Comparaison coût-bénéfice d'une césarienne sur demande maternelle et d'un accouchement par voie basse

En Suisse comme ailleurs le thème de " Césarienne sur demande maternelle " est souvent évoqué dans les milieux obstétricaux. Par ailleurs, les solutions proposées pour une maîtrise des coûts sont surtout la rationalisation de l'activité, l'usage des recommandations de pratique médicale et les études coût/bénéfice, mode d'évaluation consistant à relier les coûts d'une stratégie médicale à ses conséquences en terme de santé. Comment s'y prendre face à cette demande nouvelle pour la césarienne et comment l'évaluer par rapport à son coût, sa morbidité et sa mortalité ? Le but de ce travail est de contribuer à répondre à cette question en analysant les données de la Maternité du CHUV

Bone erosions in rheumatoid arthritis can be repaired through reduction in disease activity with conventional disease-modifying antirheumatic drugs

We conducted the present study to determine whether repair of erosions occurs in patients with rheumatoid arthritis (RA) treated with conventional disease-modifying anti-rheumatic drugs (DMARDs) and to compare clinical characteristics between patients exhibiting and not exhibiting erosion repair. We included in the study a total of 122 RA patients who fulfilled the 1987 American College of Rheumatology criteria for RA; all patients had paired sequential radiographs of both hands and wrists showing erosive changes at baseline. Patients were classified into two groups according to the presence of repair of erosions at follow up, namely the 'repair observed' and 'repair not observed' groups. Clinical characteristics, disease activity, radiographic scores and treatment in the two groups were compared. Forty-four repairs were observed in 13 patients (10.7%). Compared with the repair not observed group, the functional class of the patients in the repair observed group was lower at baseline (P < 0.01) and the mean disease activity was lower at follow up (P < 0.005). The changes in radiographic scores per year (total radiographic score and erosion score) were lower (P < 0.05 and P < 0.01, respectively) in the repair observed group. No difference in treatment was observed. Repair of erosions was detected in 10.7% of RA patients treated with conventional DMARDs. Repairs were associated with low functional class at baseline and low disease activity at follow up. These observations support the importance of reduction in disease activity in RA patients. Because repair of erosions was detected in a substantial number of patients, assessment of erosion repair should be incorporated into the radiographic evaluation and scoring of RA

Risk factors for postoperative complications in patients on maintenance hemodialysis who undergo abdominal surgery

SummaryBackground/ObjectivePatients on hemodialysis (HD) who undergo abdominal surgery for gastrointestinal disease are at increased risk of postoperative complications. In this study, we retrospectively investigated the predictors of postoperative complications among such patients.MethodsThe study group comprised 36 HD patients who underwent abdominal surgery for gastrointestinal disease between 2003 and 2012. The clinicopathological factors of the patients who did and did not suffer postoperative complications were compared.ResultsThe overall morbidity and mortality rates were 39% (14/36) and 14% (5/36), respectively. Physical status according to the American Society of Anesthesiologists (ASA) classification (p = 0.0203) and intraoperative blood loss (p = 0.0013) were found to differ significantly between the groups.ConclusionThe morbidity and mortality rates of HD patients who underwent abdominal surgery for gastrointestinal disease were high. Physical status according to the ASA classification and intraoperative blood loss were found to be associated with postoperative complications. Therefore, patients with comorbidities, such as heart disease and diabetes mellitus, have to be treated appropriately before surgery. In addition, it is important that surgeons perform operations carefully and avoid excessive blood loss

戸隠・飯綱高原の低層湿原植生

[論文] Articl

Characterization of precipitates in strip-cast 2.7%Si steel under different heat treatment conditions

A 1.5mm thickness as-cast Fe-2.7%Si strip was produced by twin-roll strip casting and the precipitates under different isothermal holding time (0.5 min–30 min) and cooling rates (1∘/s–20 ∘C/s) were investigated by thermal simulation experiment technology and electron probe micro-analyzer. The main precipitates in all specimens are AlN-MnS complex with a structure of core-edge. During isothermal holding, the number density of relatively large precipitates (≥ 0.3 μm) decrease with increase in time and the mean size of the small precipitates (≤150 nm) increases gradually. It can be attributed to the complicated interactions of dissolve, precipitation and coarsening behavior. For precipitates in strips cooling from 1380 ∘C to 20 ∘C, the mean size decreases continuously with increase in cooling rate because the corresponding growth rate and time of precipitates decrease. These results indicate that isothermal holding time and cooling rate have an important influence on size of precipitates in strip, which will be of great importance in optimizing properties of silicon steel

Molybdenum alloying in high-performance flat-rolled steel grades

Considerable progress in developing flat-rolled steel grades has been made by the Chinese steel industry over the recent two decades. The increasing demand for high-performance products to be used in infrastructural projects as well as in production of consumer and capital goods has been driving this development until today. The installation of state-of-the-art steel making and rolling facilities has provided the possibility of processing the most advanced steel grades. The production of high-performance steel grades relies on specific alloying elements of which molybdenum is one of the most powerful. China is nearly self-sufficient in molybdenum supplies. This paper highlights the potential and advantages of molybdenum alloying over the entire range of flat-rolled steel products. Specific aspects of steel property improvement with respect to particular applications are indicated

〔研究ノート〕文化・社会的企業活動視点からの中山間地域の 持続的地域形成についての一考察

This study demonstrates that regional formation through cultural and social enterprise activities is useful in ensuring the sustainability of towns in mountainous areas. The target area is Nantan City （formerly Miyama Town）, Kyoto Prefecture, which is in a typical mountainous area. The reason for choosing Miyama Town is that it is an area with a valuable tourism resource: a “thatched-roof village” （Kayabuki-no-sato）. The researchers reviewed previous research and conducted field visits in November 2019 and March 2020.In 2002, as a result of repeated discussions among the residents, a limited company, Network Hiraya （currently an incorporated company） was established jointly by the residents, who also, in the same year, opened and operated a store, Flat Miyama. It became clear that the Miyama Town Development Committee is indispensable for sustainable regional formation. Such efforts to promote regional development are expected to lead to further development of cultural and social enterprises

Volumetric measurement of paranasal sinuses and its clinical significance in pituitary neuroendocrine tumors operated using an endoscopic endonasal approach

ObjectiveEndoscopic endonasal surgery (EES) for deep intracranial lesions has gained popularity following recent developments in endoscopic technology. The operability of invasive pituitary neuroendocrine tumors (PitNETs) depends on the anatomy of the nasal cavity and paranasal sinus. This study aimed to establish a simple volume reconstruction algorithm of the nasal cavity and paranasal sinus. Additionally, this is the first study to demonstrate the relationship between the segmentation method and the clinical significance in patients with PitNET.MethodsPre-and postoperative tumor volumes were analyzed in 106 patients with primary (new-onset) PitNETs (80 nonfunctioning and 26 functioning) who underwent EES. The efficiency and accuracy of the semiautomatic segmentation with manual adjustments (SSMA) method was compared with other established segmentation methods for volumetric analysis in the nasal cavity and paranasal sinuses. Correlations between the measured nasal cavity and paranasal sinus volumes and the extent of tumor removal were evaluated.ResultsThe SSMA method yielded accurate and time-saving results following the volumetric analyses of nasal cavity and paranasal sinuses with complex structures. Alternatively, the manual and semiautomatic segmentation methods proved time-consuming and inaccurate, respectively. The sphenoid sinus volume measured by SSMA was significantly correlated with the extent of tumor removal in patients with nonfunctioning Knosp grade 3 and 4 PitNET (r = 0.318; p = 0.015).ConclusionThe volume of sphenoid sinus potentially could predict the extent of resection due to better visualization of the tumor for PitNETs with CS invasion

持続可能な地域形成をめざす欧州農村地域のとりくみ手法とその実態 : その2「Ecomuseum」による地域づくり

In the rural areas of EU, various approaches that aim at a sustainable community formation have been executed. In the first report, it reported on the technique of the community formation from the result of the European inspection investigation by the LEADER projects of EU and it reported on the practical cases. In this report, Ecomuseum thought to be one of the methods of the community formation is taken up. The report describes the background and the development details of the birth of the Ecomuseum, and introduces the Bresse Bourguignonne Ecomuseum that is the case with the Ecomuseum in France that is the birthplace; in addition, it introduces the SAMSO Island as a case with Denmark. The author\u27s opinion of the possibility of the Ecomuseum seen from the aspect of a sustainable regional formation in the future and its task are brought together