Acute neurorehabilitation: does a neurosensory and coordinated interdisciplinary programme reduce tracheostomy weaning time and weaning failure?

BACKGROUND/PURPOSE: A new coordinated interdisciplinary unit was created in the acute section of the department of clinical neurosciences, the Acute NeuroRehabilitation (NRA) unit. The objective was to evaluate the impact of the unit and its neurosensory programme on the management of tracheostomy patients in terms of reduction in the average time taken for weaning, weaning success rate and therapeutic efficiency. METHODS: This 49-month retrospective study compares 2 groups of tracheostomy patients before (n = 34) and after (n = 46) NRA intervention. The outcome measures evaluate the benefits of the NRA unit intervention (time to decannulation, weaning and complication rates) and the benefits of the coordination (time to registration in a rehabilitation centre and rate of non-compliance with standards of care). RESULTS: Weaning failure rate was reduced from 27.3% to 9.1%, no complications or recannulations were observed in the post-intervention group after weaning and time to decannulation following admission to our unit decreased from 19.13 to 12.75 days. The rate of non-compliance with patient standards of care was significantly reduced from 45% to 30% (Mann-Whitney p = 0.003). DISCUSSION/CONCLUSIONS: This interdisciplinary weaning programme helped to reduce weaning time and weaning failure, without increased complications, in the sample studied. Coordination improved the efficiency of the interdisciplinary team in the multiplicity and complexity of the different treatments.

Multicenter, Prospective Clinical Evaluation of Respiratory Samples from Subjects at Risk for Pneumocystis jirovecii Infection by Use of a Commercial Real-Time PCR Assay.

Pneumocystis jirovecii pneumonia (PCP) is a common opportunistic infection. Microscopic diagnosis, including diagnosis using the Merifluor-Pneumocystis direct fluorescent antigen (MP-DFA) test, has limitations. Real-time PCR may assist in diagnosis, but no commercially validated real-time PCR assay has been available to date. MycAssay Pneumocystis is a commercial assay that targets the P. jirovecii mitochondrial large subunit (analytical detection limit, ≤3.5 copies/μl of sample). A multicenter trial recruited 110 subjects: 54 with transplants (40 with lung transplants), 32 with nonmalignant conditions, 13 with leukemia, and 11 with solid tumors; 9 were HIV positive. A total of 110 respiratory samples (92% of which were bronchoalveolar lavage [BAL] specimens) were analyzed by PCR. Performance was characterized relative to investigator-determined clinical diagnosis of PCP (including local diagnostic tests), and PCR results were compared with MP-DFA test results for 83 subjects. Thirteen of 14 subjects with PCP and 9/96 without PCP (including 5 undergoing BAL surveillance after lung transplantation) had positive PCR results; sensitivity, specificity, and positive and negative predictive values (PPV and NPV, respectively) were 93%, 91%, 59%, and 99%, respectively. Fourteen of 83 subjects for whom PCR and MP-DFA test results were available had PCP; PCR sensitivity, specificity, PPV, and NPV were 93%, 90%, 65%, and 98%, respectively, and MP-DFA test sensitivity, specificity, PPV, and NPV were 93%, 100%, 100%, and 98%. Of the 9 PCR-positive subjects without PCP, 1 later developed PCP. The PCR diagnostic assay compares well with clinical diagnosis using nonmolecular methods. Additional positive results compared with the MP-DFA test may reflect low-level infection or colonization.

A collagen-poly(lactic acid-co-ɛ-caprolactone) hybrid scaffold for bladder tissue regeneration.

Scaffold materials should favor cell attachment and proliferation, and provide designable 3D structures with appropriate mechanical strength. Collagen matrices have proven to be beneficial scaffolds for tissue regeneration. However, apart from small intestinal submucosa, they offer a limited mechanical strength even if crosslinking can enhance their mechanical properties. A more cell-friendly way to increase material strength is to combine synthetic polymer meshes with plastic compressed collagen gels. This work describes the potential of plastic compressed collagen-poly(lactic acid-co-ɛ-caprolactone) (PLAC) hybrids as scaffolds for bladder tissue regeneration. Human bladder smooth muscle and urothelial cells were cultured on and inside collagen-PLAC hybrids in vitro. Scaffolds were analyzed by electron microscopy, histology, immunohistochemistry, and AlamarBlue assay. Both cell types proliferated in and on the hybrid, forming dense cell layers on top after two weeks. Furthermore, hybrids were implanted subcutaneously in the backs of nude mice. Host cell infiltration, scaffold degradation, and the presence of the seeded bladder cells were analyzed. Hybrids showed a lower inflammatory reaction in vivo than PLAC meshes alone, and first signs of polymer degradation were visible at six months. Collagen-PLAC hybrids have potential for bladder tissue regeneration, as they show efficient cell seeding, proliferation, and good mechanical properties.

Características físicas y oceanográficas del mar peruano en un área seleccionada (7°-9°) a fines de la primavera 1999

El estudio se realizó durante la realización del Crucero BIC José Olaya Balandra 9908-09 para la evaluación de la abundancia de huevos de anchoveta entre los 07° y 9° S.

When nightclub security agents assault clients more insight through a qualitative approach.

Between 2007 and 2009, aggressions by security agents of nightclubs on clients increased from 6% to 10% among community violence situations encountered at the Violence Medical Unit (VMU) at the Lausanne University Hospital in Switzerland. Most victims were young men who had been drinking alcohol before the assault. About one quarter (25.7%) presented with one or several fractures, all of them in the head area. (For more details, refer to the previous article "When nightclub security agents assault clients" published in 2012(1).) Following this first study, we performed a second qualitative study in order to bring more information about the context and highlight victims' behaviors and experiences. Four themes emerged: how the assault began; the assault itself; third-party involvement; and the psychological state of victims when they consulted the VMU. The findings of this second study complemented the statistical results of the first study by showing under what circumstances security agents of nightclubs respond with physical violence to situations they consider a threat to security. Furthermore, the study described consequences for the victims that could be quite serious. Our findings support the need for nightclubs to improve selection and training of security staff.

Expression of killer cell immunoglobulin-like receptors (KIRs) by natural killer cells during acute CMV infection after kidney transplantation.

Human cytomegalovirus (CMV) infection may be a serious complication related to immunosuppression after solid organ transplantation. Due to their cytotoxicity, T-cells and natural killer (NK) cells target and clear the virus from CMV-infected cells. Although immunosuppressive drugs suppress T-cell proliferation and activation, they do not affect NK cells that are crucial for controlling the infection. The regulation of NK cells depends on a wide range of activating and inhibitory receptors such as the family of killer-cell immunoglobulin-like receptors (KIRs). Several human genetic studies have demonstrated the association of KIR genes with the clearance of infections. Since the respective activities of the different KIR proteins expressed by NK cells during CMV infection have not been extensively studied, we analyzed the expression of KIRs in a cohort of 22 CMV-IgG(+) renal transplant patients at the time of CMV reactivation, after antiviral therapy and 6 months later. Our data revealed a marked expression of KIR3DL1 during the acute phase of the reactivation. We set up an in vitro model in which NK cells, derived either from healthy donors or from transplanted patients, target allogeneic fibroblasts, CMV-infected or uninfected. Our results demonstrate a significant correlation between the lysis of CMV-infected fibroblasts and the expression of KIR3DL1. Blocking experiments with antibodies to MHC-I, to NKG2D and to NKG2C confirmed the importance of KIR3DL1. Consequently, our results suggest that KIR proteins and especially KIR3DL1 could play an important role during CMV-infection or CMV reactivation in immunosuppressed patients.

Correlates of frailty, prediction of functional decline and preventative approaches - selected results from the lausanne cohort 65+ (lc65+) study (Switzerland) (Lausanne) and the longitudinal urban cohort ageing study (Lucas) (Germany)

Overall introduction.- Longitudinal studies have been designed to investigate prospectively, from their beginning, the pathway leading from health to frailty and to disability. Knowledge about determinants of healthy ageing and health behaviour (resources) as well as risks of functional decline is required to propose appropriate preventative interventions. The functional status in older people is important considering clinical outcome in general, healthcare need and mortality. Part I.- Results and interventions from lucas (longitudinal urban cohort ageing study). Authors.- J. Anders, U. Dapp, L. Neumann, F. Pröfener, C. Minder, S. Golgert, A. Daubmann, K. Wegscheider,. W. von Renteln-Kruse Methods.- The LUCAS core project is a longitudinal cohort of urban community-dwelling people 60 years and older, recruited in 2000/2001. Further LUCAS projects are cross-sectional comparative and interventional studies (RCT). Results.- The emphasis will be on geriatric medical care in a population-based approach, discussing different forms of access, too. (Dapp et al. BMC Geriatrics 2012, 12:35; http://www.biomedcentral.com/1471-2318/12/35): - longitudinal data from the LUCAS urban cohort (n = 3.326) will be presented covering 10 years of observation, including the prediction of functional decline, need of nursing care, and mortality by using a self-filling screening tool; - interventions to prevent functional decline do focus on first (pre-clinical) signs of pre-frailty before entering the frailty-cascade ("Active Health Promotion in Old Age", "geriatric mobility centre") or disability ("home visits"). Conclusions.- The LUCAS research consortium was established to study particular aspects of functional competence, its changes with ageing, to detect pre-clinical signs of functional decline, and to address questions on how to maintain functional competence and to prevent adverse outcome in different settings. The multidimensional data base allows the exploration of several further questions. Gait performance was exmined by GAITRite®-System. Supported by the Federal Ministry for Education and Research (BMBF Funding No. 01ET1002A). Part II.- Selected results from the lausanne cohort 65+ (Lc65 + ) Study (Switzerland). Authors.- Prof Santos-Eggimann Brigitte, Dr Seematter-Bagnoud Laurence, Prof Büla Christophe, Dr Rochat Stéphane. Methods.- The Lc65+ cohort was launched in 2004 with the random selection of 3054 eligible individuals aged 65 to 70 (birth year 1934-1938) in the non-institutionalized population of Lausanne (Switzerland). Results.- Information is collected about life course social and health-related events, socio-economics, medical and psychosocial dimensions, lifestyle habits, limitations in activities of daily living, mobility impairments, and falls. Gait performance are objectively measured using body-fixed sensors. Frailty is assessed using Fried's frailty phenotype. Follow-up consists in annual self-completed questionnaires, as well as physical examination and physical and mental performance tests every three years. - Lausanne cohort 65+ (Lc65 + ): design and longitudinal outcomes. The baseline data collection was completed among 1422 participants in 2004-2005 through self-completed questionnaires, face-to-face interviews, physical examination and tests of mental and physical performances. Information about institutionalization, self-reported health services utilization, and death is also assessed. An additional random sample (n = 1525) of 65-70 years old subjects was recruited in 2009 (birth year 1939-1943). - lecture no 4: alcohol intake and gait parameters: prevalent and longitudinal association in the Lc65+ study. The association between alcohol intake and gait performance was investigated.

Notes et extraits de Pierre-François CHIFFLET, concernant principalement la Franche-Comté et la Bourgogne.

On remarque : « Ex Glossario pervetusto » (f. 3) ; — « Ex chartis ecclesiae de Caritate » (f. 10) ; — « Ex veteri membrana et ex antiquo circulo depicto propè altare Maurimonasterii in Alsatia » (f. 10) ; — « Ex chartis R. P. Stephani Voyrin » (f. 11) ; — « Episcopi Metenses, ex ms. codice Sancti Arnulfi Metensis » (f. 12 v°) ; — Lettre de Hugues Métel à Gerland (f. 14) ; — « Ex variis catalogis sanctorum » (f. 14) ; — « Ex archivio ecclesiae Beatae Magdalenae [Bisuntinae] » (f. 17) ; — « Ex archivio Sancti Vincentii Bisont[ini] » (f. 18) ; — « Ex archivio monasterii Bellaevallis » [Bisuntinae dioecesis] (f. 20) ; — « Ex veteri necrologio Sancti Stephani [Bisuntini], quod est ad margines Martyrologii Bedae perantiqui, ad ejusdem ecclesiae usum accommodati » [cf. ms. de Besançon 712] (f. 23 v°) ; — « Inter martyrologium et regulam, seu librum primum concilii Aquisgranensis, habetur haec sententia absolutionis » (f. 25) ; — « Ante veterem Ordinem Romanum, qui est Liber Pontificalis, habentur sequentes formulae praestandae obedientiae archiepiscopis et ecclesiae Bisuntinae » (f. 25 v°) ; — « Alia ex archivo archiepiscopi [Bisuntini] » (f. 26 v°) ; — « Ex archivio Balernensi » (f. 27 v°) ; — « Ex variis sanctorum historiis manuscriptis » (f. 30) ; — « Extraits concernant Tournus » (f. 34 v°), — notamment : « Ex codice manuscripto Trenorchiensi, membraneo, quod vocare possis Registrum Trenorchiense, incipiens ab anno 1222 et desinens in 1296 ; inscribitur : Feoda ecclesiae Trenorchiensis » (f. 37) ; — « Ex notis R. P. Voyrini » [cf. supra, f. 11] (f. 49) ; — « Inscriptio vetus Luxoviensis » (f. 50 v°) ; — Notes historiques, concernant principalement des abbayes comtoises (f. 51) ; — « Scriptores rerum Burgundicarum » (f. 52) ; — « Ex parvo chartulari Sancti Benigni [Divionensis] » (f. 52 v°) ; — « Ex libro anniversariorum Sancti Benigni [Divionensis] », 1579-1629 (f. 52 v°) ; — « Ex chartulari Sancti Symphoriani Augustodunensis » (f. 53) ; — « Ex chartulari Sancti Marcelli Cabilonensis » (f. 53 v°) ; — « Ex chartulari S. Sequani » [Lingonensis dioecesis] (f. 54 v°) ; — « Ex chartulari Sanctae Capellae Divionensis » (f. 55) ; — « Ex chartulari cathedralis Augustodunensis » (f. 55 v°) ; — « Ex tomo priore chartularis Sancti Stephani Divionensis » (f. 56) ; — « Ex chartulari Cluniacensi » (f. 57) ; — « Ex apographo chartularis Matisconensis, cujus autographum vetus dicebatur Liber catenatus » (f. 57 v°) ; — « Ex chartulari Patriciaci, qui est prioratus dependens a Floriacensi abbatia, situs in comitatu Kadrellensi, dioecesi Augustodunensi » (f. 58 v°) ; — Extraits concernant Autun et les comtes d'Autun (f. 60 v°) ; — « Ex autographis Sancti Benigni Divionensis » (f. 61) ; — « Iterum ex chartulari Sancti Stephani Divionensis » (f. 61) ; — « Ex autographis monasterii puellarum Tartensis » (f. 62) ; — « Iterum ex tabulario Cluniacensi, adnotatis paginis » (f. 62 v°) ; — « Ex majore tabulario ecclesiae Cabilonensis, quod digessit Johannes Germani, Cabilonensis episcopus » (f. 64 v°) ; — « Ex tabulario abbatiae de Buxeria » (f. 65) ; — « Ex autographis monialium Benedictinarum de Pralon » (f. 66) ; — « Ex autographis prioratus Vallis Beatae Mariae juxta Talant, de Ordine Vallis Scholarium, vulgò Bonvau » (f. 66) ; — « Ex kalendario pervetusto Sancti Benigni Divionensis » (f. 66 v°) ; — « Ex martyrologio proprio Sancti Martini Eduensis » (f. 67) ; — « Ex necrologio Sancti Lazari Aeduensis » (f. 67) ; — « Ex chronico Sancti Petri Vivi Senonensis » (f. 67) ; — « Ex chronico S. Medardi Suessionensis » (f. 68) ; — « Ex brevi chronico Sancti Dionysii ad cyclos paschales » (f. 68) ; — « De Saracenis in Gallia profligatis » (f. 69) ; — « Ex necrologio Sancti Augendi Jurensis » (f. 74) ; — « Ex necrologio Sancti Petri Bisuntini » (f. 74) ; — « Ex necrologio veteri Sancti Stephani [Bisuntini] » (f. 74 v°) ; — « Ex registro Innocentii papae VI, anni IX pontificatus, Christi 1361 » (f. 82) ; — « Ex tabulis capituli Sancti Dionysii de Vergeyo, nunc Nuciacensis » (f. 83) ; — « Ex manuscripto codice donationum 208 Joannis, comitis Burgundiae et domini Salinensis, super puteum Salinarum » (f. 89 v°) ; — « Ex archivo Sancti Anatolii Salinensis ; ex magno necrologio chartaceo eique simili membraneo, composito 1390 » (f. 92) ; — « Ex chartis prioratus de Marthereto prope Vesulium » (f. 94) ; — « Ex archivo Sancti Pauli Bisonticensis » (f. 95) ; — « Ex veteri chartulario Sancti Pauli [Bisonticensis] » (f. 95 v°) ; — « Ex veteri manuscripto codice Sancti Pauli [Bisonticensis] » (f. 96) ; — « Ex antiquioribus libris ecclesiae Sancti Stephani [Bisonticensis], scriptis aut in usum adhibitis tempore Hugonis primi, [archiepiscopi Bisonticensis] » (f. 96 v°) ; — « Ex codice Sancti Stephani [Bisonticensis] pervetusto, qui Bisonticensis ecclesiae sacros ritus continet » (f. 97) ; — « Ex antiquis codicibus Sancti Pauli [Bisonticensis] » (f. 98) ; — « Ex antiquo rituum libro » (f. 98) ; — « Ex antiquis letaniis, tempore Hugonis I, [archiepiscopi Bisuntini], in ecclesia Bisontina cani solitis ; ex manuscriptis Sancti Stephani et Sancti Pauli » (f. 99) ; — « Extraits de plusieurs manuscrits de Saint-Paul de Besançon » (f. 99 v°) ; — « Ex manuscripto codice Sanctae Magdalenae [Bisuntinae] » (f. 101) ; — Inscription trouvée à Saint-Ferjeux, en 1627 (f. 101 v°) ; — « Ex antiquis membranis archivii ecclesiae metropolitanae Bisontinae », extraits de bulles pontificales, etc. (f. 102) ; — « Ex archivio Loci Crescentis seu Trium Regum » (f. 105) ; — Notes empruntées, « ut videtur », à Anselme « de Marenchiis » (f. 106) ; — « Ex actis capituli Bisontini » (f. 106 v°) ; — « Ex obitibus adnotatis ad marginem martyrologii cathedralis Aeduensis » (f. 106 v°) ; — Fragment de chronique, 563-1033, tiré « ex veteri membrana monasterii Sancti Augendi » (f. 107) ; — « Ex alia membrana, post chronicon Engolismense » (f. 107) ; — « Ex archivio abbatiae de Aceyo » (f. 108) ; — « Ex archivio abbatiae de Roseriis » (f. 109) ; — « Extrait d'un tome des recognoissances des fiefs du Charolois » (f. 109 v°) ; — « Ex polypthico Sancti Vincentii Cabilonensis » (f. 114) ; — « Ex Aeneae, Parisiensis episcopi, collectione contra Graecos, Biblioth. Thuan., n. 444 » (f. 114) ; — « Consuetudines Cluniacenses, auctore Wdalrico, monacho Cluniacensi » (f. 115) ; — Inscriptions copiées « in pervetusto manuscripto codice, post Persii satyras », etc. (f. 116) ; — Extraits d'une « Vita metrica sancti Eustachii martyris, cognomine Placidae », contenue « in manuscripto codice Cisterciensi », etc. (f. 116 v°) ; — « De archiepiscopis Bisontinis » (f. 119) ; — « Ex archivio capituli Bisontini » (f. 120 v°) ; — « Notitia nostrorum diplomatum » (f. 124-135 r° , 141 r° , 142 v° et 143 r°) ; — « De comitibus Burgundiae in Sancti Stephani basilica Bisontina sepultis, ex veteri membrana archivi ecclesiae metropolitanae » (f. 135 v°) ; — Lettre autogr. de « Pierre-François Chifflet » [à Baluze], Dijon, 18 mars 1657 (f. 161) ; — Fragment de charte, « extrait du thresor de S. Anatoile de Salins » (f. 162) ; — Lettre autogr. de « [fr.] François Du Chemin » à Chifflet, Cîteaux, 16 mai 1657 (f. 167) ; — « Nova regum Francorum series, a quâ Theodericus II et omnes ejus posteri excluduntur, ex manuscripto codice Fontanetensi » (f. 171) ; — « Vita sancti Theutbaldi, Viennensis archiepiscopi », incomplète [Bibliotheca hagiographica latina, 8044 b] (f. 172 et 172 bis) ; — « Ex chartulario Sancti Germani Autisiodorensis », diplômes carolingiens (f. 174) ; — Fragment d'une lettre [adressée vraisemblablement à Chifflet], Paris, octobre 1670 (f. 177) ; — Extraits « ex vitâ sancti Theutbaldi, Viennensis archiepiscopi..., ex manuscripto codice monasterii Sancti Theuderii, ubi sanctus Theobaldus, Viennensis archiepiscopus, requiescit » [extraits de la vie dont un fragment occupe les feuillets 172 et 172 bis] (f. 178) ; — Lettre autogr. de « P[ierre-] F[rançois] Chifflet » [à Baluze], 10 mars (f. 180) ; — Notes sur saint Théobald, archevêque de Vienne (f. 181). Cf. Ulysse Robert, Catalogue des manuscrits relatifs à la Franche-Comté, qui sont conservés dans les bibliothèques publiques de Paris (1878), p. 161-162.