第1058回千葉医学会例会・整形外科例会

Accessions of the WOSR populations. (XLSX 13 kb

Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome associated with COVID-19: An Emulated Target Trial Analysis.

RATIONALE: Whether COVID patients may benefit from extracorporeal membrane oxygenation (ECMO) compared with conventional invasive mechanical ventilation (IMV) remains unknown. OBJECTIVES: To estimate the effect of ECMO on 90-Day mortality vs IMV only Methods: Among 4,244 critically ill adult patients with COVID-19 included in a multicenter cohort study, we emulated a target trial comparing the treatment strategies of initiating ECMO vs. no ECMO within 7 days of IMV in patients with severe acute respiratory distress syndrome (PaO2/FiO2 <80 or PaCO2 ≥60 mmHg). We controlled for confounding using a multivariable Cox model based on predefined variables. MAIN RESULTS: 1,235 patients met the full eligibility criteria for the emulated trial, among whom 164 patients initiated ECMO. The ECMO strategy had a higher survival probability at Day-7 from the onset of eligibility criteria (87% vs 83%, risk difference: 4%, 95% CI 0;9%) which decreased during follow-up (survival at Day-90: 63% vs 65%, risk difference: -2%, 95% CI -10;5%). However, ECMO was associated with higher survival when performed in high-volume ECMO centers or in regions where a specific ECMO network organization was set up to handle high demand, and when initiated within the first 4 days of MV and in profoundly hypoxemic patients. CONCLUSIONS: In an emulated trial based on a nationwide COVID-19 cohort, we found differential survival over time of an ECMO compared with a no-ECMO strategy. However, ECMO was consistently associated with better outcomes when performed in high-volume centers and in regions with ECMO capacities specifically organized to handle high demand. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Saint-Mammès, terre de mariniers. Approche ethnologique d'une population et d'un territoire

enquête ethnographique réalisée par Vanessa Manceron et Cécile BouchetMode de vie des mariniers du village de St-Mammè

L’enceinte Néolithique de Carvin « Gare d’Eau » (Pas-de-Calais). Présentation préliminaire

International audienc

L’enceinte Néolithique moyen II de Carvin "La Gare d’Eau" (Pas-de-Calais). Présentation préliminaire

Das Erdwerk von Carvin " La Gare d’Eau" gehört in den mittelneolithischen Kulturraum der Spiere-Gruppe. Es befindet sich unweit der Deule und umgibt mit seinen konzentrischen Gräben und Palisaden eine in Feuchtzonen gelegene Anhöhe. Die nach einem genauen Gestaltungsprinzip errichteten Grabenzüge sind regelmäßig unterbrochen, um Durchgänge zwischen den Innen-und Außenbereichen der Anlage zu schaffen. In der umfriedeten Fläche wurden neben Speicherstrukturen zwei Gebäude identifiziert. Diese Strukturen haben eine große Menge an Fundmaterial, insbesondere Keramik, geliefert.The enclosure of Carvin " La Gare d’Eau" belongs to the neolithic chrono-cultural group of Spiere. Located near the river Deûle, it encloses a hill surrounded by wetlands with an well-organized system of concentric ditches and fences. These show frequent interruptions, according to a precise layout to create passages between outside and inside of the enclosure. Inside, along storage features, two buildings were identified. Archaeological features have yielded a considerable quantity of artefacts, especially ceramics.L’enceinte de Carvin " La Gare d’Eau" appartient au groupe chrono-culturel néolithique moyen de Spiere. Située à proximité de la Deûle, elle ceint une butte bordée de zones humides par un système organisé de fossés et palissades concentriques. Ceux-ci s’interrompent fréquemment, selon un agencement précis afin de créer des passages entre extérieur et intérieur de l’enceinte. Dans la surface enclose, outre des structures de stockage, deux bâtiments ont été identifiés. L’ensemble des structures a livré une grande quantité de mobilier, notamment céramique.Monchablon Cécile, Baillieu Michel, Bouchet Marie, Goutelard Arnaud, Praud Ivan. L’enceinte Néolithique moyen II de Carvin "La Gare d’Eau" (Pas-de-Calais). Présentation préliminaire. In: Revue archéologique de Picardie. Numéro spécial 28, 2011. pp. 407-419

Lymphœdème du membre supérieur après cancer du sein – Une pyramide kinésithérapique

Le traitement du cancer du sein est rarement sans suites sur le drainage lymphatique du membre supérieur homolatéral. Il résulte encore trop souvent du développement d’un œdème chronique. Dans beaucoup de cas, la kinésithérapie de proximité doit pouvoir suffire. Elle cherche à récupérer un volume le plus proche de l’initial. Divers protocoles peuvent être présentés mais tous associent différentes techniques. Le choix doit répondre à deux impératifs : rester indolore, ne pas majorer le déficit lymphatique (hyperémie réactionnelle, garrots, détérioration du potentiel lymphatique restant). Une révision du protocole doit être régulièrement effectuée en fonction de l’évolution. Si la décongestion se maintient, un auto-drainage (manuel et/ou pneumatique) est poursuivi régulièrement et les séances de kinésithérapie sont espacées. Une révision du protocole est à assurer si l’effet reste insuffisant ; un transfert est réalisé vers un centre si l’œdème est résistant au traitement de base et qu’aucune amélioration n’est obtenue. En cas d’épisode de lymphangite ou d’érysipèle, la kinésithérapie est suspendue. Enfin, si l’œdème est d’apparition brutale, s’il est accompagné de signes particuliers, s’il amplifie la situation antérieure ou s’il récidive sans explication, une consultation médicale s’impose

Multiscale characterization of arabinoxylan and beta-glucan composite films

Composite films made with Arabinoxylans (AXs) (with high, middle and low level of substitution by arabinose) and (1 -> 3)(1 -> 4)-beta-D-glucans (BGs) extracted from cereal cell walls have been prepared and analyzed using microscopy (SEM and ISCFM), DSC, mechanical tests and TD-NMR spectroscopy. The objectives were to correlate molecular and physico-chemical properties of films with mechanical and hydration properties of wheat cell walls. A phase separation phenomenon was observed for films made with highly substituted AXs and BGs at a ratio AX/BG of 60/40. This phase separation was correlated with lower dipolar interactions between polysaccharide chains and a decrease of ultimate strain and stress of films. Highly substituted AXs and BG composite films exhibited very weak mechanical properties in agreement with weaker interactions between the polymer chains. This effect was supported by NMR results showing that interactions between AXs and BGs decreased with increased substitution of AXs in composite films. Lower dipolar interactions between polysaccharides favored the water mobility in relation with a higher specific surface area of polysaccharides in films but also higher distances between polysaccharide chains so larger nanopores in composite films made within highly substituted AXs. These multiscale characterizations agreed with the structural changes observed in wheat grain during its development

Effet de la stoechiométrie et de réactivité des supports sur la morphologie des CNTs croissant sur ceux-ci par CVD asssisté par catalyseur

International audienc

Management of postoperative bladder emptying after proctectomy in men for rectal cancer. A retrospective study of 190 consecutive patients

International audiencePurposeEvaluation of urinary drainage after rectal resection and identification of criteria associated with postoperative urinary dysfunction (UD). UD remains a clinical problem for up to two thirds of patients after rectal resection. Currently, there are no guidelines concerning duration or type of drainage.MethodsOne hundred ninety consecutive rectal resections (abdomino-perineal resection (APR = 47), mechanical coloanal anastomosis (MechCAA = 48), manual coloanal anastomosis (ManCAA = 47), colorectal anastomosis (CRA = 48)) in male patients were included. In patients with a transurethral catheterization (TUC), the drainage was removed at day 5. Patients with a suprapubic catheterization (SPC) underwent drainage removal according to the results of a clamping test at day 5. UD was defined as drainage removal after day 6 and/or acute urinary retention (AUR).ResultsDrainage types were SPC (n = 136, 72 %) and TUC (n = 54, 28 %). SPC was used more frequently after total mesorectal excision (TME) (APR, ManCAA, MechCAA) (83–92 %). Complications rates of SPC and TUC were 20 and 9 %. The clamping test was positive for 61 patients (48 %), and SPC was removed before/on POD6 without any episode of AUR. After TUC removal, two patients (4 %) had AUR. Seventy-two (38 %) patients had UD: 11 (6 %) were discharged with an indwelling catheter, and in 61 (32 %), the catheter was removed after day6. Three independent factors were associated with UD: diabetes (OR = 2.9 (1.2–7.7)), urological history (OR = 2.9 (1.2–7.6)), and TME (OR = 5.2 (2.3–13.5)).ConclusionThe UD rate after surgery for rectal cancer was 38 %. The clamping test is accurate to prevent AUR after SPC removal. The three risk factors may serve to select good candidates for early catheter removal