Gériatrie [Review in geriatric medicine 2012].

2012 brought additional evidence regarding the benefits of exercise in older persons in showing morbidity compression in those most active. Several studies invite to revise therapeutic targets in older diabetics, especially those with cognitive impairment or dementia where a value of 8 to 9% for HbAlc might be a good compromise. On the dementia side, a study suggests that biological and structural abnormalities associated with Alzheimer's disease might occur as early as 25 years before its first clinical manifestations. On the therapeutic side, ginkgo and the double therapy with memantine and donepezil did not make it in RCTs, and two studies about treatments for behavioral symptoms of dementia showed that interruption could be deleterious.

Spatial Scale of Clustering of Motor Vehicle Crash Types and Appropriate Countermeasures, 2009

This project analyzes the characteristics and spatial distributions of motor vehicle crash types in order to evaluate the degree and scale of their spatial clustering. Crashes occur as the result of a variety of vehicle, roadway, and human factors and thus vary in their clustering behavior. Clustering can occur at a variety of scales, from the intersection level, to the corridor level, to the area level. Conversely, other crash types are less linked to geographic factors and are more spatially “random.” The degree and scale of clustering have implications for the use of strategies to promote transportation safety. In this project, Iowa's crash database, geographic information systems, and recent advances in spatial statistics methodologies and software tools were used to analyze the degree and spatial scale of clustering for several crash types within the counties of the Iowa Northland Regional Council of Governments. A statistical measure called the K function was used to analyze the clustering behavior of crashes. Several methodological issues, related to the application of this spatial statistical technique in the context of motor vehicle crashes on a road network, were identified and addressed. These methods facilitated the identification of crash clusters at appropriate scales of analysis for each crash type. This clustering information is useful for improving transportation safety through focused countermeasures directly linked to crash causes and the spatial extent of identified problem locations, as well as through the identification of less location-based crash types better suited to non-spatial countermeasures. The results of the K function analysis point to the usefulness of the procedure in identifying the degree and scale at which crashes cluster, or do not cluster, relative to each other. Moreover, for many individual crash types, different patterns and processes and potentially different countermeasures appeared at different scales of analysis. This finding highlights the importance of scale considerations in problem identification and countermeasure formulation.

Differences based on fine motor behaviour in Parkinson's patients compared to an age matched control group in proprioceptive and visuo-proprioceptive test conditions

Personality differences based on fine motor precision performance were studied in early stage Parkinson's patients and an age-matched control group under two different test conditions: proprioceptive + visual information and proprioceptive information alone. A comparative data analysis for deviations of three measured movement types (transversal, frontal and sagittal) was done for both hands (dominant and non-dominant) with relation to personality dimensions. There were found significant differences between the two groups in decision making dimension and emotionality. After splitting the data for gender subgroups, some significant differences were found for men but not for women. The differences in fine motor task performance varied, being better in some directions for the Parkinson"s patients and worse in others. The findings may suggest that medication has both positive and negative effects on motor performance and provoke personality changes, being more pronounced in men.

Time consumption and damage to the remaining stock in mechanised and motor manual pre-commercial thinning

Abstract

Complications of different ventilation strategies in endoscopic laryngeal surgery: a 10-year review.

BACKGROUND: Spontaneous ventilation, mechanical controlled ventilation, apneic intermittent ventilation, and jet ventilation are commonly used during interventional suspension microlaryngoscopy. The aim of this study was to investigate specific complications of each technique, with special emphasis on transtracheal and transglottal jet ventilation. METHODS: The authors performed a retrospective single-institution analysis of a case series of 1,093 microlaryngoscopies performed in 661 patients between January 1994 and January 2004. Data were collected from two separate prospective databases. Feasibility and complications encountered with each technique of ventilation were analyzed as main outcome measures. RESULTS: During 1,093 suspension microlaryngoscopies, ventilation was supplied by mechanical controlled ventilation via small endotracheal tubes (n = 200), intermittent apneic ventilation (n = 159), transtracheal jet ventilation (n = 265), or transglottal jet ventilation (n = 469). Twenty-nine minor and 4 major complications occurred. Seventy-five percent of the patients with major events had an American Society of Anesthesiologists physical status classification of III. Five laryngospasms were observed with apneic intermittent ventilation. All other 24 complications (including 7 barotrauma) occurred during jet ventilation. Transtracheal jet ventilation was associated with a significantly higher complication rate than transglottal jet ventilation (P < 0.0001; odds ratio, 4.3 [95% confidence interval, 1.9-10.0]). All severe complications were related to barotraumas resulting from airway outflow obstruction during jet ventilation, most often laryngospasms. CONCLUSIONS: The use of a transtracheal cannula was the major independent risk factor for complications during jet ventilation for interventional microlaryngoscopy. The anesthetist's vigilance in clinically detecting and preventing outflow airway obstruction remains the best prevention of barotrauma during subglottic jet ventilation.

A Threat to a Virtual Hand Elicits Motor Cortex Activation

We report an experiment where participants observed an attack on their virtual body as experienced in an immersive virtual reality (IVR) system. Participants sat by a table with their right hand resting upon it. In IVR, they saw a virtual table that was registered with the real one, and they had a virtual body that substituted their real body seen from a first person perspective. The virtual right hand was collocated with their real right hand. Event-related brain potentials were recorded in two conditions, one where the participant"s virtual hand was attacked with a knife and a control condition where the knife only struck the virtual table. Significantly greater P450 potentials were obtained in the attack condition confirming our expectations that participants had a strong illusion of the virtual hand being their own, which was also strongly supported by questionnaire responses. Higher levels of subjective virtual hand ownership correlated with larger P450 amplitudes. Mu-rhythm event-related desynchronization in the motor cortex and readiness potential (C3C4) negativity were clearly observed when the virtual hand was threatened as would be expected, if the real hand was threatened and the participant tried to avoid harm. Our results support the idea that event-related potentials may provide a promising non-subjective measure of virtual embodiment. They also support previous experiments on pain observation and are placed into context of similar experiments and studies of body perception and body ownership within cognitive neuroscience.

Impact of induction therapy on airway complications after sleeve lobectomy for lung cancer.

BACKGROUND: Sleeve lobectomy is a valid alternative to pneumonectomy for the treatment of centrally located operable non-small cell lung cancer (NSCLC), but concern has been evoked regarding a potentially increased risk of bronchial anastomosis complications after induction therapy. This study examined the impact of induction therapy on airway healing after sleeve lobectomy for NSCLC. METHODS: Bronchial anastomosis complications were recorded with respect to the induction regimen applied (neoadjuvant chemotherapy vs chemoradiotherapy) in a consecutive series of patients with sleeve lobectomy for NSCLC. RESULTS: Ninety-nine patients underwent sleeve resection, 28 of them after induction therapy. Twelve patients received chemotherapy alone, and 16 patients had radiochemotherapy. There were no significant differences in postoperative 90-day mortality (3.6% vs 2.8%) and morbidity (54% vs 49%) for patients with and without induction therapy. Bronchial anastomosis complications occurred in 3 patients (10.8%) with neoadjuvant therapy and in 2 (2.8%) without (p = 0.3). In the induction therapy group, two bronchial stenoses occurred after radiochemotherapy and one bronchopleural fistula after chemotherapy alone. In patients without induction therapy, one bronchial stenosis and one bronchopleural fistula were observed. All bronchial stenoses were successfully treated by dilatation, and both bronchopleural fistulas occurring after right lower lobectomy were successfully treated by reoperation and completion sleeve bilobectomy with preservation of the upper lobe. CONCLUSIONS: Sleeve lobectomy for NSCLC can be safely performed after induction chemotherapy and radiochemotherapy with mortality and incidence of airway complications similar to that observed in nonpretreated patients. The treatment of airway complications does not differ for patients with and without induction therapy.

Management of Pharyngeal Fistulas After Anterior Cervical Spine Surgery: A Treatment Algorithm for Severe Complications.

STUDY DESIGN:: Retrospective database- query to identify all anterior spinal approaches. OBJECTIVES:: To assess all patients with pharyngo-cutaneous fistulas after anterior cervical spine surgery. SUMMARY OF BACKGROUND DATA:: Patients treated in University of Heidelberg Spine Medical Center, Spinal Cord Injury Unit and Department of Otolaryngology (Germany), between 2005 and 2011 with the diagnosis of pharyngo-cutaneous fistulas. METHODS:: We conducted a retrospective study on 5 patients between 2005 and 2011 with PCF after ACSS, their therapy management and outcome according to radiologic data and patient charts. RESULTS:: Upon presentation 4 patients were paraplegic. 2 had PCF arising from one piriform sinus, two patients from the posterior pharyngeal wall and piriform sinus combined and one patient only from the posterior pharyngeal wall. 2 had previous unsuccessful surgical repair elsewhere and 1 had prior radiation therapy. In 3 patients speech and swallowing could be completely restored, 2 patients died. Both were paraplegic. The patients needed an average of 2-3 procedures for complete functional recovery consisting of primary closure with various vascularised regional flaps and refining laser procedures supplemented with negative pressure wound therapy where needed. CONCLUSION:: Based on our experience we are able to provide a treatment algorithm that indicates that chronic as opposed to acute fistulas require a primary surgical closure combined with a vascularised flap that should be accompanied by the immediate application of a negative pressure wound therapy. We also conclude that particularly in paraplegic patients suffering this complication the risk for a fatal outcome is substantial.

Motor Grader Operator Maintenance of Granular Surfaced Roads : Tips from Iowa Operators, 1991

This booklet is a compilation of notes taken during motor grader operators workshops held at some 20 different locations throughout Iowa during the last two years. It is also the advice of 16 experienced motor grader operators and maintenance foremen (from 14 different counties around Iowa), who serve as instructors and assistant instructors at the "MoGo" workshops. The instructors have all said that they learn as much from the operators who attend the workshops as they impart. Motor grader operators from throughout Iowa have shown us new, innovative and better ways of maintaining gravel roads. This booklet is an attempt to pass on some of these "tips" that we have gathered from Iowa operators. It will need to be revised, corrected, and added to based on the advice we get from you, the operators who do the work here in Iowa.

Les infections endo-artérielles, complications redoutables des infections à salmonelles non typhi [Endarterial infections, redoubtable complications of non-typhi salmonella infections].

Three cases are reported of salmonella aortitis observed in three men aged 55, 60 and 48 years, the last of whom had a prosthetic aortic valve and ascending aorta. The microorganisms were S. typhi murium, S. paratyphi B, and S. wien. Despite antibiotic treatment two patients died of perforating aortitis. The third patient developed S. wien gastroenteritis a few days after surgical replacement of the aortic valve and the ascending aorta. Five years later he presented with several bacteremic episodes due to S. wien, which recurred despite several courses of cotrimoxazole treatment. He has now been asymptomatic for over one year under prolonged cotrimoxazole treatment. Since vascular infection may occur following non typhi salmonellosis in 5% of patients over 50, or who have underlying endothelial lesions, the question arises as to whether non typhi S. gastroenteritis should be treated with antibiotics in these high risk patients, in contrast to present recommendations.