Discrete salt crystallization at the surface of a porous medium.

Efflorescence refers to crystallized salt structures that form at the surface of a porous medium. The challenge is to understand why these structures do not form everywhere at the surface of the porous medium but at some specific locations and why there exists an exclusion distance around an efflorescence where no new efflorescence forms. These are explained from a visualization experiment, pore-network simulations and a simple efflorescence growth model.

Proportion versus absolute counts of B cell populations in the assessment of immunological profiles of kidney transplant recipients.

Immunophenotyping lymphocytes in kidney transplant recipients often raises questions as to whether proportions or absolute counts should be considered, especially for longitudinal assessment. Several studies conclude the pathophysiology of rejection based on proportions of naive and memory B cells. We compared the two analytical methods for B cells sampled from 82 clinically stable, adult kidney transplant recipients. Time post-transplant was analyzed both as a continuous variable and as tertiles (<1.5 years, 1.5-8 years, and > 8 years). B cells were stained for CD38 and IgD and were classified according to mature B cells (Bm) classification. The proportion of cells in the naive Bm2 compartment decreased by more than half in the late versus the early tertile, whereas the percentages of memory early Bm5 tripled and that of memory Bm5 cells doubled. In contrast, we observed a substantial reduction in naive B cell counts, but very stable memory B cell counts. Linear regressions showed that the absolute reduction in the Bm2 cell compartment was independent of age, sex, graft function, immunosuppression scheme, and rejection occurrence. In conclusion, the physiological reservoir of naive cells decreases over time post-transplant in kidney recipients, whereas that of memory B cells remains stable. Peripheral B subset percentages should be interpreted cautiously when analyzing pathophysiological processes.

The "3R Team" in action! Implementation of a program of learning from excellence in a neonatal and pediatric intensive care unit in France.

BACKGROUND: The pursuit of improving quality of care and of patient safety is a crucial objective in intensive care units (ICUs). Classically, safety is characterized by analyzing adverse events. Neonatal and pediatric ICUs (NICUs/PICU) are highly technological units, with evidence of risk for elevated levels of emotional exhaustion and thus a significant level of staff turnover. We hypothesized that appreciative inquiry (AI), currently used in many organizations, could be introduced in our ICU. In the PICU and NICU, this new concept is termed "learning from excellence" (LFE). OBJECTIVE: To assess the impact of the implementation of an LFE program on well-being and on an educational program in the NICU/PICU of a tertiary care center in France. METHODS: We created a workgroup composed of caregivers called the "3R team" for "right resuscitations reviews," based on the concept of AI. Before and 1 year after implementation, we administered two validated surveys-the Maslach Burnout Inventory and the Siegrist survey-to the entire staff of the 22-bed unit. RESULTS: The questionnaire on satisfaction revealed a high percentage (93%) of satisfaction with the work of the 3R team and that scores of well-being and burnout were improved. The educational program was highly enhanced, especially simulation. Benevolence and happiness were increased. CONCLUSION: Implementation of an LFE program in a NICU and PICU is feasible, and tends to increase the well-being and self-confidence of all categories of caregivers. It promotes educational programs of dynamic learning, including simulation. The next important step will be to study the impact on staff turnover and on quality of care.

Winery wastewater treatment using the land filter technique.

This study outlines a new approach to the treatment of winery wastewater by application to a land FILTER (Filtration and Irrigated cropping for Land Treatment and Effluent Reuse) system. The land FILTER system was tested at a medium size rural winery crushing approximately 20,000 tonnes of grapes. The approach consisted of a preliminary treatment through a coarse screening and settling in treatment ponds, followed by application to the land FILTER planted to pasture. The land FILTER system efficiently dealt with variable volumes and nutrient loads in the wastewater. It was operated to minimize pollutant loads in the treated water (subsurface drainage) and provide adequate leaching to manage salt in the soil profile. The land FILTER system was effective in neutralizing the pH of the wastewater and removing nutrient pollutants to meet EPA discharge limits. However, suspended solids (SS) and biological oxygen demand (BOD) levels in the subsurface drainage waters slightly exceeded EPA limits for discharge. The high organic content in the wastewater initially caused some soil blockage and impeded drainage in the land FILTER site. This was addressed by reducing the hydraulic loading rate to allow increased soil drying between wastewater irrigations. The analysis of soil characteristics after the application of wastewater found that there was some potassium accumulation in the profile but sodium and nutrients decreased after wastewater application. Thus, the wastewater application and provision of subsurface drainage ensured adequate leaching, and so was adequate to avoid the risk of soil salinisation.

Comparison of radiography and ultrasonography to detect osteochondrosis lesions in the tarsocrural joint: a prospective study.

REASONS FOR PERFORMING STUDY: Lesions located on the medial malleolus of the tarsocrural joint can be difficult to image radiographically. Ultrasonography allows evaluation of articular cartilage and subchondral bone. OBJECTIVES: To compare dorso30 degrees lateral-plantaromedial-oblique (DL-PIMO) and dorso45 degrees views to detect lesions on the medial malleolus, to validate the use of ultrasonography to show lesions in the tarsocrural joint and to compare its sensitivity to radiography. METHODS: Tarsocrural joints (n=111) with osteochondrosis were evaluated ultrasonographically and radiographically prior to arthroscopic lesion debridement. A complete radiographic examination was made and the best view to detect each lesion recorded. Longitudinal and transverse ultrasonography of the dorsal aspect of the joint was performed and the best scan plane to image each lesion recorded. RESULTS: There were 94 joints with lesions on the distal intermediate ridge of tibia, 24 with lesions on the medial malleolus, and 4 with lesions on the lateral trochlear ridge. The sensitivity of radiography to detect lesions on the medial malleolus and distal intermediate ridge of tibia was 71 and 96%, respectively. Eighty-two percent of lesions on the medial malleolus were better imaged on dorso30 degrees view. The sensitivity of ultrasonography to detect lesions on the medial malleolus and distal intermediate ridge of tibia was 83 and 98%, respectively. Ultrasonography was significantly more sensitive than radiography to detect lesions on the medial malleolus and distal intermediate ridge of tibia. CONCLUSION: Dorso30 degrees lateral-plantaromedial-oblique view was the best to image lesions on the medial malleolus. Ultrasonography was a valuable diagnostic tool to diagnose lesions in the tarsocrural joint and was more sensitive than radiography for lesions located on the medial malleolus and distal intermediate ridge of tibia. CLINICAL RELEVANCE: Radiographic examination should include a dorso30 degrees view for detection of lesions on the medial malleolus and ultrasonography should be considered to diagnose osteochondrosis in the tarsocrural joints.

Assessing the accuracy of measurements obtained by dual-energy X-ray absorptiometry on pig carcasses and primal cuts.

Accuracy, trueness, and precision of dual-energy X-ray absorptiometry (DXA) assessment of pig carcasses and primal cuts dissected tissues were evaluated using available region of interests (ROI) and Total Body and Small Animal software modes. Fat mass, lean mass, and bone mineral content (BMC) DXA values were compared to dissected tissue weights (fat, muscle, and bones). Used ROI influenced (P < 0.05) DXA measurements of BMC, fat mass, and lean mass. Configuration modes influenced (P < 0.05) DXA fat mass in shoulders and bellies, whereas BMC estimates differed (P < 0.05) among configuration modes. Equations predicting dissected composition on the basis of DXA measurements showed high coefficients of determination, particularly for fat and lean masses. DXA is able to accurately evaluate the composition of pig carcasses and primal cuts. From a methodological viewpoint, and considering the variations observed in this study, the method for image acquisition and analysis should be chosen on the basis of the item to be evaluated.

Effects of growth rate, sex and slaughter weight on fat characteristics of pork bellies.

A total of 119 Duroc×(Landrace×Yorkshire) commercial pigs were used to investigate the effect of growth rate (fast vs slow), sex (barrows vs gilts) and slaughter liveweight (107, 115 and 125kg) on the fat characteristics of bellies. Backfat thickness increased with weight (P<0.01). Fat firmness score was only affected by sex (P<0.05), with gilts showing softer bellies than barrows. Fat from gilts and slow growing pigs showed a lower proportion of saturated fatty acids (SFA; P<0.001 and P<0.01, respectively), a higher proportion of linoleic fatty acid (C18:2 n-6; P<0.01), a higher proportion of total polyunsaturated fatty acids (PUFA; P<0.001 and P<0.01, respectively), and an increased iodine value (P<0.001). Consequently, the fat from these bellies had higher PUFA:SFA ratios (P<0.001) and n-6:n-3 ratios (P<0.01 and P<0.001, respectively) than that from the bellies of barrows and fast growing pigs. The belly fat from barrows and fast growing pigs had higher stearic fatty acid (C18:0; P<0.01) and SFA proportions (P<0.001 and P<0.01, respectively) than that from gilts and slow growing pigs. The belly fat from gilts and slow growing pigs would better meet the health requirements of consumers, but it is more prone to rancidity during storage leading to a potentially reduced bacon shelf-life.

Repeatability and reproducibility of measurements obtained by dual-energy X-ray absorptiometry on pig carcasses.

The precision of a dual-energy X-ray absorptiometry (DXA) device in terms of repeatability and reproducibility was evaluated on nine left half-carcasses from pigs with large variability in body weight and fat content. Repeatability was assessed by scanning each carcass 10 times sequentially in the same position. Reproducibility was assessed by scanning each carcass in 10 different positions. Images were analyzed with DXA software using a custom region of interest (ROI) and the standard head, trunk, arm, and leg ROI. Predicted values from the DEXA for bone mineral content (BMC), bone area, bone mineral density (BMD), total weight, soft-tissue weight, fat-tissue weight, and lean-tissue weight were considered. Repeatability was associated with the variance between measurements on the same carcass in the same position (repeatability conditions). An average variance value was obtained with all the carcasses combined, and the SD was calculated as the square root of this combined variance. The CV was the ratio between the SD of the measurements and its average value. Reproducibility was calculated for each carcass as the difference between the variance obtained under the reproducibility conditions and that obtained under the repeatability conditions. The effects of the ROI and conditions were evaluated by ANOVA and Tukey's test. Means of BMC, bone area, BMD, fat tissue, and lean tissue differed among the ROI (P < 0.05) in both the repeatability and reproducibility conditions. The CV of DXA measurements under repeatability condition obtained in the head, arm, and leg ROI was lesser than 1%. Only the repeatability errors of fat tissue differed (P < 0.05) among the ROI, with the lowest precision found for the trunk ROI. The reproducibility errors of BMC, bone area, fat tissue, and lean tissue differed (P < 0.05) among the ROI. The custom ROI had reproducibility errors greater than 2% for fat tissue and greater than 3.5% for BMC and bone area. In addition, the trunk ROI had the highest reproducibility errors for fat tissue (20.7%) and lean tissue (6.2%) when compared to the other ROI. In conclusion, repeatability and reproducibility results obtained for most of the studied ROI indicate that DXA is a valuable tool for carcass evaluation. From a methodological viewpoint and considering the variations observed in this study, the ROI should be chosen based on the item to be evaluated or on the conditions in which the DXA measurements are to be taken.

The relationship between different pork carcass lean yield definitions and the market carcass value.

Cutout and dissection data from 265 carcasses were used to study the impact of the lean yield definition on their ability to discriminate lean carcasses from fat carcasses. The same data were used to evaluate the relationship between the various definitions of lean yield, such as the lean yield predicted by the Destron optical probe (LYDESTRON), the saleable meat yield (SMY), the Canadian lean yield (LY2000) and the lean meat percentage (TVM), and the market carcass value. Based on the highest number of carcasses assigned to the extreme grades (leaner and fatter), the TVM had the greatest discriminating capability based on carcass leanness. The correlation coefficients obtained between market carcass value and LYDESTRON, SMY, LY2000 and TVM were 0.14, 0.54, 0.36 and 0.23, respectively. These weak correlations demonstrate that lean yield alone does not adequately explain the variation in market value between carcasses. Lean yield therefore cannot be used to estimate market value independently of the definition used.

[Alveolar capillary dysplasia and persistent pulmonary hypertension of the newborn]. / La dysplasie alvéolo-capillaire: une cause exceptionnelle d'hypertension artérielle pulmonaire persistante du nouveau né. A propos d'un cas.

Alveolar capillary dysplasia is a rare cause of persistent pulmonary hypertension of the newborn. The diagnosis of this condition is made by histological study of a pulmonary biopsy. Familial forms and associated genitor-urinary and gastrointestinal malformations have been reported. Despite optimal management, the prognosis remains poor. The authors report the case of a neonate who developed cyanosis and cardiogenic shock on the 10th day of life. There was no associated neonatal pathology. Echocardiography showed supra-systemic pulmonary hypertension with normal cardiac structure. Pulmonary vasodilator therapies (inhaled NO, prostacyclin, sildenafil, bosentan) were ineffective and the child died on the 25th day of life. Autopsy revealed alveolar capillary dysplasia.

How to assess hemodynamic status in very preterm newborns in the first week of life?

BACKGROUND: Assessing hemodynamic status in preterm newborns is an essential task, as many studies have shown increased morbidity when hemodynamic parameters are abnormal. Although oscillometric monitoring of arterial blood pressure (BP) is widely used due to its simplicity and lack of side effects, these values are not always correlated with microcirculation and oxygen delivery. OBJECTIVES: This review focuses on different tools for the assessment of hemodynamic status in preterm newborns. These include the measurement of clinical (BP, capillary refill time and urinary output (UO)) or biological parameters (lactate analysis), functional echocardiography, and near-infrared spectroscopy (NIRS). We describe the concepts and techniques involved in these tools in detail, and examine the interest and limitations of each type of assessment. CONCLUSIONS: This review highlights the complementarities between the different parameters used to assess hemodynamic status in preterm newborns during the first week of life. The analysis of arterial BP measured by oscillometric monitoring must take into account other clinical data, in particular capillary refill time and UO, and biological data such as lactate levels. Echocardiography improves noninvasive hemodynamic management in newborns but requires specific training. In contrast, NIRS may be useful in monitoring the clinical course of infants at risk of, or presenting with, hypotension. It holds the potential for early and noninvasive identification of silent hypoperfusion in critically ill preterm infants. However, more data are needed to confirm the usefulness of this promising tool in significantly changing the outcome of these infants.

Use of transabdominal ultrasonography to determine the location of cryptorchid testes in the horse.

REASONS FOR PERFORMING STUDY: Transrectal ultrasonography is a reliable technique to identify intra-abdominal testes, but can be hazardous or impractical in fractious, juvenile or small equids. The transabdominal approach therefore requires validation. OBJECTIVES: To evaluate the sensitivity and specificity of transabdominal ultrasonography to localise cryptorchid testes. METHODS: Thirty-eight horses admitted for cryptorchidism underwent transabdominal ultrasonography to locate errant testes. Location of the testes was confirmed during surgery (n = 37) or necropsy (n = 1). RESULTS: Horses weighed 175-760 kg. Twenty-two testes were located within the abdomen, 19 in the inguinal space and 3 in a subcutaneous location. In 2 horses, a thick winter coat prevented adequate contact between the probe and the skin, and visualisation of their inguinal testis and one abdominal testis was missed during transabdominal ultrasonography. Excluding the 2 horses with excessive hair, the sensitivity of transabdominal ultrasonography to locate errant testes was 97.6% (93.2% when all horses were included), and its specificity 100%. CONCLUSIONS: Transabdominal ultrasonography is a reliable, safe and immediate technique to diagnose cryptorchidism precisely in horses of all ages, sizes and temperaments. POTENTIAL RELEVANCE: Transabdominal ultrasonography provides an immediate definitive diagnosis of adominal cryptorchidism and should enhance selection of an appropriate surgical approach for their removal.

Effects of slaughter weight on carcass composition and meat quality in pigs of two different growth rates.

Three hundred and forty (340) Duroc×(Landrace×Yorkshire) crossbred piglets were allotted to a 2×2×3 factorial design experiment. The independent variables were the growth rate (fast: around -10 days at 100kg and slow: around +2 days at 100kg), based on two different EBV's (estimated breeding value) of the sire-line for age, the sex (barrows and gilts) and the live weight at slaughter (107, 115 and 125kg). A sub-population of 119 pigs (10 carcasses per treatment) was selected for the carcass and meat quality evaluation trials. As live weight increased there were significant increases in hot carcass weight and dressing percentage (P<0.05). Lean, fat and bone proportions were not affected by weight. Gilts had higher lean proportion (P<0.05) than barrows. Furthermore, carcasses of fast growing pigs were fatter (P<0.05) than those of slower growing ones. Loin muscle pH, drip loss and reflectance values did not vary significantly with any of the treatments. Intramuscular fat was higher in barrows (P<0.05) than in gilts and soluble collagen content decreased with increasing weight (P<0.05). Muscle protein (%) increased (P<0.05) from 107 to 115kg and gilts had a higher (P<0.05) content than castrates. No evidence was found that increasing slaughter weight detracts from carcass characteristics or meat quality.

The use of dual-energy X-ray absorptiometry to estimate the dissected composition of lamb carcasses.

A total of 140 male and female Dorset and Suffolk lambs were slaughtered according to four live weight classes (36-39kg, 41-44kg, 46-49kg and 51-54kg). Total tissue, fat and lean masses, and bone mineral content measured by dual-energy X-ray absorptiometry (DXA) were used to predict dissected tissue weights. The DXA total weights accurately predict half-carcasses and primal cuts weights (shoulder, leg, loin and flank) (R(2)>0.99, CVe<1.3%). The prediction of the half-carcass dissected fat percentage is weaker (R(2)=0.77, CVe=10.4%). Fatness prediction accuracy is equivalent for the shoulder, leg and loin (R(2) between 0.68 and 0.78, CVe between 10% and 13%). The R(2) obtained when predicting dissected lean content from DXA variables is 0.93 for the half-carcass and higher than 0.83 for all cuts other than flank (CVe are between 3.5% and 6.5%, except for the flank, which is 9.1%). The prediction of bone weight using the bone mineral content is not very accurate for the half-carcass, shoulder and leg (R(2): 0.48, 0.47 and 0.43; CVe: 10.2%, 12.0% and 11.6%, respectively). The situation improves, however, for the loin (R(2)=0.70, CVe=10.7%). In conclusion, DXA is an effective technology for predicting total weight and the amount of lean and fat in lamb carcasses and their primal cuts.

[B-natriuretic peptide and cardiological emergencies in childhood]. / Peptide natriurétique de type B et urgences cardiologiques chez l'enfant.

The increase in B-natiuretic peptide (BNP) is well correlated with cardiovascular symptoms in adults. Its use in children is recent and only partially evaluated. The authors undertook a prospective study of BNP concentrations and its kinetics in 54 children with an average age of 15 months (5 days to 11 years) admitted as paediatric emergencies. The symptoms were dyspnoea (60%), shock (15%), suspicion of Kawasaki disease (15%) and other (10%). Twenty children had BNP levels of more than 100 pg/ml related to decompensation of known congenital heart disease in 7 patients (average BNP 462 +/- 323 pg/ml), due to neonatal coarctation in 2 patients (BNP > 3000 pg/ml), due to cardiomyopathy in 6 patients (BNP= 2576 +/- 1215 pg/ml), due to an arrhythmia in 1 patient (BNP= 3754 pg/ml) and to Kawasaki disease in 4 patients (BNP= 521 +/- 448 pg/ml). Thirty-four children had BNP values of less than 100 pg/ml; 29 had no cardiac disease and 5 had known congenital heart disease with other symptoms. Measuring BNP is quick and economical and is a valuable aid in the diagnosis of cardiac dysfunction in symptomatic children in the emergency room. High BNP values seem to be correlated with the severity of the cardiac disease. Low BNP values seem to have a good negative predictive value in children without underlying cardiac disease. The interpretation of intermediary values, especially when there is previous cardiac disease, is more difficult in view of the absence of known threshold values for different haemodynamic situations. Further studies are required to determine the value of this test for the follow-up and setting up of prognostic values in children with congenital heart disease.

[Antenatal closure of ductus arteriosus following maternal intoxication by niflumic acid]. / Fermeture anténatale du canal artériel chez un foetus suite à une intoxication maternelle par acide niflumique.

Antenatal closure of the ductus arteriosus is an uncommon event that has been considered as a risk factor for development of congestive heart failure and persistent pulmonary hypertension of the newborn. We report here on a case of antenatal ductus arteriosus closure due to niflumic acid maternal intoxication at 32 weeks of gestation. Fetal extraction was performed few days later because of echographic signs of congestive heart failure. The child survived after 3 days of severe persistent pulmonary hypertension. This case emphasizes the potential risk of niflumic acid during pregnancy and the need of antenatal echographic monitoring for optimal management.

[Fulminant myocarditis presenting like acute myocardial infarction in a 6-year-old girl]. / Myocardite aiguë fulminante mimant un infarctus du myocarde chez une enfant de 6 ans.

Acute myocarditis is a rare inflammatory cardiac disease in children with potentially fatal issue. Clinical findings are very variable from nausea and vomiting to acute cardiovascular collapse. The cardiac function can be reversible with circulatory support. We report the case of a 6-year-old girl with ECG changes like myocardial infarction and diagnosis of fulminant myocarditis. She developped rapidly a cardiogenic shock and died before treatment with mechanical circulatory support.

[Severe chloralose intoxication in a toddler]. / Intoxication sévère par le chloralose chez un nourrisson.

UNLABELLED: We report a case of an accidental intoxication in a 20-month-old boy resulting from the ingestion of a rodenticide containing alpha-chloralose. CASE REPORT: Three hours after initial admission to the pediatric emergency department for wheezing bronchitis, this patient was readmitted with a clinical presentation of respiratory insufficiency, a Glasgow coma score of 9 alternating with agitation, areflexia and unilateral mydriasis. Parental interview revealed he had episodes of shaking in the afternoon. Chest x-ray showed thoracic distension. Blood investigations, electrocardiogram, cardiac echography, brain CT scan and CSF were normal. Electroencephalography registered slow delta waves 2-3 cycles/min and an aspect of degraded waves and spikes. The patient was transferred to the intensive care unit where he fully recovered within 48 hours. A second parental interview and clinical presentation confirmed an intoxication with a rodenticide containing alpha-chloralose. The late clinical orientation did not allow us to perform a urinanalysis. DISCUSSION: Clinical association of coma, spontaneous or triggered myoclonias and bronchial hypersecretion are indicative of chloralose intoxication. Presence of specific abnormalities on electroencephalogram and a positive Fujiwara-Ross reaction in an urine sample are additional elements for the diagnosis. The prognosis is usually good after early management which combines gastric lavage, activated charcoal, sedation with benzodiazepines, tracheal intubation and artificial ventilation if required. Severe clinical cases described in voluntary intoxications in adults and teenagers occur very rarely in toddlers.

[Very large cardiac tumor revealed by ventricular arrhythmia in a 18-month-old infant]. / Volumineuse tumeur cardiaque révélée par un trouble du rythme ventriculaire chez un nourrisson de 18 mois.

Cardiac tumors are rare in childhood and can be revealed by arrhythmias. We report the observation of an 18-month-old infant who had an episode of ventricular tachycardia (VT) which resulted in a large intramyocardic tumour diagnosis evocating a left ventricular fibroma. A treatment by amiodarone allowed a stable reduction of the VT. The presence of an intracardiac obstruction or uncontrollable arrhythmias would lead to a surgical resection.