Acquisitions thérapeutiques en médecine ambulatoire en 2013 [2013 literature findings in internal general medicine].

The prescribing of antibiotics for uncomplicated skin abscesses and diverticulitis has no benefit. Some antibiotics are more at risk of causing a Clostridium difficile infection. The tests used to exclude a history of a penicillin allergy are safe. A threshold of D-dimer adjusted for the age significantly improves the specificity of the test without affecting the sensitivity. The prescription of paraclinics tests is not an effective "treatment" for the patient's anxiety. In the sleep apnea syndrome, treatment with CPAP (Continuous positive airway pressure) appears to have more benefits compared to the mandibular advancement prosthesis. The work of primary care physicians can be supported by the work of advanced practice nurses. The limitation placed on the working hours of doctors in hospitals seems to affect their ability to spend time with their patients.

Ultrastructural changes of the internal limiting membrane removed during indocyanine green assisted peeling versus conventional surgery for an idiopathic epimacular membrane

Purpose:To evaluate the histological features of cellular retinal fragments on the internal limiting membrane (ILM) removed during epiretinal membrane peeling surgery with and without the aid of ICG diluted in 5% glucose Methods:ILM specimens removed from 88 eyes undergoing vitrectomy and membrane peeling surgery for idiopathic epiretinal membrane between 1995 and 2003 were reviewed retrospectively. Surgery was performed in all cases by the same surgeon using the same technique. ICG was diluted with 5% glucose. Histological analysis focused on the presence and characteristics of retinal structures on the retinal surface of the ILM. Statistical analysis compared the results between group I (conventional surgery without ICG) and group II (ICG-assisted peeling) Results:Seventy-one eyes underwent EMM surgery without the aid of ICG (group I) and seventeen underwent EMM ICG-assisted surgery assisted using ICG (group II). The amount of Muller cell debris on the retinal surface of the ILM was more significant in the group I (no ICG) than in the group II (ICG) (40.8 versus 11.8; p = 0.024). Large fragments of Muller cells were more frequently observed in the group I (no ICG) than in the group II (ICG) (63.4% versus 23.5%; p= 0.003).The presence of larger retinal elements such as neural axons and vessels were observed attached to retinal face of the ILM in 5 (7%) cases of the no-ICG group. No such retinal elements were detected in any of the histological ILM specimens of the ICG-assisted group Conclusions:The use of ICG diluted with 5% glucose in the aid of ILM removal during epiretinal membrane surgery was associated with less retinal debris attached to retinal face of the ILM compared to surgery in which ICG was not used. Our findings contradict previous reports in the literature, in which use of ICG diluted with balanced salt solution (BSS) was associated with more retinal fragments attached to the retinal face of the ILM. According to our results, we hypothesize that diluting ICG with 5% glucose may decrease the adhesion of the ILM to the underlying retinal layers such that less retinal debris is removed with peeling of the ILM.

Reuse of Lime Sludge from Water Softening and Coal Combustion Byproducts, TR-459, 2004

Disposal of lime sludge remains a major challenge to cities in the Midwest. Disposal of lime sludge from water softening adds about 7-10% to the cost of water treatment. Having effective and safe options is essential for future compliance with the regulations of the State of Iowa and within budget restrictions. Dewatering and drying are essential to all reuse applications as this affects transportation costs and utility. Feasibility tests were conducted on some promising applications like SOx control in power generation facilities that burn coal, replacement of limestone as an ingredient in portland cement production, dust control on gravel roads, neutralization of industrial wastewater pH, and combination with fly ash or cement in construction fill applications. A detailed report and analysis of the construction fills application is presented in the second half of the report. A brief discussion of the results directly follows.

Phosphorus acquisition and internal utilization efficiency in tropical maize genotypes

The objective of this work was to determine the relative importance of phosphorus acquisition efficiency (PAE - plant P uptake per soil available P), and phosphorus internal utilization efficiency (PUTIL - grain yield per P uptake) in the P use efficiency (PUE - grain yield per soil available P), on 28 tropical maize genotypes evaluated at three low P and two high P environments. PAE was almost two times more important than PUTIL to explain the variability observed in PUE, at low P environments, and three times more important at high P environments. These results indicate that maize breeding programs, to increase PUE in these environments, should use selection index with higher weights for PAE than for PUTIL. The correlation between these two traits showed no significance at low or at high P environments, which indicates that selection in one of these traits would not affect the other. The main component of PUTIL was P quotient of utilization (grain yield per grain P) and not the P harvest index (grain P per P uptake). Selection to reduce grain P concentration should increase the quotient of utilization and consequently increase PUTIL.

Exhaled breath condensate as a matrix for combustion-based nanoparticle exposure and health effect evaluation

Health assessment and medical surveillance of workers exposed to combustion nanoparticles are challenging. The aim was to evaluate the feasibility of using exhaled breath condensate (EBC) from healthy volunteers for (1) assessing the lung deposited dose of combustion nanoparticles and (2) determining the resulting oxidative stress by measuring hydrogen peroxide (H2O2) and malondialdehyde (MDA). Methods: Fifteen healthy nonsmoker volunteers were exposed to three different levels of sidestream cigarette smoke under controlled conditions. EBC was repeatedly collected before, during, and 1 and 2 hr after exposure. Exposure variables were measured by direct reading instruments and by active sampling. The different EBC samples were analyzed for particle number concentration (light-scattering-based method) and for selected compounds considered oxidative stress markers. Results: Subjects were exposed to an average airborne concentration up to 4.3×10(5) particles/cm(3) (average geometric size ∼60-80 nm). Up to 10×10(8) particles/mL could be measured in the collected EBC with a broad size distribution (50(th) percentile ∼160 nm), but these biological concentrations were not related to the exposure level of cigarette smoke particles. Although H2O2 and MDA concentrations in EBC increased during exposure, only H2O2 showed a transient normalization 1 hr after exposure and increased afterward. In contrast, MDA levels stayed elevated during the 2 hr post exposure. Conclusions: The use of diffusion light scattering for particle counting proved to be sufficiently sensitive to detect objects in EBC, but lacked the specificity for carbonaceous tobacco smoke particles. Our results suggest two phases of oxidation markers in EBC: first, the initial deposition of particles and gases in the lung lining liquid, and later the start of oxidative stress with associated cell membrane damage. Future studies should extend the follow-up time and should remove gases or particles from the air to allow differentiation between the different sources of H2O2 and MDA.

Traducción comentada de «Management of the Clinically Positive Axilla» y «Management of the Internal Mammary Lymph Nodes», Essentials of Breast Surgery

La transmisión de conocimiento científico constituye una de las necesidades de traducción más importantes; es preciso realizar un estudio sobre la traducción del inglés médico. Este trabajo presenta una traducción inédita de fragmentos de Essentials of Breast Surgery y un análisis de esta jerga mediante un glosario y problemas de traducción.

Elephant grass genotypes for bioenergy production by direct biomass combustion

The objective of this work was to evaluate elephant grass (Pennisetum purpureum Schum.) genotypes for bioenergy production by direct biomass combustion. Five elephant grass genotypes grown in two different soil types, both of low fertility, were evaluated. The experiment was carried out at Embrapa Agrobiologia field station in Seropédica, RJ, Brazil. The design was in randomized complete blocks, with split plots and four replicates. The genotypes studied were Cameroon, Bag 02, Gramafante, Roxo and CNPGL F06-3. Evaluations were made for biomass production, total biomass nitrogen, biomass nitrogen from biological fixation, carbon/nitrogen and stem/leaf ratios, and contents of fiber, lignin, cellulose and ash. The dry matter yields ranged from 45 to 67 Mg ha-1. Genotype Roxo had the lowest yield and genotypes Bag 02 and Cameroon had the highest ones. The biomass nitrogen accumulation varied from 240 to 343 kg ha-1. The plant nitrogen from biological fixation was 51% in average. The carbon/nitrogen and stem/leaf ratios and the contents of fiber, lignin, cellulose and ash did not vary among the genotypes. The five genotypes are suitable for energy production through combustion.

Médecine interne et gériatrie en soins aigus: mariage de raison [General internal medicine and geriatrics in the acute care setting: opportunities for collaboration]

The health care system faces a difficult challenge as a result of the demographic evolution. The acute hospital is especially challenged by the steady increase of the elderly population. The collaboration between internal medicine and geriatrics in this setting could prove useful to facilitate the adaptation of the acute care setting and greatly enhance education of the health care professionals. Internists and geriatricians can benefit from each other skills and competencies to develop together new models of acute care that would better match the elderly population needs.

Acquisitions thérapeutiques en médecine ambulatoire en 2012 [2012 literature findings in ambulatory internal medicine].

In 2012 several articles reported interesting findings for the ambulatory practice in internal general medicine. A negative rapid test for influenza does not rule out that diagnosis. A test assessing the walking speed in the elderly can help determining who would benefit from antihypertensive therapy. Antibiotic treatment has no benefit for acute uncomplicated rhinosinusitis and diverticulitis. Probiotics can reduce the risk of post-antibiotic diarrhea. Daily coffee intake could reduce mortality. Oral supplementation of calcium can be harmful to the cardiovascular system. Subclinical hyperthyroidism should be treated to prevent cardiovascular complications. Aspirin can prevent recurrences in case of a primary thromboembolic event. Local injection of corticosteroids under ultrasonographic guidance for plantar fasciitis can be a safe treatment. Ibuprofen can prevent acute mountain sickness.

Rhythmic growth explained by coincidence between internal and external cues.

Most organisms use circadian oscillators to coordinate physiological and developmental processes such as growth with predictable daily environmental changes like sunrise and sunset. The importance of such coordination is highlighted by studies showing that circadian dysfunction causes reduced fitness in bacteria and plants, as well as sleep and psychological disorders in humans. Plant cell growth requires energy and water-factors that oscillate owing to diurnal environmental changes. Indeed, two important factors controlling stem growth are the internal circadian oscillator and external light levels. However, most circadian studies have been performed in constant conditions, precluding mechanistic study of interactions between the clock and diurnal variation in the environment. Studies of stem elongation in diurnal conditions have revealed complex growth patterns, but no mechanism has been described. Here we show that the growth phase of Arabidopsis seedlings in diurnal light conditions is shifted 8-12 h relative to plants in continuous light, and we describe a mechanism underlying this environmental response. We find that the clock regulates transcript levels of two basic helix-loop-helix genes, phytochrome-interacting factor 4 (PIF4) and PIF5, whereas light regulates their protein abundance. These genes function as positive growth regulators; the coincidence of high transcript levels (by the clock) and protein accumulation (in the dark) allows them to promote plant growth at the end of the night. Thus, these two genes integrate clock and light signalling, and their coordinated regulation explains the observed diurnal growth rhythms. This interaction may serve as a paradigm for understanding how endogenous and environmental signals cooperate to control other processes.