Caractéristiques cliniques et pronostic des patients victimes d'une thrombose veineuse cérébrale sévère admis en médecine intensive

Introduction La thrombose veineuse cérébrale (TVC) fait partie des maladies cérébrovasculaires, bien que relativement rare en ne comptant qu'entre 0.5 et 1% des toutes les attaques cérébrales. La plus grande étude de cohorte de TVC (Stroke J Cereb Circ. 2004; 35:664-70) décrit une mortalité à 4.3% dans la phase aigue et à 8.3% dans le suivi à 16 mois. Le but de notre étude est d'analyser et de caractériser les patients admis dans un service de médicine intensive, ainsi que préciser les stratégies médicamenteuses, radiologiques et chirurgicales. Les patients ont été suivis pendant une année. Méthodes Nous avons inclus dans notre cohorte les patients admis dans le service de médecine intensive de l'hôpital Lariboisière (centre national de référence pour les TVC) entre 2002 et 2015. Résultats Des 47 patients admis dans le service de médicine intensive, 6 patients ont été exclus de l'étude parce que la TVC survenait dans un contexte postchirurgical. Pour les 41 patients restants, l'âge moyen était de 47 ans, 73.2 % étaient des femmes et le score de SAPS moyen était de 41. Le motif principal d'admission aux soins intensifs était l'altération rapide de l'état de conscience associé à une mydriase ou à de l'épilepsie. La perfusion cérébrale a été évaluée par US-doppler transcrânien chez 32 patients (78%). Une craniectomie précoce a été réalisée chez 16 patients (40%). 9 patients ont eu recours à la radiologie interventionnelle. Issue Le nombre total de patients décédés à une année était de 13 (31.7%). Le profil clinique des patients décédés montrait : prédominance féminine, GCS plus bas, mydriase avec des signes d'hypertension intracrânienne, utilisation plus fréquente de noradrénaline et plus de difficultés à atteindre une anticoagulation thérapeutique. Au cours de la première année, l'évolution clinique a été favorable comme en témoigne l'augmentation du pourcentage (de 60 à 88%) de patients ayant un score de Rankin modifié entre 0 et 3. Discussion Notre étude est la première qui analyse les caractéristiques cliniques et radiologiques, ainsi que le pronostic des patients admis en médecine intensive avec un diagnostic de TVC. L'analyse de l'évolution fonctionnelle (score de Rankin) sur les 12 mois qui suivent l'admission en médecine intensive montre une augmentation progressive du pourcentage des patients avec une évolution fonctionnelle considéré comme favorable (Score de Rankin modifié entre 0 et 3), en passant de 18/33 (54%) à la sortie de la médecine intensive à 23/26 (88%) à 12 mois. Le traitement anticoagulant par héparine est la base du traitement de la TVC et malgré la présence d'un hématome intraparenchymateux. Conclusion La TVC sévère est une cause rare d'admission dans un service de médicine intensive. Une approche agressive et précoce est essentielle pour prévenir une élévation de la pression intracrânienne et le développement de lésions secondaires, dans ce contexte le recours à la chirurgie par la craniectomie décompressive et/ou à la neuroradiologie peut contribuer à l'amélioration du drainage veineux et de l'hémodynamique intracérébrale. Les limites sont qu'il s'agit d'une étude monocentrique, qui a un nombre faible de cas et qu'elle est rétrospective

Disciplinary problems among high achiever students: the types and the causes

This qualitative study has been done to 24 teachers and 72 students from various secondary schools in Penang, Malaysia, in order to investigate the effect of between class ability grouping (BCAG) on high achiever secondary school students. Studies reported that BCAG triggered correspondence bias among teachers, which eventually affect them to show different perception and expectations towards high achiever classes (HAC) and low achiever classes (LAC) students. Symbolic interaction theories explained that individuals tend to be affected by others’ expectation, and therefore behave in a way they were expected to. Therefore, according to the previous studies on BCAG, it was assumed that HAC students would achieve better and would not be significantly involved in disciplinary problems. After semi-structured interview had been conducted in order to collect the data, and two-cycled analyses method, namely In-Vivo and Thematic Analyses had been operated in order to analyze the massive amount of qualitative data, the it was discovered that HAC students were involved with disciplinary problems, such as being disrespectful to teachers, paying less attention in the classroom, neglecting assignments and doing external work during classes. Other findings of this study showed that the disciplinary problems among HAC are related to their self-esteem types due to locus of control difference, as well as bigger issues apart from the competition among themselves. School management system, BCAG itself, reciprocal envy between HAC and LAC students, as well as their inclination towards tuition centers contributed to disciplinary problems among HAC students

Extracorporeal Life Support for Accidental Hypothermia

Extracorporeal Membrane Oxygenation : An Interdisciplinary Problem-Based Learning Approach” provides an overview of the latest techniques, management strategies and technology surrounding the clinical use of ECMO. This interdisciplinary book reviews the most common scenarios of ECMO in 62 chapters exploring the conditions and problems arising in ECMO practice. Each chapter begins with a stem case, followed by open questions to encourage critical thinking and enable the reader to follow the management strategies of the authors, who are world leaders in the field. Followed by an evidence-based discussion, each chapter concludes with multiple-choice questions for self-assessment. This book is current in its knowledge of organ systems and management and keeps pace with new ECMO technology and surgical techniques coupled with current guidelines for management. Starting with the history of ECMO to technical aspects, circuit biocompatibility and interaction with blood, drugs and flow physics, the volume continues into pediatric and adult sections, focussing on both respiratory and cardiovascular support, followed by a section on trauma. The volume then concludes with a section on neurologic complications and ethics, as well as rehabilitation and ambulation of ECMO patients. In addition, to reflect the current global health situation, this book also includes a chapter on ECMO management in patients suffering with COVID-19, to cover the most urgent and pressing questions around ECMO during the ongoing pandemic. This is the first ECMO book on the market to utilise a problem-based learning approach and as such is an important unprecedented project on ECMO education

Edge-based Passive Crowd Monitoring Through WiFi Beacons

Tracking people’s flows has become crucial, not only for safety and security, but also for numerous practical business applications and better management of urban spaces, facilities and services. In this paper, we proposed methodologies that, exploiting IoT technology deployed at the edge of the network, allow for the analysis of people’s movement in urban environments, both outdoors and indoors. In particular, leveraging the use of WiFi probe packets sent by smart devices carried by people on the move, we first describe an implementation of our methodology using off-the-shelf hardware to count people boarding public transportation vehicles. We then present an alternate implementation using commercial WiFi scanners connected to the edge and leveraging suitably deployed virtual network functions to process the data collected by a OneM2M IoT platform, proposing also a mobility tracking procedure that can be applied to anonymized data provided by commercial WiFi scanners. Our experimental results show that the proposed approaches to people counting and mobility detection can achieve a good level of accuracy, while overall carrying a low price tag

Linfomi MALT del tratto gastroenterico: descrizione di casi clinici e revisione della letteratura

I M A L T-omi sono tumori che originano dal tessuto linfoide asso - ciato alle mucose, senza il coinvolgimento primitivo di linfonodi e milza. Localizzati preferenzialmente nel tratto gastroenterico, soprat - tutto a livello gastrico (27%), possono avere origine anche in corrispon - denza dei sistemi respiratorio ed urinario. L’associazione all’infezione da Helicobacter pylori (Hp), già nota nei linfomi primitivi dello sto - maco, sembra giocare un ruolo importante in tumori localizzati in altre sedi; inoltre, anche in assenza di riscontro di infezione da Hp, sono stati descritti casi di successi con la terapia eradicante. In questo articolo gli Autori descrivono tre casi di MALT-linfoma, due a sede gastrica, uno a localizzazione digiuno-ileale multifocale. La diagnosi si fonda su esami strumentali, diversi a seconda del tratto coinvolto, e, in caso di interessamento gastrico, la specificità diagnostica è aumentata dall’endoscopia del digerente superiore associata a biopsie; tuttavia, a causa della localizzazione extramucosa del tumore, l’esame bioptico è gravato da una significativa incidenza di falsi negativi. In questi casi la diagnosi di certezza si otterrà solo dall’esame istologico del pezzo operatorio. La terapia chirurgica raggiunge ottimi risultati negli stadi precoci e riveste comunque un ruolo centrale anche nella palliazione (associata a chemioterapia e radioterapia) in caso di MALT- linfoma B a basso grado dello stomaco e per lo stadio I, l’eradicazione dell’Helicobacter pylori sembra ridurre l’infiltrato linfocitario nel 70-90% dei casi

c 5 Administration of Justice Expenses Act

In classical physics, properties of objects exist independently of the context, i.e., whether and how measurements are performed. Quantum physics showed this assumption to be wrong, and that Nature is indeed “contextual”. Contextuality has been observed in the simplest physical systems, such as single particles, and plays fundamental roles in quantum computation advantage. Here, we demonstrate for the first time quantum contextuality in an integrated photonic chip. The chip implements different combinations of measurements on a single photon delocalized on four distinct spatial modes, showing violations of a Clauser–Horne–Shimony–Holt (CHSH)-like noncontextuality inequality. This paves the way to compact and portable devices for contextuality-based quantum-powered protocol

Integrated-optics circuits for validation of non-classicality

Summary form only given. Contrarily to the classical physics picture, according to quantum mechanics the observable properties of the objects do not yield defined values, until a measurement is performed. The measurement outcome depends indeed also on the set of observables that is being measured [1]. Such a fundamental aspect of Nature is named quantum contextuality and it has been studied in several experimental systems, including single particles [2, 3]. Interestingly, it was recently suggested that even the non-classical power of quantum computing originates from contextuality [4]. Therefore, it is highly relevant to find experimental evidence of this aspect in technological platforms that may be adopted in future quantum computing devices, such as integrated photonics [5-7]. In this work we investigate experimentally quantum contextuality of a single photon on-a-chip, employing reconfigurable photonic circuits fabricated by femtosecond laser waveguide writing [7, 8]

Integrated-optics circuits for validation of non-classicality

Summary form only given. Contrarily to the classical physics picture, according to quantum mechanics the observable properties of the objects do not yield defined values, until a measurement is performed. The measurement outcome depends indeed also on the set of observables that is being measured [1]. Such a fundamental aspect of Nature is named quantum contextuality and it has been studied in several experimental systems, including single particles [2, 3]. Interestingly, it was recently suggested that even the non-classical power of quantum computing originates from contextuality [4]. Therefore, it is highly relevant to find experimental evidence of this aspect in technological platforms that may be adopted in future quantum computing devices, such as integrated photonics [5-7]. In this work we investigate experimentally quantum contextuality of a single photon on-a-chip, employing reconfigurable photonic circuits fabricated by femtosecond laser waveguide writing [7, 8]

How to Solve the Conundrum of Heparin-Induced Thrombocytopenia during Cardiopulmonary Bypass

Heparin-induced thrombocytopenia (HIT) is a major issue in cardiac surgery requiring cardiopulmonary bypass (CPB). HIT represents a severe adverse drug reaction after heparin administration. It consists of immune-mediated thrombocytopenia paradoxically leading to thrombotic events. Detection of antibodies against platelets factor 4/heparin (anti-PF4/H) and aggregation of platelets in the presence of heparin in functional in vitro tests confirm the diagnosis. Patients suffering from HIT and requiring cardiac surgery are at high risk of lethal complications and present specific challenges. Four distinct phases are described in the usual HIT timeline, and the anticoagulation strategy chosen for CPB depends on the phase in which the patient is categorized. In this sense, we developed an institutional protocol covering each phase. It consisted of the use of a non-heparin anticoagulant such as bivalirudin, or the association of unfractionated heparin (UFH) with a potent antiplatelet drug such as tirofiban or cangrelor. Temporary reduction of anti-PF4 with intravenous immunoglobulins (IvIg) has recently been described as a complementary strategy. In this article, we briefly described the pathophysiology of HIT and focused on the various strategies that can be applied to safely manage CPB in these patients