Impact of early valve surgery on outcome of Staphylococcus aureus prosthetic valve infective endocarditis: analysis in the International Collaboration of Endocarditis-Prospective Cohort Study.

BACKGROUND: The impact of early valve surgery (EVS) on the outcome of Staphylococcus aureus (SA) prosthetic valve infective endocarditis (PVIE) is unresolved. The objective of this study was to evaluate the association between EVS, performed within the first 60 days of hospitalization, and outcome of SA PVIE within the International Collaboration on Endocarditis-Prospective Cohort Study. METHODS: Participants were enrolled between June 2000 and December 2006. Cox proportional hazards modeling that included surgery as a time-dependent covariate and propensity adjustment for likelihood to receive cardiac surgery was used to evaluate the impact of EVS and 1-year all-cause mortality on patients with definite left-sided S. aureus PVIE and no history of injection drug use. RESULTS: EVS was performed in 74 of the 168 (44.3%) patients. One-year mortality was significantly higher among patients with S. aureus PVIE than in patients with non-S. aureus PVIE (48.2% vs 32.9%; P = .003). Staphylococcus aureus PVIE patients who underwent EVS had a significantly lower 1-year mortality rate (33.8% vs 59.1%; P = .001). In multivariate, propensity-adjusted models, EVS was not associated with 1-year mortality (risk ratio, 0.67 [95% confidence interval, .39-1.15]; P = .15). CONCLUSIONS: In this prospective, multinational cohort of patients with S. aureus PVIE, EVS was not associated with reduced 1-year mortality. The decision to pursue EVS should be individualized for each patient, based upon infection-specific characteristics rather than solely upon the microbiology of the infection causing PVIE.

Making SENSE - Sustained Effort Network for treatment of Status Epilepticus as a multicenter prospective registry.

BACKGROUND: Evidence regarding the different treatment options of status epilepticus (SE) in adults is scarce. Large randomized trials cover only one treatment at early stage and suggest the superiority of benzodiazepines over placebo, of intravenous lorazepam over intravenous diazepam or over intravenous phenytoin alone, and of intramuscular midazolam over intravenous lorazepam. However, many patients will not be treated successfully with the first treatment step. A large randomized trial covering the treatment of established status (ESETT) has just been funded recently by the NIH and will not start before 2015, with expected results in 2018; a trial on the treatment of refractory status with general anesthetics was terminated early due to insufficient recruitment. Therefore, a prospective multicenter observational registry was set up; this may help in clinical decision-making until results from randomized trials are available. METHODS/DESIGN: SENSE is a prospective, multicenter registry for patients treated for SE. The primary objective is to document patient characteristics, treatment modalities and in-house outcome of consecutive adults admitted for SE treatment in each of the participating centres and to identify predictors of outcome. Pre-treatment, treatment-related and outcome variables are documented systematically. To allow for meaningful multivariate analysis in the patient subgroups with refractory SE, a cohort size of 1000 patients is targeted. DISCUSSION: The results of the study will provide information about risks and benefits of specific treatment steps in different patient groups with SE at different points of time. Thus, it will support clinical decision-making and, furthermore, it will be helpful in the planning of treatment trials. TRIAL REGISTRATION: DRKS00000725.

L'Année coloniale / publiée sous la direction de MM. Ch. Mourey,... Louis Brunel,... ; avec la collaboration de MM. le Général Gallieni, Picquié et Teissier

1899 (A1).

L'Année coloniale / publiée sous la direction de MM. Ch. Mourey,... Louis Brunel,... ; avec la collaboration de MM. le Général Gallieni, Picquié et Teissier

1902 (A4)-1903.

L'Année coloniale / publiée sous la direction de MM. Ch. Mourey,... Louis Brunel,... ; avec la collaboration de MM. le Général Gallieni, Picquié et Teissier

1902/12 (A3).

L'Année coloniale / publiée sous la direction de MM. Ch. Mourey,... Louis Brunel,... ; avec la collaboration de MM. le Général Gallieni, Picquié et Teissier

1900 (A2).

Building an Access Network for Triple-Play Services

This final project was made for the Broadband department of TeliaSonera. This project gives an overview on how internet service provider might build an access network so that they can offer triple-play services. It also gives information on what equipment is needed and what is required from the access, aggregation and edge networks. The project starts by describing the triple-play service. Then it moves on to optical fiber cables, the network technology and network architecture. At the end of the project there is an example of the process and construction of the access network. It will give an overview of the total process and problems that a network planner might face during the planning phase of the project. It will give some indication on how one area is built from the start to finish. The conclusion of the project presents some points that must be taken into consideration when building an access network. The building of an access network has to be divided to a time span of eight to ten years, where one year is one phase in the project. One phase is divided into three parts; Selecting the areas and targets, Planning the areas and targets, and Documentation. The example area gives indication on the planning of an area. It is almost impossible to connect all targets at the same time. This means that the service provider has to complete the construction in two or three parts. The area is considered to be complete when more than 80% of the real estates have fiber.