Success rate of airway management by residents in a pre-hospital emergency setting: a retrospective study

Abstract Objective: The objective of this retrospective study over a 5-year period was to assess the success rate of airway management by residents. Criteria of successful airway management were both the adherence to a standardized protocol of pre-hospital airway.

Altered thymic selection by overexpressing cellular FLICE inhibitory protein in T cells causes lupus-like syndrome in a BALB/c but not C57BL/6 strain.

The cellular FLICE inhibitory protein (c-FLIP) is an endogenous inhibitor of the caspase-8 proapoptotic signaling pathway downstream of death receptors. Recent evidence indicates that the long form of c-FLIP (c-FLIP(L)) is required for proliferation and effector T-cell development. However, the role of c-FLIP(L) in triggering autoimmunity has not been carefully analyzed. We now report that c-FLIP(L) transgenic (Tg) mice develop splenomegaly, lymphadenopathy, multiorgan infiltration, high titers of auto-antibodies, and proliferative glomerulonephritis with immune complex deposition in a strain-dependent manner. The development of autoimmunity requires CD4(+) T cells and may result from impaired thymic selection. At the molecular level, c-FLIP(L) overexpression inhibits the zeta chain-associated protein tyrosine kinase of 70 kDa (ZAP-70) activation, thus impairing the signaling pathway derived from ZAP-70 required for thymic selection. Therefore, we have identified c-FLIP(L) as a susceptibility factor under the influence of epistatic modifiers for the development of autoimmunity.

Pre-stimulus beta oscillations within left posterior sylvian regions impact auditory temporal order judgment accuracy.

Both neural and behavioral responses to stimuli are influenced by the state of the brain immediately preceding their presentation, notably by pre-stimulus oscillatory activity. Using frequency analysis of high-density electroencephalogram coupled with source estimations, the present study investigated the role of pre-stimulus oscillatory activity in auditory spatial temporal order judgments (TOJ). Oscillations within the beta range (i.e. 18-23Hz) were significantly stronger before accurate than inaccurate TOJ trials. Distributed source estimations identified bilateral posterior sylvian regions as the principal contributors to pre-stimulus beta oscillations. Activity within the left posterior sylvian region was significantly stronger before accurate than inaccurate TOJ trials. We discuss our results in terms of a modulation of sensory gating mechanisms mediated by beta activity.

Methods for assessment of pre-harvest sprouting in wheat cultivars

The objective of this work was to test methods for pre-harvest sprouting assessment in wheat cultivars. Fourteen wheat cultivars were grown in Londrina and Ponta Grossa municipalities, Paraná state, Brazil. They were sampled at 10 and 17 days after physiological maturity and evaluated using the methods of germination by rainfall simulation (in a greenhouse), in-ear grain sprouting, and grains removed from the ears. The in-ear grain sprouting method allowed the differentiation of cultivars, but showed different resistance levels from the available description of cultivars. The sprouting of grain removed from the ears did not allow a reliable distinction of data on germination in any harvest date or location. The method of rainfall simulation is the most suitable for the assessment of cultivars as to pre-harvest sprouting, regardless of the sampling date and evaluated location.

Real-time MR imaging of myocardial regional function using strain-encoding (SENC) with tissue through-plane motion tracking.

PURPOSE: To implement real-time myocardial strain-encoding (SENC) imaging in combination with tracking the tissue displacement in the through-plane direction. MATERIALS AND METHODS: SENC imaging was combined with the slice-following technique by implementing three-dimensional (3D) selective excitation. Certain adjustments were implemented to reduce scan time to one heartbeat. A total of 10 volunteers and five pigs were scanned on a 3T MRI scanner. Spatial modulation of magnetization (SPAMM)-tagged images were acquired on planes orthogonal to the SENC planes for comparison. Myocardial infarction (MI) was induced in two pigs and the resulting SENC images were compared to standard delayed-enhancement (DE) images. RESULTS: The strain values computed from SENC imaging with slice-following showed significant difference from those acquired without slice-following, especially during systole (P < 0.01). The strain curves computed from the SENC images with and without slice-following were similar to those computed from the orthogonal SPAMM images, with and without, respectively, tracking the tag line displacement in the strain direction. The resulting SENC images showed good agreement with the DE images in identifying MI in infarcted pigs. CONCLUSION: Correction of through-plane motion in real-time cardiac functional imaging is feasible using slice-following. The strain measurements are more accurate than conventional SENC measurements in humans and animals, as validated with conventional MRI tagging.

EZ-IO intraosseous device implementation in a pre-hospital emergency service : a prospective study and review of the literature

Introduction : La prise en charge des patients critiques nécessite dans la majorité des situations l'obtention rapide d'un accès vasculaire, afin d'administrer des médicaments, des solutés de remplissage, ou des produits sanguins. La mise en place d'un accès vasculaire peut s'avérer difficile chez ces patients. En cas d'échec de pose d'une voie veineuse périphérique, des abords vasculaires alternatifs existent. Il s'agit essentiellement de la pose d'une voie veineuse centrale, la réalisation d'une dénudation veineuse, ou la pose d'une voie intra-osseuse. Depuis le développement de dispositifs d'insertion « semi-automatique » à la fin des années 90, la voie intra-osseuse, traditionnellement réservée aux cas pédiatriques, est de plus en plus fréquemment utilisée chez les patients adultes. Le Service des Urgences du CHUV a introduit en 2009 les dispositifs d'insertion d'aiguilles intra-osseuses de type EZ-IO® (perceuse électrique), en salle de réanimation des urgences vitales (déchoquage), ainsi qu'au sein du secteur préhospitalier pour les interventions du SMUR de Lausanne et de l'hélicoptère REGA de la base de Lausanne. Par cette étude, nous voulions mettre en évidence les aspects épidémiologiques des patients ayant dû être perfusés par cet abord dans un contexte préhospitalier, ainsi que les circonstances cliniques ayant justifié un tel usage, le taux de succès, les éventuelles complications, les médicaments perfusés et la mortalité des patients ayant bénéficié de ce dispositif. Méthode: Chaque patient ayant bénéficié de la mise en place d'une voie intra-osseuse par EZ-IO® du 1er janvier 2009 au 31 décembre 2011 a été inclus. Les données récoltées étaient l'âge, le sexe, l'indication à la mise en place de l'intra-osseuse, la localisation, le taux de succès, les médicaments et fluides administrés, les complications, la mortalité à 48 heures et à la sortie de l'hôpital. Tous les articles mentionnant l'utilisation de ΙΈΖ-ΙΟ® dans des situations cliniques ont également été analysés par une revue de littérature structurée exhaustive, afin de comparer nos résultats avec les données de la littérature. Résultats : Cinquante-huit patients, représentant 60 intra-osseuses EZ-IO®, ont été inclus. Leur âge moyen (47 ans), le taux de succès (90%), les indications, la localisation de l'aiguille (98% au niveau du tibia proximal) et le taux de complications (0%) correspondent aux valeurs trouvées dans la littérature. Le taux de survie de nos patients est de 38% à 48 heures et de 29% à la sortie de l'hôpital. De nombreux médicaments ou solutés de perfusion ont été administrés; l'adrénaline restant le médicament le plus fréquemment administré par cette voie. Dans 7 cas, les patients ont bénéficié d'une induction d'anesthésie par voie intra-osseuse. La revue de littérature a permis de compiler 30 études distinctes, représentant un total de 1603 accès vasculaires de type EZ-IO®. Conclusion : La voie intra-osseuse s'avère fiable et rapide pour obtenir un accès vasculaire, avec un taux de complications très faible et permet l'administration d'un grand nombre de substances. D'autres études sont nécessaires pour évaluer l'impact de la voie intra osseuse, notamment en termes de mortalité, de complications tardives, ainsi que d'analyse coût/bénéfice de ce matériel.

[Archives de la parole]. , [Valse du Père Cadet] / [Ferdinand Brunot], collecteur ; [Pierre Appaire, 49 ans, cornemuseux], cornemuse ; [Bertrand Appaire, vielleux], vielle ; [Pierre Gerbaud, 61 ans, vielleux], vielle. [Une chasse ancienne] / [Ferdinand Brunot], collecteur ; [Pierre Appaire, 49 ans, cornemuseux], cornemuse

[Traditions. France. Berry]

From rifting to passive margin - The examples of the Red Sea, Central Atlantic and Alpine Tethys

Evolution of the Red Sea/Gulf of Suez and the Central Atlantic rift systems shows that an initial, transtensive rifting phase, affecting a broad area around the future zone of crustal separation, was followed by a pre-oceanic rifting phase during which extensional strain was concentrated on the axial rift zone. This caused lateral graben systems to become inactive and they evolved into rift-rim basins. The transtensive phase of diffuse crustal extension is recognized in many intra-continental rifts. If controlling stress systems relax, these rifts abort and develop into palaeorifts. If controlling stress systems persist, transtensive rift systems can enter the pre-oceanic rifting stage, during which the rift zone narrows and becomes asymmetric as a consequence of simple-shear deformation at shallow crustal levels and pure shear deformation at lower crustal and mantle-lithospheric levels. Preceding crustal separation, extensional denudation of the lithospheric mantle is possible. Progressive lithospheric attenuation entails updoming of the asthenosphere and thermal doming of the rift shoulders. Their uplift provides a major clastic source for the rift basins and the lateral rift-rim basins. Their stratigraphic record provides a sensitive tool for dating the rift shoulder uplift. Asymmetric rifting leads to the formation of asymmetric continental margins, corresponding in a simple-shear model to an upper plate and a conjugate lower plate margin, as seen in the Central Atlantic passive margins of the United States and Morocco. This rifting model can be successfully applied to the analysis of the Alpine Tethys palaeo-margins (such as Rif and the Western Alps).