IRC préterminale : il n'est jamais trop tôt pour référer au spécialiste : Revue cochrane pour le praticien

Cette rubrique présente les résultats d'une revue systématique récente telle que publiée dans la Cochrane Library (www.thecochranelibrary.com). Volontairement limité à un champ de recherche circonscrit, cet article reflète l'état actuel des connaissances de ce domaine. Il ne s'agit donc pas de recommandations pour guider la prise en charge d'une problématique clinique considérée dans sa globalité (guidelines). Les auteurs de ce résumé se basent sur la revue systématique et ne remettent pas en question le choix des articles inclus dans la revue. Scénario: Vous suivez un patient de 71 ans connu pour un diabète et une hypertension bien contrôlés, ainsi qu'une insuffisance rénale chronique de longue date, progressive, actuellement sévère (créatinine à 267 mmol/l, taux de filtration glomérulaire estimé (TFGe) à 21 ml/min/1,73 m2). Son état général est bon, son poids est stable et il ne présente pas de symptômes urémiques. Question: Faut-il adresser ce patient à un néphrologue

Nonlinear electron-phonon coupling in doped manganites

We employ time-resolved resonant x-ray diffraction to study the melting of charge order and the associated insulator-metal transition in the doped manganite Pr$_{0.5}$Ca$_{0.5}$MnO$_3$ after resonant excitation of a high-frequency infrared-active lattice mode. We find that the charge order reduces promptly and highly nonlinearly as function of excitation fluence. Density functional theory calculations suggest that direct anharmonic coupling between the excited lattice mode and the electronic structure drive these dynamics, highlighting a new avenue of nonlinear phonon control

The photoinduced transition in magnetoresistive manganites: a comprehensive view

We use femtosecond x-ray diffraction to study the structural response of charge and orbitally ordered Pr$_{1-x}$Ca$_x$MnO$_3$ thin films across a phase transition induced by 800 nm laser pulses. By investigating the dynamics of both superlattice reflections and regular Bragg peaks, we disentangle the different structural contributions and analyze their relevant time-scales. The dynamics of the structural and charge order response are qualitatively different when excited above and below a critical fluence $f_c$. For excitations below $f_c$ the charge order and the superlattice is only partially suppressed and the ground state recovers within a few tens of nanosecond via diffusive cooling. When exciting above the critical fluence the superlattice vanishes within approximately half a picosecond followed by a change of the unit cell parameters on a 10 picoseconds time-scale. At this point all memory from the symmetry breaking is lost and the recovery time increases by many order of magnitudes due to the first order character of the structural phase transition

Domain size effects on the dynamics of a charge density wave in 1T-TaS2

Recent experiments have shown that the high temperature incommensurate (I) charge density wave (CDW) phase of 1T-TaS2 can be photoinduced from the lower temperature, nearly commensurate (NC) CDW state. Here we report a time-resolved x-ray diffraction study of the growth process of the photoinduced I-CDW domains. The layered nature of the material results in a marked anisotropy in the size of the photoinduced domains of the I-phase. These are found to grow self-similarly, their shape remaining unchanged throughout the growth process. The photoinduced dynamics of the newly formed I-CDW phase was probed at various stages of the growth process using a double pump scheme, where a first pump creates I-CDW domains and a second pump excites the newly formed I-CDW state. We observe larger magnitudes of the coherently excited I-CDW amplitude mode in smaller domains, which suggests that the incommensurate lattice distortion is less stable for smaller domain sizes.Comment: 8 pages, 8 figure

Prediction of cognitive outcome based on the progression of auditory discrimination during coma.

To date, no clinical test is able to predict cognitive and functional outcome of cardiac arrest survivors. Improvement of auditory discrimination in acute coma indicates survival with high specificity. Whether the degree of this improvement is indicative of recovery remains unknown. Here we investigated if progression of auditory discrimination can predict cognitive and functional outcome. We prospectively recorded electroencephalography responses to auditory stimuli of post-anoxic comatose patients on the first and second day after admission. For each recording, auditory discrimination was quantified and its evolution over the two recordings was used to classify survivors as "predicted" when it increased vs. "other" if not. Cognitive functions were tested on awakening and functional outcome was assessed at 3 months using the Cerebral Performance Categories (CPC) scale. Thirty-two patients were included, 14 "predicted survivors" and 18 "other survivors". "Predicted survivors" were more likely to recover basic cognitive functions shortly after awakening (ability to follow a standardized neuropsychological battery: 86% vs. 44%; p=0.03 (Fisher)) and to show a very good functional outcome at 3 months (CPC 1: 86% vs. 33%; p=0.004 (Fisher)). Moreover, progression of auditory discrimination during coma was strongly correlated with cognitive performance on awakening (phonemic verbal fluency: rs=0.48; p=0.009 (Spearman)). Progression of auditory discrimination during coma provides early indication of future recovery of cognitive functions. The degree of improvement is informative of the degree of functional impairment. If confirmed in a larger cohort, this test would be the first to predict detailed outcome at the single-patient level

Coherent Acoustic Perturbation of Second-Harmonic-Generation in NiO

We investigate the structural and magnetic origins of the unusual ultrafast second-harmonicgeneration (SHG) response of femtosecond-laser-excited nickel oxide (NiO) previously attributed to oscillatory reorientation dynamics of the magnetic structure induced by d-d excitations. Using time-resolved x-ray diffraction from the (3/2 3/2 3/2) magnetic planes, we show that changes in the magnitude of the magnetic structure factor following ultrafast optical excitation are limited to $\Delta/$ = 1.5% in the first 30 ps. An extended investigation of the ultrafast SHG response reveals a strong dependence on wavelength as well as characteristic echoes, both of which give evidence for an acoustic origin of the dynamics. We therefore propose an alternative mechanism for the SHG response based on perturbations of the nonlinear susceptibility via optically induced strain in a spatially confined medium. In this model, the two observed oscillation periods can be understood as the times required for an acoustic strain wave to traverse one coherence length of the SHG process in either the collinear or anti-collinear geometries.Comment: 26 pages, 7 figure

Ultrafast relaxation dynamics of the antiferrodistortive phase in Ca doped SrTiO3

The ultrafast dynamics of the octahedral rotation in Ca:SrTiO3 is studied by time resolved x-ray diffraction after photo excitation over the band gap. By monitoring the diffraction intensity of a superlattice reflection that is directly related to the structural order parameter of the soft-mode driven antiferrodistortive phase in Ca:SrTiO3, we observe a ultrafast relaxation on a 0.2 ps timescale of the rotation of the oxygen octahedron, which is found to be independent of the initial temperaure despite large changes in the corresponding soft-mode frequency. A further, much smaller reduction on a slower picosecond timescale is attributed to thermal effects. Time-dependent density-functional-theory calculations show that the fast response can be ascribed to an ultrafast displacive modification of the soft-mode potential towards the normal state, induced by holes created in the oxygen 2p states

Structural and magnetic dynamics of a laser induced phase transition in FeRh

We use time-resolved x-ray diffraction and magnetic optical Kerr effect to study the laser induced antiferromagnetic to ferromagnetic phase transition in FeRh. The structural response is given by the nucleation of independent ferromagnetic domains (\tau_1 ~ 30ps). This is significantly faster than the magnetic response (\tau_2 ~ 60ps) given by the subsequent domain realignment. X-ray diffraction shows that the two phases co-exist on short time-scales and that the phase transition is limited by the speed of sound. A nucleation model describing both the structural and magnetic dynamics is presented.Comment: 5 pages, 3 figures - changed to reflect version accepted for PR