Incidence and risk factors of hypoxaemia after preoxygenation at induction of anaesthesia.

BACKGROUND: The incidence of hypoxaemia related to airway management is still a matter of concern. Our aim was to determine the factors that contribute to hypoxaemia during induction of anaesthesia after a standardised preoxygenation procedure. METHODS: The study was a multicentre and prospective observational trial. It evaluated the incidence of hypoxaemia at induction of anaesthesia in adult patients. The primary endpoint was the incidence of hypoxaemia defined as pulse oximetry of arterial oxyhaemoglobin saturation (SpO2) <95%. RESULTS: Of 2398 patients, hypoxaemia was observed in 158 (6.6%). We identified five preoperative independent risk factors: chronic obstructive pulmonary disease, hypertension, anticipated difficult mask ventilation and difficult tracheal intubation, and emergency surgery. There were also three pre-induction independent risk factors: difficult preoxygenation, difficult mask ventilation, and difficult tracheal intubation. We found a high negative predictive value of preoperative risk factors for difficult mask ventilation of 0.96 (0.95-0.96), and for difficult tracheal intubation (0.95 [0.94-0.96]). A total of 723 patients (30%) experienced difficult preoxygenation (FeO2 <90% at the end of preoxygenation). Male sex, chronic obstructive pulmonary disease, hypertension, emergency surgery, and predictable difficult mask ventilation were independent patient risk factors for difficult preoxygenation. CONCLUSIONS: Difficult mask ventilation and difficult tracheal intubation are risk factors for hypoxaemia at induction of general anaesthesia. Difficult preoxygenation was observed in 30% of patients and was also identified as a risk factor for hypoxaemia. This suggests that techniques improving preoxygenation should be implemented in daily practice.

Nurses' and physicians' approaches to delirium management in the intensive care unit: A focus group investigation.

BACKGROUND: Delirium in the intensive care unit (ICU) is common, but reliable evidence-based recommendations are still limited. OBJECTIVES: The aim of our study was to explore nurses' and physicians' experiences and approaches to ICU delirium management. METHOD: Our study had a qualitative multicentre design using interdisciplinary focus groups and framework analysis. Participants were strategically selected to include nurses and physicians with experience in delirium management at five ICUs in four out of five regions in Denmark. RESULTS: We conducted eight focus group interviews with 24 nurses and 15 physicians; median ICU experience was 9 years (range 1-35). The main issues identified were (1) the decision to treat or not to treat ICU delirium based on delirium phenotype, (2) the decision to act based on experience or evidence, and (3) the decision to intervene using nursing care or medications. ICU delirium was treated with pharmacological interventions in patients with signs of agitation, hallucinations, and sleep deprivation. The first choice of agent was haloperidol or olanzapine. Agitated and combative patients received benzodiazepines, propofol, or dexmedetomidine. Calm delirious patients were managed with non-pharmacological solutions. Physicians recommended pro re nata (PRN) orders to prevent over medication, whereas nurses opposed PRN orders with the fear that it would increase their responsibilities. CONCLUSION: Our study described an algorithm of contemporary delirium management in Danish ICUs based on qualitative inquiry. When evidence-based solutions are unclear, nurses and physicians rely on personal experience, collective experience, and best available evidence to determine which patients to treat and what methods to use to treat ICU delirium. Delirium management still needs clear objectives and guidelines with evidence-based recommendations for first-line treatment and subsequent treatment options.

Case-control study found that primary language disorders were associated with screen exposure.

AIM: We explored the associations between childhood exposure to screens, including televisions, computers, game consoles, tablets and smartphones and primary language disorders. METHODS: This multi-centre case-control study comprised 167 children aged 3.5-6.5 years, who were born in 2010-2012 and diagnosed with primary language disorders, and 109 matched controls without language disorders. Questionnaires were completed by their parents who were recruited by 16 family doctors and 27 speech and language therapists in the Ille-et-Vilaine region of France. The data were analysed using a multivariate logistic regression model and presented as adjusted odds ratios (aOR) and 95% confidence intervals (95% CI). RESULTS: We found that cases (44.3%) and controls (22.0%) exposed to screens in the morning before nursery or primary school were three times more likely to develop primary language disorders (aOR 3.40, 95% CI 1.60-7.23). When this risk was combined with rarely or never discussing screen content with their parents (aOR 2.14, 95% CI 1.01-4.54) they were six times more likely to have language problems (aOR 5.86, 95% CI 1.44-23.95). CONCLUSION: Being exposed to screens in the morning before school, and rarely or never discussing screen content with parents, meant children were six times more likely to develop primary language disorders.

Development of an ICU discharge instrument predicting psychological morbidity: a multinational study.

PURPOSE: To develop an instrument for use at ICU discharge for prediction of psychological problems in ICU survivors. METHODS: Multinational, prospective cohort study in ten general ICUs in secondary and tertiary care hospitals in Sweden, Denmark and the Netherlands. Adult patients with an ICU stay ≥ 12 h were eligible for inclusion. Patients in need of neurointensive care, with documented cognitive impairment, unable to communicate in the local language, without a home address or with more than one limitation of therapy were excluded. Primary outcome was psychological morbidity 3 months after ICU discharge, defined as Hospital Anxiety and Depression Scale (HADS) subscale score ≥ 11 or Post-traumatic Stress Symptoms Checklist-14 (PTSS-14) part B score > 45. RESULTS: A total of 572 patients were included and 78% of patients alive at follow-up responded to questionnaires. Twenty percent were classified as having psychological problems post-ICU. Of 18 potential risk factors, four were included in the final prediction model after multivariable logistic regression analysis: symptoms of depression [odds ratio (OR) 1.29, 95% confidence interval (CI) 1.10-1.50], traumatic memories (OR 1.44, 95% CI 1.13-1.82), lack of social support (OR 3.28, 95% CI 1.47-7.32) and age (age-dependent OR, peak risk at age 49-65 years). The area under the receiver operating characteristics curve (AUC) for the instrument was 0.76 (95% CI 0.70-0.81). CONCLUSIONS: We developed an instrument to predict individual patients' risk for psychological problems 3 months post-ICU, http://www.imm.ki.se/biostatistics/calculators/psychmorb/ . The instrument can be used for triage of patients for psychological ICU follow-up. TRIAL REGISTRATION: The study was registered at clinicaltrials.gov, NCT02679157.

Validated chromatographic method for the simultaneous determination of eight drugs (morphine, ropivacaine, bupivacaine, baclofen, clonidine, sufentanil, fentanyl and ziconotide) for intrathecal analgesia.

Intrathecal analgesia has increased over the past two decades in various indications: chronic refractory pain from cancerous or non-cancerous origins, spasticity. These different indications involve the use of different molecules alone or in combination such as morphine, ropivacaine, bupivacaine, fentanyl, sufentanil, clonidine, baclofen and ziconotide. Pump refills are prepared at the pharmacy under a laminar flow hood. An analytical control should be carried out before release of the preparation. A new method of analytical control by chromatography has been developed and validated according to the International Conference on Harmonization guideline in order to secure the production process.

Haloperidol for delirium in critically ill patients - protocol for a systematic review.

BACKGROUND: In the intensive care unit, the prevalence of delirium is high. Delirium has been associated with morbidity and mortality including more ventilator days, longer intensive care unit stay, increased long-term mortality, and cognitive impairment. Thus, the burden of delirium for patients, relatives, and societies is considerable. The objective of this systematic review was to critically access the evidence of randomised clinical trials on the effects of haloperidol vs. placebo or any other agents for delirium in critically ill patients. METHODS: We will search for randomised clinical trials in the following databases: Cochrane Library, MEDLINE, EMBASE, Science Citation Index, BIOSIS, Cumulative Index to Nursing and Allied Health Literature, Latin American and Caribbean Health Sciences Literature, and Allied and Complementary Medicine Database. Two authors will independently screen and select references for inclusion using Covidence, extract data and assess the methodological quality of the included randomised clinical trials using the Cochrane risk of bias tool. Any disagreement will be resolved by consensus. We will analyse the extracted data using Review Manager, STATA 15, and Trial Sequential. ANALYSIS: The aim of this study was to assess the quality of the evidence, we will create a 'Summary of Findings' table containing our primary and secondary outcomes using the GRADE assessment. DISCUSSION: Our ambition with this systematic review is to provide reliable and powered evidence to better inform decision makers on the use of or future trials with haloperidol for the management of delirium in critically ill patients.

Development and internal validation of the Simplified Mortality Score for the Intensive Care Unit (SMS-ICU).

BACKGROUND: Intensive care unit (ICU) mortality prediction scores deteriorate over time, and their complexity decreases clinical applicability and commonly causes problems with missing data. We aimed to develop and internally validate a new and simple score that predicts 90-day mortality in adults upon acute admission to the ICU: the Simplified Mortality Score for the Intensive Care Unit (SMS-ICU). METHODS: We used data from an international cohort of 2139 patients acutely admitted to the ICU and 1947 ICU patients with severe sepsis/septic shock from 2009 to 2016. We performed multiple imputations for missing data and used binary logistic regression analysis with variable selection by backward elimination, followed by conversion to a simple point-based score. We assessed the apparent performance and validated the score internally using bootstrapping to present optimism-corrected performance estimates. RESULTS: The SMS-ICU comprises seven variables available in 99.5% of the patients: two numeric variables: age and lowest systolic blood pressure, and five dichotomous variables: haematologic malignancy/metastatic cancer, acute surgical admission and use of vasopressors/inotropes, respiratory support and renal replacement therapy. Discrimination (area under the receiver operating characteristic curve) was 0.72 (95% CI: 0.71-0.74), overall performance (Nagelkerke's R2 ) was 0.19 and calibration (intercept and slope) was 0.00 and 0.99, respectively. Optimism-corrected performance was similar to apparent performance. CONCLUSIONS: The SMS-ICU predicted 90-day mortality with reasonable and stable performance. If performance remains adequate after external validation, the SMS-ICU could prove a valuable tool for ICU clinicians and researchers because of its simplicity and expected very low number of missing values.

Frequency of the Val1016Ile mutation on the kdr gene in Aedes aegypti (Diptera: Culicidae) in south Brazil.

Recently, the number of Aedes aegypti foci has increased in west of Santa Catarina, south Brazil, which has increased concern regarding mosquito-borne disease outbreaks such as dengue fever, Zika virus, and chikungunya. Therefore, it is important to monitor genetic resistance to insecticides through "knockdown resistance". Homozygosity (Ile/Ile) at position 1016 in the coding region of a voltage-dependent sodium channel gene (Nav) may induce resistance to pyrethroid insecticides. We evaluated the frequency of these alleles in A. aegypti in west Santa Catarina. In total, 349 specimens were obtained from the microregions of Joaçaba (31), Concórdia (35), Chapecó (154), and São Miguel do Oeste (129). We found that 109 individuals (31.0%) were homozygous for Val/Val, 102 (29.0%) were heterozygous for Val/Ile, and 138 (40.0%) were homozygous for Ile/Ile. The allele frequencies were similar for Val (0.455) and Ile (0.545). Joaçaba and Concórdia had the highest mutant allele frequencies (0.825 and 0.685, respectively). Therefore, these populations should be monitored for increases in pyrethroid resistance. The São Miguel do Oeste and Chapecó populations had similar frequencies of Val and Ile and were not in Hardy-Weinberg equilibrium, suggesting that a selection pressure or other evolutionary force has occurred. In conclusion, the observed frequency of Ile/Ile homozygous individuals in the region studied requires attention, because the implementation of controls using pyrethroid may increase the frequency of the mutant allele through the selection of resistant populations.

Direct observation of dynamic modes excited in a magnetic insulator by pure spin current.

Excitation of magnetization dynamics by pure spin currents has been recently recognized as an enabling mechanism for spintronics and magnonics, which allows implementation of spin-torque devices based on low-damping insulating magnetic materials. Here we report the first spatially-resolved study of the dynamic modes excited by pure spin current in nanometer-thick microscopic insulating Yttrium Iron Garnet disks. We show that these modes exhibit nonlinear self-broadening preventing the formation of the self-localized magnetic bullet, which plays a crucial role in the stabilization of the single-mode magnetization oscillations in all-metallic systems. This peculiarity associated with the efficient nonlinear mode coupling in low-damping materials can be among the main factors governing the interaction of pure spin currents with the dynamic magnetization in high-quality magnetic insulators.

Direct and indirect genetic effects of sex-specific mitonuclear epistasis on reproductive ageing.

Mitochondria are involved in ageing and their function requires coordinated action of both mitochondrial and nuclear genes. Epistasis between the two genomes can influence lifespan but whether this also holds for reproductive senescence is unclear. Maternal inheritance of mitochondria predicts sex differences in the efficacy of selection on mitonuclear genotypes that should result in differences between females and males in mitochondrial genetic effects. Mitonuclear genotype of a focal individual may also indirectly affect trait expression in the mating partner. We tested these predictions in the seed beetle Callosobruchus maculatus, using introgression lines harbouring distinct mitonuclear genotypes. Our results reveal both direct and indirect sex-specific effects of mitonuclear epistasis on reproductive ageing. Females harbouring coadapted mitonuclear genotypes showed higher lifetime fecundity due to slower senescence relative to novel mitonuclear combinations. We found no evidence for mitonuclear coadaptation in males. Mitonuclear epistasis not only affected age-specific ejaculate weight, but also influenced male age-dependent indirect effects on traits expressed by their female partners (fecundity, egg size, longevity). These results demonstrate important consequences of sex-specific mitonuclear epistasis for both mating partners, consistent with a role for mitonuclear genetic constraints upon sex-specific adaptive evolution.

Generation of coherent spin-wave modes in yttrium iron garnet microdiscs by spin-orbit torque.

In recent years, spin-orbit effects have been widely used to produce and detect spin currents in spintronic devices. The peculiar symmetry of the spin Hall effect allows creation of a spin accumulation at the interface between a metal with strong spin-orbit interaction and a magnetic insulator, which can lead to a net pure spin current flowing from the metal into the insulator. This spin current applies a torque on the magnetization, which can eventually be driven into steady motion. Tailoring this experiment on extended films has proven to be elusive, probably due to mode competition. This requires the reduction of both the thickness and lateral size to reach full damping compensation. Here we show clear evidence of coherent spin-orbit torque-induced auto-oscillation in micron-sized yttrium iron garnet discs of thickness 20 nm. Our results emphasize the key role of quasi-degenerate spin-wave modes, which increase the threshold current.

[Management and outcomes of pregnancies complicated by preterm premature rupture of membranes before 26 weeks of gestation]. / Prise en charge et issues des grossesses compliquées d'une rupture prématurée des membranes avant 26 semaines d'aménorrhée.

OBJECTIVE: To evaluate short-term outcomes of pregnancies complicated by preterm premature rupture of membranes (PPROM) before 26 weeks of gestation (wg). PATIENTS AND METHODS: Forty patients were included in a retrospective study from 1998 to 2008. RESULTS: Fifty percent of PPROM occurred before 23 wg. Survival rate was 21.4% when PPROM occurred before 22 wg versus 54.5% when it occurred between 22 and 23+6 wg and reached 80% after 24 wg (P=0.006). Perinatal mortality affected more frequently primigravida women (OR=5.16; IC9 5% [0.99-36.59]). Invasive procedures before PPROM did not affect survival rates. Smoking induced shorter latency (19.1±13.8 vs. 40.3±2.3j; P=0.01). Chorioamnionitis complicated all pregnancies terminated before 26 wg versus 50% of pregnancies terminated after 26 wg (P=0.02). In case of chorioamnionitis, 70% of the germs were identified prenatally. Patients whose CRP was higher than 6 mg/L at the time of PPROM had a higher fetal mortality rate (63.6% vs. 27.8%; P=0.02; OR=4.3; IC95% [0,99-22,1]). No significant difference was found in the occurrence of chorioamnionitis based on gestational age at PPROM, result of the vaginal swab on admission or the amount of amniotic fluid. DISCUSSION AND CONCLUSION: The gestational age of PPROM and the one of delivery are the major prognostic factors. Primigravida women are more exposed to perinatal mortality. CRP appears to be a predictive factor of perinatal mortality.

[Puberty, fertility and chronic diseases]. / Puberté, fertilité et maladies chroniques.

The onset of puberty is the sum of complex and multifactorial mechanisms resulting from the action of both activating and inhibiting factors, leading to the maturation of the gonads and the ability to reproduce. Many contributors to pubertal development are involved in fat mass acquisition and their action is relayed through the hypothalamus. It is therefore easy to understand how chronic diseases can affect the development of puberty and fertility apart from the specific impact of their molecular alteration. We have chosen cystic fibrosis and chronic renal disease as examples of chronic disorders affecting puberty through distinct mechanisms. As drugs are undistinguishable from chronic diseases, we also describe the impact of corticosteroids and chemotherapy on reproductive function. Last, we describe the surveillance and care of pubertal delay and its consequences (growth and bone mineralization) of patients affected with chronic disorders during adolescence.

[Vaccination coverage in 6-year-old preschool children, France, 2005-2006]. / Couverture vaccinale des enfants âgés de 6ans, scolarisés en grande section de maternelle, France, 2005-2006.

INTRODUCTION: School-based triennial surveys have been implemented in France since 1999 in order to follow up indicators estimating children's health status, including vaccination coverage. METHODS: The survey was conducted in 2005-2006 in preschools, using a two-stage cross-sectional sampling design (first sampling schools, with pupils then randomly chosen). RESULTS: Among all the children targeted by the survey, 21,346 of them were selected to show their health booklet (carnet de santé) in which the vaccination part was completed. Vaccination coverage was high for vaccines against tuberculosis (BCG 96.8 %), diphtheria, tetanus, poliomyelitis (four doses: 95.6 %), pertussis (four doses: 95.0 %), Haemophilus influenzae type b (four doses: 89.9 %) and for the first dose of the measles, mumps, and rubella vaccine (MMR 93.7 %, 91.4 %, 91.4 %). It was low for the second dose of MMR (45.1 %, 43.2 %, and 43.3 %) and for hepatitis B (37.9 %). The region where the child attended school, the size of the urban unit, the school sector, the father's profession, and the child's birth rank were associated with MMR (second dose) and hepatitis B coverage. DISCUSSION - CONCLUSION: In 2005-2006, vaccination coverage for BCG, DTPolio, pertussis, and Hib was stable and satisfactory in 6-year-old children. MMR (first dose) and hepatitis B coverage were insufficient. MMR coverage (second dose) had increased since 2002 but still needs to be improved.

6-micron interaction length electro-optic modulation based on lithium niobate photonic crystal cavity.

We report on electro-optic modulation using a Lithium Niobate (LN) Photonic Crystal (PC) cavity structure. The compact device (6 µm in length) consists of a 2D photonic crystal cavity made on an Annealed Proton Exchange (APE) LN waveguide with vertical deposited electrodes. Experimental results show a tunability of 0.6 nm/V. This compact design opens a way towards micro and nano-scale tunable photonic devices with low driving electrical power.

Enhanced electro-optical lithium niobate photonic crystal wire waveguide on a smart-cut thin film.

We report an electro-optically tunable photonic crystal linear cavity etched on a 200 nm lithium niobate waveguide ridge. The photonic crystal cavity and the ridge are both fabricated on a 1 µm thin film of lithium niobate obtained by smart-cut technology. The photonic crystal, of area 4x0.8 µm2, has been engineered to work in a slow light configuration so that the electro-optic effect is 20 times more important than in bulk material.

The cytotoxic effect of combined hyperthermia and taxane chemotherapy on ovarian cancer cells: results of an in vitro study.

PURPOSE: Hyperthermic intraperitoneal chemotherapy (HIPEC) is under continuous evaluation as a potential treatment for ovarian cancer. The purpose of this study was to evaluate the effect of chemotherapy, drug concentration and temperature. MATERIALS AND METHODS: We examined the combined effects of hyperthermia and taxane chemotherapy on the clonogenic survival of the human ovarian carcinoma SHIN-3 cell line in vitro. RESULTS: When hyperthermia was combined with chemotherapy, the median lethal dose (LD50) was equivalent regardless of the duration of exposure, and was independent of the exposure temperature. Taxanes showed a similar LD50 over the temperature range tested. CONCLUSIONS: In our study, hyperthermia does not increase the cytotoxic effects of taxanes, at least for the concentrations and durations tested.

[Quantitative assessment of medical students' clinical practical learning in department of obstetrics and gynecology of Brest Hospital University]. / Évaluation quantitative de l'enseignement pratique des étudiants hospitaliers en gynécologie-obstétrique au CHU de Brest.

OBJECTIVE: The main objective of this study was to describe how medical students got progressively trained to perform the most frequent medical procedures in obstetrics and gynecology. The secondary objective was to rationalize and plan the training. METHODS: The medical students in our University Hospital were contacted either directly or by e-mail. They were given an anonymous simple choice questionnaire relating to eight most important acts in the specialty. RESULTS: Three hundred and eighty-two medical students have been consulted. We got 173 answers which means a participation rate of 45.3%. The survey showed up that the considered procedures were progressively put into practice with the exception of two: the insertion of an intrauterine contraceptive device (coil) and of an implant. CONCLUSION: The study showed off some insufficiency in the training in two of the considered procedures. An amendment was proposed with simulated performances of the acts and the setting up of a training course booklet.

Ellipsometric and Rutherford Back scattering Spectrometry studies of SiO(X)N(Y) films elaborated by plasma-enhanced chemical vapour deposition technique.

Silicon oxynitride (SiO(X)N(Y)) thin films were deposited by plasma-enhanced chemical vapour deposition technique (PECVD) from silane (SiH4), nitrous oxide (N2O), ammonia (NH3) and nitrogen (N2) mixture. Spectroscopic ellipsometry (SE), in the range of wavelengths 450-900 nm, was used to define the film thickness and therefore the deposition rate, as well as the refractive index as a function of the N2O gaseous flow. While considering the (Si3N4, SiO2, H2 or void) heterogeneous mixture, Maxwell Garnett (MG) theory allows to fit the SE measurements and to define the volume fraction of the different phases. Finally, Rutherford Backscattering Spectrometry (RBS) results showed that x = O/Si ratio increases gradually with increasing the N2O flow, allowing the correlation of the SiO(X)N(Y) films main parameters.

[Breastfeeding in a population of preterm infants: a prospective study in a university-affiliated hospital]. / Allaitement maternel du nouveau-né prématuré : évaluation prospective dans une maternité universitaire.

AIMS: To evaluate mothers' breastfeeding intention at birth and the breastfeeding rate at hospital discharge and at 3 months of life in a population of preterm infants. To study the relation between gestational age and the breastfeeding rate at birth. To analyze sociodemographic and neonatal factors that could influence breastfeeding rate. METHODS: We present a prospective study concerning preterm infants born between November 1st 2006 and April 20th 2007 at Brest University Hospital. Exclusion criteria were: death during hospitalization and neurological or digestive diseases not allowing enteral feeding. The following data were extracted from medical charts: birth weight, gestational age, medical care in the neonatal period, delivery circumstances, and feeding mode at hospital discharge. Mothers were asked their sociodemographic status and their intention to breastfeed. Parents were contacted 3 months later to determine the feeding mode at that time. Risk factors were studied for single births through univariate and multivariate analysis. RESULTS: We recruited 149 mother-infant dyads. There were 9 lost to follow-up at 3 months. Breastfeeding rates were: 69.13% (range: 61.7-76.5) at birth, 57.82% (range: 49.8-65.8) at hospital discharge, and 33.57% (range: 25.9-41.7) at 3 months. There was an inverse relation between breastfeeding rate and gestational age: OR=0.07 (0; 0.50). Other factors significantly associated with a high breastfeeding rate were: mother's high level of education: OR=3.19 (1.39; 7.33) and low birth weight: OR=0.20 (0.08; 0.53). CONCLUSION: Our breastfeeding rates are lower than recommended by WHO. Mothers of late preterm infants or with a low socioeconomic status should benefit from supportive care.