Surgical Stabilization for Multiple Rib Fractures: Whom the Benefit? -A Prospective Observational Study

Background: Surgical repair has demonstrated a beneficial effect on outcome for patients presenting with flail chest or with multiple rib fractures. We hypothesized that benefit on outcome parameters concerns predominantly patients being extubated within 24 hours post-operatively. Methods: We prospectively recorded all patients presenting with chest traumatism eligible for surgical repair with anticipated early extubation according to our institutional consensus (flail chest, major deformity, poor pain control, associated lesions requiring thoracotomy). We compared outcomes of patients extubated within 24 hours post-operatively to those who required prolonged ventilator support. We tested predictive factors for prolonged intubation with univariate and multivariate analysis. Results: From 2010 to 2014, 132 patients required surgical repair. Two thirds were extubated within 24 hours following surgical repair. Pneumonia was the main complication and occurred in 30.3% of all patients. Patients extubated within 24 hours following surgical repair had significantly shorter ICU stay and shorter in-hospital stay (P<0.0001 both). Pneumonia occurred significantly more often in patients with longer mechanical ventilation (over 24 hours) (P<0.0001) and the overall post-operative complications rate was higher (P=0.0001). Main independent risk factors for delayed extubation were bilateral chest rib fractures and initially associated pneumothorax. Conclusions: We conclude that patients extubated within 24 hours after repair have an improved outcome with reduced complication rate and shorter hospital stay. The initial extent of the trauma is an important risk factor for delayed extubation and high complication rate despite surgical stabilization

CC9 Livestock-Associated Staphylococcus aureus Emerges in Bloodstream Infections in French Patients Unconnected With Animal Farming

We report 4 bloodstream infections associated with CC9 agr type II Staphylococcus aureus in individuals without animal exposure. We demonstrate, by microarray analysis, the presence of egc cluster, fnbA, cap operon, lukS, set2, set12, splE, splD, sak, epiD, and can, genomic features associated with a high virulence potential in human

Antiretroviral-naive and -treated HIV-1 patients can harbour more resistant viruses in CSF than in plasma

Objectives The neurological disorders in HIV-1-infected patients remain prevalent. The HIV-1 resistance in plasma and CSF was compared in patients with neurological disorders in a multicentre study. Methods Blood and CSF samples were collected at time of neurological disorders for 244 patients. The viral loads were >50 copies/mL in both compartments and bulk genotypic tests were realized. Results On 244 patients, 89 and 155 were antiretroviral (ARV) naive and ARV treated, respectively. In ARV-naive patients, detection of mutations in CSF and not in plasma were reported for the reverse transcriptase (RT) gene in 2/89 patients (2.2%) and for the protease gene in 1/89 patients (1.1%). In ARV-treated patients, 19/152 (12.5%) patients had HIV-1 mutations only in the CSF for the RT gene and 30/151 (19.8%) for the protease gene. Two mutations appeared statistically more prevalent in the CSF than in plasma: M41L (P = 0.0455) and T215Y (P = 0.0455). Conclusions In most cases, resistance mutations were present and similar in both studied compartments. However, in 3.4% of ARV-naive and 8.8% of ARV-treated patients, the virus was more resistant in CSF than in plasma. These results support the need for genotypic resistance testing when lumbar puncture is performe

Repérer et évaluer les effets thérapeutiques des dispositifs-cadres de médiation dans l’accompagnement des troubles d’apprentissage

International audienc

Cliniques des souffrances d’apprendre : Jeux de transferts et transferts de jeux dans les groupes à médiation thérapeutique

International audienc

Repérer et évaluer les effets thérapeutiques des dispositifs-cadres de médiation dans l’accompagnement des troubles d’apprentissage

International audienc

Une approche psychodynamique des troubles spécifiques des apprentissages

International audienc

Conseils aux voyageurs pour Madagascar

LYON1-BU Santé (693882101) / SudocSudocFranceF

Foreign trade in wood products - is there truly a french paradox?

The purpose of this article is to question the recurring idea that there is a paradox relating to the French forestry and forest-based industry which, in spite of its plentiful forest resources, generates a trade deficit of several billion euros. Based on an international comparison between major exporting countries, the authors show that while the existence and harvesting of these resources can contribute to the competitiveness of the forest-based industries in some countries, this is neither enough nor even necessary. Comparative advantage for exports of an industry is the outcome of a combination of factors, including ability to innovate, offer of high added value products, the institutional environment, etc. To better identify the role played by these factors for the forestry and forest-based industries would resolve the paradoxCet article a pour objet de questionner l’idée récurrente d’un paradoxe de la filière bois française qui, bien que disposant d’une ressource forestière abondante, affiche un déficit commercial de plusieurs milliards d’euros. En s’appuyant sur une comparaison internationale entre les principaux pays exportateurs, nous montrons que si la ressource et sa mobilisation peuvent contribuer à assurer la compétitivité des industries du bois dans certains pays, ce n’est ni un facteur suffisant ni même forcément nécessaire. Les avantages comparatifs à l’exportation d’une industrie résultent en effet d’une combinaison de facteurs, dont la capacité à innover, l’offre de produits à forte valeur ajoutée, l’environnement institutionnel… C’est finalement la mise en évidence du rôle de ces facteurs pour les industries du bois, qui reste encore à mieux cerner, qui permettra de dépasser l’idée de paradox

Recherche dans les institutions patrimoniales (La)

Table ronde modérée par Pierre Guinard (directeur des collections et des contenus, BmL). Avec la participation de : - Françoise Banat-Berger (directrice des Archives nationales). - Jocelyne Deschaux (directrice du réseau des médiathèques du Grand Albigeois). - Anne Pasquignon (adjointe chargée des Affaires scientifiques et techniques, chef de la mission de Coordination, Bibliothèque nationale de France)