Is it really worth the effort to renounce to 5 mm trocars?

Objective: Single port laparoscopy andNOTES aim at decreasing the number¦of trocars, at a price of increased technical difficulty and cost, without until now¦any proof of benefit for the patient.Morbidity related to 5 mm trocar sites (TS)¦is claimed to be low, but there are no good quality data on this topic. The aim¦of the present prospective study is to measure the morbidity and overall specific¦impact related to the 5 mm TS and compare them to larger TS.¦Methods:Wecollected prospectively data on 300 consecutive patients operated¦by laparoscopy in our institution between 2009 and 2010. Pain, morbidity,¦cosmetic, and overall patient discomfort were assessed specifically for each¦TS, using standardized questionnaires, at 3 time points: at discharge from¦the hospital, at 1 month and at 6 months after surgery. Results were compared¦between 5 mmand larger TS (10 mm, 12 mmand 15 mm).Trocar sites replaced¦by a minilaparotomy or a stoma were excluded from analysis. In this study we¦present the short-term results.¦Results: Three-hundred patients (mean age 47·5, women 55%) were operated¦with 1074 TS of which 477(44%) were 5 mm TS. Indication to laparoscopy was¦cholecystectomy (31·3%), appendectomy (26·6%), upper GI surgery (16·3%),¦colon resection (13·3%) or other (12·3%). Follow-up at 1 month was completed¦in 90%.¦The 5 mm TS had an infection rate of 0·2%, and a hematoma rate of 1·7%.¦VAS pain scores at the 5mm TS were ≤3 in 91·6% at rest and in 75·9% upon¦effort at discharge, and in 97% at 1 month. Median patient scar assessment¦score (PSAS) of the 5 mm TS at 1 month was 6 (IQR: 2-9) out of 60 (0 =¦best score). Overall discomfort of the 5 mm TS in a VAS scale was 0 in 77%¦and ≤3 in 95% of patients at 1 month. Morbidity, pain assessments, PSAS, and¦overall discomfort scores were all significantly better for 5 mm TS compared to¦larger TS.¦Conclusion: Morbidity, pain, cosmetic impact and overall patient's discomfort¦related to a 5 mm trocar site is extremely low. For this reason, any potential¦advantage related to omitting 5 mm trocars to perform the same type of surgery¦will be difficult to demonstrate.

Mastocytose: quand faut-il y penser ? [Mastocytosis: when should it be considered?]

Mast cell disorders are defined by the accumulation of mast cells in one or more organ systems. Cutaneous forms are mainly observed in children whereas systemic forms are predominant in adults. Mast cells cause symptoms by the release of proinflammatory mediators or by infiltration of various organs. The measurement of serum tryptase has opened the possibility of screening for mastocytosis, which must be taken into consideration in case of severe anaphylactic reactions. Definite diagnosis is established based on a biopsy of skin or bone marrow. An activating mutation of stem cell factor receptor c-kit is often found. Treatment is based on control of the symptoms triggered by mast cell degranulation. Moreover, novel treatment options targeting mast cell proliferation become available for clinical use.

Phthalates in the NICU: Is it safe?

AIMS: As growing concerns exist regarding phthalate exposure, which could be teratogenic, carcinogenic or induce reproductive toxicity, we aimed to review the evidence of the risks due to the use of medical devices containing di(2-ethylhexyl)phthalate in hospitalized neonates. METHODS: We reviewed the literature, searching through medical literature databases (Pubmed, MEDLINE, EBM reviews, Cochrane database, Embase and Google Scholar) using the following keywords: phthalate, di(2-ethylhexyl)phthalate, newborn and neonate. RESULTS: We identified several associations with short and long term health dangers, mainly subfertility, broncho-pulmonary dysplasia, necrotising enterocolitis, parenteral nutrition associated cholestasis and neuro-developmental disorders. These data are based mainly on animal or observational human studies. CONCLUSION: Clinicians must be aware of the potential risks due to phthalate exposure in the NICU. Di(2-ethylhexyl)phthalate containing materials should be identified and alternative devices should be considered. There is a need to improve knowledge in this area.

To use it or not to use it: differences between adolescent males carrying a weapon and those using it in a fight

Purpose Data indicate that 19% of male adolescents living in Switzerland carried a weapon in the last 12 months. The main objective of this research is to compare the characteristics of male adolescents carrying a weapon and having used it in a fight from those who have carried but not used it in the previous 12 months. Methods Data were drawn from the 2002 Swiss Multicenter Adolescent Survey on Health (SMASH02) data base, a survey including 7,548[3,710 males] in-school adolescents aged 16-20 years in Switzerland. Only males declaring having carried a weapon (N = 711; 19.2% of the sample) were included in the analysis. Three groups were created: those not having used a weapon (WO; N = 538 subjects), those having used a weapon in a fight once or twice (W12; N = 127), and those having used a weapon in a fight 3 or more times (W3+; N = 46). Multinomial logistic regression was performed to compare the 3 groups on individual, family, school, and social factors using WO as the reference category. Analyses were performed with STATA9. Results are presented as relative risk ratios (RRR). Results W12 males were significantly more likely to perceive their puberty as advanced compared to their peers (RRR: 2.1), to be foreign born (RRR: 2.6), to live in an urban environment (RRR: 1.9), to be in vocational school (RRR: 4.7), to have a poor school connectedness (RRR: 1.8), to skip classes (RRR: 2.1) and to quarrel while intoxicated (RRR: 5.3). W3+ males were significantly more likely to be foreign born (RRR: 3.6) and to live in an urban environment (RRR: 2.4), to be current users of illegal drugs other than cannabis (RRR: 3.8) and to quarrel while intoxicated (RRR: 4.1). No differences were found between groups for tobacco, alcohol, or cannabis use. Conclusions Within a national sample of Swiss youth aged 16-20 years, almost one fifth of male adolescents have carried a weapon in the previous 12 months. Nevertheless, most of them (75.7%) have never used a weapon in a fight. Whether they carry a weapon for defense purposes or as a manly behavior remains to be elucidated. However, urban foreign-born adolescents who quarrel while intoxicated are the most at risk of using a weapon in a fight, and therefore culturally-sensitive prevention approaches need to be developed to decrease violence in this specific population of youth. Having school problems or using illegal drugs other than cannabis seem to differentiate between those who use it in a fight occasionally (once or twice) and those who do it more often.

Mycorrhizal ecology and evolution: the past, the present, and the future.

1406 I. 1407 II. 1408 III. 1410 IV. 1411 V. 1413 VI. 1416 VII. 1418 1418 References 1419 SUMMARY: Almost all land plants form symbiotic associations with mycorrhizal fungi. These below-ground fungi play a key role in terrestrial ecosystems as they regulate nutrient and carbon cycles, and influence soil structure and ecosystem multifunctionality. Up to 80% of plant N and P is provided by mycorrhizal fungi and many plant species depend on these symbionts for growth and survival. Estimates suggest that there are c. 50 000 fungal species that form mycorrhizal associations with c. 250 000 plant species. The development of high-throughput molecular tools has helped us to better understand the biology, evolution, and biodiversity of mycorrhizal associations. Nuclear genome assemblies and gene annotations of 33 mycorrhizal fungal species are now available providing fascinating opportunities to deepen our understanding of the mycorrhizal lifestyle, the metabolic capabilities of these plant symbionts, the molecular dialogue between symbionts, and evolutionary adaptations across a range of mycorrhizal associations. Large-scale molecular surveys have provided novel insights into the diversity, spatial and temporal dynamics of mycorrhizal fungal communities. At the ecological level, network theory makes it possible to analyze interactions between plant-fungal partners as complex underground multi-species networks. Our analysis suggests that nestedness, modularity and specificity of mycorrhizal networks vary and depend on mycorrhizal type. Mechanistic models explaining partner choice, resource exchange, and coevolution in mycorrhizal associations have been developed and are being tested. This review ends with major frontiers for further research.

Epilepsy meets cancer: when, why, and what to do about it?

The lifetime risk of having epileptic seizures is profoundly increased in patients with cancer: about 20% of all patients with systemic cancer may develop brain metastases. These patients and those with primary brain tumours have a lifetime risk of epilepsy of 20-80%. Moreover, exposure to chemotherapy or radiotherapy to the brain, cancer-related metabolic disturbances, stroke, and infection can provoke seizures. The management of epilepsy in patients with cancer includes diagnosis and treatment of the underlying cerebral pathological changes, secondary prophylaxis with antiepileptic drugs, and limiting of the effect of epilepsy and its treatment on the efficacy and tolerability of anticancer treatments, cognitive function, and quality of life. Because of the concern of drug-drug interactions, the pharmacological approach to epilepsy requires a multidisciplinary approach, specifically in a setting of rapidly increasing choices of agents both to treat cancer and cancer-associated epilepsy.

The KAI Cognitive Style Inventory: Was it personality all along?

Kirton's Adaption-Innovation Inventory (KAI) is a widely-used measure of "cognitive style." Surprisingly, there is very little research investigating the discriminant and incremental validity of the KAI. In two studies (n = 213), we examined whether (a) we could predict KAI scores with the "big five" personality dimensions and (b) the KAI scores predicted leadership behavior when controlling for personality and ability. Correcting for measurement error, we found that KAI scores were predicted mostly by personality and gender (multiple R = 0.82). KAI scores did not predict variance in leadership while controlling for established predictors. Our findings add to recent literature that questions the uniqueness and utility of cognitive style or similar "style" constructs; researchers using such measures must control for the big five factors and correct for measurement error to avoid confounded interpretations.

Quantitative monitoring of tamoxifen in human plasma extended to 40 metabolites using liquid-chromatography high-resolution mass spectrometry: new investigation capabilities for clinical pharmacology.

Liquid-chromatography (LC) high-resolution (HR) mass spectrometry (MS) analysis can record HR full scans, a technique of detection that shows comparable selectivity and sensitivity to ion transitions (SRM) performed with triple-quadrupole (TQ)-MS but that allows de facto determination of "all" ions including drug metabolites. This could be of potential utility in in vivo drug metabolism and pharmacovigilance studies in order to have a more comprehensive insight in drug biotransformation profile differences in patients. This simultaneous quantitative and qualitative (Quan/Qual) approach has been tested with 20 patients chronically treated with tamoxifen (TAM). The absolute quantification of TAM and three metabolites in plasma was realized using HR- and TQ-MS and compared. The same LC-HR-MS analysis allowed the identification and relative quantification of 37 additional TAM metabolites. A number of new metabolites were detected in patients' plasma including metabolites identified as didemethyl-trihydroxy-TAM-glucoside and didemethyl-tetrahydroxy-TAM-glucoside conjugates corresponding to TAM with six and seven biotransformation steps, respectively. Multivariate analysis allowed relevant patterns of metabolites and ratios to be associated with TAM administration and CYP2D6 genotype. Two hydroxylated metabolites, α-OH-TAM and 4'-OH-TAM, were newly identified as putative CYP2D6 substrates. The relative quantification was precise (<20 %), and the semiquantitative estimation suggests that metabolite levels are non-negligible. Metabolites could play an important role in drug toxicity, but their impact on drug-related side effects has been partially neglected due to the tremendous effort needed with previous MS technologies. Using present HR-MS, this situation should evolve with the straightforward determination of drug metabolites, enlarging the possibilities in studying inter- and intra-patients drug metabolism variability and related effects.

Modular support for developing mobile ad hoc applications

Abstract This PhD thesis addresses the issue of alleviating the burden of developing ad hoc applications. Such applications have the particularity of running on mobile devices, communicating in a peer-to-peer manner and implement some proximity-based semantics. A typical example of such application can be a radar application where users see their avatar as well as the avatars of their friends on a map on their mobile phone. Such application become increasingly popular with the advent of the latest generation of mobile smart phones with their impressive computational power, their peer-to-peer communication capabilities and their location detection technology. Unfortunately, the existing programming support for such applications is limited, hence the need to address this issue in order to alleviate their development burden. This thesis specifically tackles this problem by providing several tools for application development support. First, it provides the location-based publish/subscribe service (LPSS), a communication abstraction, which elegantly captures recurrent communication issues and thus allows to dramatically reduce the code complexity. LPSS is implemented in a modular manner in order to be able to target two different network architectures. One pragmatic implementation is aimed at mainstream infrastructure-based mobile networks, where mobile devices can communicate through fixed antennas. The other fully decentralized implementation targets emerging mobile ad hoc networks (MANETs), where no fixed infrastructure is available and communication can only occur in a peer-to-peer fashion. For each of these architectures, various implementation strategies tailored for different application scenarios that can be parametrized at deployment time. Second, this thesis provides two location-based message diffusion protocols, namely 6Shot broadcast and 6Shot multicast, specifically aimed at MANETs and fine tuned to be used as building blocks for LPSS. Finally this thesis proposes Phomo, a phone motion testing tool that allows to test proximity semantics of ad hoc applications without having to move around with mobile devices. These different developing support tools have been packaged in a coherent middleware framework called Pervaho.

Pain assessment in PICU and NICU: Have we got it right?

Pain assessment in critically ill infants and nonverbal children remains a challenge for health professionals. Despite the numerous pain observational measures that have been developed or adapted for infants and children with impaired communication, pain prevalence in paediatric and neonatal intensive care unit remains too high. As pain assessment has been recognised as a pre-requisite for appropriate pain management, much effort was put in the validation or the adaptation of pain measures with little emphasis on implementation of these instruments into practice. Only a few studies demonstrated the benefit of using standardised protocols for the management of pain to guide practice with variable effects. When standardised protocols are undeniably useful in practice, they do not replace health professionals' clinical reasoning necessary to care for individuals. The diversity of the PICU population makes that pain scores need to be interpreted within its clinical context. This session will present pain assessment as a complex transaction that describes structured clinical reasoning from expert nurses that goes beyond the "silver" standard of hetero-evaluation of pain in non-communicative children. Besides pain scores, several patients and nurses factors play a major role in making decisions about analgesia and/or sedation. Patient's clinical instability, change in patient's clinical status, source for observed agitated behaviour, patient's known reactions to analgesia and sedation and anticipation of risks are factors that should be taken into account when implementing pain assessment and management guidelines in PICU and NICU.