A descriptive study on the surgery and the microbiology of Gustilo type III fractures in an university hospital in Switzerland.

OBJECTIVE: To describe the epidemiology, the surgical treatment, the microbiology, the antibiotic prophylaxis and the outcome of patients with the most severe type of open fractures. METHODS: Retrospective chart reviews of patients with Gustilo type III open fracture admitted to an university hospital in Switzerland between January 2007 and December 2011. The patient's and fracture's characteristics, surgery, antibiotic prophylaxis, and microbiology findings at the initial and at the revision surgery were described. RESULTS: Thirty patients were included (83% male, mean age 41 years). More than half of the patients had polytrauma. In all patients, debridement and stabilization surgery (70% using external fixation) were performed at admission. Soft tissue reconstruction was performed in 87% and in 23% immediate bone graft was performed. Antibiotic prophylaxis were given in all patients for a median duration of 9 days (60% received amoxicillin/clavulanic acid). Positive bacterial culture was found in 53% of the patients at initial surgery and in 88% at revision surgery. At initial and revision surgery, 47% and 88% of the pathogens were amoxicillin/clavulanic acid-resistant. Treatment outcome was favorable in 24 of 30 patients (80%) and in six cases (20%) an amputation had to be performed. None of the patients had chronic bone infection. CONCLUSIONS: Positive cultures were found often in open fractures. Amoxicillin/clavulanic acid which is often mentioned in many guidelines as prophylaxis in open fractures does not cover the most common isolated organisms. The combination of surgery and antibiotic prophylaxis leads to good outcome in Gustilo type III fracture.

Characterization and genetic mapping of eceriferum-ym (cer-ym), a cutin deficient barley mutant with impaired leaf water retention capacity.

The cuticle covers the aerial parts of land plants, where it serves many important functions, including water retention. Here, a recessive cuticle mutant, eceriferum-ym (cer-ym), of Hordeum vulgare L. (barley) showed abnormally glossy spikes, sheaths, and leaves. The cer-ym mutant plant detached from its root system was hypersensitive to desiccation treatment compared with wild type plants, and detached leaves of mutant lost 41.8% of their initial weight after 1 h of dehydration under laboratory conditions, while that of the wild type plants lost only 7.1%. Stomata function was not affected by the mutation, but the mutant leaves showed increased cuticular permeability to water, suggesting a defective leaf cuticle, which was confirmed by toluidine blue staining. The mutant leaves showed a substantial reduction in the amounts of the major cutin monomers and a slight increase in the main wax component, suggesting that the enhanced cuticle permeability was a consequence of cutin deficiency. cer-ym was mapped within a 0.8 cM interval between EST marker AK370363 and AK251484, a pericentromeric region on chromosome 4H. The results indicate that the desiccation sensitivity of cer-ym is caused by a defect in leaf cutin, and that cer-ym is located in a chromosome 4H pericentromeric region.

Etat de stress post-traumatique : quel type de psychothérapie proposer? : Revue cochrane pour le praticien

L'état de stress post-traumatique (ESPT) apparaît dans les mois qui suivent un ou plusieurs événements potentiellement traumatiques (EPT) (par exemple, guerre, violences, accidents, chirurgie invasive). Les symptômes comprennent des souvenirs intrusifs, des cauchemars, un évitement et des émotions négatives (par exemple, honte, culpabilité, perte d'espoir, sentiment d'étrangeté), ainsi qu'une hypervigilance. Sous-diagnostiqué et sous-traité, l'ESPT a un impact négatif sur la qualité de vie et le fonctionnement des patients. Sa prévalence en Suisse est de 0,7 % (plus élevée dans certaines populations, par exemple, 13 % chez les hommes requérants d'asile déboutés). L'approche psychothérapeutique est centrale dans la prise en charge, un traitement médicamenteux pouvant également être utile. Cette revue (systématique) cherche à actualiser les connaissances sur l'efficacité des psychothérapies pour le traitement de l'ESPT.

Prévention de l'état de stress post-traumatique : efficacité des interventions pharmacologiques ? : Revue cochrane pour le praticien

Après un ou plusieurs événements potentiellement traumatisants (EPT), tels qu'accidents, mort inattendue d'une personne aimée, chirurgie invasive, guerre, violences physiques et sexuelles par exemple, certaines personnes peuvent développer un état de stress posttraumatique (ESPT). Elles ont l'impression de revivre le traumatisme et présentent des comportements d'évitement, une hyperexcitation ainsi que des émotions négatives. L'ESPT est associé à une réduction de la qualité de vie des patients concernéset a un impact majeur sur leur fonctionnement. Son coût économique est également important. Sa prévalence varie en Europe de 0,6 à 6,7 %. En Suisse, elle est estimée à 0,7 % mais peut atteindre des niveaux beaucoup plus élevés selon les populations ; 13 % des hommes demandeurs d'asile déboutés souffrent d'ESPT par exemple. Des études suggèrent que des changements cérébraux d'hormones de stress peuvent contribuer à l'ESPT. Cette revue systématique cherche à déterminer si la prescription d'une médication active au niveau cérébral est susceptible de prévenir l'apparition d'un ESPT.

Experimental enhancement of corticosterone levels positively affects subsequent male survival.

Corticosterone is an important hormone of the stress response that regulates physiological processes and modifies animal behavior. While it positively acts on locomotor activity, it may negatively affect reproduction and social activity. This suggests that corticosterone may promote behaviors that increase survival at the cost of reproduction. In this study, we experimentally investigate the link between corticosterone levels and survival in adult common lizards (Lacerta vivipara) by comparing corticosterone-treated with placebo-treated lizards. We experimentally show that corticosterone enhances energy expenditure, daily activity, food intake, and it modifies the behavioral time budget. Enhanced appetite of corticosterone-treated individuals compensated for increased energy expenditure and corticosterone-treated males showed increased survival. This suggests that corticosterone may promote behaviors that reduce stress and it shows that corticosterone per se does not reduce but directly or indirectly increases longer-term survival. This suggests that the production of corticosterone as a response to a stressor may be an adaptive mechanism that even controls survival.

A cast of shadow on adjuvant radiotherapy for prostate cancer: A critical review based on a methodological perspective.

OBJECTIVE: To perform a critical review focusing on the applicability in clinical daily practice of data from three randomized controlled trials (RCTs): SWOG 8794, EORTC 22911, and ARO/AUO 96-02. METHODS AND MATERIALS: An analytical framework, based on the identified population, interventions, comparators, and outcomes (PICO) was used to refine the search of the evidence from the three large randomized trials regarding the use of radiation therapy after prostatectomy as adjuvant therapy (ART). RESULTS: With regard to the inclusion criteria: (1) POPULATION: in the time since they were designed, in two among three trial (SWOG 8794 and EORTC 22911) patients had a detectable PSA at the time of randomization, thus representing de facto a substantial proportion of patients who eventually received salvage RT (SRT) at non-normalised PSA levels rather than ART. (2) INTERVENTIONS: although all the trials showed the benefit of postoperative ART compared to a wait-and-see approach, the dose herein employed would be now considered inadequate; (3) COMPARATORS: the comparison arm in all the 3 RCTs was an uncontrolled observation arm, where patients who subsequently developed biochemical failure were treated in various ways, with up to half of them receiving SRT at PSA well above 1ng/mL, a level that would be now deemed inappropriate; (4) OUTCOMES: only in one trial (SWOG 8794) ART was found to significantly improve overall survival compared to observation, with a ten-year overall survival rate of 74% vs. 66%, although this might be partly the result of imbalanced risk factors due to competing event risk stratification. CONCLUSIONS: ART has a high level of evidence due to three RCTs with at least 10-year follow-up recording a benefit in biochemical PFS, but its penetrance in present daily clinics should be reconsidered. While the benefit of ART or SRT is eagerly expected from ongoing randomized trials, a dynamic risk-stratified approach should drive the decisions making process.

Prevalence of sleep apnoea syndrome in the middle to old age general population.

On the basis of a large populationbased sample who underwent full polysomnography at home (HypnoLaus cohort), we recently reported that 49·7% of men and 23·4% of women aged 40 years or older had an apnoea-hypopnoea index of 15 events per h or more1 according to the American Academy of Sleep Medicine (AASM) 2013 scoring criteria. When excessive daytime sleepiness (ie, Epworth score >10 [maximum score 24]) was included in the definition with an apnoea-hypopnoea index of 5 events per h or more, the prevalence was 12·5% in men and 5·9% in women. This high prevalence of sleep disordered breathing reinforced the idea that the treatment decision should not only be based the apnoeahypopnoea index, but should also take into account associated symptoms and cardiovascular and metabolic comorbidities. After this Article was published, several readers contacted us to ask for the prevalence of sleep apnoea syndrome in our sample according to the International Classification of Sleep Disorders (ICSD-3) criteria. These criteria include either the presence of an apnoea-hypopnoea index of 5 events per h or more associated with obstructive sleep apnoearelated symptoms or cardiovascular and metabolic comorbidities, or an apnoea-hypopnoea index of 15 events per h or more (figure).

Pubic growth study: applicability in sexual and age diagnostic.

The growth of five variables of the ischiopubic area was analyzed from bone material from birth to old age. The main purpose was to evaluate its significance and capacity for age and sex determination during and after growth. The material used consisted of 327 specimens from four documented Western European collections. Growth curves were calculated by polynomial regression for two classical variables of the ischiopubic area (pubis length and ischiopubic index) and three new variables of the pubic acetabular area (horizontal and vertical diameter of the pubic acetabular area and the pubic acetabular index). None of the curves showed lineal growth, with the exception of the ischiopubic index and the masculine vertical diameter of the pubis acetabular area. Pubis length has the most complicated growth, expressed by a five-degree polynomial. All the variables are useful for adult sex determination, except the pubic acetabular index. The ischopubic index, vertical diameter of the pubic acetabular area and the pubic acetabular index seem to be good variables for sub-adult sex determination. For age estimation the best variables, in both archaeological and forensic remains, are the absolute measurements (pubic length, vertical and horizontal diameter of the pubis). However, pubis length is the best variable for age estimation because it can be applied until 25 years of age.

Biopsies de la prostate en 2015: quelle biopsie pour quel patient [Prostate biopsy: which strategy for which patient?].

L'adoption de l'IRM dans le parcours diagnostique a déterminé la transition des biopsies aléatoires aux biopsies ciblées vers les lésions visibles à l'imagerie. L'utilisation de logiciels rendant possible la fusion d'images IRM et échographiques permet d'améliorer significativement la précision diagnostique de ces biopsies. De plus, pour déterminer l'éligibilité d'un patient à une thérapie focale, davantage de précision diagnostique est requise au niveau de toute la glande ; par conséquent, des biopsies avec une densité d'échantillonnage plus élevée par voie transpérinéale peuvent être proposées.Les nouvelles techniques de biopsie de la prostate permettent une prise en charge personnalisée grâce à une meilleure caractérisation de l'agressivité et de l'extension locale du cancer de la prostate. The adoption of multiparametric MRI within the diagnostic pathway has allowed urologists to move from random biopsy to targeted biopsy directed towards MR-visible lesions. The use of software for MR to TRUS fusion may enhance the diagnostic accuracy of targeted biopsy. To determine the eligibility for tissue-preserving approaches, further precision is required, and template prostate mapping biopsy may be offered. The employment of novel biopsy techniques provide better characterisation of the disease, and allows a tailored approach to a single subject.

Trabecular bone score in kidney transplant recipients.

UNLABELLED: It is uncertain whether bone mineral density (BMD) can accurately predict fracture in kidney transplant recipients. Trabecular bone score (TBS) provides information independent of BMD. Kidney transplant recipients had abnormal bone texture as measured by lumbar spine TBS, and a lower TBS was associated with incident fractures in recipients. INTRODUCTION: Trabecular bone score (TBS) is a texture measure derived from dual energy X-ray absorptiometry (DXA) lumbar spine images, providing information independent of bone mineral density. We assessed characteristics associated with TBS and fracture outcomes in kidney transplant recipients. METHODS: We included 327 kidney transplant recipients from Manitoba, Canada, who received a post-transplant DXA (median 106 days post-transplant). We matched each kidney transplant recipient (mean age 45 years, 39 % men) to three controls from the general population (matched on age, sex, and DXA date). Lumbar spine (L1-L4) DXA images were used to derive TBS. Non-traumatic incident fracture (excluding hand, foot, and craniofacial) (n = 31) was assessed during a mean follow-up of 6.6 years. We used multivariable linear regression models to test predictors of TBS, and multivariable Cox proportional hazard regression was used to estimate hazard ratios (HRs) per standard deviation decrease in TBS to express the gradient of risk. RESULTS: Compared to the general population, kidney transplant recipients had a significantly lower lumbar spine TBS (1.365 ± 0.129 versus 1.406 ± 0.125, P < 0.001). Multivariable linear regression revealed that receipt of a kidney transplant was associated with a significantly lower mean TBS compared to controls (-0.0369, 95 % confidence interval [95 % CI] -0.0537 to -0.0202). TBS was associated with fractures independent of the Fracture Risk Assessment score including BMD (adjusted HR per standard deviation decrease in TBS 1.64, 95 % CI 1.15-2.36). CONCLUSION: Kidney transplant recipients had abnormal bone texture as assessed by TBS and a lower lumbar spine TBS was associated with fractures in recipients.

Bok- och biblioteksväsen

Samlingen med signum HB Ib finns vid huvudbiblioteket och innehåller böcker, småskrifter och kataloger om böcker och om bibliotek. Bok- och biblioteksväsen har särskilt intresserat bibliotekets överbibliotekarier och detta har gjort att samlingen vid huvudbiblioteket blivit mycket omfattande, över 13.600 titlar, genom ett aktivt anskaffande av speciellt utländskt material som komplement till den litteratur som från och med år 1919 erhållits som friexemplar. Huvudbibliotekets systematiska kortkatalog som går till år 1980 är finindelad i klasserna HB Ib1 – HB Ib7. HB Ib1 Bok- och biblioteksväsen, allmänt period / antal titlar -1899 / 26 1900-49 / 184 1950-59 / 155 1960-69 / 144 1970-79 / 283 HB Ib2a Bibliografier, allmänt -1899 / 39 1900-49 / 77 1950-59 / 58 1960-69 / 149 1970-79 / 152 HB Ib2b Bibliografier enligt bibliotekets klassifikationssystem -1899 / 69 1900-49 / 168 1950-59 / 168 1960-69 / 451 1970-79 / 719 HB Ib2c Bibliografier, länder -1899 / 180 1900-49 / 497 1950-59 / 190 1960-69 / 283 1970-79 / 208 HB Ib2d Bibliografier, personbibliografier -1899 / 5 1900-49 / 117 1950-59 / 72 1960-69 / 146 1970-79 / 161 HB Ib3 Bibliotek -1899 / 162 1900-49 / 949 1950-59 / 292 1960-69 / 533 1970-79 / 968 HB Ib4 Arkiv, arkivteknik, organisation -1899 / 17 1900-49 / 69 1950-59 / 25 1960-69 / 58 1970-79 / 82 HB Ib5 Bokhandel, förlag, antikvariat -1899 / 62 1900-49 / 235 1950-59 / 71 1960-69 / 81 1970-79 / 77 HB Ib6a Bokväsen, allmänt -1899 / -- 1900-49 / 2 1950-59 / 2 1960-69 / 6 1970-79 / 18 HB Ib6a Bokväsen, bibliofili -1899 / 8 1900-49 / 35 1950-59 / 8 1960-69 / 4 1970-79 / 5 HB Ib6b Bokväsen, boktryckeri, bokhistoria -1899 / 89 1900-49 / 295 1950-59 / 119 1960-69 / 139 1970-79 / 104 HB Ib6d Bokväsen, bokbindning -1899 / 4 1900-49 / 30 1950-59 / 5 1960-69 / 13 1970-79 / 13 HB Ib6e Bokväsen, exlibris -1899 / 5 1900-49 / 34 1950-59 / 5 1960-69 / 9 1970-79 / 7 HB Ib7 Utställningskataloger -1899 / 4 1900-49 / 55 1950-59 / 66 1960-69 / 49 1970-79 / 41 Från och med år 1980 har litteraturen om bok- och biblioteksväsen införts i Alma utan finfördelning, dvs allt material mellan åren 1980 och 1999 har ett gemensamt signum, HB Ib. Från och med år 2000 ingår litteraturen om bok- och biblioteksväsen vid huvudbiblioteket i en numerus currens-samling. Sökning i Alma med ämnesord ger litteratur vid hela akademibiblioteket.