Ostéogénèse atypique après séquestrectomies multiples pour fracture ouverte infectée du fémur: un cas [Atypical osteogenesis following multiple sequestrectomies for infected open fracture of the femur: a case]

The authors present the case of an open fracture of femur Cauchoix type II with an infection due to Escherichia coli, Clostridium perfringens, Enterococcus and Aspergillus fumigatus. After several sequestrectomies and five hyperbaric sessions, apyrexia was attained at the end of the third month, the femur having been stabilised with an external fixator. The 15 cm gap due to loss of bone substance, filled at each dressing with an antiseptic iodine based ointment, closed itself finishing as continuous bone five months after the accident, the granulation tissue having been recovered by thin skin grafts. A repeated fracture occurring forty-eight hours after the removal of the Hoffmann frame was treated by fitting an Ilizarov fixator arriving at consolidation in seven months. The authors examine different possibilities of accelerating osteogenesis and highlight the potential role of iodine ointment as inductive to osteogenesis stemming from a periosteal layer seemingly held in place.

Serologic evidence of human metapneumovirus circulation in Uruguay

First identified in 2001, the human metapneumovirus (hMPV), is a respiratory tract pathogen that affects young children, elderly, and immunocompromised patients. The present work represents the first serologic study carried out in Uruguay. It was performed with the purpose of obtaining serological evidence of hMPV circulation in Uruguay and to contribute to the few serologic reports described until now. Sixty nine serum samples collected between 1998 and 2001 by vein puncture from patients without respiratory symptoms or underlying pathology aged 6 days to 60 years were examined using an indirect immunofluorescence assay (IFA). The global seropositivity rate of the samples was 80% (55/69). Rates of 60% (15/25) and 91% (40/44) were observed for the pediatric and adult cohorts, respectively. Results obtained from a longitudinal analysis of 6 children aged 6 days to 18 months are discussed. These results are a clear evidence of hMPV circulation in Uruguay, at least since 1998, and reinforce the previous data on worldwide circulation of this virus.

Evaluation of MRSA-Screen, a simple anti-PBP 2a slide latex agglutination kit, for rapid detection of methicillin resistance in Staphylococcus aureus.

The MRSA-Screen test (Denka Seiken Co., Ltd., Tokyo, Japan), consisting of a slide latex agglutination kit that detects PBP 2a with a monoclonal antibody, was blindly compared to the oxacillin disk diffusion test, the oxacillin-salt agar screen, and PCR of the mecA gene for the detection of methicillin resistance in Staphylococcus aureus. A total of 120 methicillin-susceptible S. aureus (MSSA) and 80 methicillin-resistant S. aureus (MRSA) isolates, defined by the absence or presence of the mecA gene, respectively, were tested. The MRSA-Screen test, the oxacillin disk diffusion test, and the oxacillin-salt agar screening test showed sensitivities of 100, 61.3, and 82.5% and specificities of 99.2, 96.7, and 98.3%, respectively. We conclude that the MRSA-Screen is a very accurate, reliable, and fast test (15 min) for differentiation of MRSA from MSSA colonies on agar plates.

Publication trends of shared decision making in 15 high impact medical journals: a full-text review with bibliometric analysis.

BACKGROUND: Shared Decision Making (SDM) is increasingly advocated as a model for medical decision making. However, there is still low use of SDM in clinical practice. High impact factor journals might represent an efficient way for its dissemination. We aimed to identify and characterize publication trends of SDM in 15 high impact medical journals. METHODS: We selected the 15 general and internal medicine journals with the highest impact factor publishing original articles, letters and editorials. We retrieved publications from 1996 to 2011 through the full-text search function on each journal website and abstracted bibliometric data. We included publications of any type containing the phrase "shared decision making" or five other variants in their abstract or full text. These were referred to as SDM publications. A polynomial Poisson regression model with logarithmic link function was used to assess the evolution across the period of the number of SDM publications according to publication characteristics. RESULTS: We identified 1285 SDM publications out of 229,179 publications in 15 journals from 1996 to 2011. The absolute number of SDM publications by journal ranged from 2 to 273 over 16 years. SDM publications increased both in absolute and relative numbers per year, from 46 (0.32% relative to all publications from the 15 journals) in 1996 to 165 (1.17%) in 2011. This growth was exponential (P < 0.01). We found fewer research publications (465, 36.2% of all SDM publications) than non-research publications, which included non-systematic reviews, letters, and editorials. The increase of research publications across time was linear. Full-text search retrieved ten times more SDM publications than a similar PubMed search (1285 vs. 119 respectively). CONCLUSION: This review in full-text showed that SDM publications increased exponentially in major medical journals from 1996 to 2011. This growth might reflect an increased dissemination of the SDM concept to the medical community.

Alternative ways to estimate change points in multinomial sequences. An application to an authorship attribution problem

The statistical analysis of literary style is the part of stylometry that compares measurable characteristicsin a text that are rarely controlled by the author, with those in other texts. When thegoal is to settle authorship questions, these characteristics should relate to the author’s style andnot to the genre, epoch or editor, and they should be such that their variation between authors islarger than the variation within comparable texts from the same author.For an overview of the literature on stylometry and some of the techniques involved, see for exampleMosteller and Wallace (1964, 82), Herdan (1964), Morton (1978), Holmes (1985), Oakes (1998) orLebart, Salem and Berry (1998).Tirant lo Blanc, a chivalry book, is the main work in catalan literature and it was hailed to be“the best book of its kind in the world” by Cervantes in Don Quixote. Considered by writterslike Vargas Llosa or Damaso Alonso to be the first modern novel in Europe, it has been translatedseveral times into Spanish, Italian and French, with modern English translations by Rosenthal(1996) and La Fontaine (1993). The main body of this book was written between 1460 and 1465,but it was not printed until 1490.There is an intense and long lasting debate around its authorship sprouting from its first edition,where its introduction states that the whole book is the work of Martorell (1413?-1468), while atthe end it is stated that the last one fourth of the book is by Galba (?-1490), after the death ofMartorell. Some of the authors that support the theory of single authorship are Riquer (1990),Chiner (1993) and Badia (1993), while some of those supporting the double authorship are Riquer(1947), Coromines (1956) and Ferrando (1995). For an overview of this debate, see Riquer (1990).Neither of the two candidate authors left any text comparable to the one under study, and thereforediscriminant analysis can not be used to help classify chapters by author. By using sample textsencompassing about ten percent of the book, and looking at word length and at the use of 44conjunctions, prepositions and articles, Ginebra and Cabos (1998) detect heterogeneities that mightindicate the existence of two authors. By analyzing the diversity of the vocabulary, Riba andGinebra (2000) estimates that stylistic boundary to be near chapter 383.Following the lead of the extensive literature, this paper looks into word length, the use of the mostfrequent words and into the use of vowels in each chapter of the book. Given that the featuresselected are categorical, that leads to three contingency tables of ordered rows and therefore tothree sequences of multinomial observations.Section 2 explores these sequences graphically, observing a clear shift in their distribution. Section 3describes the problem of the estimation of a suden change-point in those sequences, in the followingsections we propose various ways to estimate change-points in multinomial sequences; the methodin section 4 involves fitting models for polytomous data, the one in Section 5 fits gamma modelsonto the sequence of Chi-square distances between each row profiles and the average profile, theone in Section 6 fits models onto the sequence of values taken by the first component of thecorrespondence analysis as well as onto sequences of other summary measures like the averageword length. In Section 7 we fit models onto the marginal binomial sequences to identify thefeatures that distinguish the chapters before and after that boundary. Most methods rely heavilyon the use of generalized linear models

Projectes d’adaptació a la nova normativa de benestar animal per a truges reproductores en una explotació situada al T.M. de Les Masies de Voltragà (Osona)

El present projecte pretén reformar les naus de gestació d’una explotació de porcí blanc de cicle tancat, per tal de complir amb el Reial Decret 1135/2002 sobre “Benestar animal en les explotacions porcines”

Cost-effectiveness of the implementation of an enhanced recovery protocol for colorectal surgery.

BACKGROUND: Enhanced recovery protocols may reduce postoperative complications and length of hospital stay. However, the implementation of these protocols requires time and financial investment. This study evaluated the cost-effectiveness of enhanced recovery implementation. METHODS: The first 50 consecutive patients treated during implementation of an enhanced recovery programme were compared with 50 consecutive patients treated in the year before its introduction. The enhanced recovery protocol principally implemented preoperative counselling, reduced preoperative fasting, preoperative carbohydrate loading, avoidance of premedication, optimized fluid balance, standardized postoperative analgesia, use of a no-drain policy, as well as early nutrition and mobilization. Length of stay, readmissions and complications within 30 days were compared. A cost-minimization analysis was performed. RESULTS: Hospital stay was significantly shorter in the enhanced recovery group: median 7 (interquartile range 5-12) versus 10 (7-18) days (P = 0·003); two patients were readmitted in each group. The rate of severe complications was lower in the enhanced recovery group (12 versus 20 per cent), but there was no difference in overall morbidity. The mean saving per patient in the enhanced recovery group was euro1651. CONCLUSION: Enhanced recovery is cost-effective, with savings evident even in the initial implementation period.

Growth and characterization of CoO ultra thin films

In this report we present the growth process of the cobalt oxide system using reactive electron beam deposition. In that technique, a target of metallic cobalt is evaporated and its atoms are in-flight oxidized in an oxygen rich reactive atmosphere before reaching the surface of the substrate. With a trial and error procedure the deposition parameters have been optimized to obtain the correct stoichiometry and crystalline phase. The evaporation conditions to achieve the correct cobalt oxide salt rock structure, when evaporating over amorphous silicon nitride, are: 525 K of substrate temperature, 2.5·10-4 mbar of oxygen partial pressure and 1 Å/s of evaporation rate. Once the parameters were optimized a set of ultra thin film ranging from samples of 1 nm of nominal thickness to 20nm thick and bulk samples were grown. With the aim to characterize the samples and study their microstructure and morphology, X-ray diffraction, transmission electron microscopy, electron diffraction, energy dispersive X-ray spectroscopy and quasi-adiabatic nanocalorimetry techniques are utilised. The final results show a size dependent effect of the antiferromagnetic transition. Its Néel temperature becomes depressed as the size of the grains forming the layer decreases.

L'empreinte écologique : un indicateur ambigu

Célèbre est devenu le concept d'empreinte écologique qui se présente comme un indicateur composite supposé nous renseigner sur l'espace utilisé par les hommes pour produire les ressources qu'ils consomment et les déchets qu'ils rejettent, le mettre en regard de la capacité écologique de la planète (la biocapacité), donc le revenu écologique à disposition des hommes. Lorsque l'empreinte écologique excède la biodiversité, cela signifie que la planète est en danger. Le succès de cet indicateur élaboré par le Global Footprint Network (GFN) tient sans doute aux conclusions sensationnelles qui se dégagent des calculs effectués : par exemple, la propagation à la planète du mode de vie nord-américain exigerait à elle seule cinq planètes... Il est donc important de comprendre comment a été élaboré cet indicateur, quelle est sa fiabilité et quels enseignements peuvent en être tirés en vue de l'adoption d'une politique de développement durable. Tel est le premier objectif de cet article qui en explique la philosophie, montre comment est conçu cet indicateur et comment sont opérés les calculs. Mais les auteurs ne s'arrêtent pas là. Ils rappellent certaines impasses faites consciemment par le GFN, puis les critiques déjà adressées à cet indicateur qui, précisément en raison de son caractère composite, agrège des données hétérogènes et procède à des calculs et des pondérations sujets à caution dont les enseignements sont donc contestables ? par exemple lorsqu'il suggère que certains pays auraient intérêt à remplacer leurs forêts pour accroître les surfaces cultivables, alors même que l'espace bâti (amputant lui aussi des terres arables) n'est absolument pas remis en question. Au-delà même de ces réserves, les auteurs prolongent et approfondissent la critique de l'empreinte écologique. Ainsi soulignent-ils, par exemple, que l'empreinte carbone compte pour la moitié de l'empreinte totale et que, si on se contentait de mesurer celle-ci en quantité physique plutôt qu'en usant d'un artefact (l'hectare global), le calcul serait sans doute plus robuste et les conclusions non moins alarmistes puisqu'il faudrait cette fois 11 planètes si d'aventure le mode de vie nord-américain devait s'étendre au monde entier. Même s'il peut paraître parfois un peu ardu, cet article est à lire absolument car ses auteurs y mettent en évidence un certain nombre de problèmes majeurs que nul ne saurait ignorer.

Recherche translationnelle: de l'animal modèle de schizophrénie à la forme humaine de difficulté cognitive. Evaluation des performances de navigation spatiale et des stratégies utilisées

Un protocole de tests sur labyrinthe radial permettant d'évaluer la navigation spatial chez l'homme a été réalisé. Ces tests sur labyrinthe radial sont basés sur le protocole utilisé sur l'animal modèle de schizophrénie dans le CNP (Centre de neuroscience psychiatrique) de Lausanne. Les recherches actuelles du CNP ont montré un déficit dans les capacités d'orientation spatiale de ces animaux [13]. Ainsi notre méthodologie consistera à tester des sujets humains dans des tâches de labyrinthe afin d'étudier de la manière la plus équivalente les différents déficits observés dans la pathologie humaine et dans le rat modèle. Cette démarche est à la base d'une approche translationnelle qui combine recherches cliniques et expérimentales. Le travail expérimental a été mené sur deux dispositifs analogues. a) «radial au doigt», ensemble de petits canaux qui peuvent être explorés par le doigt, yeux ouverts ou fermés et dans lesquels des textures différentes tapissent chaque bras. b) «radial sur écran tactile», deux labyrinthes qui comparent deux types d'indice locale, couleurs différentes ou patrons noir-blanc. Dans les deux dispositifs a été prévu une série de tests permettant d'évaluer la mémorisation des indices utilisés en les supprimant temporairement où en les mettant en contradiction. La première perturbation a pour but de tester l'importance du référentiel locale par une rotation de 90° du labyrinthe. La permutation des bras lors d'un dernier essai permet d'induire une situation ou les informations ont été soit correctes spatialement mais incorrectes localement (texture) soit inversement. Ces perturbations des informations sensorielles qui sont fournies au sujet, permettent d'observer les systèmes de repérage et leur poids relatif dans la construction d'un système de référence durant la navigation spatiale. Les résultats du labyrinthe radial au doigt montrent que dans les conditions utilisant les informations visuelles les participants sont sensiblement plus performants. Il est apparu que les informations visuelles prédominent sur les informations proprioceptives et tactiles. Ainsi dans la condition intégrant informations visuospatiales, proprioceptives et tactiles, les sujets basent plus fortement leur navigation spatiale sur les indices visuelles soit locale soit spatiale. Dans cette condition une différence significative de stratégie entre hommes et femmes est apparue. Les hommes se basent majoritairement sur des indices spatiaux tandis que les femmes préfèrent les indices locaux. En présence d'informations tactiles et proprioceptives mais en absence de la vision, les participants utilisent les références spatiale et locale complémentairement sans avoir un système prédominant. Alors que si uniquement les informations proprioceptives sont présentes, les sujets utilisent un système de référence spatiale (globale). Le labyrinthe radial sur écran tactile indique une différence de système de référence selon l'indice local employé. Les couleurs, étant des forts indices locaux, vont favoriser un système de référence local. Au contraire les patrons noirs-blancs sont des indices visiblement très complexes et difficiles à mémoriser qui vont pousser les sujets à utiliser une stratégie de référence spatiale.

Hypertension artérielle pulmonaire primitive et maladie de Basedow [Primary pulmonary hypertension arterial and Basedow disease].

We report a case of a fifty year old woman with Graves' disease with positive AntiTPO antibodies and positive AntiTSH receptor antibodies, who was hospitalized with a right cardiac failure. A pulmonary hypertension was discovered on echocardiography. After adequate antithyroid therapy, the right cardiac failure regressed rapidly and pulmonary pressure normalised. An autoimmune process has often been proposed to explain the association between pulmonary hypertension and hyperthyroidism. We report the arguments supporting this autoimmune etiopathogenesis. We also discuss an other hypothesis based on a direct effect of thyroid hormones on the pulmonary circulation and the effects of high cardiac output associated with hyperthyroidism.