Adverse events during nursing care procedure in intensive care unit: The PREVENIR study.

OBJECTIVES: Intensive care unit patients undergo several nursing care procedures (NCP) every day. These procedures involve a risk for adverse events (AE). Yet, their prevalence, intensity, and predisposing risk factors remain poorly established. The main objective of the study was to measure the incidence and severity of NCP related AE. DESIGN: This prospective observational multicentre study was conducted in 9 ICUs. All NCP were recorded for four consecutive weeks. For each NCP, the following were collected: patients' baseline characteristics, type of NCP, characteristics of the NCP, AE and therapeutic responses. RESULTS: 5849 NCP occurred in 340 patients. Among the 340 patients included, 292 (85.9%) were affected by at least one AE, and 141 (41.5%) by an SAE during a NCP. Thirty % of NCP were associated with at least one AE: hemodynamic AE in 17.1%, respiratory AE in 13.6%, agitation and pain (3.7% and 3.3%). Eight invasive devices were accidentally removed. Severe Adverse Events (SAE) occurred in 5.5% of NCP. The main risk factor associated with SAE was pain/agitation at the beginning of the NCP. CONCLUSION: AE are frequent during NCP in ICU. We identified several risk factors, some of them preventable, that could be considered for the development of recommendations for the nursing care of critically ill patients. TRIAL REGISTRATION: ClinicalTrials.gov NCT02881645.

Fluorogenic Bifunctional trans-Cyclooctenes as Efficient Tools for Investigating Click-to-Release Kinetics.

The inverse electron demand Diels-Alder pyridazine elimination reaction between tetrazines and allylic substituted trans-cyclooctenes (TCOs) is a key player in bioorthogonal bond cleavage reactions. Determining the rate of elimination of alkylamine substrates has so far proven difficult. Here, we report a fluorogenic tool consisting of a TCO-linked EDANS fluorophore and a DABCYL quencher for accurate determination of both the click and release rate constants for any tetrazine at physiologically relevant concentrations.

Two new African siblings of Pulveroboletusravenelii (Boletaceae).

This paper sorts out the taxonomy of species affiliated with Pulveroboletusravenelii in the Guineo-soudanian and Zambezian woodlands of Africa. Morphological and genetic characters of African Pulveroboletus collections were studied and compared to those of North American and Asian species. A phylogenetic analysis showed that the African specimens form a subclade, sister to the Asian and American taxa. Although clamp connections have previously never been reported from Pulveroboletus, all specimens of the African subclade show very small clamp connections. Two new African species, Pulveroboletusafricanus sp. nov. and P.sokponianus sp. nov., are described and illustrated. Comments concerning morphology and identification, as well as distribution and ecology, are given for both species.

Secondary organic aerosol origin in an urban environment: influence of biogenic and fuel combustion precursors.

Source contributions of organic aerosol (OA) are still not fully understood, especially in terms of quantitative distinction between secondary OA formed from anthropogenic precursors vs. that formed from natural precursors. In order to investigate the OA origin, a field campaign was carried out in Barcelona in summer 2013, including two periods characterized by low and high traffic conditions. Volatile organic compound (VOC) concentrations were higher during the second period, especially aromatic hydrocarbons related to traffic emissions, which showed a marked daily cycle peaking during traffic rush hours, similarly to black carbon (BC) concentrations. Biogenic VOC (BVOC) concentrations showed only minor changes from the low to the high traffic period, and their intra-day variability was related to temperature and solar radiation cycles, although a decrease was observed for monoterpenes during the day. The organic carbon (OC) concentrations increased from the first to the second period, and the fraction of non-fossil OC as determined by (14)C analysis increased from 43% to 54% of the total OC. The combination of (14)C analysis and Aerosol Chemical Speciation Monitor (ACSM) OA source apportionment showed that the fossil OC was mainly secondary (>70%) except for the last sample, when the fossil secondary OC only represented 51% of the total fossil OC. The fraction of non-fossil secondary OC increased from 37% of total secondary OC for the first sample to 60% for the last sample. This enhanced formation of non-fossil secondary OA (SOA) could be attributed to the reaction of BVOC precursors with NOx emitted from road traffic (or from its nocturnal derivative nitrate that enhances night-time semi-volatile oxygenated OA (SV-OOA)), since NO2 concentrations increased from 19 to 42 µg m(-3) from the first to the last sample.

Dielectric Investigation of Parylene D Thin Films: Relaxation and Conduction Mechanisms.

Parylene is a generic name indicating a family of polymers with the basic chemical structure of poly-p-xylylene. Parylene N and Parylene C are the most popular for applications. Curiously, Parylene D (poly( dichloro-p-xylylene), (C8H6Cl2)) was forgotten for applications. This report is the consequence of a later availability of a commercial dimer of Parylene D and also to the recent advent of fluorinated Parylenes allowing extending applications at higher temperatures. In our work, from a dielectric analysis, we present the potentialities of Parylene D for applications particularly interesting for integration in organic field-effect transistors. Dielectric and electrical properties, macromolecular structures, and dynamics interaction with electric field as a function of frequency and temperature are studied in 5.8 µm thick Parylene D grown by chemical vapor deposition. More exactly, the dielectric permittivity, the dissipation factor, the electrical conductivity, and the electric modulus of Parylene D were investigated in a wide temperature and frequency ranges from -140 to +350 °C and from 0.1 Hz to 1 MHz, respectively. According to the temperature dependence of the dielectric permittivity, Parylene D has two different dielectric responses. It is retained as a nonpolar material at very low temperature (like Parylene N) and as a polar material at high temperature (like parylene C). The dissipation factor shows the manifestation of two relaxations mechanisms: γ and ß at very low and high temperatures, respectively. The γ relaxation is assigned to the local motions of the C-H end of the chains when the cryogenic temperature range is approached. A broad peak in tan δ is assigned to the ß relaxation. It corresponds to rotational motion of some polar C-Cl groups. For temperature above 260 °C a mechanism of Maxwell-Wagner-Sillars polarization at the amorphous/crystalline interfaces was identified with two activation energies of Ea1 = 2.12 eV and Ea2 = 3.8 eV. Moreover, the conductivity and the dielectric permittivity relaxation processes have been discussed in terms of nearly constant loss (NCL) and universal dynamic regime (UDR). Finally, ionic conduction and electrode polarization effects are identified at very high temperatures and their physical origins are discussed.

Evaluation of activation parameters of molecular mobility of parylene C using differential scanning calorimetry, dielectric spectroscopy, and thermally stimulated depolarization currents.

The molecular kinetics of α-relaxation were studied by dielectric spectroscopy (DS) and thermally stimulated depolarization currents (TSDC) for the thermoplastic semicrystalline parylene C (-H2C-C6H3Cl-CH2-)n thin film. Activation energy of the α-relaxation process brings very close values with both methods (155 ± 2 kJ mol(-1)). Dielectric spectroscopy carried out in a wide temperature range allowed one to determine the α-relaxation time against the temperature and then to estimate the Kauzmann and Angell temperatures for parylene C. From these temperatures and the determination of kinetics and thermodynamics parameters from DSC analysis, it was possible to investigate the cooperative rearranging region (CRR) in parylene C. CRR is quantified in terms of characteristic length (ζCRR), volume (VCRR), number z of rearranging units, and height barrier Δµ of the rearranging unit. Moreover, the fragility index m, calculated from these three methods, is discussed. A value of m = 94 is obtained by DSC confirming a "strong" character of parylene C. A lowest value of 35 ± 4 obtained from electric analyses (DS and TSDC) must be considered with caution because these methods of characterizations bring into play only dipolar relaxations. Last, the kinetic and thermodynamic parameters for parylene C highlighted in this work are positioned in comparison with other organic and inorganic materials.

[Helical tomotherapy in the treatment of malignant pleural mesothelioma: The impact of low doses on pulmonary and oesophageal toxicity]. / Tomothérapie hélicoïdale dans le traitement du mésothéliome pleural malin : impact des faibles doses sur la toxicité pulmonaire et œsophagienne.

PURPOSE: To evaluate the adjuvant treatment of malignant pleural mesothelioma by helical tomotherapy and the impact of low doses on esophageal and pulmonary toxicity. PATIENTS AND METHODS: Between June 2007 and May 2011, 29 patients diagnosed with malignant pleural mesothelioma received adjuvant radiotherapy by helical tomotherapy. The median age was 63 years (34-72). Histologically, 83 % of patients had epithelioid malignant pleural mesothelioma. Clinically, 45 % of patients were T3 and 55 % N0. Eighty six percent of the patients were treated by extrapleural pneumonectomy and 35 % received neoadjuvant chemotherapy with platinum and pemetrexed. The median dose in the pneumonectomy cavity was 50Gy at 2Gy/fraction. RESULTS: The mean follow-up was 2.3 years after diagnosis. Overall survival at 1 and 2 years was 65 and 36 % respectively. The median survival from diagnosis was 18 months. Median lung volumes receiving 2, 5, 10, 13, 15 and 20Gy (V2, V5, V10, V13, V15 and V20) were 100, 98, 52, 36, 19 and 5 %. The median of the mean remaining lung dose was 11Gy. Two patients died of pulmonary complications, three patients had grade 3 lung toxicity, while esophageal grade 3-4 toxicity was observed in three other patients. No significant impact of clinical characteristics and dosimetric parameters were found on pulmonary toxicity, however a V10≥50 %, a V15≥15 % and mean lung dose of 10Gy or more had a tendency to be predictive of pulmonary toxicity (P<0.1). Moreover, in our analysis, the mean lung dose seems to have a significant impact on esophageal toxicity (P=0.03) as well as low doses to the controlateral lung: V5, V10 and V13 (P<0.05). CONCLUSION: Helical tomotherapy is a promising technique in the multimodality treatment of malignant pleural mesothelioma. Low doses received by the contralateral lung appear to be the limiting factor. A dosimetric comparison with volumetric modulated arctherapy techniques would be interesting in this setting.

[Value of tomotherapy in malignant pleural mesothelioma: first clinical results]. / Intérêt de la tomothérapie après pleuro-pneumonectomie extrapleurale dans le mésothéliome pleural malin: premiers résultats cliniques.

INTRODUCTION: There is little clinical data about the place of helicoidal tomotherapy (HT) in the treatment of malignant pleural mesothelioma (MPM). This new form of intensity modulated radiotherapy (IMRT) has great theoretical advantages in large and complex volumes when compared to "traditional" forms of radiotherapy. PATIENTS AND METHODS: Fourteen patients diagnosed with MPM received adjuvant radiotherapy by HT. The patients were treated at the Curie Institute and the René Gauducheau Centre, starting in August 12007. All patients had a complete initial staging, an extrapleural pneumonectomy (EPP), and a minimum follow-up of six months. The median dose prescribed to the surgical cavity was 50 Gy (48-54 Gy) in 2 Gy (1.80-2.07) fractions. High dose regions received concomitant 57 Gy (54-69 Gy) in 2.16 Gy (2.00-2.30 Gy) fractions. RESULTS: Median follow-up was 12.6 months after ending HT. Seven patients received neoadjuvant chemotherapy (cisplatin or carboplatin, and pemetrexed). Eight patients were staged pT3 and five were staged pN1-2. HT was well tolerated. Two patients had suspected G5 radiation pneumonitis within 6 months of ending HT. Of the 12 patients who survived treatment, six relapsed (in average 5.1 months after HT): distant. Four relapses were distant; two relapses were both local and distant. Three patients died after their initial relapse. After initial diagnosis, the median survival was 18.4 months. A learning curve was observed in the optimization of the dosimetric parameters. CONCLUSION: Helicoidal tomotherapy is a reliable, quite well tolerated, and efficient way of treating MPM patients after an EPP.

Carbohydrate production in relation to microphytobenthic biofilm development: an integrated approach in a tidal mesocosm.

Experiments were performed to evaluate short-term changes in sediment extracellular carbohydrates for a multispecific assemblage of benthic diatoms in relation to physiological status, endogenous migratory rhythms, and environmental conditions. For this purpose, a mesocosm was used, which simulated both tidal and dark: light alternating cycles under controlled conditions. Scanning electronic microscopy in combination with picture analyses indicated that natural diatom migration patterns were reproduced in the mesocosm. Two EPS fractions were operationally separated in colloidal carbohydrate measurements: alcohol-soluble EPS (termed "soluble EPS") and alcohol-insoluble EPS (termed "bound EPS"). Microphytobenthic biomass followed a logistic-type curve and converged toward a maximal value termed the "biotic capacity of the local environment." Both EPS fractions showed oscillations with production during photosynthetic periods and sharp decreases during night immersion periods. Productions of both EPS fractions increased with Chl a production during light periods suggesting a light dependence in relation to migratory patterns. The decreases in both EPS fractions, which occurred during night immersion periods suggest that carbohydrate hydrolysis and/or washaway affected both EPS fractions similarly in benthic environments. Our results confirm the theory according to which the two distinct fractions are under different metabolic controls. No change in soluble EPS release was obtained during the transition from logarithmic to stationary phase. On the other hand, a metabolism modification of microalgae, probably related to ammonium depletion, occurred when cells entered the stationary phase, since there was a high enhancement in bound EPS production. Mesocosm results can serve as a system of reference useful to characterize biofilm development in field investigations and to revisit the effective implication of each EPS fraction in sediment stability.

[Non-Hodgkin lymphoma mimicking renal carcinoma: apropos of 1 case of follicular lymphoma]. / Lymphome non hodgkinien simulant un carcinome rénal. A propos d'un cas de lymphome folliculaire.

Primary renal non-Hodgkin's lymphoma (NHL) is unusual, in contrast to the frequent renal involvement in disseminated NHL. We report a case of follicular lymphoma presenting initially as a renal mass. In the literature, twenty-seven similar cases have been described since 1980. The median age at diagnosis is 64 years with a male predominance. Clinical and radiological findings generally evoke renal carcinoma. Histologically, tumors are usually large B-cell lymphomas. The existence of renal non-Hodgkin lymphoma mimicking renal carcinoma must be recognized. Such lymphomas can either be primitive or be nodal with a renal presentation. Nephrectomy followed by chemotherapy permits long disease free survival.

Blood vessel density in canine osteosarcoma.

Canine osteosarcoma is a prevalent bone neoplasm which has similarities to the human disease. We used a retrospective study to investigate the possibility that tumor vascularity may provide useful prognostic information, indicative of the role of this parameter in progression of this cancer. We quantified microvessel density in 52 histological specimens of primary tumor, immunostained for von Willebrand's Factor to identify vascular endothelium. For the 20 cases not euthanized at presentation or lost to follow-up, we found significantly higher tumor microvascular densities in animals presenting with detectable pulmonary metastases (5 of 20), and significantly lower densities in animals without metastatic disease at presentation, but later surviving to develop pulmonary metastases (7 of 20; P < 0.05). Animals with no evidence of pulmonary metastases at time of death (8 of 20) had intermediate vascular densities in their tumors. The results of this preliminary study suggest that vascularity of the primary tumor may be an indication of tumor progression. Future studies with a larger number of cases should establish whether vascular density can be a useful prognostic parameter for canine osteosarcoma.

Potential factors affecting the outcome of dogs with a resection of the lateral wall of the vertical ear canal.

The records of 60 dogs that had a resection of the lateral wall of the vertical ear canal (Zepp) were examined. The surgical outcomes were evaluated in association with the following variables: breed, sex, age of onset of the otitis externa, duration of the disease before the surgery was performed, treatment received for the otitis externa, the status of the ear and tympanic membrane at the time of the surgery, the culture results, and concurrent medical problems. The outcome of surgery was acceptable in 45% and unacceptable in 55% of the cases. Breed was the only factor that could be correlated with the outcome. The procedure failed in 86.5% of the cocker spaniels. When surgical outcomes in breeds other than cocker spaniels were evaluated, 63% were acceptable and 37% were unacceptable. Sharpeis were found to have an ear canal of small diameter compared with that of other breeds and a tendency to have better outcomes.

Management of a congenitally shortened soft palate in a dog.

An 8-week-old puppy that was examined because of a nasal discharge was found to have a congenitally shortened soft palate. The palate was partially rebuilt with pharyngeal flaps constructed from the tonsillar crypts. The reconstructed soft palate extended approximately 40% of the distance between the caudal aspect of the hard palate and rostral tip of the epiglottis. During the first 18 months after surgery, the dog had 3 episodes of halitosis, sneezing, and mucopurulent nasal discharge but responded to antimicrobial treatment. The dog was fed dry dog food and drank water from an elevated bowl. Water would flow from the dog's nose if it drank water with its head lowered. Compensatory mechanisms likely play an important role in the outcome of animals with this condition.

The use of a prosthetic appliance to manage a large palatal defect in a dog.

Large defects of the hard palate can result from a congenital abnormality, trauma, or surgical treatment of oral masses. Closure of these defects can be challenging as dehiscence is common. Large, inoperable hard palate defects may be managed with prosthetic obturators, which recreate the separation between the oral and nasal cavities. This report describes the use of a palatal obturator to manage a large palatal defect that persisted after resection of a palatal fibrosarcoma. Three prior attempts at surgical closure of the defect had failed.

The sartorius muscle flap in the cat: an anatomic study and two case reports.

The sartorius muscle in the cat is a broad, sheet-like muscle which covers the craniomedial aspect of the thigh. The major portion of the blood supply arises from the proximal pole of the muscle. A single sartorius muscle can be positioned over the abdomen in a transverse manner along the pubis, to cover the entire (i.e., left and right sides) caudal 30% of the abdomen. It also can be extended in a cranial-to-caudal fashion where it covers approximately 80% of the length and 75% of the width of the ipsilateral abdomen. The sartorius muscle flap is easy to harvest and provides good coverage for defects of the caudal abdominal wall. This muscle flap was used successfully in two feline patients.

Lateral exploration of fistulas developing after total ear canal ablations: 10 cases (1989-1993).

A lateral approach was used successfully in seven of 10 dogs to resolve fistulas which developed after total ear canal ablations and bulla osteotomies. The approach facilitated identification and removal of horizontal ear canal remnants in four of the 10 cases. Facial nerve function was worsened temporarily by lateral exploration in two cases. Seven cases had no fistula recurrence during follow-up, which ranged from 12 to 72 months. Three cases each had fistula recurrence one-to-two months after fistula exploration.

Magnetic motor evoked potentials during methohexital anesthesia in the dog.

Magnetic motor evoked potentials (MMEPs) were recorded from the right cranial tibial muscle after magnetic stimulation of the left motor cortex in six dogs sedated with oxymorphone. Anesthesia was induced with an intravenous bolus of 5.5 mg/kg of methohexital and maintained with a methohexital infusion. The dogs inspired 100% oxygen during anesthesia. Blood pressure, heart rate, respiratory rate, esophageal temperature, and end-tidal carbon dioxide tension were recorded. The depth of anesthesia was increased until the amplitude of the MMEP was less than 5% of the control value, and the dogs were then allowed to recover. Every 5 minutes during anesthesia, a blood sample was taken for methohexital assay and at the same time, four replicate MMEPs were recorded. Plasma methohexital levels were significantly (P < 0.05) correlated with heart rate (p = 0.38) and end-tidal carbon dioxide tension (p = 0.49) and negatively correlated with respiratory rate (p = 0.74). There was no significant correlation between blood pressure and methohexital levels. The dogs regained consciousness at a plasma methohexital level of 10.4 +/- 3.8 micrograms/ml (mean +/- SD). The amplitude of the MMEP decreased significantly with increasing methohexital levels. In four dogs, the relationship was reasonably linear. The MMEP disappeared at a plasma methohexital level of 23 +/- 6.6 micrograms/ml. The latency of onset of the MMEP increased significantly from its control value of 14.7 +/- 1.0 ms to 17.5 +/- 1.3 ms at the highest methohexital levels at which MMEPs were recordable. This study demonstrated that MMEPs can be reliably recorded under methohexital anesthesia.

Magnetic motor evoked potentials for assessing spinal cord integrity in dogs with intervertebral disc disease.

Magnetically elicited transcranial motor evoked potentials (MEPs) were studied in 37 dogs with type 1 intervertebral disc (IVD) disease. The waveforms were recorded from both cranial tibial muscles before and after surgery. The latencies and amplitudes obtained were compared to those of a control population (n = 14). MEPs were recordable in all dogs with mild or no neurologic deficits, but they were recordable in only 50% of ambulatory dogs that were severely ataxic. MEPs could not be elicited from nonambulatory dogs. There was a significant attenuation of the amplitudes in all clinical cases, even if the dogs demonstrated back pain alone. Significantly prolonged latencies were associated with neurologic deficits. MEPs were not good predictors of neurologic recovery. The responses obtained from the side where the disc material was found were not different from those recorded from the opposite side. MEPs were very sensitive to lesions of the spinal cord, as indicated by the significant changes in the waves in patients with mild or no neurologic deficits and in the loss of response in dogs that still demonstrated purposeful movement. Neurologic exams provided more accurate diagnoses and prognoses than did MEPs in dogs with IVD disease.