Analyses chimiques des eaux du fleuve Niger à Niamey : premiers résultats d'une campagne annuelle de mesures

Nous avons déterminé, d'août 1984 à février 1986, les concentrations des silicates, chlorures, nitrites, phosphates, potassium, sodium, calcium, magnésium, ammonium et fer ferrique ainsi que le pH, la conductivité, la turbidité, l'oxygène dissous, l'alcalinité et la D.B.O. dans l'eau du fleuve Niger à hauteur de la ville de Niamey. L'exploitation statistique de ces résultats fait apparaître l'existence de deux périodes stables et d'une période instable au cours de l'année. (Résumé d'auteur

Expression Levels of Thymidylate Synthase, Thymidylate Phosphorylase and Dihydropyrimidine Dehydrogenase in Head and Neck Squamous Cell Carcinoma: Preliminary Study

Introduction Pharyngo-laryngeal tumors classified as T3-4, N0-3, M0, are conventionally treated by mutilating surgery (total (pharyngo)-laryngectomy). Neo-adjuvant chemotherapy with 5-FU/platinum salt can be proposed in an attempt to preserve the larynx. The level of the response to chemotherapy ranges from 36 to 54% of cases. Thus, a large number of patients receive chemotherapy that is ineffective and not free from adverse effects. Three main enzymes are involved in the metabolism of 5-FU: thymidylate synthase (TS), thymidylate phosphorylase (TP) and dihydropyrimidine dehydrogenase (DPD). Several studies suggest that a high level of expression of these three genes correlates with a poor clinical response to 5-FU. The main purpose of our study was to look for a correlation between the levels of expression of the genes for sensitivity to 5-FU (TS, TP, DPD) within the tumor and the clinical response observed after three courses of chemotherapy combining 5-FU/platinum salt in patients presenting with advanced cancer of the pharyngolarynx. Methods This was a prospective genetic study that had required approval from the Ethics Committee. The main assessment criterion was based on the assessment of the clinical response by an ENT panendoscopy and a cervical CT scan, after three courses of chemotherapy. The expression of the genes was determined by quantitative RT-PCR, using total RNA extracted from tumor biopsies taken during the initial panendoscopy. Results The means calculated, in our study, for the three genes of interest (TS, TP, DPD) were lower in the responder group than those in the non-responder group. Discussion Our preliminary findings reveal trends that confirm the hypothesis that the lower the level of expression of the sensitivity genes, the better the clinical response to chemotherapy. They now form part of a larger study that is currently in progress

Enteral versus parenteral early nutrition in ventilated adults with shock: a randomised, controlled, multicentre, open-label, parallel-group study (NUTRIREA-2)

BACKGROUND: Whether the route of early feeding affects outcomes of patients with severe critical illnesses is controversial. We hypothesised that outcomes were better with early first-line enteral nutrition than with early first-line parenteral nutrition. METHODS: In this randomised, controlled, multicentre, open-label, parallel-group study (NUTRIREA-2 trial) done at 44 French intensive-care units (ICUs), adults (18 years or older) receiving invasive mechanical ventilation and vasopressor support for shock were randomly assigned (1:1) to either parenteral nutrition or enteral nutrition, both targeting normocaloric goals (20-25 kcal/kg per day), within 24 h after intubation. Randomisation was stratified by centre using permutation blocks of variable sizes. Given that route of nutrition cannot be masked, blinding of the physicians and nurses was not feasible. Patients receiving parenteral nutrition could be switched to enteral nutrition after at least 72 h in the event of shock resolution (no vasopressor support for 24 consecutive hours and arterial lactate <2 mmol/L). The primary endpoint was mortality on day 28 after randomisation in the intention-to-treat-population. This study is registered with ClinicalTrials.gov, number NCT01802099. FINDINGS: After the second interim analysis, the independent Data Safety and Monitoring Board deemed that completing patient enrolment was unlikely to significantly change the results of the trial and recommended stopping patient recruitment. Between March 22, 2013, and June 30, 2015, 2410 patients were enrolled and randomly assigned; 1202 to the enteral group and 1208 to the parenteral group. By day 28, 443 (37%) of 1202 patients in the enteral group and 422 (35%) of 1208 patients in the parenteral group had died (absolute difference estimate 2·0%; [95% CI -1·9 to 5·8]; p=0·33). Cumulative incidence of patients with ICU-acquired infections did not differ between the enteral group (173 [14%]) and the parenteral group (194 [16%]; hazard ratio [HR] 0·89 [95% CI 0·72-1·09]; p=0·25). Compared with the parenteral group, the enteral group had higher cumulative incidences of patients with vomiting (406 [34%] vs 246 [20%]; HR 1·89 [1·62-2·20]; p<0·0001), diarrhoea (432 [36%] vs 393 [33%]; 1·20 [1·05-1·37]; p=0·009), bowel ischaemia (19 [2%] vs five [<1%]; 3·84 [1·43-10·3]; p=0·007), and acute colonic pseudo-obstruction (11 [1%] vs three [<1%]; 3·7 [1·03-13·2; p=0·04). INTERPRETATION: In critically ill adults with shock, early isocaloric enteral nutrition did not reduce mortality or the risk of secondary infections but was associated with a greater risk of digestive complications compared with early isocaloric parenteral nutrition. FUNDING: La Roche-sur-Yon Departmental Hospital and French Ministry of Health

Study of large hemispherical photomultiplier tubes for the ANTARES neutrino telescope

The ANTARES neutrino telescope, to be immersed depth in the Mediterranean Sea, will consist of a 3 dimensional matrix of 900 large area photomultiplier tubes housed in pressure resistant glass spheres. The selection of the optimal photomultiplier was a critical step for the project and required an intensive phase of tests and developments carried out in close collaboration with the main manufacturers worldwide. This paper provides an overview of the tests performed by the collaboration and describes in detail the features of the PMT chosen for ANTARES

ANTARES: the first undersea neutrino telescope

The ANTARES Neutrino Telescope was completed in May 2008 and is the first operational Neutrino Telescope in the Mediterranean Sea. The main purpose of the detector is to perform neutrino astronomy and the apparatus also offers facilities for marine and Earth sciences. This paper describes the design, the construction and the installation of the telescope in the deep sea, offshore from Toulon in France. An illustration of the detector performance is given

Prise en charge des complications neurologiques, respiratoires et cardiovasculaires: argumentaire des recommandations de pratique clinique

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Recommandations pour la prise en charge des complications neurologiques, respiratoires et circulatoires des intoxications.

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Prise en charge symptomatique: neurologique, respiratoire, hémodynamique et hépatique des intoxications graves par médicaments et substances illicites

Management of drug-induced organ failure is a medical emergency that should not be delayed by any additional examination or attempt at decontamination. Drug-induced neurological disturbances are very frequent in acute poisonings (coma, encephalopathy, seizures, and abnormal movements). There is no correlation between their magnitude and the severity of the poisoning. The immediate severity is related to the depth of drug-induced coma. However, the outcome depends on the mechanism of toxicity as well as the occurrence of complications. Supportive treatment of neurological manifestations is a medical emergency and the early medical management of unconscious patients should be recommended. Drug-induced respiratory distress (including central respiratory depression, obstruction of the airways, aspiration pneumonia, and ARDS) is frequent in drug-induced poisoning and may alter the final outcome of non-life-threatening poisonings. Supportive treatment of drug-induced respiratory distress is rather non-specific including medical observation, mechanical ventilation, and even sophisticated methods like extracorporeal removal of CO 2 whose efficiency in drug-induced poisoning remains to be determined. Drug-induced cardiovascular disturbances may occur early and abruptly. Thus, the transfer of all patients poisoned with cardiotropic drugs requires medical supervision, even in asymptomatic patients. Sustained release drugs may cause a delay in onset of sustained toxic effects. The mechanisms of toxicity are frequently associated. The precise knowledge of the different mechanisms involved in a drug-induced cardiovascular shock is mandatory for providing adequate supportive treatment. There is some specificity regarding the treatment of drug-induced cardiovascular shock including the administration of molar sodium bicarbonate, calcium salts, high-dose of glucagon, and insulin. The indication of extracorporeal life-support should be considered in case of poisonings involving membrane-stabilizing agent, refractory to conventional treatment, before the onset of irreversible multiorgan failure. Drug-induced hepatitis globally accounts for 20% of fulminant hepatitis. Fulminant hepatitis requires considering the early transfer in center specialized in liver transplantation. © 2006.SCOPUS: sh.jinfo:eu-repo/semantics/publishe