Management of neurological complications of infective endocarditis in ICU patients

Patients with infective endocarditis (IE) are generally referred to the intensive care unit (ICU) for one or more organ dysfunctions caused by complications of IE. Neurologic events are frequent causes of ICU admission in patients with IE. They can arise through various mechanisms consisting of stroke or transient ischemic attack, cerebral hemorrhage, mycotic aneurysm, meningitis, cerebral abscess, or encephalopathy. Most complications occur early during the course of IE and are a hallmark of left-sided abnormalities of native or prosthetic valves. Occlusion of cerebral arteries, with stroke or transient ischemic attack, accounts for 40% to 50% of the central nervous system complications of IE. CT scan is the most easily feasible neuroimaging in critically unstable patients. However, magnetic resonance imaging is more sensitive and when performed should follow a standardized protocol. In patients with ischemic stroke who are already receiving oral anticoagulant therapy, this treatment should be replaced by unfractionated heparin for at least 2 weeks with a close monitoring of coagulation tests. Mounting evidence shows that, for both complicated left-sided native valve endocarditis and Staphylococcus aureus prosthetic valve endocarditis, valve replacement combined with medical therapy is associated with a better outcome than medical treatment alone. In a recent series, approximately 50% of patients underwent valve replacement during the acute phase of IE before completion of antibiotic treatment. After a neurological event, most patients have at least one indication for cardiac surgery. Recent data from literature suggest that after a stroke, surgery indicated for heart failure, uncontrolled infection, abscess, or persisting high emboli risk should not be delayed, provided that the patient is not comatose or has no severe deficit. Neurologic complications of IE contribute to a severe prognosis in ICU patients. However, patients with only silent or transient stroke had a better prognosis than patients with symptomatic events. In addition, more than neurologic event per se, a better predictor of mortality is neurologic dysfunction, which is associated with location and extension of brain damage. Patients with severe neurological impairment and those with brain hemorrhage have the worse outcome

Méthadone ou torture ?

Pour la première fois, la Cour européenne des droits de l’homme basée à Strasbourg se penche sur la question de savoir si les patients dépendants à l’héroïne ont un droit à poursuivre leur traitement à base de méthadone lorsqu’ils sont privés de leur liberté. S’appuyant sur l’art. 3 de la Convention, lequel interdit la torture comme les autres traitements inhumains et dégradants, la Cour estime que c’est à l’Etat, qui entend refuser l’accès à la méthadone, de prouver – sur la base d’une expertise indépendante – qu’une approche médicale autre que celle fondée sur un médicament agoniste aurait de sérieuses chances de succès dans le traitement de la dépendance du patient en cause. La présente contribution discute la portée et les limites de cet arrêt

Year-round records of bulk and size-segregated aerosol composition in central Antarctica (Concordia site) Part 1: Fractionation of sea-salt particles

Abstract. Multiple year-round records of bulk and size-segregated composition of aerosol were obtained at the inland site of Concordia located at Dome C in East Antarctica. In parallel, sampling of acidic gases on denuder tubes was carried out to quantify the concentrations of HCl and HNO3 present in the gas phase. These time-series are used to examine aerosol present over central Antarctica in terms of chloride depletion relative to sodium with respect to freshly emitted sea-salt aerosol as well as depletion of sulfate relative to sodium with respect to the composition of seawater. A depletion of chloride relative to sodium is observed over most of the year, reaching a maximum of ~ 20 ng m−3 in spring when there are still large sea-salt amounts and acidic components start to recover. The role of acidic sulfur aerosol and nitric acid in replacing chloride from sea-salt particles is here discussed. HCl is found to be around twice more abundant than the amount of chloride lost by sea-salt aerosol, suggesting that either HCl is more efficiently transported to Concordia than sea-salt aerosol or reemission from the snow pack over the Antarctic plateau represents an additional significant HCl source. The size-segregated composition of aerosol collected in winter (from 2006 to 2011) indicates a mean sulfate to sodium ratio of sea-salt aerosol present over central Antarctica of 0.16 ± 0.05, suggesting that, on average, the sea-ice and open ocean emissions equally contribute to sea-salt aerosol load of the inland Antarctic atmosphere. The temporal variability of the sulfate depletion relative to sodium was examined at the light of air mass backward trajectories, showing an overall decreasing trend of the ratio (i.e. a stronger sulfate depletion relative to sodium) when air masses arriving at Dome C had travelled a longer time over sea-ice than over open-ocean. The findings are shown to be useful to discuss sea-salt ice records extracted at deep drilling sites located inland Antarctica. </jats:p

P. Mönnig – Mathematik – SUPPLEMENT

Bruno Antonio Buike, Hrsg. - title: P. Mönnig – Mathematik – SUPPLEMENT Neuss: Bruno Buike 2023, 187 p. - E113 - handwritten skript on the formal logics chapter - metamathematics - Goedel - multivalued logics - supplement to: E112 Paul Mönnig: Grundkurs Mathematik - Reprint, Neuss: Bruno Buike 2023, 237 p. - mit Vorwort des Herausgebers - mit formaler Logik in Russel-Whitehead-Notation - doiURL https://doi.org/10.17613/j1ap-cp20 - in Library Genesis RU repository as wel

Model study for the nonequlibrium magnetic domain structure during the growth of nanostructured ultrathin films

The nonequilibrium magnetic domain structure of growing ultrathin ferromagnetic films with a realistic atomic structure is studied as a function of coverage and temperature. We apply a kinetic Monte Carlo method to a micromagnetic model describing the transition from superparamagnetic islands at low coverages to a closed ferromagnetic film. The magnetic relaxation and the island growth happen simultaneously. Near the percolation threshold a metastable magnetic domain structure is obtained with an average domain area ranging between the area of individual magnetic islands and the area of the large domains observed for thicker ferromagnetic films. We conclude that this micro-domain structure is controlled and stabilized by the nonuniform atomic nanostructure of the ultrathin film, causing a random interaction between magnetic islands with varying sizes and shapes. The average domain area and domain roughness are determined. A maximum of the domain area and a minimum of the domain roughness are obtained as a function of the temperature.Comment: 19 pages, 4 Postscript figures; to be published in J. Magn. Magn. Mater., accepted (2001); completely revised manuscrip

Reporte de \u3ci\u3eStigmacoccus paranaensis\u3c/i\u3e Foldi (Hemiptera, Stigmacoccidae), insecto escama asociado con la producción de miel de mielato en Rio Grande do Sul, Brasil

Se provee una diagnosis de Stigmacoccus paranaensis Foldi (Hemiptera, Stigmacoccidae), especie de insecto escama asociada a la producción de miel de mielato en Rio Grande do Sul, Brasil. Se proveen nuevos registros de distribución y plantas hospederas de S. paranaensis. Stigmacoccus paranaensis Foldi (Hemiptera, Stigmacoccidae), a species of scale insect associated with honeydew honey production in Rio Grande do Sul, Brazil, is diagnosed. New distribution records and the host range of Stigmacoccus paranaensis Foldi are provided

Gilbert Damping in Magnetic Multilayers

We study the enhancement of the ferromagnetic relaxation rate in thin films due to the adjacent normal metal layers. Using linear response theory, we derive the dissipative torque produced by the s-d exchange interaction at the ferromagnet-normal metal interface. For a slow precession, the enhancement of Gilbert damping constant is proportional to the square of the s-d exchange constant times the zero-frequency limit of the frequency derivative of the local dynamic spin susceptibility of the normal metal at the interface. Electron-electron interactions increase the relaxation rate by the Stoner factor squared. We attribute the large anisotropic enhancements of the relaxation rate observed recently in multilayers containing palladium to this mechanism. For free electrons, the present theory compares favorably with recent spin-pumping result of Tserkovnyak et al. [Phys. Rev. Lett. \textbf{88},117601 (2002)].Comment: 1 figure, 5page