Metabolic and cardiovascular improvements after biliopancreatic diversion in a severely obese patient

BACKGROUND: Severe obesity is associated with important morbidity and increased mortality. The successes of lifestyle modifications and drug therapy have been partial and mostly unsustained in reducing obesity and its comorbidities. Bariatric surgery, particularly biliopancreatic diversion with duodenal switch reduces efficiently excess body weight and improves metabolic and cardiovascular functions. CASE PRESENTATION: A 56-year-old man with severe clinical obesity underwent a biliopancreatic diversion with a duodenal switch after unsuccessful treatment with weight loss pharmacotherapy. He had diabetes, hypertension and sleep apnea syndrome and was on three medications for hypertension and two hypoglycemic agents in addition to > 200 insulin units daily. Eleven months after the surgery, he had lost 40% of his body weight. The lipid profile showed great improvement and the hypertension and diabetes were more easily controlled with no more insulin needed. The pseudonormalized pattern of left ventricular diastolic function improved and ventricular walls showed decreased thickness. CONCLUSION: Biliopancreatic diversion may bring metabolic and cardiovascular benefits in severely obese patients from a cardiovascular perspective

Profondeur d'extraction racinaire et signature isotopique de l'eau prélevée par les racines des couverts végétaux

International audienceNous cherchons à identifier la profondeur à laquelle l'eau est extraite par les racines dans les sols. En effet, à l'état isotopique stationnaire dans le réservoir d'eau foliaire, la transpiration introduit dans l'atmosphère une vapeur dont la signature isotopique est identique à celle de l'eau racinaire. Dans les modèles isotopiques de circulation générale atmosphérique, il est classiquement admis que la signature de la transpiration appartient à la droite des eaux météoriques. Ceci suppose que l'eau prélevée par les racines ait échappé à l'évaporation du sol et soit donc issue des couches profondes du sol. Lors d'une expérimentation réalisée sur des plants de maïs (Nemours, Seine-et-Marne), cette profondeur d'extraction a été déterminée à partir de la comparaison entre la signature de l'eau mesurée au niveau du premier entre-noeud des tiges des végétaux et le profil isotopique de l'eau dans le sol. Lorsque le flux de transpiration atteint une valeur maximale, la plante prélève de l'eau issue des précipitations, qui conserve son caractère non évaporatoire après s'être rapidement infiltrée dans les couches profondes du sol. Lors de cette expérience, ceci ne concerne que 55% de la vapeur d'eau émise par le couvert végétal, le restant présentant un caractère évaporatoire plus ou moins marqué en fonction des conditions environnementales. Cette expérience invalide, en régions tempérées, l'hypothèse retenue dans les modèles isotopiques de circulation générale atmosphérique. En effet, seule la moitié de la quantité de vapeur d'eau émise par la plante au cours de la journée présente une signature identique à celle de l'eau des précipitations prélevées dans les couches profondes du sol

Guide de transition vers l'âge adulte

Marie-Josée Lemieux Chef du service de santé, responsable des soins infirmiers Direction des services de réadaptation aux adolescents, Centre jeunesse de Montréal - Institut universitaire courriel: [email protected] téléphone: 514-356-4457 site web de l’organisme: http://www.cjm-iu.qc.ca/Joseph Giulione Président du Regroupement des organismes spécialisés pour l'emploi des personnes handicapées (ROSEPH) Directeur de l’Arrimage Inc., Service d’aide à l’emploi courriel: [email protected] téléphone: 514-389-9393, poste 106 site web de l’organisme: http://www.larrimage.ca/fr/index.phpGabrielle Marier-Desroches, responsable de communication de l'équipe 10 (PHA 1415), courriel: [email protected] réalisé dans le cadre du cours PHA2415Il peut être difficile pour certaines personnes atteintes d’un problème de santé mentale de trouver un emploi dans lequel elles peuvent s’épanouir, spécialement les jeunes amorçant leur transition vers l’âge adulte. Certains peuvent aussi se sentir contraints à renoncer à leur rêve de faire des études universitaires à cause des restrictions que leur impose leur maladie. C’est dans cette optique que nous avons élaboré le Guide de Transition vers l’âge adulte et la présentation interactive Prezi qui l’accompagne, qui résument les différents organismes communautaires en place, les diverses ressources disponibles et quelques pistes de solution pour aider les jeunes faisant face à ces défis. Le but de cet outil est de rendre plus accessible ces ressources aux personnes pouvant en bénéficier, les aidant à réaliser l’étendue des opportunités disponibles

Short-Term cost impact of compliance with clinical practice guidelines for initial sarcoma treatment

Background: The impact of compliance to clinical practice guidelines (CPG) on outcomes and/or costs of care has not been completely clarified.Objective: To estimate relationships between medical expenditures and compliance to CPG for initial sarcoma treatment.Research design: Selected cohorts of patients diagnosed with sarcoma in 2005 and 2006, and treated at the University hospital and/or the cancer centre of the Rhône-Alpes region, France (n=90). Main outcome measurements were: patient characteristics, compliance with CPG, health outcomes, and costs. Data were mainly extracted from patient records. The logarithm of treatment costs was modelled using linear and Tobit regressions.Results: Rates of compliance with CPG were 86%, 66%, 88%, 89%, and 95% for initial diagnosis, primary surgical excision, wide surgical excision, chemotherapy, and radiotherapy, respectively. Total average costs reached €24,439, with €1,784, €11,225, €10,360, and €1,016 for diagnosis, surgery (primary and wide surgical excisions), chemotherapy, and radiotherapy, respectively. Compliance of diagnosis with CPG decreased the cost of diagnosis, whereas compliance of primary surgical excision increased the cost of chemotherapy. Compliance of chemotherapy with CPG decreased the cost of radiotherapy.Conclusion: Since chemotherapy is one of the major cost drivers, these results support that compliance with guidelines increases medical care expenditures in short term.Oncology; Sarcoma; Cost; Clinical guidelines; Efficacy; Medical Practices; Government Policy; Regulation; Public Health

Paralysing gastroenteritis: disease or syndrome?

Dès 1986, les gastroentérites paralysantes (GEP) apparaissent comme une entité bien définie sur le plan clinique dans le syndrome gastroentéritique néonatal du veau. L’étude clinique montre la discrétion des signes diarrhéiques, l’absence de déshydratation et la présence de signes nerveux dominés par de la parésie. Les enquêtes microbiologiques font ressortir le rôle particulier de coliba cilles dotés de marqueurs de pathogénicité spécifiques (CS 31A et ColV). Les examens paracliniques font apparaître une acidóse métabolique sanguine avec accumulation d’acide D lactique. Les auteurs décrivent différentes étapes afin de définir si les GEP sont une maladie ou font partie d’un syndrome gastroen- térique plus général (veau non déshydraté et acidosique).Since 1986, paralysing gastroenteritis (PEG) were seen as a well defined clinical entity regarding the gastroenteritis syndrome of the new-born calf. Clinical examination shows slight diarrhoea signs, the absence of dehydratation and the presence of nervous signs amongst which paresis is the most important. Microbiological surveys have shown the particular role or E. Colt with specific pathogencity markers (CS31A and Col V). Laboratory analysis show a metabolic blood acidosis with accumulation of D Lactate. The authors describe the various steps that help defining whether PGE are a disease or if they are part of the gastroenteritis syndrome (non dehydrated, acidosic calf)

Clinicians' adherence versus non adherence to practice guidelines in the management of patients with sarcoma: a cost-effectiveness assessment in two European regions

International audienceABSTRACT: BACKGROUND: Although the management of sarcoma is improving, non adherence to clinical practice guidelines (CPGs) remains high, mainly because of the low incidence of the disease and the variety of histological subtypes. Since little is known about the health economics of sarcoma, we undertook a cost-effectiveness analysis (within the CONnective TIssue CAncer NETwork, CONTICANET) comparing costs and outcomes when clinicians adhered to CPGs and when they did not. METHODS: Patients studied had a histological diagnosis of sarcoma, were older than 15 years, and had been treated in the Rhone-Alpes region of France (in 2005/2006) or in the Veneto region of Italy (in 2007). Data collected retrospectively for the three years after diagnosis were used to determine relapse free survival and health costs (adopting the hospital's perspective and a microcosting approach). All costs were expressed in euros at their 2009 value. A 4% annual discount rate was applied to both costs and effects. The incremental cost-effectiveness ratio (ICER) was expressed as cost per relapse-free year gained when management was compliant with CPGs compared with when it was not. To capture uncertainty surrounding ICER, a probabilistic sensitivity analysis was performed based on a non-parametric bootstrap method. RESULTS: A total of 219 patients were included in the study. Compliance with CPGs was observed for 118 patients (54%). Average total costs reached 23,571 euros when treatment was in accordance with CPGs and 27,313 euros when it was not. In relation to relapse-free survival, compliance with CPGs strictly dominates non compliance, i.e. it is both less costly and more effective. Taking uncertainty into account, the probability that compliance with CPGs still strictly dominates was 75%. CONCLUSIONS: Our findings should encourage physicians to increase their compliance with CPGs and healthcare administrators to invest in the implementation of CPGs in the management of sarcoma

Nära till naturen : en diskussion om riktlinjer för grundtillgång på friluftsmarker nära tätorter /

This study tested a method to quantify and locate hydraulic lift (HL, defined as the passive upward water flow from wetter to dryer soil zones through the plant root system) by combining an experiment using the stable water isotope 1H218O as a tracer with a soil–plant water flow model. Our methodology consisted in (i) establishing the initial conditions for HL in a large rhizobox planted with Italian ryegrass (Lolium multiflorum Lam.), (ii) labeling water in the deepest soil layer with an 18O-enriched solution, (iii) monitoring the water O isotopic composition in soil layers to find out changes in the upper layers that would reflect redistribution of 18O-enriched water from the bottom layers by the roots, and (iv) comparing the observed soil water O isotopic composition to simulation results of a three-dimensional model of water flow and isotope transport in the soil–root system. Our main findings were that (i) the depth and strength of the observed changes in soil water O isotopic composition could be well reproduced with a modeling approach (RMSE = 0.2‰, i.e., equivalent to the precision of the isotopic measurements), (ii) the corresponding water volume involved in HL was estimated to account for 19% of the plant transpiration of the following day, i.e., 0.45 mm of water, and was in agreement with the observed soil water content changes, and (iii) the magnitude of the simulated HL was sensitive to both plant and soil hydraulic properties

Design Procedure for Loss Compensation of Planar Microwave Filters Using Negative Resistances For Tuneable Bandstop and Bandpass Applications

In this paper, we present a method to synthesise microwave active bandpass and bandstop filters using negative resistance circuits and/or active inductance circuits realised in MMIC technology. We show measurements of a negative resistance circuit which is after associated with passive lumped elements to realise an active bandstop filter, tuneable in frequency. We also present the synthesis of an adjustable active inductance close to an ideal element over the 3.8-4.2 GHz band. This element is introduced in a passive bandpass filter to compensate its losses and realise a high-Q selective structure

Mise au point d'un capteur immunoenzymatique : application au dosage de l'alpha-foetoproteine

SIGLECNRS T Bordereau / INIST-CNRS - Institut de l'Information Scientifique et TechniqueFRFranc