The effects of morphine on dyspnea and ventilatory function in elderly patients with advanced cancer: A randomized double-blind controlled trial

Background: Dyspnea represents a very frequent and distressing symptom in patients with advanced cancer. This study was undertaken to assess the efficacy of morphine on dyspnea and its safety for ventilatory function in elderly advanced cancer patients. Patients and methods: Nine elderly patients with dyspnea due to lung involvement were randomized to receive either morphine subcutaneously (5 mg in seven opioid-naïve patients and 3.75 mg in two patients on top of their regular oral dose of 7.5 mg q4h) or placebo on day 1. On day 2, they were crossed over to receive the alternate treatment. Dyspnea was assessed every fifteen minutes using a visual analogue scale (VAS: 0-100 mm) and the ordinal scale developed by Borg (0-10 points). Pain, somnolence and anxiety were assessed using VAS. Respiratory effort, respiratory rate and oxygen saturation were also measured repeatly. Results: Mean changes in dyspnea 45 minutes after injection were −25 ± 10 mm and −1.2 ± 1.2 points for morphine, versus 0.6 ± 7.7 mm (P < 0.01) and −0.1 ± 0.3 points (P = 0.03) for placebo on VAS and Borg scale, respectively. No relevant changes were observed in somnolence, pain, anxiety, respiratory effort and rate, and oxygen saturation. Conclusions: Morphine appears effective for cancer dyspnea, and it does not compromise respiratory function at the dose level use

STUDY OF CORROSION AND WEAR OF SURGICAL INSTRUMENTS DURING STERILIZATION

Oral Communication presented at the ";Forum des Jeunes Chercheurs";, Brest (France) 2011

Pectin-like heteroxylans in the early-diverging charophyte Klebsormidium fluitans

The cell walls of charophytic algae both resemble and differ from those of land plants. Cell walls in early-diverging charophytes (e.g. Klebsormidiophyceae) are particularly distinctive, in ways that may enable survival in environments that are incompatible with land-plant polymers. This study therefore investigates the structure of Klebsormidium polysaccharides.The ‘pectin’ fraction (defined by extractability) of Klebsormidium fluitans, solubilised by various buffers from alcohol-insoluble residues (AIRs), was digested with several treatments that (partially) hydrolyse land-plant cell-wall polysaccharides. Products were analysed by gel-permeation and thin-layer chromatography.The Klebsormidium pectic fraction made up ~30-50% of its AIR, was optimally solubilised at pH 3-4 at 100°C, and contained residues of xylose ≈ galactose &gt; rhamnose &gt; arabinose, fucose, mannose, glucose. Uronic acids were undetectable and the pectic fraction was more readily solubilised by formate than by oxalate, suggesting a lack of chelation. Some land-plant-targeting hydrolases degraded the Klebsormidium pectic fraction: digestion by α-l-arabinanase, endo-β-(1⟶4)-d-xylanase, and α-d-galactosidase suggests the presence of β-(1⟶4)-xylan with terminal α-l-arabinose, α-d-galactose and (unexpectedly) rhamnose. ‘Driselase’ released oligosaccharides of xylose and rhamnose (~1:1) and graded acid hydrolysis of these oligosaccharides indicated a ‘rhamnoxylan’ with rhamnose side-chains. Partial acid hydrolysis of Klebsormidium pectic fraction released rhamnose plus numerous oligosaccharides, one of which comprised xylose and galactose (~1:2 Gal/Xyl), suggesting a galactoxylan. Lichenase was ineffective, as were endo-β-(1⟶4)-d-galactanase, endo-β-(1⟶4)-d-mannanase, β-d-xylosidase and β-d-galactosidase.Klebsormidium pectic fraction possesses many land-plant-like linkages but is unusual in lacking uronic acid residues and in containing rhamnoxylan and galactoxylan domains. Uronic acids allow land-plant and late-diverging charophyte pectins to form Ca2+-bridges, facilitating cell-wall polymer association; their absence from Klebsormidium suggests that neutral heteroxylans rely on alternative cross-linking mechanisms. This lack of dependency on Ca2+-bridges may confer Klebsormidium’s ability to grow in the acidic, metal-rich environments which it tolerates

Efficacité de l'éducation thérapeutique chez les enfants atteints de cancer et leur famille : une revue systématique

Présentation dans le cadre d'une demi-journée de Recherch

Impact of a telenursing service on satisfaction and health outcomes of children with inflammatory rheumatic diseases and their families: a crossover randomized trial study protocol.

BACKGROUND: Pediatric rheumatic diseases have a significant impact on children's quality of life and family functioning. Disease control and management of the symptoms are important to minimize disability and pain. Specialist clinical nurses play a key role in supporting medical teams, recognizing poor disease control and the need for treatment changes, providing a resource to patients on treatment options and access to additional support and advice, and identifying best practices to achieve optimal outcomes for patients and their families. This highlights the importance of investigating follow-up telenursing (TN) consultations with experienced, specialist clinical nurses in rheumatology to provide this support to children and their families. METHODS/DESIGN: This randomized crossover, experimental longitudinal study will compare the effects of standard care against a novel telenursing consultation on children's and family outcomes. It will examine children below 16 years old, recently diagnosed with inflammatory rheumatic diseases, who attend the pediatric rheumatology outpatient clinic of a tertiary referral hospital in western Switzerland, and one of their parents. The telenursing consultation, at least once a month, by a qualified, experienced, specialist nurse in pediatric rheumatology will consist of providing affective support, health information, and aid to decision-making. Cox's Interaction Model of Client Health Behavior serves as the theoretical framework for this study. The primary outcome measure is satisfaction and this will be assessed using mixed methods (quantitative and qualitative data). Secondary outcome measures include disease activity, quality of life, adherence to treatment, use of the telenursing service, and cost. We plan to enroll 56 children. DISCUSSION: The telenursing consultation is designed to support parents and children/adolescents during the course of the disease with regular follow-up. This project is novel because it is based on a theoretical standardized intervention, yet it allows for individualized care. We expect this trial to confirm the importance of support by a clinical specialist nurse in improving outcomes for children and adolescents with inflammatory rheumatisms. TRIAL REGISTRATION: ClinicalTrial.gov identifier: NCT01511341 (December 1st, 2012)

Elimination of the BKCa Channel's High-Affinity Ca2+ Sensitivity

We report here a combination of site-directed mutations that eliminate the high-affinity Ca2+ response of the large-conductance Ca2+-activated K+ channel (BKCa), leaving only a low-affinity response blocked by high concentrations of Mg2+. Mutations at two sites are required, the “Ca2+ bowl,” which has been implicated previously in Ca2+ binding, and M513, at the end of the channel's seventh hydrophobic segment. Energetic analyses of mutations at these positions, alone and in combination, argue that the BKCa channel contains three types of Ca2+ binding sites, one of low affinity that is Mg2+ sensitive (as has been suggested previously) and two of higher affinity that have similar binding characteristics and contribute approximately equally to the power of Ca2+ to influence channel opening. Estimates of the binding characteristics of the BKCa channel's high-affinity Ca2+-binding sites are provided

Influence of the Microstructural Texture of Cast Superalloys on their High-Temperature Oxidation Behaviour

International audienceThe high-temperature oxidation behaviours of Ni base and Co base cast superalloys were studied to determine the effect of different grain sizes and different surface dendritic orientations. These microstructural characteristics were obtained by varying solidification rate and cutting orientation with regard to the external surface. Thermogravimetry tests were run at 1000 and 1100°C and parabolic oxidation constants were considered. It appears that oxidation is faster for fine microstructures than for coarser ones for Ni or Co alloys including tungsten in their chemical composition, while it is the contrary when W is not present. When the sample surface is mainly parallel to the dendritic network, the oxidation rate is greater than for a surface perpendicular to dendrites, for the studied Ni alloy. The same phenomenon is observed for the studied Co base alloy at 1100°C but the order is inverted at 1000°C. These different behaviours can be explained by the grain boundary densities and orientations obtained on surface, since they can influence the diffusion of species involved in the oxidation phenomena. It is also possible that the characteristics of the chromia scale, such as grain size and general quality, depend on the microstructural texture of the alloy

State of the Sub-surface Microstructure of Carbides strengthened cast Superalloys after High Temperature Oxidation -Use of Thermodynamic Modelling for a better Understanding

International audienceSeveral cast strengthened superalloys, Ni base and Co base, were exposed to high temperature oxidation for long times and metallographically examined. Different phenomena occurred in the sub-surface microstructure, depending on both alloy and temperature. Thermodynamic modelling was used to know what it happened for carbon during oxidation, then to explain the observed microstructural changes. It appears that carbon atoms either quit the alloy probably after its oxidation into gases, or on the contrary go deeper into the bulk where they promote the precipitation of new carbides by solid state transformation. Thereafter, thermodynamic modelling allowed to know the new local refractoriness of the zones affected by oxidation, then to appreciate the new mechanical properties in the sub-surface

Socioeconomic and living conditions are determinants of hip fracture incidence and age occurrence among community-dwelling elderly

Summary: In this prospective, 10-year study in community-dwelling elderly aged 50years and over, hip fracture incidence and accordingly age at hip fracture were inversely associated with the area-level income, independently of the geographical area. Age at hip fracture also depended of marital status but in a gender-specific way. Purpose: The purpose of this study is to investigate the impact of socioeconomic and living conditions on hip fracture incidence and age occurrence among community-dwelling elderly. Method: Between January 1991 and December 2000, 2,454 hip fractures were recorded in community-dwelling adults aged 50years and over in the Geneva University Hospital, State of Geneva, Switzerland. Median annual household income by postal code of residence (referred to as area-level income) based on the 1990 Census was used as a measure of socioeconomic condition and was stratified into tertiles (<53,170; 53,170-58,678; and ≥58,678 CHF). Hip fracture incidence and age occurrence were calculated according to area-level income categories and adjusted for confounding factors among community-dwelling elderly. Results: Independently of the geographical area (urban versus rural), community-dwelling persons residing in areas with the medium income category presented a lower hip fracture incidence [OR 0.91 (0.82-0.99), p = 0.049] compared to those from the lowest income category. Those in the highest income category had a hip fracture at a significant older age [+1.58 (0.55-2.61) year, p = 0.003] as compared to those in the lowest income category. Age at hip fracture also depended on marital status but in a gender-specific way, with married women fracturing earlier. Conclusions: These results indicate that incidence and age occurrence of hip fracture are influenced by area-level income and living conditions among community-dwelling elderly. Prevention programs may be encouraged in priority in communities with low incom

The effects of morphine on dyspnea and ventilatory function in elderly patients with advanced cancer: a randomized double-blind controlled trial

BACKGROUND: Dyspnea represents a very frequent and distressing symptom in patients with advanced cancer. This study was undertaken to assess the efficacy of morphine on dyspnea and its safety for ventilatory function in elderly advanced cancer patients. PATIENTS AND METHODS: Nine elderly patients with dyspnea due to lung involvement were randomized to receive either morphine subcutaneously (5 mg in seven opioid-naive patients and 3.75 mg in two patients on top of their regular oral dose of 7.5 mg q4 h) or placebo on day 1. On day 2, they were crossed over to receive the alternate treatment. Dyspnea was assessed every fifteen minutes using a visual analogue scale (VAS: 0-100 mm) and the ordinal scale developed by Borg (0-10 points). Pain, somnolence and anxiety were assessed using VAS. Respiratory effort, respiratory rate and oxygen saturation were also measured repeatedly. RESULTS: Mean changes in dyspnea 45 minutes after injection were -25 +/- 10 mm and -1.2 +/- 1.2 points for morphine, versus 0.6 +/- 7.7 mm (P &lt; 0.01) and -0.1 +/- 0.3 points (P = 0.03) for placebo on VAS and Borg scale, respectively. No relevant changes were observed in somnolence, pain, anxiety, respiratory effort and rate, and oxygen saturation. CONCLUSIONS: Morphine appears effective for cancer dyspnea, and it does not compromise respiratory function at the dose level used