Successful transcatheter aortic valve implantation (TAVI) with SNARE technique.

peer reviewe

Involvement of the Efflux Pumps in Chloramphenicol Selected Strains of Burkholderia thailandensis: Proteomic and Mechanistic Evidence

Burkholderia is a bacterial genus comprising several pathogenic species, including two species highly pathogenic for humans, B. pseudomallei and B. mallei. B. thailandensis is a weakly pathogenic species closely related to both B. pseudomallei and B. mallei. It is used as a study model. These bacteria are able to exhibit multiple resistance mechanisms towards various families of antibiotics. By sequentially plating B. thailandensis wild type strains on chloramphenicol we obtained several resistant variants. This chloramphenicol-induced resistance was associated with resistance against structurally unrelated antibiotics including quinolones and tetracyclines. We functionally and proteomically demonstrate that this multidrug resistance phenotype, identified in chloramphenicol-resistant variants, is associated with the overexpression of two different efflux pumps. These efflux pumps are able to expel antibiotics from several families, including chloramphenicol, quinolones, tetracyclines, trimethoprim and some β-lactams, and present a partial susceptibility to efflux pump inhibitors. It is thus possible that Burkholderia species can develop such adaptive resistance mechanisms in response to antibiotic pressure resulting in emergence of multidrug resistant strains. Antibiotics known to easily induce overexpression of these efflux pumps should be used with discernment in the treatment of Burkholderia infections

Évaluation d un protocole de sevrage de la sédation chez des patients cérébro-lésés

L arrêt de la sédation conduit souvent à l apparition d un syndrome de sevrage. Chez les patients cérébro-lésés, le syndrome de sevrage est délétère compte tenu du risque de réaggravation neurologique. Faute de recommandations, chaque équipe médicale traite le syndrome de sevrage de manière empirique. Cette étude observationnelle évalue un protocole d arrêt de la sédation par l emploi systématique du clorazépate (Tranxène®), benzodiazépine de demi-vie longue associé à la buprénorphine (Temgésic®), en cas de syndrome de sevrage aux morphiniques. C est un agoniste partiel des récepteurs morphiniques dont l affinité pour ces récepteurs est forte, possédant également un effet anti-hyperalgésique. Quarante patients consécutifs cérébro-lésés (traumatisme crânien ou accident vasculaire cérébral grave) ont été inclus. La sédation comprenait du midazolam et du sufentanil ou du fentanyl pendant 14 jours. A l arrêt du midazolam, du clorazépate a été introduit pendant 4 jours. A l arrêt du morphinique (H0) et du clorazépate, des paramètres évaluant le syndrome de sevrage ont été colligés toutes les heures. Sur les 40 patients, 10 n ont pas reçu de buprénorphine car ils n ont pas présenté de syndrome de sevrage aux morphiniques. Pour les 30 autres, les signes de syndrome de sevrage apparaissent en moyenne au bout 7 heures. Les valeurs de fréquence cardiaque, pression artérielle systolique, fréquence respiratoire et agitation sont significativement plus élevées à HB qu à H0 (analyse de variance type ANOVA pour mesures répétées). La buprénorphine corrige les signes de syndrome de sevrage dès la 6ème heure. D autres causes d agitation sont écartées, notamment septique ou métabolique. Aucun patient n a eu de réintroduction des agents de sédation. L association du clorazépate et de la buprénorphine prévient et traite le syndrome de sevrage de la sédation.GRENOBLE1-BU Médecine pharm. (385162101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

[A protocol for the cessation of sedation in brain-injured patients].

International audienceOBJECTIVES: The cessation of sedation in brain-injured patients may result in severe agitation and/or acute withdrawal syndrome related to the prolonged administration of large doses of benzodiazepines and/or opioids. The aim of the present study was to assess the clinical efficacy of a written protocol to withdraw sedation for these patients. STUDY DESIGN: Observational prospective study. PATIENTS AND METHODS: After approval by the Institutional Review Board, 40 severely brain-injured patients were included. They had received continuous administration of midazolam and sufentanil or fentanyl for median 15 days. On cessation of midazolam infusion, patients were given clorazepate for 3 days. On cessation of opioid infusion and clorazepate, clinical data were collected for 48 hours: heart rate, systolic blood pressure, respiratory rate, agitation, and pupil diameter. If an opioid withdrawal syndrome occurred, patients received a 48-hour continuous infusion of buprenorphine. RESULTS: Of 40 patients, there were 10 who did not require buprenorphine. An agitation occurred 5 hours (1-21) after cessation of opioid, associated with tachycardia, arterial hypertension, and tachypnea. After 6 hours buprenorphine treatment, these parameters were normalized. No patient needed the reintroduction of the initial sedation. CONCLUSION: The cessation of sedation in severely brain-injured patients can be successfully managed with the use of clorazepate, associated with buprenorphine in the presence of agitation

Construction and commissioning of a technological prototype of a high-granularity semi-digital hadronic calorimeter

A large prototype of 1.3m3 was designed and built as a demonstrator of the semi-digital hadronic calorimeter (SDHCAL) concept proposed for the future ILC experiments. The prototype is a sampling hadronic calorimeter of 48 units. Each unit is built of an active layer made of 1m2 Glass Resistive Plate Chamber(GRPC) detector placed inside a cassette whose walls are made of stainless steel. The cassette contains also the electronics used to read out the GRPC detector. The lateral granularity of the active layer is provided by the electronics pick-up pads of 1cm2 each. The cassettes are inserted into a self-supporting mechanical structure built also of stainless steel plates which, with the cassettes walls, play the role of the absorber. The prototype was designed to be very compact and important efforts were made to minimize the number of services cables to optimize the efficiency of the Particle Flow Algorithm techniques to be used in the future ILC experiments. The different components of the SDHCAL prototype were studied individually and strict criteria were applied for the final selection of these components. Basic calibration procedures were performed after the prototype assembling. The prototype is the first of a series of new-generation detectors equipped with a power-pulsing mode intended to reduce the power consumption of this highly granular detector. A dedicated acquisition system was developed to deal with the output of more than 440000 electronics channels in both trigger and triggerless modes. After its completion in 2011, the prototype was commissioned using cosmic rays and particles beams at CERN

Discussion sur les détails donnés par M. le baron d'Elbecq sur la fédération des trois départements du Nord, lors de la séance du 11 juin 1790

Davin Henri, Bouche Charles-François, Elbhecq Pierre-Joseph du Chambge, baron d'. Discussion sur les détails donnés par M. le baron d'Elbecq sur la fédération des trois départements du Nord, lors de la séance du 11 juin 1790. In: Archives Parlementaires de 1787 à 1860 - Première série (1787-1799) Tome XVI - Du 31 mai au 8 juillet 1790. Paris : Librairie Administrative P. Dupont, 1883. pp. 164-165

Discussion sur les détails donnés par M. le baron d'Elbecq sur la fédération des trois départements du Nord, lors de la séance du 11 juin 1790

Davin Henri, Bouche Charles-François, Elbhecq Pierre-Joseph du Chambge, baron d'. Discussion sur les détails donnés par M. le baron d'Elbecq sur la fédération des trois départements du Nord, lors de la séance du 11 juin 1790. In: Archives Parlementaires de 1787 à 1860 - Première série (1787-1799) Tome XVI - Du 31 mai au 8 juillet 1790. Paris : Librairie Administrative P. Dupont, 1883. pp. 164-165

Mechanical behavior of bioactive TiC nanocomposite thin films

Carbon-based nanocomposite thin films have large application potential because they possess unique mechanical properties, especially high hardness, high elasticity, and a low widely adjustable friction coefficient. In this work, relatively easy preparation of the nanocomposite Ti and C system with good mechanical properties and bioactivity was showed. Formation of physical and mechanical processes, relationship between the evolving structure and other properties of TiC films were studied. The films were deposited on oxidized silicon substrates by dc magnetron sputtering of Ti and C targets in argon and nitrogen at different temperatures between 25°C and 800°C. The composite films consisted of metallic nanocrystalls embedded in a carbon matrix. Highest hardness ~ 18 GPa and reduced modulus of elasticity ~ 205 GPa were obtained when the crystalline nanoparticles were separated by 2-3 nm thin carbon matrix consisting of amorphous and graphitelike carbon phases. In these films the H/E ratio in the both cases is ~ 0,1. Bioactivity studies were carried out on human osteoblast-like cell line MG-63. The number of initially adhering cells on day 7 after seeding was significantly higher on the TiC surface than on the control culture dishes. Good biocompatibility and bioadhesion of these surfaces are attained by a favourable combination of surface roughness and chemistry