Postsurgery analgesic and sedative drug use in a French neonatal intensive care unit: A single-center retrospective cohort study.

OBJECTIVE: To describe pain assessment, the pattern of analgesic and sedative drug use, and adverse drug reactions in a neonatal intensive care unit (NICU) during the postsurgery phase. METHOD: Demographic characteristics, pain scores, and drug use were extracted and analyzed from electronic patient medical files for infants after surgery, admitted consecutively between January 2012 and June 2013. RESULT: One hundred and sixty-eight infants were included. Acute (DAN score) and prolonged (EDIN score) pain assessment scores were used in 79% and 64% of infants, respectively, on the 1st day. This percentage decreased over the 7 days following surgery. The weekly average scores postsurgery were 2/15 (±2.2) for the EDIN score and 1.6/10 (±2.0) for the DAN score. The rates of pain control were 88% for the EDIN and 72% for the DAN. The most prescribed opiate drug was fentanyl (98 patients; 58%) with an average dose of 1.8 (±0.6) µg/kg/h. Midazolam was used in 95 patients (56%), with an average dose of 35 (±14) µg/kg/h. A bolus was administered in 7% (±7.4) of the total dose for fentanyl and 8% (±9.3) for midazolam. Similar doses were used in term and preterm neonates. Of 118 patients receiving fentanyl and/or midazolam, 40% presented urinary retention, 28% a weaning syndrome. Paracetamol (155 patients; 92%) and nalbuphine (55 patients; 33%) were the other medications most often prescribed. CONCLUSION: The off-label use of fentanyl and midazolam was necessary to treat pain after surgery. Pain assessment should be conducted for all neonates in order to optimize their treatment. Research on analgesic and sedative medicine in vulnerable neonates seems necessary to standardize practices and reduce adverse drug reactions.

Eyesafe coherent detection wind lidar based on a beam-combined pulsed laser source.

We report on a coherent wind lidar built with two coherently-beam-combined fiber amplifiers. The lidar performances of the combined-amplifier and the single-amplifier are compared using two criterions: carrier-to-noise ratio and wind speed noise floor. In both cases, lidar performances are not degraded with a combined source and are close to the theoretical optimum. Combined sources are well suited to improve coherent wind lidar accuracy, range, and integration time.

[Determination of the 120-day post prostatic biopsy mortality rate]. / Mesure de la mortalité à 120 jours après biopsie de la prostate.

OBJECTIVE: Concerning death-rates were reported following prostate biopsy but the lack of contexts in which event occurred makes it difficult to take any position. Therefore, we aimed to determine the 120-day post-biopsy mortality rate. MATERIAL AND METHODS: Between 2000 and 2011, 8804 men underwent prostate biopsy in the hospice civils de Lyon. We studied retrospectively, the mortality rate after each of the 11,816 procedures. Biopsies imputability was assessed by examining all medical records. Dates of death were extracted from our local patient management database, which is updated trimestrially with death notifications from the French National Institute for Statistics and Economic Studies. RESULTS: In our study 42 deaths occurred within 120days after 11,816 prostate biopsies (0.36%). Of the 42 records: 9 were lost to follow-up, 3 had no identifiable cause of death, 28 had an intercurrent event ruling out prostate biopsy as a cause of death. Only 2 deaths could be linked to biopsy. CONCLUSIONS: We reported at most 2 deaths possibly related to prostate biopsy over 11,816 procedures (0.02%). We confirmed the fact that prostate biopsies can be lethal but this rare outcome should not be considered as an argument against prostate screening given the circumstances in which it occurs. LEVEL OF EVIDENCE: 5.

HPV vaccination among French girls and women aged 14-23 years and the relationship with their mothers' uptake of Pap smear screening: a study in general practice.

INTRODUCTION: HPV vaccination is recommended in France for girls aged 14 and for those aged 15-23 before sexual debut or who have become sexually active within the previous year. The first aim was to describe vaccination practice among 14-23-year-old girls visiting a general practitioner. A second objective was to investigate factors associated with starting vaccination among girls aged 14-18, in particular the regular practice of Pap-smear screening (PSS) by their mothers. METHODS: A cross-sectional study was conducted from June to August 2009. A total of 87 general practitioners from the large Rhône-Alpes region contributed data on 502 girls/women who came for consultation. RESULTS: 231 (46.0%) of these girls/women had begun the process of HPV vaccination (68.2%, 56.9% and 18.7% of the 14-16, 17-20 and 21-23-year-olds respectively) of whom 139 (60.2%) had received all three doses. 92 girls/women (39.8%) had received only one or two doses at the time of study. However, in 71 (77.2%) cases, the gap between the last dose received and the time of study was within the between-dose interval recommended in the vaccination schedule. GPs reported that 16 (11.5%) had mentioned side effects following injections. Having a mother who practised regular PSS (Odds Ratio 6.2 [1.5-25.8]), having never lived with a partner (4.6 [1.6-13.5]) and vaccination against hepatitis B (3.2 [1.6-6.1]) were found to be independently correlated with the initiation of HPV vaccination among girls/women aged 14-18 years. CONCLUSION: Two years after the start of the programme, only half of girls/women aged 14-23 years had begun the process of HPV vaccination. HPV vaccination status was correlated with PSS in the mother, family status and hepatitis B vaccination. Such information may help to better target girls who are less likely to be vaccinated.

Fourth-order cascaded Raman shift in AsSe chalcogenide suspended-core fiber pumped at 2 µm.

Cascaded Raman wavelength shifting up to the fourth order ranging from 2092 to 2450 nm is demonstrated using a nanosecond pump at 1995 nm in a low-loss As(38)Se(62) suspended-core microstructured fiber. These four Stokes shifts are obtained with a low peak power of 11 W, and only 3 W are required to obtain three shifts. The Raman gain coefficient for the fiber is estimated to (1.6±0.5)×10(-11) m/W at 1995 nm. The positions and the amplitudes of the Raman peaks are well reproduced by the numerical simulations of the nonlinear propagation.

Coherent beam combination of narrow-linewidth 1.5 µm fiber amplifiers in a long-pulse regime.

We report what we believe to be the first experimental demonstration of coherent beam combining of two fiber amplifiers in a 100 ns pulse regime using a signal leak between the pulses. Pulses of ∼100 W stimulated-Brillouin-scattering limited peak power are combined with 95% efficiency, a residual phase error of λ/27, and no significant beam quality degradation.

Low loss microstructured chalcogenide fibers for large non linear effects at 1995 nm.

Microstructured optical fibers (MOFs) are traditionally prepared using the stack and draw technique. In order to avoid the interfaces problems observed in chalcogenide glasses, we have developed a new casting method to prepare the chalcogenide preform. This method allows to reach optical losses around 0.4 dB/m at 1.55 µm and less than 0.05 dB/m in the mid IR. Various As(38)Se(62) chalcogenide microstructured fibers have been prepared in order to combine large non linear index of these glasses with the mode control offered by MOF structures. Small core fibers have been drawn to enhance the non linearities. In one of these, three Stokes order have been generated by Raman scattering in a suspended core MOF pumped at 1995 nm.

Multifilament-core fibers for high energy pulse amplification at 1.5 microm with excellent beam quality.

We report on what we believe to be the first demonstration of an erbium-ytterbium-doped multifilament-core (MFC) fiber for single-mode amplification of narrow linewidth high peak power pulses. A master-oscillator-power-fiber-amplifier laser source has been demonstrated using a 37-filament MFC fiber in the last amplification stage. Pulses with 750 microJ (940 W peak power) and laser linewidth<1 MHz have beam generated with M2 approximately 1.3. This value is close to the theoretical value M2 approximately 1.5.

Characteristics of the Brillouin spectra in Erbium-Ytterbium fibers.

This paper reports the main characteristics of the Stokes spectra for typical pumped and unpumped Erbium-Ytterbium doped fibers. Doped fibers show shorter Brillouin shifts and their spectra are up to 1.6 times broader than undoped fibers. Those spectra are composed of several peaks originating from several longitudinal acoustic modes. The effective Brillouin gain of the secondary modes can be as large as 20% of the main peak gain. They can merge into a more complex structure for the largest cores. Simulations allow to relate these characteristics to the influence of codoping and index profile inhomogeneity. An additional broadening of the Stokes spectrum in pumped fibers is reported and attributed to thermal effects.