Combined SERS/DFT studies of push–pull chromophore self-assembled monolayers: insights into their surface orientation

Having clear and deep information on the surface/interface of deposited molecules is of crucial importance for the development of efficient optoelectronic devices.

Enzymatic hydrolysis of fumonisins in the gastrointestinal tract of broiler chickens

Fumonisins (FB) are among the most frequently detected mycotoxins in feedstuffs and finished feed, and recent data suggest that the functions of the gastrointestinal tract (GIT) in poultry species might be compromised at doses ranging from 10 to 20 mg/kg, close to field incidences and below the US and EU guidelines. Strategies are therefore necessary to reduce the exposure of poultry to FB. In the present study, we assessed the efficacy of fumonisin esterase FumD (EC 3.1.1.87, commercial name FUMzyme®) to cleave the tricarballylic acid side chains of FB, leading to the formation of non-toxic hydrolyzed fumonisins in the GIT of broiler chickens. Broiler chickens were fed for 14 d (7 to 21 d of age) 3 different diets (6 birds/cage, 6 cages/diet), i) control feed (negative control group), ii) feed contaminated with 10 mg FB/kg (FB group), and iii) feed contaminated with 10 mg FB/kg and supplemented with 100 units of FUMzyme®/kg (FB+FUMzyme® group). To determine the degree of reduction of FB in the GIT, 2 characteristics were analyzed. First, the sphinganine-to-sphingosine ratio in the serum and liver was determined as a biomarker of effect for exposure to FB. Second, the concentration of fumonisin B1 and its hydrolyzed forms was evaluated in the gizzard, the proximal and distal parts of the small intestine, and the excreta. Significantly reduced sphinganine-to-sphingosine ratios in the serum and liver of the FB+FUMzyme® group (serum: 0.15 ± 0.01; liver: 0.17 ± 0.01) compared to the FB group (serum: 0.20 ± 0.01; liver: 0.29 ± 0.03) proved that supplementation of broiler feed with FUMzyme® was effective in partially counteracting the toxic effect of dietary FB. Likewise, FB concentrations in digesta and excreta were significantly reduced in the FB+FUMzyme® group compared to the FB group (P < 0.05; up to 75%). FUMzyme® furthermore partially counteracted FB-induced up-regulation of cytokine gene expression (IL-8 and IL-10) in the jejunum. The FB group showed significantly higher gene expression of IL-8 and IL-10 compared to the negative control group (IL-8: fold change = 2.9 ± 1.1, P < 0.05; IL-10: fold change = 3.6 ± 1.4, P < 0.05), whereas IL-8 and IL-10 mRNA levels were not significantly different in the FB+FUMzyme®® group compared to the other 2 groups. In conclusion, FUMzyme® is suitable to detoxify FB in chickens and maintain gut functions.

Prevalence and effects of mycotoxins on poultry health and performance, and recent development in mycotoxin counteracting strategies

Extensive research over the last couple of decades has made it obvious that mycotoxins are commonly prevalent in majority of feed ingredients. A worldwide mycotoxin survey in 2013 revealed 81% of around 3,000 grain and feed samples analyzed had at least 1 mycotoxin, which was higher than the 10-year average (from 2004 to 2013) of 76% in a total of 25,944 samples. The considerable increase in the number of positive samples in 2013 may be due to the improvements in detection methods and their sensitivity. The recently developed liquid chromatography coupled to (tandem) mass spectrometry allows the inclusion of a high number of analytes and is the most selective, sensitive, and accurate of all the mycotoxin analytical methods. Mycotoxins can affect the animals either individually or additively in the presence of more than 1 mycotoxin, and may affect various organs such as gastrointestinal tract, liver, and immune system, essentially resulting in reduced productivity of the birds and mortality in extreme cases. While the use of mycotoxin binding agents has been a commonly used counteracting strategy, considering the great diversity in the chemical structures of mycotoxins, it is very obvious that there is no single method that can be used to deactivate mycotoxins in feed. Therefore, different strategies have to be combined in order to specifically target individual mycotoxins without impacting the quality of feed. Enzymatic or microbial detoxification, referred to as "biotransformation" or "biodetoxification," utilizes microorganisms or purified enzymes thereof to catabolize the entire mycotoxin or transform or cleave it to less or non-toxic compounds. However, the awareness on the prevalence of mycotoxins, available modern techniques to analyze them, the effects of mycotoxicoses, and the recent developments in the ways to safely eliminate the mycotoxins from the feed are very minimal among the producers. This symposium review paper comprehensively discusses the above mentioned aspects.

Longitudinal and transverse Zeeman ladders in the Ising-like chain antiferromagnet BaCo(2)V(2)O(8)

We explore the spin dynamics emerging from the Néel phase of the chain compound antiferromagnet BaCo(2)V(2)O(8). Our inelastic neutron scattering study reveals unconventional discrete spin excitations, so-called Zeeman ladders, understood in terms of spinon confinement, due to the interchain attractive linear potential. These excitations consist of two interlaced series of modes, respectively, with transverse and longitudinal polarization. The latter, which correspond to a longitudinal fluctuation of the ordered moment, have no classical counterpart and are related to the zero-point fluctuations that weaken the ordered moment in weakly coupled quantum chains. Our analysis reveals that BaCo(2)V(2)O(8), with moderate Ising anisotropy and sizable interchain interactions, remarkably fulfills the conditions necessary for the observation of discrete long-lived longitudinal excitations.

Structural and functional development of small intestine in intrauterine growth retarded porcine offspring born to gilts fed diets with differing protein ratios throughout pregnancy

Protein level in the maternal diet plays a crucial role in fetal programming during pregnancy. Low or high protein level increases the risk of intrauterine growth retardation (IUGR). The aim of this study was to investigate the structural and functional development of the small intestine in piglets from sows fed a control (C, 12.1% protein), a high protein (HP, 30% protein), or a low protein (LP, 6.5% protein) diet during pregnancy. Newborns were classified as IUGR (birth weight ≤1.18 kg) and non-IUGR (birth weight >1.18 kg). The piglets were euthanized on postnatal day (PD)1, PD28 and PD188. The LP diet in non-IUGR neonates resulted in decreased body weight on PD1. The LP and HP diets resulted in both decreased body weight and delayed catch-up growth in the IUGR piglets. The HP and LP-diets increased the length of villi on PD1 in non-IUGRs but not in IUGRs. At birth, the expressions of Ki67 and active caspase 3 in mid-jejunum epithelium of HP and LP non-IUGR neonates were significantly lower as compared to C non-IUGRs whilst in IUGRs the respective expressions were as high as in C non-IUGRs. The postnatal dynamics of brush border enzyme activities and vacuolated enterocytes disappearance showed significant drop in enterocyte maturation in IUGR as compared to non-IUGR neonates. In conclusion, both HP and LP diets led to retarded development of non-IUGR piglets. In IUGR piglets both HP and LP diets resulted in delayed catch-up growth, without adaptive changes in brush border digestive enzymes.

Mycotoxin co-contamination of food and feed: meta-analysis of publications describing toxicological interactions

Most fungi are able to produce several mycotoxins simultaneously; moreover food and feed can be contaminated by several fungi species at the same time. Thus, humans and animals are generally not exposed to one mycotoxin but to several toxins at the same time. Most of the studies concerning the toxicological effect of mycotoxins have been carried out taking into account only one mycotoxin. In the present review, we analysed 112 reports where laboratory or farm animals were exposed to a combination of mycotoxins, and we determined for each parameter measured the type of interaction that was observed. Most of the published papers concern interactions with aflatoxins and other mycotoxins, especially fumonisins, ochratoxin A and trichothecenes. A few papers also investigated the interaction between ochratoxin A and citrinin, or between different toxins from Fusarium species. Only experiments with a 2×2 factorial design with individual and combined effects of the mycotoxins were selected. Based on the raw published data, we classified the interactions in four different categories: synergistic, additive, less than additive or antagonistic effects. This review highlights the complexity of mycotoxins interactions which varies according to the animal species, the dose of toxins, the length of exposure, but also the parameters measured.

Coexistence and interplay of superconductivity and ferromagnetism in URhGe

As ferromagnetism and superconductivity are usually considered to be antagonistic, the discovery of their coexistence in UGe(2), URhGe, UIr and UCoGe has attracted a lot of interest. The mechanism to explain such a state has, however, not yet been fully elucidated. In these compounds superconductivity may be unconventional: Cooper pairs could be formed by electrons with parallel spins and magnetic fluctuations might be involved in the pairing mechanism. URhGe becomes ferromagnetic below a Curie temperature of 9.5 K, with a spontaneous moment aligned to the c-axis. For temperatures below 260 mK and fields lower than 2 T, superconductivity was first observed in 2001. Recently, we discovered a second pocket of superconductivity. This new pocket of superconductivity appears at higher fields applied close to the b-axis, enveloping a sudden magnetic moment rotation transition at H(R) = 12 T. Detailed studies of the field induced metamagnetic transition and superconductivity are presented. The possibility that magnetic fluctuations emerging from a quantum critical point provide the pairing mechanism for superconductivity is discussed.

HOPE, an open platform for medical data management on the grid

The paper describes a platform developed for the secure management and analysis of medical data and images in a grid environment. Designed for telemedicine and built upon the EGEE gLite middleware and particularly the metadata catalogue AMGA as well as the GridSphere web portal, the platform provides to healthcare professionals the capacity to upload and query medical information stored over distributed servers. A job submission environment is also available for data analysis. Security features include authentication and authorization by grid certificates, anonymization of medical data and image encryption. The platform is currently deployed on several sites in Europe and Asia and is being customized for applications in the field of telemedicine and medical physics.

Excitations from a Bose-Einstein condensate of magnons in coupled spin ladders

The weakly coupled quasi-one-dimensional spin ladder compound (CH3)2CHNH3CuCl3 is studied by neutron scattering in magnetic fields exceeding the critical field of Bose-Einstein condensation of magnons. Commensurate long-range order and the associated Goldstone mode are detected and found to be similar to those in reference to spin-dimer materials. However, for the upper two massive magnon branches, the observed behavior is totally different, culminating in a drastic collapse of excitation bandwidth beyond the transition point.

Magnetic Field-Induced Superconductivity in the Ferromagnet URhGe

In several metals, including URhGe, superconductivity has recently been observed to appear and coexist with ferromagnetism at temperatures well below that at which the ferromagnetic state forms. However, the material characteristics leading to such a state of coexistence have not yet been fully elucidated. We report that in URhGe there is a magnetic transition where the direction of the spin axis changes when a magnetic field of 12 tesla is applied parallel to the crystal b axis. We also report that a second pocket of superconductivity occurs at low temperature for a range of fields enveloping this magnetic transition, well above the field of 2 tesla at which superconductivity is first destroyed. Our findings strongly suggest that excitations in which the spins rotate stimulate superconductivity in the neighborhood of a quantum phase transition under high magnetic field.

Flux-line lattice distortion in PrOs4Sb12

We report that the flux-line lattice in the cubic superconductor Pr(Os4Sb12 is strongly distorted from an ideal hexagonal lattice at very low temperatures in a small applied field. We attribute this to the presence of gap nodes in the superconducting state on at least some Fermi-surface sheets.

Cooperative ordering of gapped and gapless spin networks in Cu2Fe2Ge4O13

The unusual magnetic properties of a novel low-dimensional quantum ferrimagnet Cu2Fe2Ge4O13 are studied using bulk methods, neutron diffraction, and inelastic neutron scattering. It is shown that this material can be described in terms of two low-dimensional quantum spin subsystems, one gapped and the other gapless, characterized by two distinct energy scales. Long-range magnetic ordering observed at low temperatures is a cooperative phenomenon caused by weak coupling of these two spin networks.

Ordering and excitations in the field-induced magnetic phase of Cs3Cr2Br9

Field-induced magnetic order has been investigated in detail in the interacting spin 3/2 dimer system Cs3Cr2Br9. Elastic and inelastic neutron scattering measurements were performed up to H=6 T, well above the critical field H(c1) approximately 1.5 T. The ordering displays incommensurabilities and a large hysteresis before a commensurate structure is reached. This structure is fully determined. Surprisingly, the lowest excitation branch never closes. Above H(c1), the gap increases slowly with the field. An analysis in terms of projected pseudospins is given.

La douleur après une craniotomie et l'analgésie postopératoire

Neurosurgery has for a long time been considered as a minimal painful surgery. This explains why there are few references in the literature concerning postoperative neurosurgical pain. Recent papers have demonstrated that even if postoperative pain is less important than in other specialities, such pain exists and should be taken care of. Rapid neurological recovery is now possible because of the progress in the surgical techniques and the introduction of new anaesthetic drugs. This implies a strict postoperative analgesic strategy in order to avoid both direct and indirect complications associated with pain. In this respect, the use of remifentanil or other techniques like target-controlled injection of opioids should absolutely be considered. In most cases, class I and II analgesics seem to provide optimal pain relief. However, for some patients, the use of an opioid may be required.

Charge ordering and spin dynamics in NaV(2)O(5)

We report high-resolution neutron inelastic scattering experiments on the spin excitations of NaV(2)O(5). Below T(c), two branches with distinct energy gaps are identified. From the dispersion and intensity of the spin excitation modes, we deduce the precise zigzag charge distribution on the ladder rungs and the corresponding charge order: Delta(c) approximately 0.6. We argue that the spin gaps observed in the low-T phase of this compound are primarily due to the charge transfer.

Single-breath CO2 analysis as a predictor of lung volume change in a model of acute lung injury

OBJECTIVE

To examine the utility of single-breath CO2 analysis as a measure of lung volume change in a model of acute lung injury.

SETTING

Animal laboratory in a university-affiliated medical center.

DESIGN

Prospective, animal cohort study comparing 21 variables derived from single-breath CO2 analysis with lung volume measurements determined by nitrogen washout.

SUBJECTS

Seven lambs with saline lavage-induced acute lung injury.

METHODS

Animals were treated with repetitive saline lavage to achieve a uniform degree of acute lung injury (PaO2 < 100 torr [13.32 kPa] on FiO2 of 1.0). Twenty-one derived components of the CO2 expirogram were evaluated as predictors of lung volume change. Lung volume was manipulated by 3-cm H2O incremental increases in positive end-expiratory pressure from 0 to 21 cm H2O and ranged between 90 and 765 mL.

MEASUREMENTS AND MAIN RESULTS

Fifty-five measurements of lung volume were available for comparison with derived variables from the CO2 expirogram. Stepwise linear regression identified five variables that were most predictive of lung volume change: a) dynamic lung compliance; b) the slope of phase III; c) the slope of phase II divided by the mixed expired CO2 concentration; d) airway deadspace; and e) PaO2/FIO2 ratio. The multivariate equation was highly statistically significant and explained 94% of the variance (adjusted r2 = .94, p < .0001). The bias and precision of the calculated lung volume were 10.9 and 55.9, respectively. The mean percentage difference for the lung volume estimate derived from the single-breath CO2 analysis station was 3.3%.

CONCLUSIONS

Our data indicate that analysis of the CO2 expirogram can yield accurate information about lung volume in animals with saline lavage-induced acute lung injury. Specifically, five variables derived from a plot of expired CO2 concentration vs. expired volume predict changes in lung volume in healthy lambs with an adjusted coefficient of determination of 0.94. We hope to further define the utility of this technique by prospective application of this methodology in the clinical setting.

[Comparison of two measurement methods: the Bland and Altman assessment]

Bland-Altman analysis for comparison of two methods of clinical measurement is frequently used in scientific publications. This article is more appropriate than the conventional linear regression analysis. This paper gives an overview of the principles for the use of Bland-Altman analysis as well as the specific terminology attached to it. The Bland-Altman comparison analysis is mainly a tool for clinical interpretation. The bias and the agreement limits provide the variation of the values of the technique compared to the other. The difference between the two methods of measurement is plotted against the average obtained with each of the two techniques. Bland-Altman analysis can also be used to check the repeatability of a measurement technique within the same subject and to determine a repeatability coefficient. With an adaptation of the calculation of the agreement limits, the average of multiple measurements for each subject with two measurement techniques can be used for the Bland-Altman analysis.

Capnography monitoring during neurosurgery: reliability in relation to various intraoperative positions

In neurosurgery, estimation of PaCO2 from PETCO2 has been questioned. The aim of this study was to reevaluate the accuracy of PETCO2 in estimating PaCO2 during neurosurgical procedures lasting >3 h and to measure the effect of surgical positioning on arterial to end-tidal CO2 gradient (P[a-ET]CO2) over time. One hundred four neurosurgical patients classified into four groups (supine [SP], lateral [LT], prone [PR], sitting [ST]) were included in a prospective study. PaCO2, PETCO2, and P(a-ET)CO2 were measured after induction of anesthesia (T0), after positioning (T1), each following hour (T2, T3, T4), and at the end of the procedure after return to the SP position (T5). Data are expressed as the mean +/- SD, and statistical analysis used linear regression, the Bland-Altman method, and analysis of variance. The mean durations of positioning and surgery were 4.1+/-1 h and 3.7+/-1.3 h, respectively. We performed 624 simultaneous measurements of PaCO2 (33+/-5 mm Hg) and PETCO2 (27+/-4 mm Hg), leading to a mean P(a-ET)CO2 of 6+/-4 mm Hg. P(a-ET)CO2 of the LT group (7+/-3 mm Hg) was larger (compared with the SP, PR, and ST groups) because of a lower PETCO2 (26+/-4 mm Hg). Negative P(a-ET)CO2 (PETCO2 > PaCO2) occurred 22 times, only in the SP (n = 9) and ST groups (n = 13). Changes in opposite directions of PETCO2 and PaCO2 between two successive measurements were found in 26% of the cases. Correlation coefficients in the four groups (PaCO2 versus PETCO2) were not in good agreement (0.46 to 0.62; P < 0.001). The mean bias was between 5 and 7 mm Hg. The superior (13-15 mm Hg) and inferior (-5 to 0 mm Hg) limits of agreement were too large to expect PETCO2 to replace PaCO2. In conclusion, during neurosurgical procedures of >3 h, capnography should be performed with regular analysis of arterial blood gases for optimal ventilator adjustment.

IMPLICATIONS

This study, which aimed to reevaluate the ability of PETCO2 to estimate PaCO2 during neurosurgical procedures according to surgical position, indicates that PETCO2 cannot replace PaCO2 for the following reasons: scattering of individual values; occurrence of negative arterial to end-tidal CO2 gradient (P[a-ET]CO2; PaCO2 and PETCO2 variations in opposite directions; large changes in P(a-ET)CO2 between two samples; and instability of P(a-ET)CO2 over time.

Paediatric day case anaesthesia: estimate of its quality at home

The aim of this clinical audit was to evaluate the home recovery and complications of 104 daycase anaesthetized children, as well as parent satisfaction. A questionnaire, explained at the time of preoperative visit, was given to parents at hospital discharge and returned by mail. Opioids were administered in 19% of the children whereas regional anaesthesia was performed in 28% of cases. In the recovery room, 8% of them suffered pain. At home, pain was the main problem (25%) and vomiting and agitation were found in 9% and 6% of the cases respectively. Parents reported anxiety in 45% of cases, and 14% called their general practitioner. Nevertheless, 94% were satisfied with the anaesthetic. A clinical audit is useful in detecting management deficiencies. Quality of home recovery may be improved by: wider use of perioperative analgesia, systematic prescription of take-home analgesia, designation of a hospital practitioner for advice, and closer collaboration with general practitioners.

Single-breath CO2 analysis as a predictor of lung volume in a healthy animal model during controlled ventilation

OBJECTIVE

To examine the utility of single-breath CO2 analysis as a measure of lung volume.

DESIGN

A prospective, animal cohort study comparing 21 parameters derived from single-breath CO2 analysis with lung volume measurements determined by nitrogen washout in animals during controlled ventilation.

SETTING

An animal laboratory in a university-affiliated medical center.

SUBJECTS

Seven healthy lambs.

INTERVENTIONS

The single-breath CO2 analysis station consists of a mainstream capnometer, a variable orifice pneumotachometer, a signal processor and computer software with capability for both on- and off-line data analysis. Twenty-one derived components of the CO2 expirogram were evaluated as predictors of lung volume. Lung volume was manipulated by 3 cm H2O incremental increases in positive end-expiratory pressure from 0 to 21 cm H2O, and ranged between 147 and 942 mL.

MEASUREMENTS AND MAIN RESULTS

Fifty-five measurements of lung volume were available for comparison with derived variables from the CO2 expirogam. Stepwise linear regression identified four variables that were most predictive of lung volume: a) dynamic lung compliance; b) the slope of phase 3; c) the slope of phase 2 divided by the mixed expired CO2 tension; and d) airway deadspace. The multivariate equation was highly statistically significant and explained 94% of the variance (adjusted r2 =.94, p < .0001). The bias and precision of the calculated lung volume was .00 and 51, respectively. The mean percent difference for the lung volume estimate derived from the single-breath CO2 analysis station was 0.79%.

CONCLUSIONS

Our data indicate that analysis of the CO2 expirogram can yield accurate information about lung volume. Specifically, four variables derived from a plot of expired CO2 concentration vs. expired volume predict changes in lung volume in healthy lambs with an adjusted coefficient of determination of .94. Prospective application of this technology in the setting of lung injury and rapidly changing physiology is essential in determining the clinical usefulness of the technique.

Normal blood-glucose concentration which range for what?

Two definitions of normality ("isolated" or "correlated") are considered. The boundaries of "isolated" normality were determined by a statistical procedure, whereas the "correlated" approach was related to a clinical or predictive definition. In the latter case, the biological variations were considered abnormal if they implied a hazard with some significant future ailment as a risk factor. In this pragmatic approach, the upper limit of normal/abnormal variations is the point beyond which medical strategy is related to the most expected benefit when applied to a definite population or to an individual patient. The capacity of a diagnostic test to discriminate between patients with a defined risk and those without risk depends strictly on the value of the parameter chosen. In medical care for the prevention of vascular complications in diabetic patients or with foetal risks in pregnant women, the limits of the so-called normal range of glycaemia and other parameters should be determined according to the objective of the preventive and/or therapeutic measures to be prescribed.

[Must we justify our medical decisions?]

To provide an equal or better health care with limited resources, is an inescapable constraint for health care providers. Every physician and clinical decision maker must now account for economical and technical resources that are to be invested in diagnostic and therapeutic procedures, in public as well as in private medical practice. Every medical decision must be endorsed in relation with the expected benefits and risks for the patient and/or the society. Methods and protocols must provide a definite efficiency and rely on a better management of resources allowed to health services and facilities. Words, concepts and basic principles of medical decision analysis are inescapable tools to cope with uncertainty, to evaluate medical decisions according to their expected consequences, objective and subjective, for a definite patient in a bedside situation, as for a larger community. In a context of economic constraint, rational decision analysis is a prerequisite for a better quality of care, optimizing expected results, personal preferences and expenses of financial, technical and human resources in order to save time, risks and suffering.

Noninvasive determination of cardiac output in a model of acute lung injury

OBJECTIVE

To examine the utility of single breath CO2 analysis as a noninvasive measure of cardiac output in a model of acute lung injury.

SETTING

An animal laboratory in a university-affiliated medical center.

DESIGN

A prospective, animal cohort study comparing 21 parameters derived from single breath CO2 analysis with cardiac output determined by an ultrasonic flow probe.

SUBJECTS

Six adult sheep with saline lavage-induced acute lung injury.

INTERVENTIONS

Animals were treated with repetitive saline lavage to achieve a uniform degree of acute lung injury (PaO2 of < 100 torr [< 13.32 kPa] on an FIO2 of 1.0). Cardiac output was manipulated by successive injections of an hydraulic constrictor placed around the inferior vena cava and measured using an ultrasonic flow probe. Twenty-one derived components of the CO2 expirogram were evaluated as predictors of cardiac output.

MEASUREMENTS AND MAIN RESULTS

Thirty-eight measurements of cardiac output were available for comparison with derived variables from the CO2 expirogam. Stepwise linear regression identified four variables for the equation predicting cardiac output: a) PaO2/FIO2 ratio; b) the angle between the slope lines for phases II and III divided by the tidal volume; c) mixed expired CO2 tension; and d) physiologic deadspace to tidal volume ratio. The multivariate equation was highly statistically significant and explained 80% of the variance (adjusted R2 = .80, p < .0001). The blas and precision of the calculated cardiac output were .00 and .38, respectively. The mean percent difference for the cardiac output estimates derived from the single breath CO2 analysis station was -0.01%.

CONCLUSIONS

Our results indicate that changes in cardiac output can be determined using components of the CO2 expirogram with a high degree of reliability in animals with induced acute lung injury. Specifically, the use of four parameters derived from a plot of expired CO2 concentration vs. expired volume predict changes in cardiac output in adult sheep with induced lung injury with an adjusted coefficient of determination of .80. Prospective application of this technology in the clinical setting with the rapidly changing physiology that is characteristic of the acutely ill patient will be essential in determining the clinical usefulness of single breath CO2 analysis as a noninvasive measure of cardiac output.

[What should medical decision be based on?]

Medical decision making is basically related to three criteria: 1) estimated effectiveness in terms of objective and subjective results: 2) equity related to the concept of justice in the societal context; 3) legitimacy according to the willingness to pay of the society, its resource availability and the fraction of its income that is allowed to be spent for health care. A worsening dilemma is unescapable between a utilitarian medical project, and the traditional hippocratic rule of rescue no matter what the cost may be. Every care taker should be involved to give a clear account of medical decision in order to generate and adopt some acceptable view for a reliable implementation with respect to equity and justice.

High-frequency oscillatory ventilation in pediatric patients

High-frequency oscillatory ventilation (HFOV) offers the potential to maintain adequate gas exchange without imposing the large pressure swings and tidal volumes associated with ventilatory-induced lung injury. This article reviews the studies evaluating the use of HFOV to treat pediatric respiratory failure, discusses the complications associated with HFOV, and details an approach to the practical application of HFOV in the non-neonatal pediatric population.

[Severe hyperthermia caused by sudden withdrawal of continuous intrathecal administration of baclofen]

Baclofen is used for the treatment of post-traumatic spasticity. It carries a risk of overdose as well as of an acute withdrawal syndrome. We report two cases of severe hypertonia and hyperthermia (> 42 degrees C), occurring after accidental discontinuation of intrathecal infusion of baclofen. Both hypertonia and hyperthermia ceased when administration of baclofen was resumed. In parallel, the patients developed transient life-threatening alterations of hepatic (cytolysis), haematologic (coagulopathy) and cardiorespiratory functions for some days. It is concluded that the occurrence of such a withdrawal syndrome should be prevented, especially in patients with chronic intrathecal administration and first symptoms should be recognized without delay. Relationships with other malignant hyperthermias are discussed.

[Chronic cervico-brachial neuralgia treated by cervical epidural injection of corticosteroids. Long-term results]

OBJECTIVE

To assess long-term results of a single cervical epidural corticosteroid injection (CECI) in patients suffering from chronic cervicobrachial neuralgia (CCBN).

STUDY DESIGN

Open prospective study.

PATIENTS

A CECI was performed in 29 patients suffering for more than 12 months from a non-compressive and non-surgical CCBN with permanent pain for at least three months non relieved by an adequately conducted medical treatment.

METHODS

The cervical epidural space was injected (C7-T1, 18 G needle) with an increasing volume (maximum 10 mL) of isotonic saline solution to exacerbate patient's cervicobrachial pain. The patients then received an equivalent volume of 0.5% lidocaine plus triamcinolone acetonide (10 mg.mL-1). The pain decrease was estimated on a visual analogic scale (VAS), in comparison to intensity of pain rated at 100 mm before CECI.

RESULTS

The mean volume injected into the epidural space was 6 +/- 2 mL. It increased pain in 26 out of 29 patients. After 3 months, a success rate of 83% was obtained, with a pain rate of 12 mm on VAS. Concerning mid- and long-term results, pain relief remained stable for at least 24 months (mean follow-up: 48 +/- 18 months). Simultaneously, the need for analgesics decreased significantly.

CONCLUSION

A single CECI in patients suffering from non-compressive and non-surgical CCBN results in long-lasting pain relief.

Effect of timolol vs. acetazolamide on sodium hyaluronate-induced rise in intraocular pressure after cataract surgery

This prospective study was done to compare the efficacy of timolol and acetazolamide in lowering the intraocular pressure (IOP) secondary to the use of sodium hyaluronate (Healon) in cataract surgery. Fifty patients undergoing extracapsular cataract extraction and implantation of a posterior chamber lens were randomly assigned to one of four treatment groups: no viscoelastic (10 patients), Healon with 0.5% timolol drops postoperatively (12 patients), Healon with acetazolamide postoperatively (16 patients), or Healon only (12 patients). The IOP was measured during the first 24 hours after surgery. Sodium hyaluronate caused a marked increase in IOP in the early (6 to 12 hours) postoperative period. Timolol proved to be more effective than acetazolamide in controlling this pressure increase.

[Tools for the evaluation of diagnostic techniques]

This presentation focuses on evaluation of the diagnostic value of clinical findings, laboratory test results and data provided by diagnostic technologies including imaging techniques. A sign S or indicant of a disease D is a datum which is more frequent (more likely) in patients with the disease D than in subjects free of the disease D. The ratio of these two conditional probabilities is the likelihood ratio or Bayes factor of S for D. For a given test T, the number of likelihood ratios is equal to the number of different result patterns obtained with test T. The likelihood ratio reflects the role of the test result in the predictive value, i.e., the likelihood that the disease is present given the test result observed. The likelihood ratio is the tool of choice for evaluating the diagnostic value of a test. The method proposed by Spiegelhalter and Knill-Jones is based on the likelihood ratio. Evaluation of an imaging technique rests on the characteristics of the "image-physician" combination. The rating method can be used to analyze Receiver Operating Characteristic curves in view of assessing either the imaging technique or the physician's diagnostic skills.

[Choice of antibiotic treatment in otitis media]

The choice of antibiotics to be prescribed in otitis media may be guided by microbiological culture of the middle ear exudate obtained by tympanocentesis, or by direct examination and culture of purulent material obtained by myringotomy after rupture of the tympanic membrane. Otherwise, routine antibiotic prescription is based on the epidemiological frequencies of bacteria such as Streptococcus pneumoniae, Hoemophilus influenza or Strepcococcus A. In children who have infrequently received beta-lactam antibiotics, amoxicillin 50-75 mg/kg/day for 10 days may be the first choice. Children who suffer from recurrent episodes of acute otitis media may benefit from one of the three following prescriptions: amoxicillin + clavulanate (Augmentin), or an oral cephalosporin, or the erythromycin + sulfisoxazole combination (Pediazole). If recurrences are frequent and at short intervals, antibiotic prophylaxis may be effective, using penicillin V (Oracillin) 250,000 IU daily throughout the entire cold period.

[Is the qualitative research of benzodiazepines by the EMIT method and diazocopulation in accidental poisoning in children relevant?]

A retrospective study was undertaken to evaluate the relevance of benzodiazepine detection in 42 children with accidental poisoning. Immunoenzymatic assay for benzodiazepine in serum and colorimetric method in urines were positive respectively in 3 and 4 patients only. Several reasons could explain these results: the high detection threshold, the different drug reactivity according to the molecular structure and the great delay between intoxication and toxicology analysis. An advised physician should not prescribe a toxicological analysis after a small quantity of benzodiazepine ingestion.