Twelve Tips for Preparing a Surgical Discharge Summary: Enabling a Safe Discharge

The surgical discharge summary allows the perioperative care team to summarize a recent hospitalization and relay important information to a variety of invested parties including other healthcare providers, outpatient caregivers, and the surgical patient. The inpatient care team can promote a smooth transition of care and empower outpatient providers and the patient to foster a confident progression through recovery. We describe twelve tips for a streamlined, successful discharge summary geared towards the surgical intern. A successful surgical discharge summary begins with patient and caregiver collaboration, communication and teamwork, and culminates with concise documentation. These tips reflect a review of the current literature and rely on the clinical expertise of an interdisciplinary surgical team. Our aim is to empower surgical educators and trainees to understand the complexity of discharge planning, and to improve the efficiency with which it can be completed and the quality of the discharge process at their training hospitals

Microtubule self-organisation during seed germination in Arabidopsis

International audienceBackground: Upon water uptake and release of seed dormancy, embryonic plant cells expand, while being mechanically constrained by the seed coat. Cortical microtubules (CMTs) are key players of cell elongation in plants: their anisotropic orientation channels the axis of cell elongation through the guidance of oriented deposition of load-bearing cellulose microfibrils in the cell wall. Interestingly, CMTs align with tensile stress, and consistently, they reorient upon compressive stress in growing hypocotyls. How CMTs first organise in germinating embryos is unknown, and their relation with mechanical stress has not been investigated at such an early developing stage. Results: Here, we analysed CMT dynamics in dormant and non-dormant Arabidopsis seeds by microscopy of fluorescently tagged microtubule markers at different developmental time points and in response to abscisic acid and gibberellins. We found that CMTs first appear as very few thick bundles in dormant seeds. Consistently, analysis of available transcriptome and translatome datasets show that limiting amounts of tubulin and microtubule regulators initially hinder microtubule self-organisation. Seeds imbibed in the presence of gibberellic acid or abscisic acid displayed altered microtubule organisation and transcriptional regulation. Upon the release of dormancy, CMTs then self-organise into multiple parallel transverse arrays. Such behaviour matches the tensile stress patterns in such mechanically constrained embryos. This suggests that, as CMTs first self-organise, they also align with shape-derived tensile stress patterns. Conclusions: Our results provide a scenario in which dormancy release in the embryo triggers microtubule self-organisation and alignment with tensile stress prior to germination and anisotropic growth

The formation of microthrombi in parenchymal microvessels after traumatic brain injury is independent of coagulation factor XI

Microthrombus formation and bleeding worsen the outcome after traumatic brain injury (TBI). The aim of the current study was to characterize these processes in the brain parenchyma after experimental TBI and to determine the involvement of coagulation factor XI (FXI). C57BL/6 mice (n = 101) and FXI-deficient mice (n = 15) were subjected to controlled cortical impact (CCI). Wild-type mice received an inhibitory antibody against FXI (14E11) or control immunoglobulin G 24 h before or 30 or 120 min after CCI. Cerebral microcirculation was visualized in vivo by 2-photon microscopy 2-3 h post-trauma and histopathological outcome was assessed after 24 h. TBI induced hemorrhage and microthrombus formation in the brain parenchyma (p < 0.001). Inhibition of FXI activation or FXI deficiency did not reduce cerebral thrombogenesis, lesion volume, or hemispheric swelling. However, it also did not increase intracranial hemorrhage. Formation of microthrombosis in the brain parenchyma after TBI is independent of the intrinsic coagulation cascade since it was not reduced by inhibition of FXI. However, since targeting FXI has well-established antithrombotic effects in humans and experimental animals, inhibition of FXI could represent a reasonable strategy for the prevention of deep venous thrombosis in immobilized patients with TBI

A posteriori dietary patterns better explain variations of the gut microbiome than individual markers in the American Gut Project

BackgroundIndividual diet components and specific dietary regimens have been shown to impact the gut microbiome.ObjectivesHere, we explored the contribution of long-term diet by searching for dietary patterns that would best associate with the gut microbiome in a population-based cohort.MethodsUsing a priori and a posteriori approaches, we constructed dietary patterns from an FFQ completed by 1800 adults in the American Gut Project. Dietary patterns were defined as groups of participants or combinations of food variables (factors) driven by criteria ranging from individual nutrients to overall diet. We associated these patterns with 16S ribosomal RNA-based gut microbiome data for a subset of 744 participants.ResultsCompared to individual features (e.g., fiber and protein), or to factors representing a reduced number of dietary features, 5 a posteriori dietary patterns based on food groups were best associated with gut microbiome beta diversity (P&nbsp;≤&nbsp;0.0002). Two patterns followed Prudent-like diets-Plant-Based and Flexitarian-and exhibited the highest Healthy Eating Index 2010 (HEI-2010) scores. Two other patterns presented Western-like diets with a gradient in HEI-2010 scores. A fifth pattern consisted mostly of participants following an Exclusion diet (e.g., low carbohydrate). Notably, gut microbiome alpha diversity was significantly lower in the most Western pattern compared to the Flexitarian pattern (P&nbsp;≤&nbsp;0.009), and the Exclusion diet pattern was associated with low relative abundance of Bifidobacterium (P&nbsp;≤&nbsp;1.2&nbsp;×&nbsp;10-7), which was better explained by diet than health status.ConclusionsWe demonstrated that global-diet a posteriori patterns were more associated with gut microbiome variations than individual dietary features among adults in the United States. These results confirm that evaluating diet as a whole is important when studying the gut microbiome. It will also facilitate the design of more personalized dietary strategies in general populations

Rationale and design of the TRANSFACT project phase I : A study to assess the effect of the two different dietary sources of trans fatty acids on cardiovascular risk factors in humans

International audienceBACKGROUND: Detrimental effects of consumption of industrial trans fatty acids (TFA) from partially hydrogenated vegetable oils (PHVO) on cardiovascular disease (CVD) risk factors are well documented. However, very little information is available on the effect of natural sources of TFA coming from milk fat, dairy products and ruminant meat. In fact, due to the naturally low level of TFA in milk fat, it is almost impossible to conduct a clinical trial with a limited number of subjects (<200). METHODOLOGY: To compare the effects of industrial and natural dietary sources of TFA, two specific test fats have been designed and produced. A substantial amount of milk fat (130 kg) enriched in TFA has been produced by modification of the cow's diet and selection of cows with the highest TFA content. The level obtained was approximately 4- to 7-fold higher than typically present in milk fat (approximately 20 instead of 3-6 g/100 g of total fatty acids). The control fat is composed of PHVO balanced in saturated fatty acids (lauric, myristic and palmitic). Both experimental fats contain about 20-22% of monounsaturated TFA and the volunteers' daily experimental fat intake (54 g), will represent about 12.0 g/day of TFA or 5.4% of the daily energy (based on 2000 kcal/day). These two test fats have been incorporated into food items and will be provided to 46 healthy subjects under a randomised, double blind, controlled, cross-over design. The primary outcome is high-density lipoprotein cholesterol (HDL-C), which is an independent risk factor for CVD. Other parameters such as low-density lipoprotein cholesterol (LDL-C), very low-density lipoprotein cholesterol (VLDL-C), and HDL-C level and subclasses will be also to be evaluated. CONCLUSION: We have shown that it is technically feasible to perform a clinical trial on the comparative effects of natural and industrial sources of TFA isomers on CVD risk factors. Results are expected by mid-2006

L’Arménie et Byzance

Le voisinage étroit et ancien du monde arménien et de l’Empire byzantin a multiplié entre eux les liens, et il y a longtemps déjà que les divers domaines où se sont manifestés ces contacts font l’objet d’études. Si les Arméniens étaient attentifs à leur indépendance religieuse, ils n’en furent pas moins séduits par le prestige diplomatique et culturel de l’Empire. Quant aux Byzantins, ils appréciaient les guerriers en quête de fortune, qui, longtemps, les protégèrent de l’avance musulmane. Ces sentiments complexes ont perduré, en se transformant, à travers tous les bouleversements du Proche Orient : expansion arabe des viie-viiie siècles, impérialisme byzantin des xe-xie, et avance turque des xie-xiie. À l’heure où l’attention se porte aussi sur les différences et incompatibilités entre Arméniens et Byzantins, le moment était venu pour des historiens d’Arménie, de Russie, des États-Unis et de France, de se rencontrer et de poser les bases d’un bilan sur ces relations contrastées. On trouvera donc ici les contributions de S. S. Arevsatyan, Viada Arutjunova-Fidanjan, Hratch Bartikian, Paul Bellier, Patricia Boisson-Chenorhokian, Isabelle Brousselle, Marie-Louise Chaumont, Jean-Claude Cheynet, Gérard Dédéyan, Patrick Donabédian, Nina G. Garsoïan, Mourad Hasrat’yan, Jean-Pierre Mahé, Seiranouche Manoukian, Bernadette Martin-Hisard, Petre S. Nasturel, Catherine Otten-Froux, Bernard Outtier, Charles Renoux, Michel Thierry, Nicole Thierry et Karen Yuzbashian

Progression et transversalité

Quoi de plus incontournable, en matière d'enseignement-apprentissage, que la progression des dispositifs mis en œuvre par les enseignants et des acquisitions qu'ils permettent de susciter ? La progression est sans conteste la condition fondamentale de la dynamique du savoir et de son enrichissement, car tout enseignement est inscrit dans le temps et comporte une dimension narrative : apprendre quelque chose à quelqu'un, c'est nécessairement construire une histoire avec lui, c'est l'entrainer dans un récit dont il est le héros. Peut-on caractériser plus précisément cette progression des apprentissages ? Comment se construit l'histoire de l'apprentissage dans chaque domaine du savoir et dans la diversité des contextes éducatifs ? Telle est la première question à laquelle les contributions du présent ouvrage ont cherché à apporter quelques éléments de réponse. Si l'apprentissage ne peut se passer de progression, il ne peut pas davantage se passer de transversalité. Un savoir ne peut en effet être considéré comme acquis que lorsqu'il fait l'objet d'un transfert, c'est-à-dire lorsque l'apprenant se montre capable de l'utiliser dans d'autres contextes que celui où il lui a été transmis et à d'autres fins que pour lui-même ou pour des visées « savantes ». Apprendre, c'est devenir capable d'utiliser des savoirs dans le cadre d'autres disciplines, en les mettant au service de l'apprentissage scolaire dans son ensemble… et au service de la vie. Mais si cette importance de la transversalité relève à certains égards de l'évidence, il ne suffit pas de l'affirmer ; la convocation de différents regards disciplinaires doit permettre d'aller plus loin en montrant concrètement comment chaque discipline favorise des transferts vers d'autres « champs » qu'elle-même. Tel est le second défi qui était posé aux contributeurs du présent ouvrage, qui constitue les actes de la troisième journée d'études organisée par le CRIPEDIS depuis sa création en 2008