Le "neurally adjusted ventilatory assist": vers une révolution de la ventilation mécanique [Neurally adjusted ventilatory assist: a revolution of mechanical ventilation?].

Neurally adjusted ventilatory assist or NAVA is a new assisted ventilatory mode which, in comparison with pressure support, leads to improved patient-ventilator synchrony and a more variable ventilatory pattern. It also improves arterial oxygenation. With NAVA, the electrical activity of the diaphragm is recorded through a nasogastric tube equipped with electrodes. This electrical activity is then used to pilot the ventilator. With NAVA, the patient's respiratory pattern controls the ventilator's timing of triggering and cycling as well as the magnitude of pressurization, which is proportional to inspiratory demand. The effect of NAVA on patient outcome remains to be determined through well-designed prospective studies.

Protective effects of maternal nutritional supplementation with lactoferrin on growth and brain metabolism.

Background:Intrauterine growth restriction (IUGR) is a major risk factor for both perinatal and long-term morbidity. Bovine lactoferrin (bLf) is a major milk glycoprotein considered as a pleiotropic functional nutrient. The impact of maternal supplementation with bLf on IUGR-induced sequelae, including inadequate growth and altered cerebral development, remains unknown.Methods:IUGR was induced through maternal dexamethasone infusion (100 μg/kg during last gestational week) in rats. Maternal supplementation with bLf (0.85% in food pellet) was provided during both gestation and lactation. Pup growth was monitored, and Pup brain metabolism and gene expression were studied using in vivo (1)H NMR spectroscopy, quantitative PCR, and microarray in the hippocampus at postnatal day (PND)7.Results:Maternal bLf supplementation did not change gestational weight but increased the birth body weight of control pups (4%) with no effect on the IUGR pups. Maternal bLf supplementation allowed IUGR pups to recover a normalized weight at PND21 (weaning) improving catch-up growth. Significantly altered levels of brain metabolites (γ-aminobutyric acid, glutamate, N-acetylaspartate, and N-acetylaspartylglutamate) and transcripts (brain-derived neurotrophic factor (BDNF), divalent metal transporter 1 (DMT-1), and glutamate receptors) in IUGR pups were normalized with maternal bLf supplementation.Conclusion:Our data suggest that maternal bLf supplementation is a beneficial nutritional intervention able to revert some of the IUGR-induced sequelae, including brain hippocampal changes.

Evaluation of the user-friendliness of seven new generation intensive care ventilators.

OBJECTIVE: To explore the user-friendliness and ergonomics of seven new generation intensive care ventilators. DESIGN: Prospective task-performing study. SETTING: Intensive care research laboratory, university hospital. METHODS: Ten physicians experienced in mechanical ventilation, but without prior knowledge of the ventilators, were asked to perform eight specific tasks [turning the ventilator on; recognizing mode and parameters; recognizing and setting alarms; mode change; finding and activating the pre-oxygenation function; pressure support setting; stand-by; finding and activating non-invasive ventilation (NIV) mode]. The time needed for each task was compared to a reference time (by trained physiotherapist familiar with the devices). A time >180 s was considered a task failure. RESULTS: For each of the tests on the ventilators, all physicians' times were significantly higher than the reference time (P < 0.001). A mean of 13 +/- 8 task failures (16%) was observed by the ventilator. The most frequently failed tasks were mode and parameter recognition, starting pressure support and finding the NIV mode. Least often failed tasks were turning on the pre-oxygenation function and alarm recognition and management. Overall, there was substantial heterogeneity between machines, some exhibiting better user-friendliness than others for certain tasks, but no ventilator was clearly better that the others on all points tested. CONCLUSIONS: The present study adds to the available literature outlining the ergonomic shortcomings of mechanical ventilators. These results suggest that closer ties between end-users and manufacturers should be promoted, at an early development phase of these machines, based on the scientific evaluation of the cognitive processes involved by users in the clinical setting.

Behavior of Carbonate Rocks as Concrete Aggregates, HR-15, 1962

The problem of determining the suitability of carbonate rocks as concrete aggregates is extremely complex and calls for more new data than has been available or obtainable from usual methods. Since 1955 the approach which has served as a primary basis for the project has been to gather as much new information as possible to apply to the problem. New information obtained by new and different techniques provides better understanding. This approach was decided on since, in all prior studies, a standard petrographic and petrologic approach correlated in many instances with standard engineering tests did not provide the answer in Iowa or elsewhere. One can theorize that concrete fails (excluding external causes such as traffic, foundation failure, etc.) because of stresses of internal origin. The stresses can be of a physical nature, such as frost action, or result from chemical activity such as the alkali aggregate reaction. If, as service records show, the aggregate is considered the cause of distress in concrete, it will without doubt be the manner in which an aggregate can create or contribute to stress of internal origin by physical or chemical means. Therefore the main emphasis was placed on studying physical and chemical properties of aggregates as well as the behavior of carbonate rocks in concrete environments. Although standard geologic and engineering methods were also utilized, the approach adopted required considerable effort in devising new techniques and methods. This report is intended to be a detailed summary of the research performed. Whenever possible, the work accomplished will be summarized and all pertinent data will be included. For further details, reference to the various theses and publications transmitted with this report or at previous times will be made wherever possible.

Nervous glucose sensing regulates postnatal β cell proliferation and glucose homeostasis.

How glucose sensing by the nervous system impacts the regulation of β cell mass and function during postnatal development and throughout adulthood is incompletely understood. Here, we studied mice with inactivation of glucose transporter 2 (Glut2) in the nervous system (NG2KO mice). These mice displayed normal energy homeostasis but developed late-onset glucose intolerance due to reduced insulin secretion, which was precipitated by high-fat diet feeding. The β cell mass of adult NG2KO mice was reduced compared with that of WT mice due to lower β cell proliferation rates in NG2KO mice during the early postnatal period. The difference in proliferation between NG2KO and control islets was abolished by ganglionic blockade or by weaning the mice on a carbohydrate-free diet. In adult NG2KO mice, first-phase insulin secretion was lost, and these glucose-intolerant mice developed impaired glucagon secretion when fed a high-fat diet. Electrophysiological recordings showed reduced parasympathetic nerve activity in the basal state and no stimulation by glucose. Furthermore, sympathetic activity was also insensitive to glucose. Collectively, our data show that GLUT2-dependent control of parasympathetic activity defines a nervous system/endocrine pancreas axis that is critical for β cell mass establishment in the postnatal period and for long-term maintenance of β cell function.

Fecundity versus offspring size in the greater white-toothed shrew Crocidura russula

1. The relationships between female body mass (WWal)i, tter size (m), juvenile growth rate (G) and mass at weaning (W20) were examined by monitoring natural litters in 29 greater white-toothed shrews, Crocidura russula (Hermann 1780). The trade-offs between m and G or W20 were further investigated by manipulating litter sizes: each of seven females reared four litters of 2, 4, 6 and 8 offspring. 2. Offspring mass at weaning (W20) exhibited a large variance, most of which could be attributed (ANCOVA on manipulated litters) to two effects: a litter-size effect, and a female individual effect, referred to as 'female quality'. 3. Litter size explained 68% of the variance in W20 among manipulated litters (linear regression). The limited milk supply was probably responsible for this effect, because litter size depressed growth rate during the first half of the lactation period (G1), but not during the weaning stage (G2). 4. Among non-manipulated litters, litter size correlated positively with maternal body mass (Wa), so that large females tended to produce small juveniles. This correlation between m and Wa is seen as the result of a body-mass dependence in the cost of raising a litter of a given size, during either pregnancy or lactation. 5. Differences in 'female quality' explained 16% of the variance in W20 among manipulated litters. This factor did not affect GI and may thus relate to differences among offspring of different females in their rates of processing milk and/or external food during late lactation. 6. 'Female quality' was independent of both body mass and litter size: larger females did not produce larger offspring when controlled for litter size, while higher-quality females did not produce larger litters. 7. Our results support the hypothesis that most variance in adult and juvenile body masses is non-genetic, and stems from the trade-off between litter size and offspring size.

Cómo elaborar, tutorizar y evaluar un trabajo de fin de máster

Los estudios de nivel superior en el marco de la Unión Europea se componen del Grado y del Postgrado (Másters y doctorados). Los Másters son titulaciones producto de una formación avanzada, multidisciplinar o especializada, dirigida a la consecución de logros académicos en profundidad, de especialidades profesionales o de iniciación a la investigación. Los estudios deMaster exigen la evaluación continua del proceso de aprendizaje que se concreta finalmente en el denominado Trabajo de Fin de Máster, verdadera piedra angular de la formación del estudiante. Ese trabajo final está pensado para evidenciar las competencias adquiridas a lolargo de todo el programa formativo y para demostrar el logro de los objetivos globales del aprendizaje. Es la prueba definitiva de la madurez y de la profesionalidad de una carrera hecha a conciencia...

Cómo elaborar, tutorizar y evaluar un trabajo de fin de máster

Los estudios de nivel superior en el marco de la Unión Europea se componen del Grado y del Postgrado (Másters y doctorados). Los Másters son titulaciones producto de una formación avanzada, multidisciplinar o especializada, dirigida a la consecución de logros académicos en profundidad, de especialidades profesionales o de iniciación a la investigación. Los estudios deMaster exigen la evaluación continua del proceso de aprendizaje que se concreta finalmente en el denominado Trabajo de Fin de Máster, verdadera piedra angular de la formación del estudiante. Ese trabajo final está pensado para evidenciar las competencias adquiridas a lolargo de todo el programa formativo y para demostrar el logro de los objetivos globales del aprendizaje. Es la prueba definitiva de la madurez y de la profesionalidad de una carrera hecha a conciencia...

Cómo elaborar, tutorizar y evaluar un trabajo de fin de máster

Los estudios de nivel superior en el marco de la Unión Europea se componen del Grado y del Postgrado (Másters y doctorados). Los Másters son titulaciones producto de una formación avanzada, multidisciplinar o especializada, dirigida a la consecución de logros académicos en profundidad, de especialidades profesionales o de iniciación a la investigación. Los estudios deMaster exigen la evaluación continua del proceso de aprendizaje que se concreta finalmente en el denominado Trabajo de Fin de Máster, verdadera piedra angular de la formación del estudiante. Ese trabajo final está pensado para evidenciar las competencias adquiridas a lolargo de todo el programa formativo y para demostrar el logro de los objetivos globales del aprendizaje. Es la prueba definitiva de la madurez y de la profesionalidad de una carrera hecha a conciencia...

Cómo elaborar, tutorizar y evaluar un trabajo de fin de máster

Los estudios de nivel superior en el marco de la Unión Europea se componen del Grado y del Postgrado (Másters y doctorados). Los Másters son titulaciones producto de una formación avanzada, multidisciplinar o especializada, dirigida a la consecución de logros académicos en profundidad, de especialidades profesionales o de iniciación a la investigación. Los estudios deMaster exigen la evaluación continua del proceso de aprendizaje que se concreta finalmente en el denominado Trabajo de Fin de Máster, verdadera piedra angular de la formación del estudiante. Ese trabajo final está pensado para evidenciar las competencias adquiridas a lolargo de todo el programa formativo y para demostrar el logro de los objetivos globales del aprendizaje. Es la prueba definitiva de la madurez y de la profesionalidad de una carrera hecha a conciencia...

Com elaborar, tutoritzar i avaluar um treball de fi de màster

Els estudis de nivell superior en el marc de la Unió Europea es componen del Grau i delPostgrau (Màsters i Doctorats). Els Màsters són titulacions producte d’una formació avançada, multidisciplinària o especialitzada, dirigida a la consecució d’assoliments acadèmics enprofunditat, d’especialitats professionals o d’iniciació a la recerca. Els estudis de Màster exigeixen l’avaluació continuada del procés d’aprenentatge que es concreta finalment en el denominat Treball de Fi de Màster (TFM), vertadera pedra angular de la formació de l’estudiant. Aquest treball final està pensat per evidenciar les competències adquirides al llarg de tot elprograma formatiu i demostrar l’assoliment dels objectius globals de l’aprenentatge. És la prova definitiva de la maduresa i de la professionalitat d’una carrera feta a consciència...

Com elaborar, tutoritzar i avaluar um treball de fi de màster

Els estudis de nivell superior en el marc de la Unió Europea es componen del Grau i delPostgrau (Màsters i Doctorats). Els Màsters són titulacions producte d’una formació avançada, multidisciplinària o especialitzada, dirigida a la consecució d’assoliments acadèmics enprofunditat, d’especialitats professionals o d’iniciació a la recerca. Els estudis de Màster exigeixen l’avaluació continuada del procés d’aprenentatge que es concreta finalment en el denominat Treball de Fi de Màster (TFM), vertadera pedra angular de la formació de l’estudiant. Aquest treball final està pensat per evidenciar les competències adquirides al llarg de tot elprograma formatiu i demostrar l’assoliment dels objectius globals de l’aprenentatge. És la prova definitiva de la maduresa i de la professionalitat d’una carrera feta a consciència...

Com elaborar, tutoritzar i avaluar um treball de fi de màster

Els estudis de nivell superior en el marc de la Unió Europea es componen del Grau i delPostgrau (Màsters i Doctorats). Els Màsters són titulacions producte d’una formació avançada, multidisciplinària o especialitzada, dirigida a la consecució d’assoliments acadèmics enprofunditat, d’especialitats professionals o d’iniciació a la recerca. Els estudis de Màster exigeixen l’avaluació continuada del procés d’aprenentatge que es concreta finalment en el denominat Treball de Fi de Màster (TFM), vertadera pedra angular de la formació de l’estudiant. Aquest treball final està pensat per evidenciar les competències adquirides al llarg de tot elprograma formatiu i demostrar l’assoliment dels objectius globals de l’aprenentatge. És la prova definitiva de la maduresa i de la professionalitat d’una carrera feta a consciència...

Com elaborar, tutoritzar i avaluar um treball de fi de màster

Els estudis de nivell superior en el marc de la Unió Europea es componen del Grau i delPostgrau (Màsters i Doctorats). Els Màsters són titulacions producte d’una formació avançada, multidisciplinària o especialitzada, dirigida a la consecució d’assoliments acadèmics enprofunditat, d’especialitats professionals o d’iniciació a la recerca. Els estudis de Màster exigeixen l’avaluació continuada del procés d’aprenentatge que es concreta finalment en el denominat Treball de Fi de Màster (TFM), vertadera pedra angular de la formació de l’estudiant. Aquest treball final està pensat per evidenciar les competències adquirides al llarg de tot elprograma formatiu i demostrar l’assoliment dels objectius globals de l’aprenentatge. És la prova definitiva de la maduresa i de la professionalitat d’una carrera feta a consciència...

Rhumatologie. Anti-TNF alpha: quels risques infectieux? Recommandations pratiques [Rheumatology. TNF alpha-inhibitors: infection risks? Practical recommendations].

Anti-TNF alpha are immunomodulatory treatments prescribed for some rheumatologic inflammatory diseases (ex: spondylarthropathy, rheumatoid polyarthritis). The randomised studies suggested that anti-TNF alpha therapy is associated with an overall risk of infectious diseases. The results of the observational studies are more reassuring. In this article, we will describe some results of theses studies and propose some practical recommendations in use of the anti-TNF alpha therapy.