of two young children and is able to take care of them. She has never had a relapse of her psychotic disorder or catatonic state.The etiopathogenic diagnosis is problematic. Some indices in the familial history may suggest a traumatic event. But one to the total residual amnesia it was never confirmed, and traumatic catatonia are extremely rare. Normal CPK levels, with autonomic disturbance limited to tachycardia and the lack of resolution after discontinuance of medication, argues against a diagnosis of neuroleptic malignant syndrome (NMS). But CPK levels are non specific, and NMS without pyrexia has been described. The occurrence of the catatonic syndrome 21 days after the first dose of a neuroleptic could be diagnostic. This case involved a non organic catatonic psychosis followed by neuroleptic induced catatonia. Catatonia is described as a risk factor for the development of NMS and some consider NMS to be a variant of malignant catatonia. The interest of this report is (1) it reinforces the need to be cautious before prescribing neuroleptics in adolescents presenting with symptoms of catatonia; (2) the complete recovery from catatonia after treatment with intensive care and more than three weeks of intravenous clonazepam without the use of ECT and (3) the effectiveness of carbamazepine over a long period of follow-up. Although trials on carbamazepine in catatonia are published, there are no data available for the control of residual symptoms or the long term prognosis, especially in child and adolescent psychiatry.

In this paper, the imaging features of traumatic injuries of the spine in an emergency department will be reviewed. Three themes are discussed. 1) Review of current indications for additional imaging work-up. Conventional radiographs are not always mandatory, especially at the cervical level since validated criteria are available from the literature. The low sensitivity of conventional radiographs often requires additional imaging by CT (bone lesions) or MRI (disk and ligamentous lesions). The degree of urgency in scheduling these different examinations will be defined by the clinical setting and risk level (low/intermediate/high) of the injury. 2) Review of imaging features associated with stable and unstable lesions. The analysis of conventional radiographs is based on biomechanical concepts. The features of the main lesions will be illustrated by clinical cases and diagrams. 3) Review of key points that must urgently be transmitted to clinicians. The preliminary radiology report is an essential document for the management of patients with traumatic injury to the spine. It will have an impact on the type of immediate management (medical, orthopedic or surgical). A final report validating the initial interpretation should, of course, soon follow.

Traumatic injuries of the hip, mostly fractures of the proximal femur, are in constant progression. Though morbidity has decreased due to improved surgical and anesthesiologic techniques and postsurgical rehabilitation, mortality from hip fractures remains significant. Radiographs of the hip remain helpful, but MDCT and MRI have become indispensable tools. Findings on imaging studies must be well characterized to ensure rapid and cost-effective management. Difficult or cases with imaging features that are difficult to interpret or misleading will be presented to avoid incorrect interpretations that could lead to inadequate management of patients.

For colonic delivery, pectin beads obtained by ionotropic gelation method have been already reported as an interesting approach. This study investigated the influence of the cross-linking agent (calcium or zinc) and the type of shell capsule used (classical or enteric capsules) on pectin beads properties and on their performance to target the colon (in vitro dissolution studies with subsequent pH change to mimic overall gastro-intestinal tract). Zinc pectinate beads seemed to be relatively similar to calcium's ones in morphological point, except on the surface aspect. When beads were introduced in classical hard capsules, ketoprofen release was not significantly different between CPG and ZPG beads, and it was too premature and too quick due to a chemical erosion of the pectinate matrix (acid + basic attacks). However, zinc pectinate beads showed slower ketoprofen release compared with calcium pectinate beads when enteric hard capsules were used. This interesting finding could be due to the strength of the network formed during the process between the zinc cations and the LM-pectin following the "egg-box" model. This network was stronger and induced a reduction of swelling and hydration when contact with dissolution medium, then subsequently a decrease of drug release. Thus, the zinc pectinate beads could protect sufficiently drug entrapped from the upper gastro-intestinal conditions and drug release will be controlled by pectin degradation with colonic microflora. Finally, these zinc pectinate beads in enteric hard capsules are promising as a carrier for specific colonic delivery of drugs after oral administration.

In this study, pectinate gel beads were produced by ionotropic gelation method with different solutions of cross-linking agents and ketoprofen was entrapped as model drug. The influence of these formulation parameters was investigated upon bead properties and upon their performance to target the colon. Zinc pectinate beads obtained with 10% of counter-ions solution at pH 1.6 exhibited the strongest gel network due to "egg-box" dimmer formation helped by hydrogen bonding. Furthermore the gel network formed at low pH was arranged in a compact three-fold conformation. Thus, this matrix structure in enteric capsules induced the lowest drug release in the upper gastro-intestinal tract (pH 1.2 following by pH 7.4). However ketoprofen release occurred specifically in the colon thanks to the presence of pectinolytic enzymes and the release rate can be modulated by the counter-ion concentration during the reticulation process. Therefore this approach using pectinate beads is very promising as efficient carrier for specific delivery of drug into the colon, after oral administration.

This study compared mood changes in 212 patients treated for hypercholesterolemia, as a function of their level of adherence to dietary recommendations. Assessments of mood (anxiety, depression, and hostility), measured by the Profile of Mood States, were obtained at baseline and 3-, 6-, and 12-month follow-up. Adherence to diet was categorized as low, medium, or high based on the Food Record Rating. Repeated-measures ANOVAs showed a significant decrease over time for anxiety, total cholesterol (TC), and low-density lipoproteins (LDL). A multiple regression was performed to determine if reductions in TC or LDL were associated with the anxiety decrease. The model for anxiety change was highly significant and included gender, baseline anxiety, number of stressful events, psychological stress, baseline level of adherence to diet, gender x adherence interaction, and change in TC x adherence interaction. In conclusion, cholesterol lowering did not negatively affect patients' moods. However, those who adhered poorly but nonetheless showed stable or reduced TC exhibited a greater decrease in anxiety.

Intraoperative radiation exposure during intramedullary nailing procedures is still of current interest. What is the mean exposure time and how is it distributed intraoperatively? Is there a time-dose relationship? When does it begin to become biologically noxious to the patient and to the operating room personnel? In this chapter, our objective is to give some elements of answer, mainly through the analysis of X-ray exposure times.

A lack of resources has created waiting lists for many elective surgical procedures within Canada's universal health care system. Coronary artery bypass grafting (CABG) for the treatment of atherosclerotic ischemic heart disease is one of these affected surgical procedures. We studied the impact of waiting times on the quality of life of patients awaiting CABG.A prospective cohort of 266 patients from 3 hospitals in Montreal was used. Patients who gave informed consent were followed from the time they were registered for CABG until 6 months after surgery; recruitment began in November 1993, and the last follow-up was completed in July 1995. Patient groups were classified according to the duration of the wait for CABG (or = 97 days or97 days). We measured the following outcomes: quality of life (using the Medical Outcomes Study 36-item Short Form [SF-36]), incidence of chest pain (using the New York Heart Association angina classification), frequency of symptoms (using the Cardiac Symptom Inventory) and rates of complications and death before and after surgery.There were no differences in quality of life at baseline between the 2 groups. Immediately before surgery, compared with patients who waited 97 days or less, those who waited longer had significantly reduced physical functioning (change from baseline SF-36 score 0 v. -4 respectively, p = 0.001), vitality (change from baseline score -0.1 v. -1.3, p = 0.01), social functioning (change from baseline score 0.4 v. -0.4, p = 0.03) and general health (change from baseline score 1.1 v. -1.7, p = 0.001). At 6 months after surgery, compared with patients who waited 97 days or less for CABG, those who waited longer had reduced physical functioning (change from baseline SF-36 score 4.0 v. -0.1 respectively, p = 0.001), physical role (change from baseline score 0.8 v. 0.0, p = 0.001), vitality (change from baseline score 2.2 v. 0.9, p = 0.001), mental health (change from baseline score 1.2 v. 0.0, p = 0.001) and general health (change from baseline score 1.8 v. -0.3, p = 0.001). The incidence of postoperative adverse events was significantly greater among the patients with longer waits for CABG than among those with shorter waits (32 v. 14 events respectively, p = 0.005). Longer waits before CABG were associated with an increased likelihood of not returning to work after surgery (p = 0.08): 10 (53%) of the 19 patients with longer waiting times remained employed after CABG, as compared with 17 (85%) of the 20 with shorter waiting times.The significant decrease in physical and social functioning, both before and after surgery, for patients waiting more than 3 months for CABG is an important observation. Longer waiting times were also associated with increased postoperative adverse events. By decreasing waiting times for CABG, we may improve patients' quality of life and decrease the psychological morbidity associated with CABG.

Imaging of the brachial plexus and of the thoracic outlet syndrome is difficult due to the complex path of the brachial plexus and the morphological variations during the movements. This imaging includes simple radiographs, computed tomographies (CT) and myelo CT scan, magnetic resonance imaging and echo-Doppler. Pathologies of this area include congenital deformities (dysplasia of the upper RIB or of the clavicle), non-malignant or malignant tumors, muscular pathologies, and pathologies of the nerve roots or trunks.

We have treated Jurkat T lymphocytes with a concentration (160 nM) of phorbol myristyl acetate (PMA) that down-regulates conventional and novel protein kinase C (PKC) isozymes and we have investigated the effects on Ca2+ signaling and protein tyrosine phosphorylation using mAb (C305) directed against the beta-subunit of the Ti heterodimer or the epsilon/delta-component of the CD3 complex (mAb Leu 4 or OKT 3). The levels of expression of PKC alpha, betaI, betaII, and delta were reduced by 90% or more in PMA-treated cells, whereas the expression of PKCtheta decreased by approximately 30%. In contrast, the chronic treatment with PMA increased the expression of PKCepsilon and PKCzeta. There was a lack of Ca2+ response and myo-inositol trisphosphate (IP3) production in PMA-treated cells when they were exposed to mAb Leu 4 but the cells responded to mAb C305. The treatment with PMA did not affect the surface expression of Ti or CD3. The overall levels of tyrosine-phosphorylated proteins were markedly reduced in PMA-treated cells. We investigated whether these observations were related to defects in signal transduction related to protein tyrosine kinase (PTK) of the src and syk families. The electrophoretic mobilities of p59(fyn) or ZAP-70 were not changed in PMA-treated cells but p56(Ick) migrated as a large band of M(r) 60-62 kDa. The decreased mobility of p56(Ick) was related to a state of hyperphosphorylation. The activity of modified p56(Ick) was not up-regulated in activated Jurkat cells. Our data suggest that clonotypic Ti can trigger Ca2+ mobilization independently of conventional PKC isoforms. Our observations further suggest that conventional PKC isoforms are involved early in the cascade of events associated with Jurkat T lymphocyte activation.

This study compared 96 women and 58 men suffering from panic disorder with agoraphobia. Participants completed questionnaires assessing various clinical features associated with panic disorder with agoraphobia (PDA), general adjustment, and drug/alcohol use. Results showed that PDA is a more severe condition in women. Women reported more severe agoraphobic avoidance when facing situations or places alone, more catastrophic thoughts, more body sensations, and higher scores on the Fear Survey Schedule. Also, women more often had a comorbid social phobia or posttraumatic stress disorder. The lower agoraphobic avoidance of men was associated with their alcohol use. However, there were no differences between genders in other dimensions, including depression, situational and trait anxiety, stressful life events, social self-esteem, marital adjustment, and drug use.

Lymphocyte extravasation involves a step(s) of de-adhesion to allow trans- and subendothelial migration in response to inflammatory signals. We show here that ligated VCAM-1 was rapidly internalized (t1/2 14.5 min) in ECV 304 endothelial cells and in TNF-alpha-primed human umbilical vein-derived endothelial cells (t1/2 11.2 min). The process required energy (ATP), intracellular Ca2+, an intact cytoskeletal network and active protein kinases. The internalization of VCAM-1 involved a clathrin-dependent pathway based on the observations that 1) it was inhibited in cells treated with lysosomotropic agents or with a hypertonic concentration of sucrose, and 2) internalized VCAM-1 colocalized with clathrin. In contrast, the cross-linked alpha 4 beta 1 integrin counter-receptor of VCAM-1 remained associated with the plasma membrane of purified peripheral T and Jurkat cells. Our results suggest a model where VCAM-1 would initially participate in the retention of T cells to the endothelium by binding alpha 4 beta 1 integrin. Lymphocyte de-adhesion would be facilitated as a result of the internalization of VCAM-1. The persistent cell surface expression of alpha 4 beta 1 integrin would allow the migrating T cells to interact with and receive signal(s) from its fibronectin ligand of the extracellular matrix.

We report an intracranial epidural abscess caused by Aspergillus fumigatus in an immunocompetent patient. Infection occurred in a 20-year-old man 2 months after a frontal craniotomy following trauma. The abscess was encapsulated by a thickened dura and although the fungus did not invade the brain, frontal bone was infected and the patient presented with a subcutaneous frontal cellulitis. Initial management combined surgical drainage, resection of necrotic bone and liposomal amphotericin B (1 mg kg-1 per day). After 3 weeks of antifungal treatment a second evaluation surgery was performed. A clinically and radiologically unsuspected new abscess was found and evacuated. Treatment was completed with instillation into the cavity of amphotericin B at a concentration of 5 mg ml-1 and prolonged oral itraconazole (400-600 mg day-1). Treatment was successful and the patient is free of infection after 3 years.

Nodular or pseudo-nodular aspects of Hashimoto's thyroiditis raise the problem of the association with a differentiated carcinoma or a non Hodgkin's lymphoma.We looked for patients needing surgery in 165 cases of Hashimoto's thyroiditis. For this purpose, we used fine needle aspiration cytology.We found a differentiated carcinoma in 4% of cases and a non Hodgkin's lymphoma in 1% of cases.In nodular or pseudo-nodular aspects of Hashimoto's thyroiditis, fine needle aspiration cytology is helpful for the nodule diagnosis and for the selection of suspicious nodules only to be referred to surgery.

To examine the association among panic disorder, atypical chest pain and coronary artery disease (CAD). This article's purpose is to inform cardiologists of the prevalence of psychiatric disorders, primarily panic disorder, among patients consulting for chest pain. Panic disorder is described. Treatment modalities are summarized, and social, financial and medical consequences of nondetection are underlined.PSYCHLIT and MEDLINE searches under panic disorder and chest pain-related headings were conducted.The search covered January 1973 to June 1993. Thirty-eight articles were studied.Panic disorder is present in 30% or more of chest pain patients with no or minimal CAD and may coexist with CAD. Panic disorder may often be unrecognized by physicians. Left untreated, risk for disease progression may be augmented, and social vocational disability as well as medical costs may increase.Physicians should attend to the panic symptomatology and, when in doubt, refer possible panic patients with or without CAD to a mental health professional for assessment and treatment. Future panic prevalence studies in cardiology patients should be prospective, attempt to increase sample size and use randomized protocols where experimenters are blind to chest pain and medical diagnoses. Studies should also focus on CAD patients with atypical chest pain refractory to optimal cardiac therapy.