Indoor noise exposure at home: a field study in the family of urban schoolchildren.

This article aims at evaluating indoor noise levels at home and investigating the factors that may influence their variability. An 8-day noise measurement campaign was conducted in the homes of 44 schoolchildren attending the public primary schools of Besançon (France). The presence of the inhabitants in the dwelling and the noisy events occurring indoors and outdoors was daily collected using a time-location-activity diary (TLAD); 902 time periods were analyzed. The indoor noise level increased significantly with the outdoor noise level, along with the duration of the presence or level of activity of the inhabitants at home. However, this effect may vary according to the period of day and the day of the week. Moreover, a significant part of the day and evening indoor noise level variability was explained when considering the TLAD variables: 46% and 45% in the bedroom, 54% and 39% in the main room, respectively. Our results highlight the complexity of the indoor environment in the dwellings of children living in an urban area. Combining the inhabitant presence and indoor noise source descriptors with outdoor noise levels and other dwelling or inhabitant characteristics could improve large-scale epidemiological studies. However, additional efforts are still needed, particularly during the night period.

Effect of outdoor grazing-area access time and enrichment on space and pasture use, behaviour, health and growth traits of weaned rabbits.

Providing rabbits with a grassy outdoor area allows them to express a broad variety of specific behaviours such as grazing where grazeable herbage persists. However, rabbits that graze are also exposed to external stressors. Controlled outdoor access time may help preserve the grassland resource, while a hiding place may offer the rabbits a secure space. We focused on rabbit growth, health and behaviour according to outdoor access time and the presence of a hideout on a 30-m2 pasture area. We divided 144 rabbits into four groups (group of rabbits with 8 hours per day (H8) of access to pastures provided with an hideout (Y) (H8Y): n = 36; group of rabbits with 8 hours per day (H8) of access to pastures unprovided with an hideout (N) (H8N): n = 36; group of rabbits with 3 hours per day (H3) of access to pastures provided with an hideout (Y) (H3Y): n = 36; group of rabbits with 3 hours per day (H3) of access to pastures unprovided with an hideout (N) (H3N): n = 36) that differed in access time (H8, four replicates, eight hours a day from 0900 h to 1700 h; and H3, four replicates, three hours a day from 0900 h to 1200 h) and the presence of a hideout (presence of an hideout on the pasture (Y), four replicates, with a roof-shaped wooden hideout; and absence of an hideout on the pasture (N), four replicates, without). Rabbit growth and morbidity were measured weekly for each rabbit from 34 to 76 days of age. Rabbit behaviour was assessed on days 43, 60 and 74 by direct visual scanning. Available grassy biomass was evaluated on days 36, 54 and 77. We also measured the time rabbits took to enter and exit the mobile house and the level of corticosterone accumulated in their hair during the fattening period. There were no between-group differences in live weight (on average, 2 534 g at 76 days of age) and mortality rate (18.7%). The rabbits expressed a broad variety of specific behaviours, with grazing being the most frequent (30.9% of all the observed behaviours). Foraging behaviours including pawscraping and sniffing were more frequently observed in H3 rabbits than H8 rabbits (1.1 vs 0.3% and 8.4 vs 6.2%, respectively; P < 0.05). There was neither an access-time nor hideout presence effect on rabbit hair corticosterone levels or time to exit and enter the pens. Patches of bare ground were more frequent in H8 pastures than in H3 pastures (26.8 vs 15.6%, respectively; P < 0.05). Over the whole growing period, the biomass intake rate was higher in H3 than H8 and higher in N than Y (1.9 vs 0.9 g/rabbit/h and 1.8 vs 0.9 g/rabbit/h, respectively; P < 0.05). In conclusion, restricted access time tended to slow the reduction of the grass resource but had no detrimental effects on rabbit growth or health. Rabbits facing restricted access time adapted their grazing behaviour. A hideout helps rabbits cope with external stressors.

Etravirine concentrations in CSF in HIV-infected patients.

OBJECTIVES: To determine etravirine concentrations in CSF in HIV-infected patients. METHODS: Twelve HIV-1 adult antiretroviral-experienced patients receiving an etravirine-containing regimen for at least 1 month were enrolled. Both CSF and blood samples were taken around 12 h after the last etravirine dose. Liquid chromatography-tandem mass spectrometry was used to determine etravirine concentrations, and HIV-1 viral load was determined by real-time PCR (limit of detection 40 copies/mL). RESULTS: Twelve blood and 12 CSF samples were collected. The median CD4 count was 333 (84-765) cells/mm(3) and the median plasma HIV-1 viral load was <40 (range <40-1777) copies/mL. The median time on etravirine was 34 (range 4-140) weeks. The median etravirine concentration in plasma was 611.5 (range 148-991) ng/mL. The median CSF etravirine concentration was 7.24 (range 3.59-17.9) ng/mL; in all cases, values were above the IC(50) range (0.39-2.4 ng/mL). The median etravirine CSF:plasma ratio was 0.01 (range 0.005-0.03). The CSF viral load was >40 copies/mL in one patient and plasma viral load was still detectable after 4 weeks of therapy. CONCLUSIONS: Etravirine achieves concentrations several times greater than the IC(50) range in CSF. All patients with undetectable plasma viral load were virologically suppressed in CSF while receiving an etravirine-containing regimen. Etravirine may help in controlling HIV-1 in CNS.

Effect of access to outdoor grazing and stocking density on space and pasture use, behaviour, reactivity, and growth traits of weaned rabbits.

In a context of evolving concern over housing conditions of farmed rabbits, we developed a housing system that allows access to an outdoor area. The aim was to study the health status, growth and behaviour of rabbits raised at two stocking densities with access to a paddock, or not. We distributed 299 weaned rabbits in four groups (YH: 100, NH: 99, YL: 50 and NL: 50) using a 2 × 2 factorial design including access (Y: yes) or not (N: not) to a 23 m2 paddock and the indoor stocking density (H, high: 17 or L, low: 9 rabbits/m2). We measured the growth and health status of each animal weekly for 42 days (from 31 to 73 days of age) and performed reactivity tests to a new environment, a human and new object. We also assessed the rabbits' behaviour at days 26 and 40 by doing a visual scan of each animal at regular time intervals. Our results showed that stocking density had no effect on mortality, but mortality tended to increase with outdoor access from 3.0% to 7.0% (P < 0.10). Although the stocking density had no effect on average daily gain, it was higher in rabbits in the N group than in the Y group (+3.6 g/day; P < 0.05). Rabbits entered the paddocks for the first time in less time at the beginning of the trial (50 s at day 3 vs 10 min at day 31; P < 0.001). The proportion of rabbits outside after 20 min of the new environment test was higher among rabbits in the L group than in the H group (+24% points at day 3 and +11% points at day 20; P < 0.001). Regardless of the stocking density, more rabbits in the N group touched the experimenter's hand (16% vs 27%; P < 0.05) and the new object (34% vs 20%; P < 0.05) than rabbits in the Y group. Inactivity was more frequent in rabbits inside the pens than in the paddocks (70.0% vs 34.2% at days 26 and 40; P < 0.05). Locomotion was more frequent in the paddocks than in the indoor pens (20.0% vs 7.2% at days 26 and 40; P < 0.05). The stocking density did not affect the behavioural traits measured. In conclusion, providing rabbits access to a paddock could allow them to fulfil some natural behaviours but slightly reduced their growth.

[Blood transfusion in neonatology: Study of practical aspects in 2016 in France, excluding acute bleeding or surgical care]. / Réalisation d'une transfusion sanguine en néonatologie : état des lieux des pratiques en 2016 en France ; situations aiguës ou chirurgicales exclues.

BACKGROUND: Blood transfusion is common in neonatology, especially in preterm or low birth weight infants. Recommendations were proposed by the French National Authority of Health (HAS) in 2014 and 2015 for red blood cells and platelet transfusion respectively, but an heterogeneity of practical attitudes persist. The objective of this survey is to evaluate transfusion practices in neonatal intensive care units. METHODS: Investigation of practice of neonatal transfusion was organized among 68 neonatal intensive care unit (level 3) between September 2016 and May 2017, by mailing survey focused on systematic training of nurses, patient identification, immunohematology, information and technical aspects of blood components administration. RESULTS: Twenty-three neonatal intensive care units among the 68s answered the questionnaire. One thousand five hundred sixty seven neonates were transfused and 3382 blood products were administered. The results highlight a consensual attitude concerning the procedures of patient identification, immunohematology tests and blood products administration. However, heterogeneity remains concerning information of the parents or the person with parental authority, immediate and delayed follow-up and devices used for the transfusion. However HAS guidelines (2014 and 2015) appear to be well applied by clinicians for blood products, specifications and calcul of transfused volume based on gestational age and weight.

[Analysis of causes of destruction of labile blood products in health institutions: A multicentric study]. / Analyse des causes de destruction des produits sanguins labiles dans les établissements de santé : une étude multicentrique.

OBJECTIVE: One of the tasks of haemovigilance correspondents in Health Institutions (HI) is to reduce the destruction of labile blood components (LBC). The objective of this study was to analyse in depth, five years after a first multicentric study, the causes of LBC destruction in order to assess the impact of measures taken and to define new ways of improvement. METHODS: Prospective analysis was carried out throughout 2016. For every LBC destroyed, the following elements were reported: type of LBC, transfusion department, cause of destruction analysed according to a decision tree, subsequently classed as avoidable or unavoidable. RESULTS: The study included 15 HI. A total 3058 LBC were destroyed, representing an average 0.90% of issued LBC, and this analysis concerned 2576 LBC. Sixty-seven percent of LBC were issued for surgery, intensive care or emergencies. Forty percent of the causes of destruction were patient-related (death, clinical worsening, adverse effects or abnormal constants prior to delivery). Thirty percent were prescription-related, mainly cases of excessive prescription for different reasons. Eleven percent were linked to organisational issues. The rate of destruction judged avoidable, all causes combined, was 36%. CONCLUSION: Comparison with the precedent study shows improvement, thus revealing the efficacy of implemented measures (single-dose distribution, return procedures back to the site of distribution, training of participants). In order to further reduce this rate of destruction, we suggest to promote storage procedures and, above all, to continue to raise awareness within healthcare teams.

[Is the research of posttransfusional alloantibodies still relevant?] / Est-ce que la réalisation de la recherche d'anticorps antiérythrocytaires post­transfusionnelle est toujours pertinente ?

The decision of November 6th, 2006 defining the principles of best practices recommends that posttransfusional red cell alloantibodies research is performed after one to three months after. In the University hospital of Brest, the haemovigilance unit takes charge of sending the medical prescription within the required time and centralizing the results. We wished to estimate if the realization of this research still remains relevant. METHODS: A prospective analysis was performed in 2015. We evaluated the realization rate, the red cell alloantibodies rate and the recipient adverse reactions with the diagnostic category: alloimmunization (delayed serological transfusion reaction, DSTR). RESULTS: In 2015, 2162 prescriptions were sent to the 3271 transfused patients. One thousand and eighteen red cell alloantibodies research were done, i.e. a return rate of 61%. Among them, 12 alloantibodies appeared (0.9%) within an average of 56 days. Thirty-three other alloantibodies appeared and were discovered most frequently before a new transfusion. In 10 cases, a posttransfusional research was done that was negative. A survey was conducted among GHCOH members to describe the practices in these health institutions. Twelve questionnaires were analysed. Ten institutions performed a posttransfusional alloantibodies research by issuing a prescription at the patient's exit with a return rate between 0.14 and 16%; 1 institution has a centralized organization with a return rate of 68.3%; 1566 red cell alloantibodies research were performed and among them, 24 alloantibodies appeared (1.53%). CONCLUSION: These results indicate that to be effective, the management of this biological test must be centralized. Despite this, the red cell alloantibodies rate remains very low (0.9 and 1.53%) and raises the question of the relevance of this systematic testing after transfusion, which is in any case mandatory before a new transfusion of red blood cells.

Development of three multiplex RT-PCR assays for the detection of 12 respiratory RNA viruses.

Three multiplex hemi-nested RT-PCR assays were developed to detect simultaneously 12 RNA respiratory viruses: influenza viruses A, B and C, human respiratory syncytial virus (hRSV), human metapneumovirus (hMPV), parainfluenza virus types 1-4 (PIV-1, -2, -3 and -4), human coronavirus OC43 and 229E (HCoV) and rhinovirus (hRV). An internal amplification control was included in one of the RT-PCR assays. The RT-PCR multiplex 1 and the hemi-nested multiplex 1 detected 1 and 0.1 TCID50 of RSV A, respectively, and 0.01 and 0.001 TCID50 of influenza virus A/H3N2, respectively. Two hundred and three nasal aspirates from hospitalised children were retrospectively tested in comparison with two conventional methods: direct immunofluorescence assay and viral isolation technique. Almost all samples (89/91) that were positive by immunofluorescence assay and/or viral isolation technique were detected by the multiplex assay. This method also detected an additional 85 viruses and 33 co-infections. The overall sensitivity (98%), rapidity and enhanced efficiency of these multiplex hemi-nested RT-PCR assays suggest that they would be a significant improvement over conventional methods for the detection of a broad spectrum of respiratory viruses.

Situs inversus totalis and abdominal aortic aneurysm: Surgical repair of an extremely uncommon association.

INTRODUCTION: Situs inversus totalis (SIT) is an uncommon congenital syndrome, which refers to a reversal mirror-image of the normal thoracoabdominal organs position. The coexistence of SIT and abdominal aortic aneurysm has been seldom previously reported. PRESENTATION OF THE CASE: We report a case of a 69-year-old man with SIT and infrarenal abdominal aortic aneurysm (AAA) that underwent open repair with a straight graft through a minilaparatomy without evisceration. DISCUSSION: There is no consensus on which should be the optimum approach in cases of open surgical repair of AAA due to the limited number of cases described. The fact of intestinal scrolling to the left abdomen, unlike usual, is due to the anatomical arrangement of the root of the mesentery which is directed obliquely from duodenojejunal on the left side of the vertebra L2 to the ileocecal junction and right sacroiliac joint. CONCLUSION: A minilaparotomy without evisceration and with intestinal scrolling to left hemiabdomen, can be very useful and beneficial on those cases of congenital anatomical abnormalities that may add difficulty during the surgical procedure.

A selective HPLC method for determination of lercanidipine in tablets.

An HPLC reversed phase method using both UV (356 nm) and electrochemical (1000 mV) detection was developed in order to determine lercanidipine in commercial tablets. Repeatability and reproducibility were adequate. For quantification we have used the calibration plot method for lercanidipine concentration ranging between 1 x 10(-5) and 1 x 10(-4) M. Also, the proposed method is sufficiently selective to distinguish the parent drug and the degradation products after hydrolysis, photolysis or chemical oxidation. Furthermore, the typical excipients included in the drug formulation (talc, lactose, cornstarch, microcrystalline cellulose, carboxymethylcellulose and magnesium stearate) do not interfere with the selectivity of the method. Finally, the proposed chromatographic method was successfully applied to the quantitative determination of lercanidipine in commercial tablets.

[Neurological accidents after epidural anesthesia in obstetrics]. / Accidents neurologiques après anesthésie péridurale en milieu obstétrical.

Several neurological complications have been described after epidural anaesthesia, including direct trauma to the spinal cord or nerve roots, epidural haematoma, meningitis, epidural abscess, spinal cord infarction. neurologic toxicity of injected agents. In obstetric practice, these complications are very uncommon. However, their real occurrence may be underrated, partly for medicolegal reasons. Different complication mechanisms are described; they should be kept in mind while evaluating post block neurological deficits so that prompt corrective measures can be taken whenever appropriate to prevent permanent damage.

Reacción inflamatoria sistémica y activación de citoquinas tras la cirugía abierta de aorta abdominal con medidas perioperatorias fast-track. Estudio prospectivo aleatorizado / The systemic inflammatory response and cytokines release in open abdominal aortic surgery with fast-track versus conventional perioperative management. A prospective randomised study

Introducción: Nuestro objetivo es medir la incidencia del síndrome de respuesta inflamatoria sistémica (SIRS) y la liberación de citoquinas en pacientes intervenidos de cirugía abierta de aorta abdominal con medidas perioperatorias fast-track en comparación con las convencionales. Material y métodos: Estudio prospectivo aleatorizado unicéntrico de octubre de 2015 a noviembre de 2017. Incluimos pacientes consecutivos intervenidos de cirugía abierta de aorta abdominal. Establecimos un grupo fast-track (GFT) y un grupo convencional (GC). El manejo fast-track consistió en: ingesta de bebida carbohidratada 2 h preoperatorias, analgesia con elastómero preperitoneal, movilización y dieta temprana. Registramos variables demográficas y perioperatorias, concentraciones de citoquinas séricas (TNFalfa, IL-1Beta, IL-6, IL-8, IL-10 e IL-12p70) basales, a las 8, 24 y 48 h postoperatorias, incidencia de SIRS en las primeras 72 h postoperatorias y complicaciones en el ingreso. Resultados: Se incluyeron 49 pacientes (GFT: 26, GC: 23) con edad media de 67,8 ± 8,6 años, 91,8% hombres. Ambos grupos fueron comparables en variables demográficas y perioperatorias, excepto en índice de masa corporal (GFT: 25,67 ± 3,07 vs. GC: 29,29 ± 4,66 [p=0,008]) y tiempo de clampaje (FT:52,4 ± 12,63 vs. GC: 63,91 ± 14,34 min [p=0,005]). La incidencia de SIRS en GFT vs. GC fue 38,5% vs. 45,5%, 38,5% vs. 45,5%, 23,1% vs. 26,1%, 15,4% vs. 19% (p > 0,05) a las 8, 24, 48 y 72 h postoperatorias respectivamente. Evidenciamos una mayor liberación de IL-6, IL-8, IL-10 y TNFalfa en GC en comparación con GFT. A las 8 h, IL-6 alcanzó un aumento estadísticamente significativo respecto al valor basal en GC (p = 0,045). A las 24h, la IL-10 aumentó respecto al valor inicial, siendo estadísticamente más elevada en GC en comparación con GFT (p = 0,024). En GC 6/23 (26,1%) presentaron insuficiencia renal aguda y en GFT 1/26 (3,8%) (p = 0,041). Conclusiones: La CA de aorta abdominal implica una elevada incidencia de SIRS. Aunque IL-6, IL-8, IL-10 y TNFalfa aumentan después de la cirugía en ambos grupos, el manejo perioperatorio fast-track pareció modular solo la liberación de IL-6 e IL-10. Necesitamos más estudios para valorar las citoquinas como biomarcadores de pronóstico

Introduction: The aim of this study was to determine the incidence of systemic inflammatory response syndrome (SIRS) and cytokines release in patients after open abdominal aortic surgery with fast-track compared to those with conventional peri-operative management. Material and methods A prospective, single centre, randomised study was conducted from October 2015-November 2017 that included consecutive patients undergoing open abdominal aortic surgery. Two groups were established: fast-track group (GFT) and conventional group (GC) depending on the peri-operative management. GFT peri-operative management consisted of: a carbohydrate drink 2hours before surgery, analgesia using pre-peritoneal elastomer, mobilisation, and early diet. The main demographic and perioperative variables were collected, and the levels of serum cytokines (TNFalfa, IL-1Beta, IL-6, IL-8, IL-10, and IL-12p70) were analysed at baseline, 8, 24, and 48 hours, post-operatively. The SIRS incidence was recorded in the first 72hours after surgery, as well as the mortality and complications rate during admission. Results: A total of 49 patients were included (GFT: 26, GC: 23) with a mean age of 67.8±8.6 years, of whom 91.8% were men. Both groups were comparable in demographic and perioperative variables, except in terms of the pre-operative body mass index: GFT: 25.67±3.07 vs. GC: 29.29 ± 4.66 (P=.008) and total clamping time: GFT: 52.4±12.63 vs. GC: 63.91 ± 14.34 min (P=.005). The incidence of SIRS in GFT vs. GC was 38.5% vs. 45.5%, 38.5% vs. 45.5%, 23.1% vs. 26.1%, 15.4% vs. 19% (P>.05) at 8, 24, 48, and 72 h postoperatively, respectively. As regards serum cytokines, a higher release of IL-6, IL-8, IL-10 and TNFα in GC was observed compared to GFT. At 8 h, IL-6 reached a statistically significant increase compared to baseline in GC (P = .045). At 24h, the IL-10 increased compared to the baseline, and was statistically higher in GC compared to GFT (P =.024). Acute renal failure was observed in the GC (6/23, 26.1%) and 1/26 (3.8%) in GFT (P = .041). Conclusions: Open abdominal aortic surgery showed a high incidence of SIRS. Although IL-6, IL-8, IL-10, and TNFalfa serum increased after open abdominal aortic surgery in both groups, fast-track peri-operative management seemed to modulate only IL-6 and IL-10 release. More studies are required to evaluate cytokines as biomarkers to measure outcome

Síndrome compartimental abdominal / Abdominal compartment syndrome

El aumento de la presión intraabdominal es un problema clínico frecuente en pacientes críticos, en pacientes sometidos a cirugía abdominal, y especialmente tras la cirugía de un aneurisma de aorta abdominal roto. El aumento mantenido de la presión intraabdominal puede conllevar un fallo orgánico por hipoperfusión, cumpliendo criterios de síndrome compartimental abdominal. Es de vital importancia su identificación por la elevada morbimortalidad que asocia. Tras la cirugía de un aneurisma de aorta abdominal roto se recomienda la monitorización de la presión intraabdominal cada 4 h para conseguir un diagnóstico precoz. Un manejo médico intensivo puede reducir la incidencia de síndrome compartimental abdominal. Cuando este se establece, el tratamiento de elección es la laparotomía descompresiva. Un correcto manejo posterior del abdomen abierto, mediante terapias de cierre abdominal temporal es crucial para mejorar el pronóstico en estos pacientes

The increase in intra-abdominal pressure is a common problem in critically ill patients, as well as patients subjected to abdominal surgery, and particularly after surgery of an abdominal aortic aneurysm rupture. The persistent increase in intra-abdominal pressure can lead to organ failure due to hypoperfusion, thus fulfilling the criteria of abdominal compartment syndrome. Its identification is of vital importance, due to its associated morbidity and mortality. It is recommended to monitor the intra-abdominal pressure every 4hours after surgery of an abdominal aortic aneurysm rupture, in order to make an early diagnosis. Intensive medical management can reduce the incidence of abdominal compartment syndrome. When this diagnosis is established, the treatment of choice is decompression laparotomy. The correct management after open abdomen is crucial in order to improve the prognosis of these patients (AU)

Bypass carótido-subclavio por síndrome de robo coronario-subclavio / Carotid-subclavian bypass for coronary-subclavian steal syndrome

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