Infections du site opératoire sur ablation de varices d’après une série continue de 408 interventions réalisées dans un centre hospitalier universitaire

But de l’étudeNotre objectif était de déterminer l’incidence des infections du site opératoire (ISO) consécutives à des interventions sur varices dans le service de chirurgie vasculaire d’un centre hospitalier universitaire. Patients et méthodes Une surveillance prospective des ISO a été mise en place pendant un an, avec un suivi postopératoire des patients de 30 jours. Le diagnostic d’ISO a été réalisé suivant les définitions des Centers for Disease Control (CDC, États-Unis). La saisie et l’analyse des données ont été réalisées à l’aide du logiciel Epi-Info des CDC. Résultats Les trois-quarts des 408 interventions incluses étaient caractérisées par un score de NNISS égal à 0. Une dépilation a été effectuée pour tous les patients, avec des modalités très variables et souvent non conformes (rasage mécanique dans 44,6 % des cas) aux recommandations nationales. L’incidence des ISO était de 1,2 % (intervalle de confiance à 95 % = [0,2–2,2]). Toutes les infections ont été diagnostiquées après retour au domicile. Quatre patients infectés sur cinq présentaient des problèmes de surpoids ou d’obésité et deux d’entre eux étaient diabétiques. L’âge moyen des patients était plus élevé chez les patients infectés (70,4 ans versus 52,0 ; p < 0,01). Les cinq ISO ont eu des conséquences (réhospitalisation et/ou reprise chirurgicale et/ou antibiothérapie). Conclusion D’après ces résultats, les ISO consécutives à des interventions sur varices sont rares et concernent principalement des patients à haut risque. Dans un but de prévention, il semble cependant nécessaire d’homogénéiser les pratiques de dépilation dans ce service

LUX -- A Laser-Plasma Driven Undulator Beamline

The LUX beamline is a novel type of laser-plasma accelerator. Building on the joint expertise of the University of Hamburg and DESY the beamline was carefully designed to combine state-of-the-art expertise in laser-plasma acceleration with the latest advances in accelerator technology and beam diagnostics. LUX introduces a paradigm change moving from single-shot demonstration experiments towards available, stable and controllable accelerator operation. Here, we discuss the general design concepts of LUX and present first critical milestones that have recently been achieved, including the generation of electron beams at the repetition rate of up to 5 Hz with energies above 600 MeV and the generation of spontaneous undulator radiation at a wavelength well below 9 nm.Comment: submitte

Chirp mitigation of plasma-accelerated beams using a modulated plasma density

Plasma-based accelerators offer the possibility to drive future compact light sources and high-energy physics applications. Achieving good beam quality, especially a small beam energy spread, is still one of the major challenges. For stable transport, the beam is located in the focusing region of the wakefield which covers only the slope of the accelerating field. This, however, imprints a longitudinal energy correlation (chirp) along the bunch. Here, we propose an alternating focusing scheme in the plasma to mitigate the development of this chirp and thus maintain a small energy spread

A novel experimental approach for studying spontaneous imbibition processes with alkaline solutions

Spontaneous imbibition processes can play an important role in oil production. It can be enhanced or influenced by wettability changes generated by properly designed chemicals or by the natural surfactants resulting from reactive crude oils in the presence of alkaline solutions. The reaction of basic salts with some components of oil can, indeed, lead to the formation of natural soaps that reduces the interfacial tension between oil and brine. The latter scenario is studied herein on samples and oil from the St Ulrich oil field in the Vienna basin. To that end, spontaneous imbibition experiments were performed with two brines differing by the absence or presence of alkali. We first present a general novel technique to monitor saturation changes on small rock samples for the purpose of assessing the efficiency of a given recovery process. Samples of only 15 mm in diameter and 20 mm in length and set at irreducible saturation were fully immersed in the solution of interest, and the evolution of the samples’ saturation with time was monitored thanks to a dedicated NMR technique involving the quantification of the sole oil phase present within the sample. A fully-3D imbibition configuration was adopted, involving counter-current flows through all faces of the sample. The experimental method is fast for two reasons: (i) the kinetics of capillary imbibition process is proportional to the square of sample size, i.e. very rapid if accurate measurements can be acquired on tiny samples, (ii) the present 3D situation also involves faster kinetics than the 1D configuration often used. The NMR technique was crucial to achieve such conditions that cannot be satisfied with conventional volumetric methods. The kinetics of oil desaturation during spontaneous imbibition is interpreted with the help of an analytical 3D diffusion model. For the alkaline solution, the diffusion coefficient is reduced by a factor of only two compared to the non-alkaline brine, although the interfacial tension between the oil and the imbibing solution is reduced by a factor of 10. Hence, a wettability change to a more water wet state has to be assumed when the alkaline solution replaces the non-alkaline solution in the imbibition process. However, no significant impact on the final saturation was observed

The FLASHForward Facility at DESY

The FLASHForward project at DESY is a pioneering plasma-wakefield acceleration experiment that aims to produce, in a few centimetres of ionised hydrogen, beams with energy of order GeV that are of quality sufficient to be used in a free-electron laser. The plasma wave will be driven by high-current density electron beams from the FLASH linear accelerator and will explore both external and internal witness-beam injection techniques. The plasma is created by ionising a gas in a gas cell with a multi-TW laser system, which can also be used to provide optical diagnostics of the plasma and electron beams due to the <30 fs synchronisation between the laser and the driving electron beam. The operation parameters of the experiment are discussed, as well as the scientific program.Comment: 19 pages, 9 figure

Water-Window X-Ray Pulses from a Laser-Plasma Driven Undulator

Femtosecond (fs) x-ray pulses are a key tool to study the structure and dynamics of matter on its natural length and time scale. To complement radio-frequency accelerator-based large-scale facilities, novel laser-based mechanisms hold promise for compact laboratory-scale x-ray sources. Laser-plasma driven undulator radiation in particular offers high peak-brightness, optically synchronized few-fs pulses reaching into the few-nanometer (nm) regime. To date, however, few experiments have successfully demonstrated plasma-driven undulator radiation. Those that have, typically operated at single and comparably long wavelengths. Here we demonstrate plasma-driven undulator radiation with octave-spanning tuneability at discrete wavelengths reaching from 13nm to 4nm. Studying spontaneous undulator radiation is an important step towards a plasma-driven free-electron laser. Our specific setup creates a photon pulse, which closely resembles the plasma electron bunch length and charge profile and thus might enable novel methods to characterize the longitudinal electron phase space

Place des nouveaux traitements médicaux dans l’endométriose douloureuse, RPC Endométriose CNGOF-HAS

OBJECTIVE: The objective of this work is to evaluate the place of new treatments in the management of endometriosis outside the context of infertility. METHODS: A review of the literature was conducted by consulting Medline data until July 2017. RESULTS: Dienogest is effective compared to placebo in short term (NP2) and long term (NP4) for the treatment of painful endometriosis. In comparison with GnRH agonists, dienogest is also effective in terms of decreased pain and improved quality of life in non-operated patients (NP2) as well as for recurrence of lesions and symptomatology postoperatively (NP2). Data on GnRH antagonists, selective progesterone receptor modulators as well as selective inhibitors (anti-TNF-α, matrix metalloprotease inhibitors, angiogenesis growth factor inhibitors) are insufficient to provide evidence of interest in clinical practice for the management of painful endometriosis (NP3). CONCLUSION: Dienogest is recommended as second-line therapy for the management of painful endometriosis (Grade B). Because of lack of evidence, aromatase inhibitors, elagolix, SERM, SPRM and anti-TNF-α are not recommended for the management of painful endometriosis (Grade C)

Microstructure and photocatalytic activity of APS coatings obtained from different TiO2 nanopowders

In recent years, intense research has shown that thermal spray techniques, especially atmospheric plasma spraying (APS), can be used to obtain nanostructured TiO2 coatings with effective photocatalytic activity. This study compares the photocatalytic activity of APS coatings obtained from different powders: two nanostructured TiO2 powders produced by spray-drying of two TiO2 nanosuspensions with different solids contents, one spray-dried powder obtained from a suspension comprising a mixture of submicronic and nanometric TiO2 particles and finally one commercial, nanostructured, TiO2 spray-dried powder. All powders were characterised by XRD, FEG-ESEM, granule size distribution, and a flowability evaluation. Feedstock powders were then deposited on austenitic stainless steel coupons using APS. Hydrogen or helium was used as secondary plasma gas. Coating microstructure and phase composition were characterised using FEG-ESEM and XRD techniques; coating anatase content was quantified by the Rietveld method. A significant amount of anatase to rutile transformation was found to take place during the plasma spraying process. In general, the coatings had a bimodal microstructure characterised by the presence of completely fused areas in addition to non-molten areas consisting of agglomerates of anatase nanoparticles. Results also showed that anatase content and porosity of the coatings largely depend on the secondary plasma gas nature, as well as on the characteristics of the feedstock. Finally the photocatalytic activity of the coatings was determined by measuring the degradation of methylene blue dye in an aqueous solution. A reasonably good fit of a first-order kinetic model to the experimental data was found for all coatings. The values of the kinetic constant were related to feedstock characteristics as well as to plasma spraying conditions. (C) 2012 Elsevier B.V. All rights reserved.Bordes, MC.; Vicent, M.; Moreno, A.; Moreno, R.; Borrell Tomás, MA.; Salvador Moya, MD.; Sanchez, E. (2013). Microstructure and photocatalytic activity of APS coatings obtained from different TiO2 nanopowders. Surface and Coatings Technology. 220:179-186. doi:10.1016/j.surfcoat.2012.08.059S17918622

Comparative effect of intraoperative propacetamol versus placebo on morphine consumption after elective reduction mammoplasty under remifentanil-based anesthesia: a randomized control trial [ISRCTN71723173]

BACKGROUND: Postoperative administration of paracetamol or its prodrug propacetamol has been shown to decrease pain with a morphine sparing effect. However, the effect of propacetamol administered intra-operatively on post-operative pain and early postoperative morphine consumption has not been clearly evaluated. In order to evaluate the effectiveness of analgesic protocols in the management of post-operative pain, a standardized anesthesia protocol without long-acting opioids is crucial. Thus, for ethical reasons, the surgical procedure under general anesthesia with remifentanil as the only intraoperative analgesic must be associated with a moderate predictable postoperative pain. METHODS: We were interested in determining the postoperative effect of propacetamol administered intraoperatively after intraoperative remifentanil. Thirty-six adult women undergoing mammoplasty with remifentanil-based anesthesia were randomly assigned to receive propacetamol 2 g or placebo one hour before the end of surgery. After remifentanil interruption and tracheal extubation in recovery room, pain was assessed and intravenous titrated morphine was given. The primary end-point was the cumulative dose of morphine administered in the recovery room. The secondary end-points were the pain score after tracheal extubation and one hour after, the delay for obtaining a Simplified Numerical Pain Scale (SNPS) less than 4, and the incidence of morphine side effects in the recovery room. For intergroup comparisons, categorical variables were compared using the chi-squared test and continuous variables were compared using the Student t test or Mann-Whitney U test, as appropriate. A p value less than 0.05 was considered as significant. RESULTS: In recovery room, morphine consumption was lower in the propacetamol group than in the placebo group (p = 0.01). Pain scores were similar in both groups after tracheal extubation and lower in the propacetamol group (p = 0.003) one hour after tracheal extubation. The time to reach a SNPS < 4 was significantly shorter in the propacetamol group (p = 0.02). The incidence of morphine related side effects did not differ between the two groups. CONCLUSIONS: Intraoperative propacetamol administration with remifentanil based-anesthesia improved significantly early postoperative pain by sparing morphine and shortening the delay to achieve pain relief