108 research outputs found
Total laparoscopic abdominal aortic aneurysm repair with reimplantation of the inferior mesenteric artery
AbstractWe performed a total laparoscopic reimplantation of the inferior mesenteric artery (IMA) during laparoscopic infrarenal aortic aneurysm repair. The postoperative course was uneventful, and angiograms showed a patent IMA after reimplantation. To our knowledge, total laparoscopic reimplantation of the IMA in human beings has not previously been described
Total laparoscopic infrarenal aortic aneurysm repair: Preliminary results
ObjectivesWe describe our initial experience of total laparoscopic abdominal aortic aneurysm (AAA) repair.Material and methodsBetween February 2002 and September 2003, we performed 30 total laparoscopic AAA repairs in 27 men and 3 women. Median age was 71.5 years (range, 46-85 years). Median aneurysm size was 51.5 mm (range, 30-79 mm). American Society of Anesthesiologists class of patients was II, III and IV in 10, 19, and 1 cases, respectively. We performed total laparoscopic endoaneurysmorrhaphy and aneurysm exclusion in 27 and 3 patients, respectively. We used the laparoscopic transperitoneal left retrocolic approach in 27 patients. We operated on 2 patients via a tranperitoneal left retrorenal approach and 1 patient via a retroperitoneoscopic approach.ResultsWe implanted tube grafts and bifurcated grafts in 11 and 19 patients, respectively. Two minilaparotomies were performed. In 1 case, exposure via a retroperitoneal approach was difficult and, in another case, distal aorta was extremely calcified. Median operative time was 290 minutes (range, 160-420 minutes). Median aortic clamping time was 78 minutes (range, 35-230 minutes). Median blood loss was 1680 cc (range, 300-6900 cc). In our early experience, 2 patients died of myocardial infarction. Ten major nonlethal postoperative complications were observed in 8 patients: 4 transcient renal insufficiencies, 2 cases of lung atelectasis, 1 bowel obstruction, 1 spleen rupture, 1 external iliac artery dissection, and 1 iliac hematoma. Others patients had an excellent recovery with rapid return to general diet and ambulation. Median hospital stay was 9 days (range, 8-37 days). With a median follow-up of 12 months (range, 0.5-20 months), patients had a complete recovery and all grafts were patent.ConclusionThese preliminary results show that total laparoscopic AAA repair is feasible and worthwhile for patients once the learning curve is overcome. However, prior training and experience in laparoscopic aortic surgery are needed to perform total laparoscopic AAA repair. Despite these encouraging results, a greater experience and further evaluation are required to ensure the real benefit of this technique compared with open AAA repair
Oradour-sur-Glane, sobre la emergencia de un lugar de memoria glocal en Francia
Oradour-sur-Glane (France) is the memorial site of a massacre perpetrated by the Second SS Panzer Division Das Reich on June 10th, 1944. It preserves the memory of the 642 people slaughtered there, including 18 Spanish refugees. In 1945, the French State, led by General de Gaulle, decided to preserve the ruins of Oradour-sur- Glane. Since then, a series of commemorative processes have ensued at the site, corresponding to different temporalities. Over time, this site of national memory has been linked both with European memory discourse and with the private memory of exiled Spaniards and, consequently, with the memory of the Spanish Civil War and Francoism. In this article, I analyze the different appropriations and interpretations of the site, focusing in particular on the memory of the exiles. To do so, I will look into the initiatives undertaken between 2008 and 2014, considering both the institutions and the associations related to Oradour-sur-Glane.Oradour-sur-Glane (Francia) es el lugar de memoria de una masacre perpetrada por la segunda división blindada S.S. Das Reich el 10 de junio de 1944 que conserva el recuerdo de sus 642 supliciados, entre los cuales 18 españoles refugiados. En 1945, el Estado francés encabezado por el General de Gaulle decidió preservar las ruinas de Oradour-sur-Glane. Desde entonces, diferentes procesos conmemorativos, correspondientes a temporalidades destacadas, se han sucedido en el sitio. Con el tiempo, este lugar de memoria nacional, se ha vinculado tanto con un discurso de memoria europeo como con la memoria particular de los españoles exiliados y a través de ello con la memoria de la Guerra Civil española y del franquismo. En este estudio analizaré las diferentes apropiaciones e interpretaciones de este lugar, enfocåndome especialmente en la memoria de los exiliados. Para esto, contemplaré las iniciativas que se han desarrollado entre los años 2008 y 2014, atendiendo tanto a las instituciones como a las asociaciones que tengan relación con Oradour-sur-Glane
Genomic evolution of staphylococcus aureus during artificial and natural colonization of the human nose
Staphylococcus aureus can colonize the human vestibulum nasi for many years. It is unknown whether and, how S. aureus adapts to this ecological niche during colonization. We determined the short (1 and 3 months) and mid-term (36 months) genomic evolution of S. aureus in natural carriers and artificially colonized volunteers. Eighty-five S. aureus strains were collected from 6 natural carriers during 3 years and 6 artificially colonized volunteers during 1 month. Multi-locus sequence typing (MLST) and single nucleotide polymorphism (SNP) analysis based on whole-genome sequencing (WGS) were carried out. Mutation frequencies within resident bacterial populations over time were quantified using core genome SNP counts (comparing groups of genomes) and pairwise SNP divergence assessment (comparing two genomes from strains originating from one host and sharing identical MLST). SNP counts (within 1-3 months) in all naturally colonizing strains varied from 0 to 757 (median 4). These strains showed random and independent patterns of pairwise SNP divergence (0 to 44 SNPs, median 7). When the different core genome SNP counts over a period of 3 years were considered, the median SNP count was 4 (range 0-26). Host-specific pairwise SNP divergence for the same period ranged from 9 to 57 SNPs (median 20). During short term artificial colonization the mutation frequency was even lower (0-7 SNPs, median 2) and the pairwise SNP distances were 0 to 5 SNPs (median 2). Quantifying mutation frequencies is important for the longitudinal follow-up of epidemics of infections and outbreak management. Random pattern of pairwise SNP divergence between the strains isolated from single carriers suggested that the WGS of multiple colonies is necessary in this context. Over periods up to 3 years, maximum median core genome SNP counts and SNP divergence for the strains studied were 4 and 20 SNPs or lower. During artificial colonization, where median core genome SNP and pairwise SNP distance scores were 2, there is no early stage selection of different genotypes. Therefore, we suggest an epidemiological cut off value of 20 SNPs as a marker of S. aureus strain identity during studies on nasal colonization and also outbreaks of infection
Conceptions of health and spinal manipulation practice of osteopathic students during their training
Notre recherche sâest dĂ©veloppĂ©e dans le contexte de la formation Ă lâostĂ©opathie. Durant leur apprentissage, les Ă©tudiants sont amenĂ©s Ă expĂ©rimenter la dualitĂ© dâeffecteur et de rĂ©cepteur des manipulations vertĂ©brales. Cette pratique occasionnerait des troubles musculosquelettiques du rachis Ă lâorigine, chez certains, dâun conflit intrapsychique trop important, les Ă©loignant trop de leur zone proximale de dĂ©veloppement. Notre questionnement vise Ă rĂ©pondre en quoi leurs conceptions en santĂ© et leurs conceptions des manipulations vertĂ©brales Ă©tayent le dĂ©veloppement de leur pratique professionnelle ? Notre mĂ©thode empirique a consistĂ© en une Ă©tude qualitative et une modĂ©lisation de leurs conceptions en santĂ© et de leurs conceptions de lâapprentissage et de la pratique des manipulations vertĂ©brales et une Ă©tude quantitative de leur santĂ© musculosquelettique du rachis. Les Ă©tudiants en ostĂ©opathie semblent mobiliser avant tout les dĂ©terminants du domaine de la biologie, avec parfois un appui sur le domaine de la psychologie. Le domaine du social est trĂšs souvent escamotĂ© et semble plus difficile Ă mobiliser dans lâaction thĂ©rapeutique individuelle dâune consultation. Les conceptions de lâapprentissage et de la pratique des manipulations semblent sâorganiser Ă partir de deux sujets de questionnement principaux : le phĂ©nomĂšne de cavitation et la douleur. Deux dĂ©terminants prĂ©sentent des liens entre les deux conceptions : la douleur et les propres sentiments et Ă©motions des Ă©tudiants. Durant leur apprentissage clinique, les Ă©tudiants en ostĂ©opathie doivent arbitrer entre proposer une manipulation vertĂ©brale qui peut soulager la douleur du patient et prendre le risque dâaggraver la douleur si la manipulation venait Ă ĂȘtre mal rĂ©alisĂ©e. Pour rĂ©guler ce conflit, il leur faut mettre en accord leurs conceptions de la santĂ© avec celles de leurs pratiques et leurs registres de connaissances. Pour les accompagner, nous proposons de valoriser lâanalyse des conceptions Ă diffĂ©rentes Ă©tapes de la formation, en sâappuyant sur leur modĂ©lisation graphique, et de dĂ©velopper une pĂ©dagogie explicite de prĂ©vention des troubles musculosquelettiques du rachis.Our research has developed in the context of osteopathy training. During their apprenticeship,students are led to experience the duality of effector and receptor of spinal manipulations. Thispractice would cause spinal musculoskeletal disorders, at the origin in some of a too importantintrapsychic conflict, moving them too far from their proximal zone of development. Ourquestioning aims to answer how their conceptions in health and their conceptions of spinalmanipulations support the development of their professional practice ? Our empirical methodconsisted of a qualitative study and modeling of their conceptions in health and theirconceptions of learning and practicing spinal manipulations and a quantitative study of theirspinal musculoskeletal health. Osteopathic students seem to mobilize as a priority determinantsof the biological field, with sometimes a support in the psychological field. The social field isvery often overlooked and seems more difficult to mobilize in the individual therapeutic actionof a consultation. The conceptions of learning and practicing manipulations seem to beorganized around two main questions : the phenomenon of cavitation and pain. Twodeterminants present links between the two conceptions : pain and the students' own feelingsand emotions. During their clinical training, osteopathic students must decide between proposea spinal manipulation that can relieve the patient's pain and take the risk of aggravating the painif the manipulation were to be performed improperly. To regulate this conflict, they need toalign their conceptions in health with those of their practices, and their knowledge registers. Tosupport them, we propose to enhance the analysis of conceptions at different stages of training,based on their graphic modeling, and to develop an explicit pedagogy for the prevention ofspinal musculoskeletal disorders
Conceptions de la santĂ© et de la pratique des manipulations vertĂ©brales dâĂ©tudiants en ostĂ©opathie au cours de leur formation
Our research has developed in the context of osteopathy training. During their apprenticeship,students are led to experience the duality of effector and receptor of spinal manipulations. Thispractice would cause spinal musculoskeletal disorders, at the origin in some of a too importantintrapsychic conflict, moving them too far from their proximal zone of development. Ourquestioning aims to answer how their conceptions in health and their conceptions of spinalmanipulations support the development of their professional practice ? Our empirical methodconsisted of a qualitative study and modeling of their conceptions in health and theirconceptions of learning and practicing spinal manipulations and a quantitative study of theirspinal musculoskeletal health. Osteopathic students seem to mobilize as a priority determinantsof the biological field, with sometimes a support in the psychological field. The social field isvery often overlooked and seems more difficult to mobilize in the individual therapeutic actionof a consultation. The conceptions of learning and practicing manipulations seem to beorganized around two main questions : the phenomenon of cavitation and pain. Twodeterminants present links between the two conceptions : pain and the students' own feelingsand emotions. During their clinical training, osteopathic students must decide between proposea spinal manipulation that can relieve the patient's pain and take the risk of aggravating the painif the manipulation were to be performed improperly. To regulate this conflict, they need toalign their conceptions in health with those of their practices, and their knowledge registers. Tosupport them, we propose to enhance the analysis of conceptions at different stages of training,based on their graphic modeling, and to develop an explicit pedagogy for the prevention ofspinal musculoskeletal disorders.Notre recherche sâest dĂ©veloppĂ©e dans le contexte de la formation Ă lâostĂ©opathie. Durant leur apprentissage, les Ă©tudiants sont amenĂ©s Ă expĂ©rimenter la dualitĂ© dâeffecteur et de rĂ©cepteur des manipulations vertĂ©brales. Cette pratique occasionnerait des troubles musculosquelettiques du rachis Ă lâorigine, chez certains, dâun conflit intrapsychique trop important, les Ă©loignant trop de leur zone proximale de dĂ©veloppement. Notre questionnement vise Ă rĂ©pondre en quoi leurs conceptions en santĂ© et leurs conceptions des manipulations vertĂ©brales Ă©tayent le dĂ©veloppement de leur pratique professionnelle ? Notre mĂ©thode empirique a consistĂ© en une Ă©tude qualitative et une modĂ©lisation de leurs conceptions en santĂ© et de leurs conceptions de lâapprentissage et de la pratique des manipulations vertĂ©brales et une Ă©tude quantitative de leur santĂ© musculosquelettique du rachis. Les Ă©tudiants en ostĂ©opathie semblent mobiliser avant tout les dĂ©terminants du domaine de la biologie, avec parfois un appui sur le domaine de la psychologie. Le domaine du social est trĂšs souvent escamotĂ© et semble plus difficile Ă mobiliser dans lâaction thĂ©rapeutique individuelle dâune consultation. Les conceptions de lâapprentissage et de la pratique des manipulations semblent sâorganiser Ă partir de deux sujets de questionnement principaux : le phĂ©nomĂšne de cavitation et la douleur. Deux dĂ©terminants prĂ©sentent des liens entre les deux conceptions : la douleur et les propres sentiments et Ă©motions des Ă©tudiants. Durant leur apprentissage clinique, les Ă©tudiants en ostĂ©opathie doivent arbitrer entre proposer une manipulation vertĂ©brale qui peut soulager la douleur du patient et prendre le risque dâaggraver la douleur si la manipulation venait Ă ĂȘtre mal rĂ©alisĂ©e. Pour rĂ©guler ce conflit, il leur faut mettre en accord leurs conceptions de la santĂ© avec celles de leurs pratiques et leurs registres de connaissances. Pour les accompagner, nous proposons de valoriser lâanalyse des conceptions Ă diffĂ©rentes Ă©tapes de la formation, en sâappuyant sur leur modĂ©lisation graphique, et de dĂ©velopper une pĂ©dagogie explicite de prĂ©vention des troubles musculosquelettiques du rachis
Ătude de la structuration des communautĂ©s procaryotes des drainages miniers acides par le sĂ©quençage haut dĂ©bit
The study of prokaryotic communities is an important part of microbial ecology. Processes that structure communities are of two types: stochastic with random dispersal events of birth and death; and deterministic with the habitat selection and interactions between microorganisms. The power of sequencing technologies and computer processing currently allow to enrich our knowledge of these processes. We performed a comparative study of twelve locations from acid mine drainage (AMD) from three regions: the south-east of France, south-west of the iberian peninsula and Bolivia. We have shown the importance of habitat filter on the structure of prokaryotic communities whose majority are specific to this environment, as well as an uncharacterized archaea richnesse. The study of a co-occurrence network suggests a special relationship between certain microorganisms. Finally the study of the diversity of arsenic membrane transporters ArsB and Acr3 shows patterns of population exchange between communities of DMA.LâĂ©tude des communautĂ©s procaryotes est une part importante de lâĂ©cologie microbienne. Les processus qui structurent les communautĂ©s sont de deux natures : stochastique par des Ă©vĂ©nements alĂ©atoires de dispersion, de naissance et de mort ; et dĂ©terministe par la sĂ©lection de lâhabitat et les interactions entre les micro-organismes. La puissance des technologies de sĂ©quençage et du traitement informatique permet actuellement dâenrichir les connaissances sur ces processus. Nous avons rĂ©alisĂ© une Ă©tude comparative de douze sites provenant de drainage minier acide (DMA) de trois rĂ©gions du monde : le sud-est de la France, le sud-ouest de la pĂ©ninsule ibĂ©rique et la Bolivie. Nous avons montrĂ© lâimportance du ïŹltre de lâhabitat sur la structuration des communautĂ©s procaryotes dont une majoritĂ© sont spĂ©cifiques de cet environnement, ainsi quâune richesse archaea non caractĂ©risĂ©e. LâĂ©tude dâun rĂ©seau de cooccurences suggĂšre des relations privilĂ©giĂ©es entre certains micro-organismes. EnïŹn lâĂ©tude de la diversitĂ© des transporteurs membranaires dâarsenic ArsB et Acr3 et montre des patrons dâĂ©changes de populations entre les communautĂ©s des DMA
Conceptions de la santĂ© et de la pratique des manipulations vertĂ©brales dâĂ©tudiants en ostĂ©opathie au cours de leur formation
Our research has developed in the context of osteopathy training. During their apprenticeship,students are led to experience the duality of effector and receptor of spinal manipulations. Thispractice would cause spinal musculoskeletal disorders, at the origin in some of a too importantintrapsychic conflict, moving them too far from their proximal zone of development. Ourquestioning aims to answer how their conceptions in health and their conceptions of spinalmanipulations support the development of their professional practice ? Our empirical methodconsisted of a qualitative study and modeling of their conceptions in health and theirconceptions of learning and practicing spinal manipulations and a quantitative study of theirspinal musculoskeletal health. Osteopathic students seem to mobilize as a priority determinantsof the biological field, with sometimes a support in the psychological field. The social field isvery often overlooked and seems more difficult to mobilize in the individual therapeutic actionof a consultation. The conceptions of learning and practicing manipulations seem to beorganized around two main questions : the phenomenon of cavitation and pain. Twodeterminants present links between the two conceptions : pain and the students' own feelingsand emotions. During their clinical training, osteopathic students must decide between proposea spinal manipulation that can relieve the patient's pain and take the risk of aggravating the painif the manipulation were to be performed improperly. To regulate this conflict, they need toalign their conceptions in health with those of their practices, and their knowledge registers. Tosupport them, we propose to enhance the analysis of conceptions at different stages of training,based on their graphic modeling, and to develop an explicit pedagogy for the prevention ofspinal musculoskeletal disorders.Notre recherche sâest dĂ©veloppĂ©e dans le contexte de la formation Ă lâostĂ©opathie. Durant leur apprentissage, les Ă©tudiants sont amenĂ©s Ă expĂ©rimenter la dualitĂ© dâeffecteur et de rĂ©cepteur des manipulations vertĂ©brales. Cette pratique occasionnerait des troubles musculosquelettiques du rachis Ă lâorigine, chez certains, dâun conflit intrapsychique trop important, les Ă©loignant trop de leur zone proximale de dĂ©veloppement. Notre questionnement vise Ă rĂ©pondre en quoi leurs conceptions en santĂ© et leurs conceptions des manipulations vertĂ©brales Ă©tayent le dĂ©veloppement de leur pratique professionnelle ? Notre mĂ©thode empirique a consistĂ© en une Ă©tude qualitative et une modĂ©lisation de leurs conceptions en santĂ© et de leurs conceptions de lâapprentissage et de la pratique des manipulations vertĂ©brales et une Ă©tude quantitative de leur santĂ© musculosquelettique du rachis. Les Ă©tudiants en ostĂ©opathie semblent mobiliser avant tout les dĂ©terminants du domaine de la biologie, avec parfois un appui sur le domaine de la psychologie. Le domaine du social est trĂšs souvent escamotĂ© et semble plus difficile Ă mobiliser dans lâaction thĂ©rapeutique individuelle dâune consultation. Les conceptions de lâapprentissage et de la pratique des manipulations semblent sâorganiser Ă partir de deux sujets de questionnement principaux : le phĂ©nomĂšne de cavitation et la douleur. Deux dĂ©terminants prĂ©sentent des liens entre les deux conceptions : la douleur et les propres sentiments et Ă©motions des Ă©tudiants. Durant leur apprentissage clinique, les Ă©tudiants en ostĂ©opathie doivent arbitrer entre proposer une manipulation vertĂ©brale qui peut soulager la douleur du patient et prendre le risque dâaggraver la douleur si la manipulation venait Ă ĂȘtre mal rĂ©alisĂ©e. Pour rĂ©guler ce conflit, il leur faut mettre en accord leurs conceptions de la santĂ© avec celles de leurs pratiques et leurs registres de connaissances. Pour les accompagner, nous proposons de valoriser lâanalyse des conceptions Ă diffĂ©rentes Ă©tapes de la formation, en sâappuyant sur leur modĂ©lisation graphique, et de dĂ©velopper une pĂ©dagogie explicite de prĂ©vention des troubles musculosquelettiques du rachis
Ătude exploratoire de la santĂ© musculo-squelettique du rachis dâĂ©tudiants en ostĂ©opathie
International audienc
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