The analgesic efficacy of local infiltration analgesia vs femoral nerve block after total knee arthroplasty: a systematic review and meta-analysis.

Many consider femoral nerve block the gold standard in pain management following knee arthroplasty. Local infiltration analgesia is an alternate approach that applies the concept of surgical wound infiltration with local anaesthetics. This meta-analysis aims to compare both analgesic treatments for analgesia and functional outcomes after total knee arthroplasty. This meta-analysis was performed according to the PRISMA statement guidelines. The primary outcomes were cumulative i.v. morphine consumption, pain scores at rest and on movement on postoperative day one (analogue scale,0-10). Secondary outcomes included range of motion, quadriceps muscle strength, length of stay and rates of complications (neurologic events, cardiovascular events, falls and knee infections). Fourteen trials, including 1122 adult patients were identified. There was no difference in i.v. morphine consumption (mean difference: -2.0 mg; 95% CI: -4.9, 0.9 mg; I(2)=69%; P=0.19), pain scores at rest (mean difference: -0.1; 95% CI: -0.4, 0.3; I(2)=72%; P=0.80) and pain scores on movement (mean difference: 0.2; 95% CI: -0.5, 0.8; I(2)=80%; P=0.64) on postoperative day one (a negative mean difference favours local infiltration analgesia). The qualities of evidence for our primary outcomes were moderate according to the GRADE system. There were no clinical differences in functional outcomes or rates of complications. Complication rates were captured by three trials or fewer with exception of knee infection, which was sought by eight trials. Local infiltration analgesia provides similar postoperative analgesia after total knee arthroplasty to femoral nerve block. Although this meta-analysis did not capture any difference in rates of complications, the low number of trials that specifically sought these outcomes dictates caution

Degradation mechanisms of reinforcement iron rebars in monuments: Time-resolved X-ray microtomography of water percolation in corrosion layers

International audienceIron rebars have been used for centuries in stone monuments. Their corrosion seriously endangers the structural integrity of the monument in the long term and thus needs to be appropriately assessed and understood. Corrosion layers are constituted of different iron oxides and oxi-hydroxides, along with a significant porosity which plays a significant role in the corrosion process by allowing transport of electrolytes from outside to the vicinity of the metal core [1]. Previous investigations by X-ray microtomography have shown that this porosity forms a complex and anisotropic network with pores ranging from the micro-to the nano-scale [2]. Here we show that time-resolved X-ray microtomography allows to visualize the flow of water within the corrosion layers, a first step towards the quantification of important transport properties such as permeability and diffusion coefficients. Samples of corroded iron rebars from the cathedral of Metz were cut and embedded into resin to present a cavity on the top of the corroded surface where water mixed with a contrast product was added. X-ray microtomography images of 870nm voxel size were acquired by propagation phase contrast on the PSICHE beamline, with a pink beam of 63keV. After imaging of the dry sample, the contrast solution was added and tomography images were acquired every few minutes, allowing after suitable image processing the 3D time-resolved visualization of water percolation in the corroded layers (Figure 1). We further characterized the process by means of several metrics (chord distribution functions, Betti numbers and diffusion coefficient computations) and could evidence a two-step percolation dynamics and the influence of sub-resolution nanoporosity

Équité des soins en gynécologie-obstétrique pour les personnes sourdes et malentendantes : enjeux [Equity of care in gynecology-obstetrics for the deaf and hard of hearing : issues]

The deaf and hard of hearing population suffers from difficulties in accessing the health care system due to communication barriers with health care and administrative personnel who are often insufficiently trained in deafness issues. Gynecology-obstetrics consultations represent a gateway to the health system. Since 2011, there is a gynecology and obstetrics consultation dedicated to deaf people at the CHUV. This article presents the means of communication support put in place within the context of this specific consultation as well as the experience of a group of patients. Awareness of deafness among all staff in contact with patients as well as the use of professional interpreters are the key elements of care that respects the needs and rights of deaf people

LWR-PROTEUS verification of reaction rate distributions in modern 10x10 boiling water reactor fuel

HELIOS, CASMO-4, and MCNP4B calculations of reaction rate distributions in a modern, fresh 10 10 boiling water reactor fuel element have been validated using the experimental results of the LWR-PROTEUS Phase I project corresponding to full-density water moderation conditions (core 1 B). The reaction rate distributions measured with a special gamma-scanning machine employing twin germanium detectors consisted of total fission Ftot and 238U-capture C8. The average statistical errors for the gamma scans were better than 0.5% for Ftot and 0.9% for C8. The rod-by-rod measurements were performed on 60 different fuel rods selected from the central part of a test zone consisting of actual, fresh SVEA-96+ fuel elements, thus gaining in realism by departing from conventional fuel rod mockups. In the case of Ftot, the root-mean-square (rms) of the rod-by-rod distribution of differences between calculational and experimental (C-E) values has been found to be 1.1% for HELLOS and for CASMO-4, and 1.3% for MCNP4B. For C8, the rms values of the (C-E) distributions are 1.0, 1.3, and 1.4% as obtained with HELIOS, CASMO-4, and MCNP4B, respectively. The effects of using different data libraries (ENDF/B-V, ENDF/B-VI, and JEF-2.2) with MCNP4B were also studied and have been found to be small

Neutronics investigations for the lower part of a Westinghouse SVEA-96+ assembly

Accurate critical experiments have been performed for the validation of total fission (Ftot) and 238U-capture (C8) reaction rate distributions obtained with CASMO-4, HELIOS, BOXER, and MCNP4B for the lower axial region of a real Westinghouse SVEA-96 + fuel assembly. The assembly comprised fresh fuel with an average 235U enrichment of 4.02 wt%, a maximum enrichment of 4.74 wt%, 14 burnable-absorber fuel pins, and full-density water moderation. The experimental configuration investigated was core 1A of the LWR-PROTEUS Phase 1 project, where 61 different fuel pins, representing 64% of the assembly, were gamma-scanned individually. Calculated (C) and measured (E) values have been compared in terms of C/E distributions. For Ftot, the standard deviations are 1.2% for HELIOS, 0.9% for CASMO-4, 0.8% for MCNP4B, and 1.7% for BOXER. Standard deviations of 1.1% for HELIOS, CASMO-4, and MCNP4B and 1.2% for BOXER were obtained in the case of C8. Despite the high degree of accuracy observed on the average, it was found that the five burnable-absorber fuel pins investigated showed a noticeable underprediction of Ftot, quite systematically, for the deterministic codes evaluated (average C/E for the burnable-absorber fuel pins in the range 0.974 to 0.988, depending on the code)