EZ-IO intraosseous device implementation in a pre-hospital emergency service : a prospective study and review of the literature

Introduction : La prise en charge des patients critiques n��cessite dans la majorit�� des situations l'obtention rapide d'un acc��s vasculaire, afin d'administrer des m��dicaments, des solut��s de remplissage, ou des produits sanguins. La mise en place d'un acc��s vasculaire peut s'av��rer difficile chez ces patients. En cas d'��chec de pose d'une voie veineuse p��riph��rique, des abords vasculaires alternatifs existent. Il s'agit essentiellement de la pose d'une voie veineuse centrale, la r��alisation d'une d��nudation veineuse, ou la pose d'une voie intra-osseuse. Depuis le d��veloppement de dispositifs d'insertion �� semi-automatique �� �� la fin des ann��es 90, la voie intra-osseuse, traditionnellement r��serv��e aux cas p��diatriques, est de plus en plus fr��quemment utilis��e chez les patients adultes. Le Service des Urgences du CHUV a introduit en 2009 les dispositifs d'insertion d'aiguilles intra-osseuses de type EZ-IO�� (perceuse ��lectrique), en salle de r��animation des urgences vitales (d��choquage), ainsi qu'au sein du secteur pr��hospitalier pour les interventions du SMUR de Lausanne et de l'h��licopt��re REGA de la base de Lausanne. Par cette ��tude, nous voulions mettre en ��vidence les aspects ��pid��miologiques des patients ayant d�� ��tre perfus��s par cet abord dans un contexte pr��hospitalier, ainsi que les circonstances cliniques ayant justifi�� un tel usage, le taux de succ��s, les ��ventuelles complications, les m��dicaments perfus��s et la mortalit�� des patients ayant b��n��fici�� de ce dispositif. M��thode: Chaque patient ayant b��n��fici�� de la mise en place d'une voie intra-osseuse par EZ-IO�� du 1er janvier 2009 au 31 d��cembre 2011 a ��t�� inclus. Les donn��es r��colt��es ��taient l'��ge, le sexe, l'indication �� la mise en place de l'intra-osseuse, la localisation, le taux de succ��s, les m��dicaments et fluides administr��s, les complications, la mortalit�� �� 48 heures et �� la sortie de l'h��pital. Tous les articles mentionnant l'utilisation de ΙΈΖ-ΙΟ�� dans des situations cliniques ont ��galement ��t�� analys��s par une revue de litt��rature structur��e exhaustive, afin de comparer nos r��sultats avec les donn��es de la litt��rature. R��sultats : Cinquante-huit patients, repr��sentant 60 intra-osseuses EZ-IO��, ont ��t�� inclus. Leur ��ge moyen (47 ans), le taux de succ��s (90%), les indications, la localisation de l'aiguille (98% au niveau du tibia proximal) et le taux de complications (0%) correspondent aux valeurs trouv��es dans la litt��rature. Le taux de survie de nos patients est de 38% �� 48 heures et de 29% �� la sortie de l'h��pital. De nombreux m��dicaments ou solut��s de perfusion ont ��t�� administr��s; l'adr��naline restant le m��dicament le plus fr��quemment administr�� par cette voie. Dans 7 cas, les patients ont b��n��fici�� d'une induction d'anesth��sie par voie intra-osseuse. La revue de litt��rature a permis de compiler 30 ��tudes distinctes, repr��sentant un total de 1603 acc��s vasculaires de type EZ-IO��. Conclusion : La voie intra-osseuse s'av��re fiable et rapide pour obtenir un acc��s vasculaire, avec un taux de complications tr��s faible et permet l'administration d'un grand nombre de substances. D'autres ��tudes sont n��cessaires pour ��valuer l'impact de la voie intra osseuse, notamment en termes de mortalit��, de complications tardives, ainsi que d'analyse co��t/b��n��fice de ce mat��riel.

Study and modeling of the desintegration kinetics of coated paper

The disintegration of recovered paper is the first operation in the preparation of recycled pulp. It is known that the defibering process follows a first order kinetics from which it is possible to obtain the disintegration kinetic constant (KD) by means of different ways. The disintegration constant can be obtained from the Somerville index results (%lsv and from the dissipated energy per volume unit (Ss). The %slv is related to the quantity of non-defibrated paper, as a measure of the non-disintegrated fiber residual (percentage of flakes), which is expressed in disintegration time units. In this work, disintegration kinetics from recycled coated paper has been evaluated, working at 20 revise rotor speed and for different fiber consistency (6, 8, 10, 12 and 14%). The results showed that the values of experimental disintegration kinetic constant, Ko, through the analysis of Somerville index, as function of time. Increased, the disintegration time was drastically reduced. The calculation of the disintegration kinetic constant (modelled Ko), extracted from the Rayleigh���s dissipation function, showed a good correlation with the experimental values using the evolution of the Somerville index or with the dissipated energy

In situ spectroellipsometric study of the nucleation and growth of amorphous silicon

A detailed in situ spectroellipsometric analysis of the nucleation and growth of hydrogenated amorphous silicon (a:Si:H) is presented. Photoelectronic quality a���Si:H films are deposited by plasma���enhanced chemical vapor deposition on smooth metal (NiCr alloy) and crystalline silicon (c���Si) substrates. The deposition of a���Si:H is analyzed from the first monolayer up to a final thickness of 1.2 ��m. In order to perform an improved analysis, real time ellipsometric trajectories are recorded, using fixed preparation conditions, at various photon energies ranging from 2.2 to 3.6 eV. The advantage of using such a spectroscopic experimental procedure is underlined. New insights into the nucleation and growth mechanisms of a���Si:H are obtained. The nucleation mechanism on metal and c���Si substrates is very accurately described assuming a columnar microstructural development during the early stage of the growth. Then, as a consequence of the incomplete coalescence of the initial nuclei, a surface roughness at the 10-15 �� scale is identified during the further growth of a���Si:H on both substrates. The bulk a���Si:H grows homogeneously beneath the surface roughness. Finally, an increase of the surface roughness is evidenced during the long term growth of a���Si:H. However, the nature of the substrate influenced the film growth. In particular, the film thickness involved in the nucleation���coalescence phase is found lower in the case of c���Si (67��8 ��) as compared to NiCr (118��22 ��). Likewise films deposited on c���Si present a smaller surface roughness even if thick samples are considered (>1 ��m). More generally, the present study illustrates the capability of in situ spectroellipsometry to precisely analyze fundamental processes in thin���film growth, but also to monitor the preparation of complex structures on a few monolayers scale.

Study and modelling of the effect of herbicides pulse exposure on freshwater microalgae

De plus en plus de substances chimiques sont ��mises et d��tect��es dans l'environnement.Parmi ces substances, on trouve les herbicides qui sont utilis��s en agriculture pour luttercontre la pr��sence des mauvaises herbes. Apr��s leur application sur les sols, les herbicidespeuvent ��tre entrain��s par les eaux de pluie jusque dans les ruisseaux et les rivi��res. Lesconcentrations de ces substances varient donc de mani��re importante dans les syst��mesaquatiques en p��riode de pluie ou en p��riode de temps sec. Des pics ��lev��s de concentrationssont suivis de p��riode de concentrations tr��s faibles ou nulles. Les herbicides pr��sents dans lescours d'eau peuvent engendrer des effets toxiques sur les algues et les plantes aquatiques. Orles tests classiques d'��cotoxicologie effectu��s en laboratoire sont r��alis��s en exposant lesesp��ces vivantes �� des polluants de mani��re continue. Ils ne permettent donc pas d'��valuer leseffets des concentrations fluctuantes comme celles des herbicides. Le but de cette th��se estd'��tudier et de mod��liser les effets des concentrations fluctuantes d'herbicide sur les esp��cesde microalgues vertes Scenedesmus vacuolatus et Pseudokirchneriella subcapitata. Desexp��riences en laboratoire ont ��galement ��t�� effectu��es dans le but de valider le mod��le.Quatre herbicides ont ��t�� test��s. Il s'agit de l'atrazine (utilis�� jusqu'�� r��cemment pour lema��s), du diuron (utilis�� dans la vigne), de l'isoproturon (utilis�� pour les c��r��ales) et du Sm��tolachlore(utilis�� pour le ma��s). Les r��sultats de ce travail de th��se indiquent que les effetsdes concentrations fluctuantes d'herbicide peuvent ��tre mod��lis��s sur des algues d'eau douce.Le mod��le est relativement simple pour les inhibiteurs de la photosynth��se tels que l'atrazine,le diuron ou l'isoproturon. Il n��cessite la connaissance de deux param��tres, le taux decroissance de l'algue sans polluant et la courbe dose-r��ponse pour chaque substance.Cependant, des exp��riences suppl��mentaires doivent ��tre r��alis��es si la substance ��tudi��einduit un d��lai de l'effet et du r��tablissement ou si une algue est cultiv��e avec une autre alguedans le m��me milieu de croissance. Le mod��le pourrait ��galement ��tre adapt�� pour tenircompte des m��langes de substances. Appliqu�� pour pr��dire les effets sur les algues desc��narios r��els, le mod��le montre que les longs pics de concentrations jouent le r��le le plusimportant. Il est donc crucial de les mesurer lors du monitoring des cours d'eau. D'autre part,une ��valuation du risque effectu��e avec ce mod��le montre que l'impact des pics deconcentrations sur les esp��ces les plus sensibles est total. Cela met en ��vidence, une fois deplus, l'importance de tenir compte de ces concentrations fluctuantes dans l'��valuation durisque environnemental des herbicides, mais ��galement des autres polluants.

Chemical profiling: a tool to decipher the structure and organisation of illicit drugs markets: an 8-year study in Western Switzerland

Illicit drug analyses usually focus on the identification and quantitation of questioned material to support the judicial process. In parallel, more and more laboratories develop physical and chemical profiling methods in a forensic intelligence perspective. The analysis of large databases resulting from this approach enables not only to draw tactical and operational intelligence, but may also contribute to the strategic overview of drugs markets. In Western Switzerland, the chemical analysis of illicit drug seizures is centralised in a laboratory hosted by the University of Lausanne. For over 8 years, this laboratory has analysed 5875 cocaine and 2728 heroin specimens, coming from respectively 1138 and 614 seizures operated by police and border guards or customs. Chemical (major and minor alkaloids, purity, cutting agents, chemical class), physical (packaging and appearance) as well as circumstantial (criminal case number, mass of drug seized, date and place of seizure) information are collated in a dedicated database for each specimen. The study capitalises on this extended database and defines several indicators to characterise the structure of drugs markets, to follow-up on their evolution and to compare cocaine and heroin markets. Relational, spatial, temporal and quantitative analyses of data reveal the emergence and importance of distribution networks. They enable to evaluate the cross-jurisdictional character of drug trafficking and the observation time of drug batches, as well as the quantity of drugs entering the market every year. Results highlight the stable nature of drugs markets over the years despite the very dynamic flows of distribution and consumption. This research work illustrates how the systematic analysis of forensic data may elicit knowledge on criminal activities at a strategic level. In combination with information from other sources, such knowledge can help to devise intelligence-based preventive and repressive measures and to discuss the impact of countermeasures.

Neurocognition in schizophrenia: a study of the productivity and visibility of spanish authors

This paper provides a map of the scientific productivity of authors affiliated to a Spanish institution and who have addressed one of the most important current topics in schizophrenia: The study of cognitive performance. A search of the Web of Science yielded 125 articles that met the inclusion criteria. In order to provide a comprehensive overview of scientific productivity, we examine several bibliometric indicators, concerning both productivity and impact or visibility. The analysis also focuses on qualitative aspects of key theoretical importance, such as the kinds of cognitive functions that are most often assessed and the tests most widely used to evaluate them in clinical practice. The study shows that interest in the subject of cognitive function in schizophrenia has increased considerably in Spain since the beginning of this century. The results also highlight the need to standardize the type of tests to be used in the cognitive assessment of patients with schizophrenia.

Study and modeling of the desintegration kinetics of coated paper

The disintegration of recovered paper is the first operation in the preparation of recycled pulp. It is known that the defibering process follows a first order kinetics from which it is possible to obtain the disintegration kinetic constant (KD) by means of different ways. The disintegration constant can be obtained from the Somerville index results (%lsv and from the dissipated energy per volume unit (Ss). The %slv is related to the quantity of non-defibrated paper, as a measure of the non-disintegrated fiber residual (percentage of flakes), which is expressed in disintegration time units. In this work, disintegration kinetics from recycled coated paper has been evaluated, working at 20 revise rotor speed and for different fiber consistency (6, 8, 10, 12 and 14%). The results showed that the values of experimental disintegration kinetic constant, Ko, through the analysis of Somerville index, as function of time. Increased, the disintegration time was drastically reduced. The calculation of the disintegration kinetic constant (modelled Ko), extracted from the Rayleigh���s dissipation function, showed a good correlation with the experimental values using the evolution of the Somerville index or with the dissipated energy

The regulation and function of collagenase-3 (MMP-13) in cutaneous wound healing and squamous cell carcinoma

Matrix metalloproteinase-13 (MMP-13) is a potent proteolytic enzyme, whose expression has been previously associated with fetal bone development and postnatal bone remodeling and with adult gingival wound healing. MMP-13 is also known to be involved in the growth and invasion of various cancers including squamous cell carcinoma (SCC) of the skin. The aim of this study was to further elucidate the function and regulation of MMP-13 in wound repair and cancer. In this study, it was shown that fetal skin fibroblasts express MMP-13 in response to transforming growth factor-�� in a p38 MAP kinase dependent manner. In addition, MMP-13 was found to be expressed in vivo by wound fibroblasts in human fetal skin grafted on SCID mice. Adenovirally delivered expression of MMP-13 enhanced collagen matrix contraction by fibroblasts in vitro in association with altered cytoskeletal structure, enhanced proliferation and survival. These results indicate that MMP-13 is involved in cell-mediated collagen matrix remodeling and suggest a role for MMP-13 in superior matrix remodeling and scarless healing of fetal skin wounds. Using an MMP-13 deficient mouse strain, it was shown that MMP-13 is essential for the normal development of experimental granulation tissue in mice. MMP-13 was implicated in the regulation of myofibroblast function and angiogenesis and the expression of genes involved in cellular proliferation and movement, immune response, angiogenesis and proteolysis. Finally, epidermal mitogen, keratinocyte growth factor (KGF) was shown to suppress the malignant properties of skin SCC cells by downregulating the expression of several target genes with potential cancer promoting properties, including MMP-13, and by reducing SCC cell invasion. These results provide evidence that MMP-13 potently regulates cell viability, myofibroblast function and angiogenesis associated with wound healing and cancer. In addition, fibroblasts expressing MMP-13 show high collagen reorganization capacity. Moreover, the results suggest that KGF mediates the anti-cancer effects on skin SCC

Importance of bone assessment and prevention of osteoporotic fracture in patients with prostate cancer in the gonadotropic hormone analogues use

The antiandrogenic therapy (ADT) for prostate cancer represents an additional risk factor for the development of osteoporosis and fragility fractures. Still, bone health of patients on ADT is often not evaluated. After literature research we found that simple preventive measures can prevent bone loss in these patients, resulting in more cost-effective solutions to the public health system and family when compared to the treatment of fractures.

Anatomical and functional characteristics of the pelvic floor in nulliparous women submitted to three-dimensional endovaginal ultrasonography: case control study and evaluation of interobserver agreement

PURPOSE: To determine anatomical and functional pelvic floor measurements performed with three-dimensional (3-D) endovaginal ultrasonography in asymptomatic nulliparous women without dysfunctions detected in previous dynamic 3-D anorectal ultrasonography (echo defecography) and to demonstrate the interobserver reliability of these measurements. METHODS: Asymptomatic nulliparous volunteers were submitted to echo defecography to identify dynamic dysfunctions, including anatomical (rectocele, intussusceptions, entero/sigmoidocele and perineal descent) and functional changes (non-relaxation or paradoxical contraction of the puborectalis muscle) in the posterior compartment and assessed with regard to the biometric index of levator hiatus, pubovisceral muscle thickness, urethral length, anorectal angle, anorectal junction position and bladder neck position with the 3-D endovaginal ultrasonography. All measurements were compared at rest and during the Valsalva maneuver, and perineal and bladder neck descent was determined. The level of interobserver agreement was evaluated for all measurements. RESULTS: A total of 34 volunteers were assessed by echo defecography and by 3-D endovaginal ultrasonography. Out of these, 20 subjects met the inclusion criteria. The 14 excluded subjects were found to have posterior dynamic dysfunctions. During the Valsalva maneuver, the hiatal area was significantly larger, the urethra was significantly shorter and the anorectal angle was greater. Measurements at rest and during the Valsalva maneuver differed significantly with regard to anorectal junction and bladder neck position. The mean values for normal perineal descent and bladder neck descent were 0.6 cm and 0.5 cm above the symphysis pubis, respectively. The intraclass correlation coefficient ranged from 0.62-0.93. CONCLUSIONS: Functional biometric indexes, normal perineal descent and bladder neck descent values were determined for young asymptomatic nulliparous women with the 3-D endovaginal ultrasonography. The method was found to be reliable to measure pelvic floor structures at rest and during Valsalva, and might therefore be suitable for identifying dysfunctions in symptomatic patients.

Genomics and X-ray microanalysis indicate that Ca2+ and thiols mediate the aggregation and adhesion of Xylella fastidiosa

The availability of the genome sequence of the bacterial plant pathogen Xylella fastidiosa, the causal agent of citrus variegated chlorosis, is accelerating important investigations concerning its pathogenicity. Plant vessel occlusion is critical for symptom development. The objective of the present study was to search for information that would help to explain the adhesion of X. fastidiosa cells to the xylem. Scanning electron microscopy revealed that adhesion may occur without the fastidium gum, an exopolysaccharide produced by X. fastidiosa, and X-ray microanalysis demonstrated the presence of elemental sulfur both in cells grown in vitro and in cells found inside plant vessels, indicating that the sulfur signal is generated by the pathogen surface. Calcium and magnesium peaks were detected in association with sulfur in occluded vessels. We propose an explanation for the adhesion and aggregation process. Thiol groups, maintained by the enzyme peptide methionine sulfoxide reductase, could be active on the surface of the bacteria and appear to promote cell-cell aggregation by forming disulfide bonds with thiol groups on the surface of adjacent cells. The enzyme methionine sulfoxide reductase has been shown to be an auxiliary component in the adhesiveness of some human pathogens. The negative charge conferred by the ionized thiol group could of itself constitute a mechanism of adhesion by allowing the formation of divalent cation bridges between the negatively charged bacteria and predominantly negatively charged xylem walls.