Mémoires du cardinal de Retz, de Guy Joli, et de la duchesse de Nemours; contenant ce qui s'est passé de remarquable en France pendant les premières années du règne de Louis XIV ...

t. 1. Notice sur le cardinal de Retz ... Portrait de Retz par Saint-Évremont. Portrait de Retz par La Rochefoucault. Mémoires du cardinal de Retz.--t. 2. Mémoires de Retz (cont'd)--t. 3. Mémoires de Retz (cont'd) Procès verbal de la conférence, faite à Ruel. Le trictrac. Lettre présentée au Sacré collége de la part du cardinal de Retz, pendant sa prison. Le courrier burlesque de la guerre de Paris. Sermon de Saint Louis, roi de France ... par J.F.P. de Gondi. La conjuration du comte Jean-Louis de Fiesque. Avis à M. le cardinal Mazarin, sur les affaires de M. le cardinal de Retz.--t. 4. Notice sur Guy Joli. Mémoires de Guy Joli.--t. 5. Mémoires de Guy Joli (cont'd) Mémoire concernant le cardinal de Retz ... par Claude Joli. Mémoires de la duchesse de Nemours.

Transfusion Requirements After Cardiac Surgery The TRACS Randomized Controlled Trial

Context Perioperative red blood cell transfusion is commonly used to address anemia, an independent risk factor for morbidity and mortality after cardiac operations; however, evidence regarding optimal blood transfusion practice in patients undergoing cardiac surgery is lacking. Objective To define whether a restrictive perioperative red blood cell transfusion strategy is as safe as a liberal strategy in patients undergoing elective cardiac surgery. Design, Setting, and Patients The Transfusion Requirements After Cardiac Surgery (TRACS) study, a prospective, randomized, controlled clinical noninferiority trial conducted between February 2009 and February 2010 in an intensive care unit at a university hospital cardiac surgery referral center in Brazil. Consecutive adult patients (n=502) who underwent cardiac surgery with cardiopulmonary bypass were eligible; analysis was by intention-to-treat. Intervention Patients were randomly assigned to a liberal strategy of blood transfusion (to maintain a hematocrit >= 30%) or to a restrictive strategy (hematocrit >= 24%). Main Outcome Measure Composite end point of 30-day all-cause mortality and severe morbidity (cardiogenic shock, acute respiratory distress syndrome, or acute renal injury requiring dialysis or hemofiltration) occurring during the hospital stay. The noninferiority margin was predefined at -8% (ie, 8% minimal clinically important increase in occurrence of the composite end point). Results Hemoglobin concentrations were maintained at a mean of 10.5 g/dL(95% confidence interval [CI], 10.4-10.6) in the liberal-strategy group and 9.1 g/dL (95% CI, 9.09.2) in the restrictive-strategy group (P<.001). A total of 198 of 253 patients (78%) in the liberal-strategy group and 118 of 249 (47%) in the restrictive-strategy group received a blood transfusion (P<.001). Occurrence of the primary end point was similar between groups (10% liberal vs 11% restrictive; between-group difference, 1% [95% CI, -6% to 4%]; P=.85). Independent of transfusion strategy, the number of transfused red blood cell units was an independent risk factor for clinical complications or death at 30 days (hazard ratio for each additional unit transfused, 1.2 [95% CI, 1.1-1.4]; P=.002). Conclusion Among patients undergoing cardiac surgery, the use of a restrictive perioperative transfusion strategy compared with a more liberal strategy resulted in noninferior rates of the combined outcome of 30-day all-cause mortality and severe morbidity. Trial Registration clinicaltrials.gov Identifier: NCT01021631 JAMA. 2010; 304(14):1559-1567 www.jama.com

Effects of dobutamine on gut mucosal nitric oxide production during endotoxic shock in rabbits

Background: Dobutamine is the agent of choice for increasing cardiac output during myocardial depression in humans with septic shock. Studies have shown that beta-adrenoceptor agonists influence nitric oxide generation, probably by modulating cyclic adenosine monophosphate. We investigated the effects of dobutamine on the systemic and luminal gut release of nitric oxide during endotoxic shock in rabbits. Materials/Methods: Twenty anesthetized and ventilated New Zealand rabbits received placebo or intravenous lipopolysaccharide with or without dobutamine (5 mu g/kg/min). Ultrasonic flow probes placed around the superior mesenteric artery and the abdominal aorta continously estimated the flow. A segment from the ileum was isolated and perfused, and scrum nitrate/nitrite levels were measured in the perfusate solution and the serum every hour. Results: The mean arterial pressure decreased with statistical significance in the lipopolysaccharide group but not in the lipopolysaccharide/dobutamine group. The abdominal aortic flow decreased statistically significantly after lipopolysaccharide administration in both groups but recovered to base-line in the lipopolysaccharide/dobutamine group. The flow in the superior mesenteric artery was statistically significantly higher in the lipopolysaccharide/dobutamine group than in the lipopolysaccharide group at 2 hours. The serum nitrate/nitrite levels were higher in the lipopolysaccharide group and lower in the lipopolysaccharide/dobutamine group than those in the control group. The gut luminal perfusate serum nitrate/nitric level was higher in the lipopolysaccharide group than in the lipopolysaccharide/dobutamine group. Conclusions: Dobutamine can decrease total and intestinal nitric oxide production in vivo. Those effects seem to be inversely proportional to the changes in blood flow.

Ocorrência e distribuição de pteridófitas na reserva florestal Walter Egler, Amazônia Central, Brasil

Na Reserva Florestal Walter Egler, localizada a 64 km de Manaus, no município de Rio Preto da Eva, foi investigada a ocorrência de Pteridófitas ao longo de uma toposseqüência. O grupo ocorre nos três ambientes observados na área (baixio, vertente e platô) com diferença tanto qualitativa quanto quantitativa. Foram registrados 375 indivíduos, distribuídos em oito famílias, 10 gêneros e 17 espécies; entre epífitas, hemiepífitas, herbáceas e arbóreas. Das 8 famílias, 4 ocorrem em todos os ambientes: Dennstaedtiaceae, Hymenophyllaceae, Dryopteridaceae e Lomariopsidaceae, enquanto, Cyatheaceae e Vittariaceae ocorrem apenas no baixio. Das 17 espécies encontradas, sete ocorrem apenas no baixio, três na vertente e cinco são comuns em todos os ambientes.

Tableau encyclopedique et methodique des trois règnes de la nature: Botanique.

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Tableau encyclopedique et methodique des trois règnes de la nature: Botanique.

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Tableau encyclopedique et methodique des trois règnes de la nature: Botanique.

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Encyclopédie méthodique. Botanique / par m. le chevalier de Lamarck.

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Encyclopédie méthodique. Botanique / par m. le chevalier de Lamarck.

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Encyclopédie méthodique. Botanique / par m. le chevalier de Lamarck.

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Encyclopédie méthodique. Botanique / par m. le chevalier de Lamarck.

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Encyclopédie méthodique. Botanique / par m. le chevalier de Lamarck.

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Encyclopédie méthodique. Botanique / par m. le chevalier de Lamarck.

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Encyclopédie méthodique. Botanique / par m. le chevalier de Lamarck.

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Encyclopédie méthodique. Botanique / par m. le chevalier de Lamarck.

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