Cricotracheal resection.

A surgeon facing the problem of a child with subglottic stenosis currently has a wide range of surgical options. Cricotracheal resection is the preferred option for grade IV and severe grade III stenoses that are clear of the vocal cords. Laryngotracheal reconstruction as a less extensive procedure is preferred for some grade II and less severe grade III stenoses. Stenosis close to the vocal cords remains a challenge and can be treated by extended partial cricotracheal resection. Pediatric surgeons and otolaryngologists should learn carefully the technique of partial cricotracheal resection for use in infants and children to achieve better results than with laryngotracheal reconstructions.

Higher-order colored-noise effects in multivariable systems

We extend the partial resummation technique of Fokker-Planck terms for multivariable stochastic differential equations with colored noise. As an example, a model system of a Brownian particle with colored noise is studied. We prove that the asymmetric behavior found in analog simulations is due to higher-order terms which are left out in that technique. On the contrary, the systematic ¿-expansion approach can explain the analog results.

Advances in post-mortem CT-angiography.

Performing a post-mortem multidetector CT (MDCT) scan has already become routine in some institutes of forensic medicine. To better visualize the vascular system, different techniques of post-mortem CT-angiography have been explored, which can essentially be divided into partial- and whole-body angiography techniques. Probably the most frequently applied technique today is the so-called multiphase post-mortem CT-angiography (MPMCTA) a standardized method for investigating the vessels of the head, thorax and abdomen. Different studies exist, describing its use for medicolegal investigations, and its advantages as well as its artefacts and pitfalls. With the aim to investigate the performance of PMCTA and to develop and validate techniques, an international working group was created in 2012 called the "Technical Working Group Post-mortem Angiography Methods" (TWGPAM). Beyond its primary perspective, the goals of this group include creating recommendations for the indication of the investigation and for the interpretation of the images and to distribute knowledge about PMCTA. This article provides an overview about the different approaches that have been developed and tested in recent years and an update about ongoing research in this field. It will explain the technique of MPMCTA in detail and give an outline of its indications, application, advantages and limitations.

Le sevrage ultra-rapide sous anesthésie générale: l'expérience de l'Hôpital de St-Loup [Ultrafast opiate detoxification under general anesthesia: the St. Loup Hospital experience]

Rapid antagonist induction under anesthesia is a method that has been increasingly used to detoxify opiate addicts. These procedures are useful to reduce the duration and the discomfort of withdrawal. However, the high risk and the cost of these methods require randomized clinical trial to evaluate safety and clinical effectiveness. The University Substance Abuse Division of Lausanne and the Intensive Care Unit of the St-Loup Hospital work on a randomized clinical trial comparing anesthesia-assisted versus traditional clonidine detoxification combined with an additional psychosocial week. This paper describes the technique of anesthesia used in our study. Our clinical experience suggests that, integrating this technique in a multidisciplinary network, with a strong emphasis on post-anesthetic follow-up, is a viable and safe option in the treatment of opiate dependence.

Postmortem dynamic CT-angiography : P30

Purpose: Forensic imaging and especially forensic radiology is a new trend in forensic medicine. More and more forensic institutes set up their own CT-scanner in order to perform postmortem cross-sectional imaging. Due to this trend, a new subspecialty was born: the forensic radiology. To image the vascular system after death, a postmortem CT- angiography can be performed. Methods and materials: In the Institute of Forensic Medicine in Lausanne, a science group has been created with specialists of different medical fields that has set up a new technique of forensic CT-angiography. The method consists in the creation of a postmortem circulation by the use of a modified heart lung machine. As circulating liquid Angiofil, an oily contrast agent, is injected. Results: With the aid of this technique, the whole vascular system of a deceased person can be imaged in detail without autopsy. The circulating contrast allows demonstrating the vascular system when it is under pressure, similarly to living patients. First experiences showed, that vascular pathologies such as cardiac tamponade and aortic dissection can be well demonstrated. Since the oily Angiofil strictly remains in the intravascular space, no artifacts had been observed during the CT-examination and the later performed autopsy. Conclusion: Post-mortem dynamic CT angiography is of great advantage in forensic pathology, because the detailed mapping of the entire vascular system is almost impossible with conventional autopsy tools.

Peptide vaccine induces enhanced tumor growth associated with apoptosis induction in CD8+ T cells.

CD8(+) CTLs play a critical role in antitumor immunity. However, vaccination with synthetic peptide containing CTL epitopes has not been generally effective in inducing protective antitumor immunity. In this study, we addressed the detailed mechanism(s) involved in this failure using a new tumor model of BALB/c transplanted tumors expressing NY-ESO-1, an extensively studied human cancer/testis Ag. Whereas peptide immunization with an H2-D(d)-restricted CTL epitope derived from NY-ESO-1 (NY-ESO-1 p81-88) induced NY-ESO-1(81-88)-specific CD8(+) T cells in draining lymph nodes and spleens, tumor growth was significantly enhanced. Single-cell analysis of specific CD8(+) T cells revealed that peptide immunization caused apoptosis of >80% of NY-ESO-1(81-88)-specific CD8(+) T cells at tumor sites and repetitive immunization further diminished the number of specific CD8(+) T cells. This phenomenon was associated with elevated surface expression of Fas and programmed death-1. When peptide vaccination was combined with an adjuvant, a TLR9 ligand CpG, the elevated Fas and programmed death-1 expression and apoptosis induction were not observed, and vaccine with peptide and CpG was associated with strong tumor growth inhibition. Selection of appropriate adjuvants is essential for development of effective cancer vaccines, with protection of effector T cells from peptide vaccine-induced apoptosis being a prime objective.

Ponction pleurale [Thoracentesis]

Thoracentesis is a procedure consisting in the insertion of a needle in the pleural space. It is used to remove and analyse pleural fluid. Based on a review of the literature, this article describes the indications, the contraindications, the complications and the technique of this commonly performed procedure.

CT-guided cervical foraminal injection: Is a direct foraminal approach still necessary?

Purpose: Cervical foraminal injection performed with a direct foraminal approach may induce serious neurologic complications. We describe a technique of CT-guided cervical facet joint (CFJ) injection as an indirect foraminal injection, including feasibility and diffusion pathways of the contrast agent. Methods and materials: Retrospective study included 84 punctures in 65 consecutive patients presenting neck pain and/or radiculopathy related to osteoarthritis or soft disc herniation. CT images were obtained from C2 to T1 in supine position, with a metallic landmark on the skin. CFJ punctures were performed by MSK senior radiologists with a lateral approach. CT control of the CFJ opacification was performed after injections of contrast agent (1 ml), followed by slow-acting corticosteroid (25 mg). CFJ opacification was considered as successful when joint space and/or capsular recess opacification occurred. The diffusion of contrast agent in foraminal and epidural spaces was recorded. We assessed the epidural diffusion both on axial and sagittal images, with a classification in two groups (small diffusion or large diffusion). Results: CFJ opacification was successful in 82% (69/84). An epidural and/or foraminal opacification was obtained in 74% (51/69). A foraminal opacification occurred in 92% (47/51) and an epidural opacification in 63% (32/51), with small diffusion in 47% (15/32) and large diffusion in 53% (17/32). No complication occurred. Conclusion: CT- guided CFJ injection is easy to perform and safe. It is most often successful, with a frequent epidural and/or foraminal diffusion of the contrast agent. This technique could be an interesting and safe alternative to foraminal cervical injection.

Uso de la hipotermia en el síndrome posparada cardíaca

Antecedentes: La parada cardiorrespiratoria es uno de los principalesproblemas sanitarios en los países desarrollados, además de por la mortalidadproducida, por las importantes repercusiones neurológicas posteriores quepresentan las personas que sobreviven. Hasta un 64% de los supervivientespuede presentar secuelas de gravedad, y tan solo un 1,4% queda exento dealgún tipo de alteración neurológica. Distintos ensayos clínicos, muestran quela hipotermia inducida ligera, es decir, el descenso controlado de latemperatura corporal mejora la supervivencia y los daños neurológicos en lospacientes adultos inconscientes tras una resucitación cardiopulmonar. Sinembargo, no está del todo claro cuáles son los pacientes más indicados pararecibir la terapia, la técnica de inducción ideal, la temperatura objetivo, suduración y la tasa idónea de recalentamiento.Objetivos: El objetivo del estudio es conocer la técnica de hipotermiaterapéutica como cuidado posresucitación tras sufrir una parada cardíaca.Metodología: Para ello, se realizó una búsqueda bibliográfica a través de lassiguientes bases de datos: CSIC, Medline PubMed, CINAHL, BibliotecaCochrane, Cuiden Plus, Dialnet, Scopus y ScienceDirect. Finalmente, seaceptaron 8 artículos que pertenecían a los criterios de inclusión: revisionessistemáticas, ensayos clínicos, revisiones bibliográficas y documentos deconsenso tras consejo de expertos, en español o inglés, publicados desde elaño 2005 hasta el año 2013 cuyos sujetos de estudio son adultos.Resultados: en la actualidad, se recomienda que los pacientes adultosinconscientes, con recuperación de la circulación espontánea tras una paradacardíaca extrahospitalaria, deben ser enfriados a 32-34ºC durante un periodode 12-24 horas cuando el ritmo inicial sea fibrilación ventricular. Se establecen4 periodos de tratamiento: inducción (desde el ingreso en la unidad hasta quese alcanzan los 33ºC), mantenimiento (desde el logro de los 33ºC hasta 24horas después), recalentamiento (12 horas de incremento de la temperatura,hasta alcanzar los 37ºC) y estabilización térmica (12 horas posteriores aalcanzar los 37ºC). Los métodos de inducción y mantenimiento de la hipotermiason diversos y se establecen dos grupos: técnicas invasivas y no invasivas.Palabras clave: hipotermia inducida, parada cardíaca, técnicas enfriamiento

Embryo rescue from interspecific crosses in apple rootstocks

The objetive of this work was to rescue immature embryos of apple rootstocks Malus prunifolia (Marubakaido) and Malus pumila (M9) after 40-60 days of pollination and to put them into MS culture media supplemented with agar (6 g L-1) and casein hydrolysate (500 mg L-1). Embryos originated from interspecific crosses and open pollination showed differences in the in vitro responses, depending on the female parent, the developmental stage of the embryo, and the culture medium composition. Embryos of the M. pumila rootstock, rescued within 40 days after pollination and put in culture medium supplemented with indolacetic acid (IAA), gibberellic acid (GA3), kinetin and maltose, resulted in a normal development of plantlets. However, embryos originating from hand-pollination, cultivated in medium supplemented with 14 µM IAA, 5 µM kinetin and 1.5 µM Ga3 (MS1), mainly those of M. prunifolia x M. pumila, showed a high percentage of rusted embryos (96.2%). Embryos from open pollination of M. prunifolia and M. pumila formed calluses. It was possible to identify the influence of the female parent by the enhanced development of M. pumila shoots derived from open or hand-pollination. The crossing of responsive species and the use of the technique of embryo culture provided a rapid and uniform germination and, consequently, the development of fully normal seedlings.

El dictado como tarea comunicativa

El artículo explora las utilidades didácticas del dictado (la práctica comunicativa de oralizar o leer en voz alta un escrito) para el aprendizaje funcional de una lengua materna o extranjera, en los diversos niveles de enseñanza. Después de criticar el uso tradicional de este ejercicio lingüístico, presentamos once formas diferentes de desarrollar un dictado en clase, con sus particulares contenidos, objetivos y metodologías. También analizamos con detalle la técnica más tradicional del dictado magistral, en la que el docente dicta palabra por palabra un texto al alumnado, poniendo énfasis en la ortografía; ofrecemos algunas orientaciones para incrementar el componente comunicativo de esta propuesta. Las conclusiones finales proponen entender esta técnica como un recurso metodológico variado, rico y sugerente, adaptado a cada situación de aprendizaje —y no como una práctica obligatoria y fosilizada.

Guidance parentale et respect de l'intimité. Deuil et érotisme chez les mineurs

Des parents semblent ignorer la limite entre ce que l'on est en droit de montrer et ce que l'on doit traiter avec pudeur. Une sorte d'ambiguïté les amène à être négligents et par là à tolérer des comportements ou des propos grivois de leurs enfants ou à en rire. Les thérapeutes sont invités à entreprendre un travail pédagogique de guidance parentale quand les frontières de l'intime sont floues et quand la confusion touche les jeunes devenant vulnérables et symptomatiques. Les auteurs exposent un cas d'anorexie chez une adolescente, dont la souffrance se trouve masquée par une série de comportements désinhibés. La surexcitation qui en découle peut apparaître comme une solution défensive pour lutter contre la dépression liée à l'expérience de séparation et de deuil. Pour favoriser la construction de représentations des territoires de l'intime plus respectueuses de la vulnérabilité des adolescents, les auteurs ont aussi proposé la sculpture familiale.Parental guidance and respect of intimacy. Young people's mourning and erotism. - Parents seem to be unaware of the borderline between what one may show and what one should handle with reserve. A kind of ambiguity drive them to be careless. As a result, they put up with suggestive behaviour or language from their children and even laugh at it. The therapists are invited to undertake an educational work of parental guidance when the boderlines of the intimate are hazy and when the confusion is affecting young people who become vulnerable and symptomatic. The authors present an anorexia case of a teenager whose distress is concealed by a series of uninhibited behaviours. The ensuing overexcitement could seem to be a defensive solution to fight against the depression related to parting and mourning experience. To encourage the building of representations of the territories of the intimate which would be more respectful of the teenagers vulnerability, the authors also suggest the technique of family sculpture.

Oral flurbiprofen metabolic ratio assessment using a single-point dried blood spot.

We investigated whether a single blood measurement using the minimally invasive technique of a finger prick to draw a blood sample of 5 µl (to yield a dried blood spot (DBS)) is suitable for the assessment of flurbiprofen (FLB) metabolic ratio (MR). Ten healthy volunteers who had been genotyped for CYP2C9 were recruited as subjects. They received FLB alone in session 1 and FLB with fluconazole in session 2. In session 3, the subjects were pretreated for 4 days with rifampicin and received FLB with the last dose of rifampicin on day 5. Plasma and DBS samples were obtained between 0 and 8 h after FLB administration, and urine was collected during the 8 h after administration. The pharmacokinetic profiles of the drugs were comparable in DBS and plasma. FLB's apparent clearance values decreased by 35% in plasma and DBS during session 2 and increased by 75% in plasma and by 30% in DBS during session 3. Good correlations were observed between MRs calculated from urine, plasma, and DBS samples.

What to consider for applying backfilling on non-dedicated environments

The resource utilization level in open laboratories of several universities has been shown to be very low. Our aim is to take advantage of those idle resources for parallel computation without disturbing the local load. In order to provide a system that lets us execute parallel applications in such a non-dedicated cluster, we use an integral scheduling system that considers both Space and Time sharing concerns. For dealing with the Time Sharing (TS) aspect, we use a technique based on the communication-driven coscheduling principle. This kind of TS system has some implications on the Space Sharing (SS) system, that force us to modify the way job scheduling is traditionally done. In this paper, we analyze the relation between the TS and the SS systems in a non-dedicated cluster. As a consequence of this analysis, we propose a new technique, termed 3DBackfilling. This proposal implements the well known SS technique of backfilling, but applied to an environment with a MultiProgramming Level (MPL) of the parallel applications that is greater than one. Besides, 3DBackfilling considers the requirements of the local workload running on each node. Our proposal was evaluated in a PVM/MPI Linux cluster, and it was compared with several more traditional SS policies applied to non-dedicated environments.

Investigaciones sobre la detección, difusión natural y control del enrollamiento clorótico del albaricoquero

Se ha aplicado la técnica de la tinción con el fluorocromo DAPI (4'-6- diamidino- 2-fenilindol) a la detección de organismos del tipo micoplasma («mycoplasma-like organisms» o MLOs) y al seguimiento, a lo largo de un año, de la distribución de MLOs en albaricoqueros enfermos de enrollamiento clorótico («apricot chloroiic leaf roll» o ACLR). Los resultados obtenidos confirman la poca fiabilidad de esta técnica para la detección precoz de micoplasmosis en árboles frutales, a causa de la baja concentración e irregular distribución de MLOs dentro de los árboles enfermos. Én cambio, la tinción con DAPI es útil para la observación a lo largo del año de la distribución de MLOs en diferentes partes de los árboles infectados por ACLR. A lo largo del invierno y la primavera, los MLOs fueron detectados solamente en las raíces y en los ramos formados el año anterior. La presencia de MLOs en los nuevos brotes no pudo ser detectada hasta el principio del verano. En trabajos previos se observaron grandes variaciones en la difusión natural del ACLR, incluso entre áreas próximas de la misma provincia de Valencia. Las investigaciones efectuadas ahora sobre las poblaciones de cicadélidos han mostrado que tanto el número de especies como el de individuos capturados son superiores en un área con una importante difusión natural del ACLR que en otra zona donde la difusión de la enfermedad es prácticamente nula. Las diferencias entre los cicadélidos capturados en estas dos áreas han proporcionado indicaciones acerca de las especies que tienen más probabilidades de ser vectores del ACLR. Se ha estudiado también, durante tres años, la influencia de tratamientos insecticidas y herbicidas sobre la difusión natural del ACLR en una plantación de albaricoqueros. En la mitad de la plantación que se dejó sin tratar, el número de cicadélidos capturados, así como el de nuevos árboles con síntomas de ACLR fue mayor que en la parte de la plantación que había sido tratada.