Une forêt exemplaire : le bois de Gabor (Tarn), ses avatars du XIIIe au XXIe siècle

The tiny ancient royal forest (30 ha) of Gabor, still intact since the 17 th century, has an extraordinary history. It belonged to the Counts of Toulouse since 1221, then became the property of the King in 1271 and in 1541 was subjected to the reformation. It was almost completely cleared for the purpose of growing woad, for which there was a flourishing market at the time. What remained of the forest was subjected to the coppicewith- reserves system but ruined by the officers in charge of tending to it. In 1666, Louis de Froidour notes that the oldest tree it contained was only 7 years old. Not wanting to use either the simple coppice or the high forest system on such a small surface area, he designed a long term plan for selecting standards, thus inventing the coppice-with-standards system. It was recorded in 1724 that his instructions were followed to the letter. The forest was sold as national property in 1796 and to this day has maintained many traces of its prestigious but little known past.Intacte depuis le XVIIe siècle sur la commune de Lavaur (Tarn), la toute petite (30 ha) ancienne forêt royale de Gabor a une histoire étonnante. Aux comtes de Toulouse depuis 1221, royale en 1271, elle fait l’objet d’une réformation en 1541. Elle a été presque totalement défrichée au profit de la culture du pastel, alors florissante. Le solde, cultivé en taillis sous baliveaux, est ruiné par les officiers chargés de sa garde. En 1666, Louis de Froidour y constate que l’arbre le plus âgé n’a que 7 ans. Ne voulant ni la cultiver en taillis simple ni faire une futaie sur une si petite surface, il conçoit un plan de balivage à long terme inventant là le taillissous- futaie. En 1724, il est constaté que ses prescriptions ont été parfaitement suivies. Vendue comme bien national en 1796, la forêt conserve toujours de nombreuses traces de son passé prestigieux mais inconnu

Surgical versus endovascular treatment of traumatic thoracic aortic rupture

ObjectivesBlunt traumatic thoracic aortic rupture is a life-threatening surgical emergency associated with high mortality and morbidity. The recent development of endovascular stent-graft prostheses offers a potentially less invasive alternative to open chest surgery, especially in patients with associated injuries. We sought to compare the results of conventional surgical repair and endovascular treatment of traumatic aortic rupture in a single center.MethodsFrom July 1998 to January 2004, 20 patients with acute blunt traumatic aortic rupture underwent treatment at our institution. All patients had a lesion limited to the isthmus, and associated injuries. Initial management included fluid resuscitation, treatment of other severe associated lesions, and strict monitoring of blood pressure. Eleven patients (9 men, 2 women; mean age, 32 years) underwent surgical repair, including direct suturing in 6 patients and graft interposition in 5 patients. Ten patients were operated on with cardiopulmonary support (left bypass with centrifugal pump, n = 2; extracorporeal circulation, n = 8). The delay between trauma and surgery was 2.6 days (range, 0-21 days). Nine patients (8 men, 1 woman; mean age, 32 years) underwent endovascular treatment with commercially available devices (Excluder, n = 2; Talent, n = 7). In all patients 1 stent graft was deployed. In 2 patients the left subclavian artery was intentionally covered with the device. The delay between trauma and endovascular treatment was 17.8 days (range, 1-68 days).ResultsOne patient in the surgical group (9.1%) died during the intervention. Three surgical complications occurred in 3 patients (27%), including left phrenic nerve palsy (n = 1), left-sided recurrent nerve palsy (n = 1), and hemopericardium 16 days after surgery that required a repeat intervention (n = 1). No patient in this group had paraplegia. In the endovascular group successful stent-graft deployment was achieved in all patients, with no conversion to open repair. No patient died, and no procedure-related complications, including paraplegia, occurred in this group. Control computed tomography scans obtained within 7 days after endovascular treatment showed exclusion of pseudoaneurysm in all cases. Length of follow-up for endovascular treatment ranged from 3 to 41 months (mean, 15.1 months). Computed tomography scans obtained 3 months after endovascular treatment showed complete disappearance of pseudoaneurysm in all patients.ConclusionIn the treatment of blunt traumatic thoracic aortic rupture, the immediate outcome in patients who receive endovascular stent grafts appears to be at least as good as observed after conventional surgical repair. Long-term follow-up is necessary to assess long-term effectiveness of such management

Inventaire et évaluation des vieilles forêts des Pyrénées de Midi-Pyrénées

Les 11, 12 et 13 février 2016, ce sont déroulées les 5e Rencontres Naturalistes de Midi-Pyrénées dans le Gers, à Auch. Tous les 3 ans, ce rendez-vous incontournable des amateurs et professionnels de la biodiversité de Midi-Pyrénées et d’ailleurs, a rassemblé plus de 600 participants sur les 3 jours. Le succès de cet événement n’aurait pas été aussi complet sans l’aide des bénévoles et des associations partenaires. Les 5e Rencontres Naturalistes se sont ouvertes sur les discours de Nadia Baïtiche-Moine, Adjointe au Maire d’Auch, de Jérôme Calas, Président de Nature Midi-Pyrénées et de Ronny Guardia-Mazzoleni, Conseiller régional Languedoc-Roussillon-Midi-Pyrénées. Au cours de ces 3 jours, ce sont près de 35 communications sur la faune, la flore et les espaces naturels, agricoles et forestiers qui ont été présentées : une véritable synthèse des différents travaux menés en Midi-Pyrénées depuis 3 ans dans le domaine de la connaissance et de la préservation de notre riche patrimoine naturel régional. Les nombreux participants d’horizons divers (associations, conservatoires, services de l’Etat, laboratoires de recherche, établissements scolaires, PNR ou collectivités) ont eu également l’occasion de profiter des temps de pause pour échanger autour d’une vingtaine de posters scientifiques et de différentes expositions

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat