32 research outputs found

    Évolution de la prise en charge médicale des nouveau-nés prématurés en France depuis la fin du XIXe siècle

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    ObjectiveThe majority of the children born preterm survive without neurodevelopmental anomalies. It is very important to know the history of neonatology, its beginning, its questioning and its improvements, because there has been a lot of progress.MethodsWe conducted a bibliographic search to understand the evolution of the medical care of preterm newborns in France since the end of the 19th century.Results and conclusionThe evolution of care for premature children has not been linear, with three major periods and different objectives. The first, at the end of the 19th century, corresponds to the beginnings of the care of premature babies with the development of basic support care, essential for survival. The other, in the middle of the 20th century, with obstetric-pediatric medical care leading to great medical progress and a spectacular improvement in the survival of these newborns. And finally, the last period evaluation and changes in practices to global medical care of the child and his family, with the main objective of reduction of morbidity and improvement of the long-term future.ObjectifsDe nos jours la prise en charge des nouveau-nés prématurés est telle que la majorité de ces enfants survivent et se développent le plus souvent sans séquelles. Il est fondamental de retracer l’histoire de l’évolution de cette prise en charge, ses débuts, ses remises en question et ses perfectionnements, tant les avancées dans ce domaine ont été nombreuses et capitales.Matériel et méthodesNous avons effectué une recherche bibliographique retraçant l’évolution de la prise en charge médicale des nouveau-nés prématurés en France depuis la fin du XIXème siècle. C’est en étudiant les œuvres de grandes figures de la médecine que nous avons pu retracer le cheminement et les réflexions de ces différents acteurs qui ont contribué à cette amélioration.RésultatsNous avons pu mettre en évidence le caractère disruptif de cette évolution en identifiant trois grandes périodes avec des objectifs différents. L’une, fin du XIXème siècle, correspond aux débuts de la prise en charge des prématurés avec le développement des soins de soutien basiques, essentiels à la survie. L’autre au milieu du XXème siècle, avec une prise en charge médicale obstétrico-pédiatrique entraînant de grands progrès médicaux et une amélioration spectaculaire de la survie de ces nouveau-nés. Et enfin la dernière période dans les années 2000, d’évaluation et de modification des pratiques vers une prise en charge médicale globale de l’enfant et de sa famille, centrée sur la diminution de la morbidité et l’amélioration du devenir à long terme

    A la recherche du sanctuaire prèangkorien de Vat Phou

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    Some new epigraphic and archaeological particulars concerning both the general history of ancient Cambodia as well as that of the well-known Khmer mountain-temple of Vat-Phu are submitted here : two sanskrit inscriptions (one dating from the age of Bhavavarman II, taking up the problem of Khmer Empire expansion in the first half of the VIIth century anew ; the other being the first known inscription to have been engraved during King Jayavarman II's lifetime), and several hitherto unknown monuments, including a temple of pre-Angkor art, though renowned authors hâve certified that " no trace " of any pre-Angkor sanctuary existed at Vat-Phu.De nouvelles données épigraphiques et archéologiques intéressant à la fois l'histoire générale du Cambodge ancien et celle, plus localisée, du prestigieux temple-montagne khmer de Vat Phou sont présentées : deux inscriptions sanscrites (l'une de l'époque de Bhavavarman II remettant en question ce qu'on savait sur l'expansion de l'empire khmer dans la première moitié du VIIe siècle ; l'autre de Jayavarman II, la première inscription connue qui ait été gravée du vivant de ce roi) et plusieurs monuments inédits, parmi lesquels un temple d'art préangkorien, bien que les meilleurs auteurs aient affirmé qu'il n'y avait « aucune trace » d'un sanctuaire préangkorien à Vat Phou.Lintingre Pierre. A la recherche du sanctuaire prèangkorien de Vat Phou. In: Revue française d'histoire d'outre-mer, tome 61, n°225, 4e trimestre 1974. pp. 507-521

    Permanence d'une structure monarchique en Asie : le royaume de Champassak

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    A tiny Asiatic kingdom surrounded by enterprizing and warlike Cambodian, Vietnamese and Siamese neighbours ; the unobtrusive history of a peace-loving people, yet forever oppressed ; the ruined remains of a brilliant past : such is the Kingdom of Champassak — Bassac to the earliest European travellers — , nowadays a mère province of Southern Laos, known overseas only for that reputed architectural structure, the mountain-temple of Vat Phu. Is this a reason for historians to speak doubtfully or ironically of the kingdom and its Champa, Tchenla, Khmer and Lao kings ? " When I think ", wrote Louis de Carné, a member of the French Mekong Exploration Mission in 1866, " that I am in a capital where descendants of ancient kings still réside, I am overwhelmed with sadness in visiting thèse ruined temples ". The last heir to the twelve Lao kings who created the kingdom of Champassak still lives in his capital : but since 1946, he has given up ail rights to his ancestors' one thousand five hundred years old throne. The history of the kingdom of Champassak, however meagre, is an inseparable part of that of the Kingdom of Laos, of its building-up, its tearing apart, and of its reunification.Un tout petit royaume asiatique cerné par d'entreprenants et belliqueux voisins, cambodgiens, annamites, siamois ; l'histoire discrète d'un peuple paisible et toujours opprimé ; les vestiges ruinés d'un brillant passé : c'est le royaume de Champassak — Bassac pour les premiers voyageurs européens — aujourd'hui simple province du Sud-Laos dont seul est connu outre-mer le prestigieux ensemble architectural du temple-montagne de Wat Phou. Cela justifie-t-il que les historiens parlent avec suspicion ou ironie de ce royaume et de ses rois, rois champa, rois tchenla, rois khmer, rois lao ? « Quand je songe, écrivit en 1866 le vicomte Louis de Carné (membre de l'expédition Doudart de Lagrée-Francis Garnier), que je suis dans une capitale où réside encore le descendant des anciens rois, je me sens envahi par la tristesse en visitant ces temples délabrés ». L'héritier des douze rois lao qui firent le royaume de Champassak continue à résider dans sa capitale: mais depuis 1946 il a renoncé à tous ses droits sur le trône quinze fois séculaire de ses ancêtres. L'histoire du royaume de Champassak, si mince soit-elle, est un morceau inséparable de l'histoire du royaume du Laos, de son édification, de ses déchirements, de son unification.Lintingre Pierre. Permanence d'une structure monarchique en Asie : le royaume de Champassak. In: Revue française d'histoire d'outre-mer, tome 59, n°216, 3e trimestre 1972. pp. 411-431

    Origin and control of the morphology of spray-dried grains for ceramics

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    L’objectif de cette thèse est de comprendre les effets qui contrôlent la forme des granules produits par atomisation. Ces granules sont obtenus en séchant un spray d’une suspension colloïdale. À l’issue du séchage, les granules peuvent être sphériques mais aussi se présenter sous forme de coupelles. Un premier résultat réside dans la démonstration que les différentes formes de granules observées en atomisation n’ont pas pour origine un effet hydrodynamique. La modélisation de la fragmentation du jet montre que les gouttelettes du spray sont sphériques et ne se fragmentent plus, et ce, bien avant que le séchage n’ait eu lieu. L’étude du séchage par atomisation est effectuée en comparant les formes de granules obtenus après séchage avec celles obtenues par une expérience qui mime l’atomisation à une échelle millimétrique : la caléfaction. Plus simple et rapide à mettre en œuvre, la caléfaction permet de de faire le suivi de gouttelettes isolées. Dans une dernière partie, le lien entre les interactions colloïdales et la morphologie des granules est déterminé quantitativement. En faisant varier le potentiel zeta des particules, et/ou la force ionique de la suspension, une étude quantitative du séchage montre que l’état d’agrégation est le paramètre déterminant pour orienter la morphologie granulaire. Le modèle permet ainsi de prévoir l’évolution non-monotone du temps de flambage avec la force ionique et les valeurs obtenues analytiquement sont en très bon accord avec les valeurs expérimentales.The aim of this thesis is to understand the physical parameters that controls the shape of grains produced by spray-drying a colloidal suspension. Depending on the parameters of the spray drying step, grains can be spherical or cup-shaped. Firstly, we demonstrate that hydrodynamic effects are not responsible for the different forms of grains observed. The modelisation of the jet fragmentation shows that the droplets are spherical in the spray, and no longer break up long before the drying of the spray. These results show that the morphology of the grains is controlled by the formulation of the colloidal suspension. We compare the shapes of the grains obtained by spray-drying and by an experiment that mimics the spray at a millimetric scale: calefaction. Despite grain size twenty times larger in calefaction than in spray drying, both experiments lead to the same morphologies. However, calefaction is easier to implement and gives the opportunity to benchmark different formulations and track isolated droplets and. In the last part, we determine quantitatively the link between the colloidal interactions and the morphologies of the final dried grains. By varying the zeta potential of particles and/or ionic strength of the suspension, a quantitative study of the drying shows that the aggregation state is the key parameter to determine the granular morphology. This description succeeds in predicting quantitatively the behaviour of colloidal suspensions during spray-drying

    Control of particle morphology in the spray drying of colloidal suspensions

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    International audiencePowders of nanoparticles are volatile, i.e. easily disperse in air, which makes their handling difficult. Granulation of nanoparticle powders provides a solution to that issue, and it is generally performed by spray drying the nanoparticles that have been suspended in a liquid. Spray drying of a colloidal suspension consists of atomising the suspension into droplets by a fast flowing and hot gas. Once the droplets dried, the resulting dry grains/microparticles can be used in a wide range of applications – food, pharmaceutics, fillers, ceramics, etc. It is well known that the grains resulting from spray-drying may be spherical but may also exhibit other diverse morphologies. Although different influencing parameters have been identified, no clear overview can be found in the literature for the driving mechanisms of grain shaping. In the present work, we review the assumptions made in the literature to explain the different morphologies. We analyse the orders of magnitude of the different effects at stake and show that the grain shape does not result from a hydrodynamic instability but is determined by the drying stage. However, we emphasize that neither the drying time nor the associated Péclet number are critical parameters for the determination of shape morphology. In light of those results, we also review and discuss the single droplet experiments developed to mimic spray drying. Generalising our previous works, we further analyse how the control of morphology can be achieved by tuning the colloidal interactions in the suspension. We detail the model we have developed that relates the colloidal interaction potential to a critical pressure exerted by the solvent as it flows, and we provide a quantitative prediction of the grain shape. Finally, we offer perspectives with regard to spray drying of systems such as molecular solutions, widely performed in e.g. the pharmaceutical industry

    Impact of Polymer Binders on the Structure of Highly Filled Zirconia Feedstocks

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    International audienceThe impact of polypropylene and high-density polyethylene backbone binders on the structure of organic matrix, feedstock, and ceramic parts is investigated in terms of morphology in this paper. The miscibility of wax with polyethylene and polypropylene is investigated in the molten state via a rheological study, revealing wax full miscibility with high-density polyethylene and restricted miscibility with polypropylene. Mercury porosimetry measurements realized after wax extraction allow the characterization of wax dispersion in both neat organic blends and zirconia filled feedstocks. Miscibility differences in the molten state highly impact wax dispersion in backbone polymers after cooling: wax is preferentially located in polyethylene phase, while it is easily segregated from polypropylene phase, leading to the creation of large cracks during solvent debinding. The use of a polyethylene/polypropylene ratio higher than 70/30 hinders wax segregation and favors its homogeneous dispersion in organic binder. As zirconia is added to organic blends containing polyethylene, polypropylene, and wax, the pore size distribution created by wax extraction is shifted towards smaller pores. Above zirconia percolation at 40 vol%, the pore size distribution becomes sharp attesting of wax homogeneous dispersion. As the PP content in the organic binder decreases from 100% to 0%, the pore size distribution is reduced of 30%, leading to higher densification ability. In order to ensure a maximal densification of the final ceramic, polyethylene/polypropylene ratios with a minimum content of 70% of high-density polyethylene should be employed

    Controlling the buckling instability of drying droplets of suspensions through colloidal interactions

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    International audienceThe present study focuses on the drying of droplets of colloidal suspensions using the Leidenfrost effect. At the end of drying, grains show different morphologies: cups or spheres depending on the ionic strength or zeta potential of the initial suspension. High ionic strengths and low absolute zeta potential values lead to spherical morphologies. A model based on the calculations of DLVO potentials has been implemented to extract a critical pressure, which provides a quantitative criterion for buckling whatever the initial formulation is. Particularly, the buckling time is quantitatively predicted from the interparticle interactions and shows an excellent agreement with experimental values

    The Median Nerve at the Carpal Tunnel … and Elsewhere

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    The median nerve (MN) may be affected by various peripheral neuropathies, each of which may be categorized according to its cause, as either an extrinsic (due to an entrapment or a nerve compression) or an intrinsic (including neurogenic tumors) neuropathy. Entrapment neuropathies are characterized by alterations of the nerve function that are caused by mechanical or dynamic compression. It occurs because of anatomic constraints at specific locations including sites where the nerve courses through fibro-osseous or fibromuscular tunnels or penetrates a muscle. For the diagnosis of peripheral neuropathies, physicians traditionally relied primarily on clinical fi ndings and electrodiagnostic testing with electromyography. However, if further doubt exists, clinicians may ask for an additional imaging evaluation

    Retrospective Analysis of Responders and Impaired Patients with Knee Osteoarthritis Treated with Two Consecutive Injections of Very Pure Platelet-Rich Plasma (PRP)

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    Objectives: To assess the effectiveness of two consecutive intraarticular injections of PRP to treat knee osteoarthritis (KOA), discriminating between responders and impaired patients. Methods: This retrospective study included 73 consecutive patients who were referred for two intra-articular PRP injections (one week apart) for treating symptomatic moderate/severe KOA. Biological characterization of the PRP, including platelets, leukocytes and erythrocytes, was evaluated. Patient’s subjective symptoms were recorded before the treatment and 1 year after the second injection using pain VAS and WOMAC scores. Responders were defined by an improvement of 10 points on WOMAC. Results: At a 1-year follow up, we found 36 (49.3%) patients who fulfilled the criteria of responders, and 21 (28.8%) patients were impaired. A statistically and clinically significant global improvement of −29.2 ± 14.3 (p p = 0.027). However, the average pain score remained stable with no significant differences after 1 year (p = 0.843). No clinical complications or severe adverse events after the PRP injections were reported. Conclusion: The present study suggests that two intra-articular injections of 10 mL of very pure PRP provide pain and functional improvement in symptomatic KOA
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