A 6.78-MHz Robust WPT System with Inductive Link Bandwidth Extended for cm-Sized Implantable Medical Devices.

This paper presents a new technique to design a robust inductive link for Wireless Power Transmission (WPT) to centimeter-sized (cm-sized) Implantable Medical Devices (IMDs). The consequence of this methodology is the bandwidth extension of utilized link to maximize both Power Delivered to Load (PDL) and Power Transfer Efficiency (PTE). Design, circuit implementation, and In-vivo validation experimental results are reported. Different conditions of tests, including three misalignment experiments, are performed with the proposed WPT system to prove the concept of a robust inductive link. The geometry of the Transmitter (Tx) and Receiver (Rx) coils are considered as well as the operating frequency (fp) of the WPT system. The Tx and Rx coils are crafted in a circulated shape with the diameters of 5 and 2.5 cm, respectively. Achieved PTE and PDL are in the range of 0.82%-25.7% and 44.4mW-720mW, respectively. The distance between Tx and Rx coils varies in the range of 1.5 to 4cm.

Oxigenoterapia. Nuevos datos de toxicidad, nuevas recomendaciones y soluciones innovadoras: sistemas automatizados de titulación y destete de oxigenoterapia / Oxygen therapy. New toxicity data, new recommendations and innovative solutions: automated oxygen therapy titration and weaning systems

El oxígeno se descubrió hace más de 2 siglos, pero el uso médico a gran escala comenzó en el siglo XX. La terapia de oxígeno convencional es uno de los fármacos más utilizados en hospitales y entornos pre hospitalarios, especialmente en pacientes con insuficiencia respiratoria. El primer objetivo de la oxigenoterapia es tratar la hipoxemia; el segundo es evitar la hiperoxia. La hiperoxia conduce a hipercapnia inducida, retinopatía de prematuros, vasoconstricción arterial y daño celular. La toxicidad sistémica es responsable del aumento de la mortalidad en pacientes hospitalizados. Las recomendaciones más recientes abogan por un uso restrictivo del oxígeno y consideran que la hiperoxia es perjudicial para los pacientes, así como la hipoxemia. Los nuevos dispositivos que miden con precisión la entrega de O2 según un objetivo de SO2 pueden ayudar a lograr estos objetivos. El sistema FreeO2 es el que cuenta con la mayor cantidad de datos clínicos publicados

Oxygen was discovered more than 2 centuries ago, but large-scale medical use began in the 20th century. Conventional oxygen therapy is one of the most used drugs in hospitals and prehospital settings, especially in patients with respiratory failure. The first goal of oxygen therapy is to treat hypoxemia; The second is to avoid hyperoxia. Hyperoxia leads to induced hypercapnia, retinopathy of premature infants, arterial vasoconstriction, and cell damage. Systemic toxicity is responsible for the increase in mortality in hospitalized patients. The most recent recommendations advocate a restrictive use of oxygen and consider that hyperoxia is detrimental to patients, as well as hypoxemia. New devices that accurately measure the delivery of O2 according to an S < o2 goal can help achieve these goals. The FreeO2 system is the one with the largest amount of clinical data published

[A new case of rare erythrocytosis due to EGLN1 mutation with review of the literature]. / Polyglobulie rare par mutation du gène EGLN1 : à propos d'un cas et revue de la littérature.

INTRODUCTION: The origin of polycythemia is often simple to detect. Sometimes it is necessary to look for hereditary forms, the decisive parameters being the dosage of erythropoietin and the measurement of the oxygen dissociation curve (P50). These rare diseases are related to high oxygen-affinity haemoglobins, abnormalities of the erythropoietin receptor or dysfunction of the HIF (hypoxia-inducible factor) pathway. CASE REPORT: We report the case of a 56-year-old patient with unexplained polycythemia associated with normal serum erythropoietin and normal P50, in whom the never previously described mutation c.400C>T(p.Gln134*) on exon 1 in the EGLN1 gene (encoding PHD2) was found. CONCLUSION: In the face of an unexplained polycythemia a good cooperation between clinicians and biologists is necessary to be able to characterize rare hereditary pathologies.

[A fatal septic shock due to Capnocytophaga canimorsus and review of literature]. / Infection fulminante fatale à Capnocytophaga canimorsus : à propos d'un cas et revue de la littérature.

INTRODUCTION: Capnocytophaga canimorsus is a Gram-negative bacterium present in normal dogs and cats mouths. It can be responsible for septic shocks after dog or cat bite, especially in asplenic patients. CASE REPORT: We report here a case of C. canimorsus infection rapidly presenting as a multiple organ dysfonction syndrome in an immunocompetent 54 years old patient, who lives near a dog, without any sign of bite. The evolution was a rapidly fatal fulminant septic shock. CONCLUSION: Among patients with a septic shock of unknown etiology, fatal evolution due to C. canimorsus should be avoided by systematic use of early antibiotherapy with amoxicilline and clavulanic acid, especially in patients who live near a pet, even if they are immunocompetent.

[Diagnostic workup in front of an atypical non hemolytic anemia]. / Démarche diagnostique devant une anémie « non hémolytique ¼ sans étiologie apparente.

The most potential causes of "non hemolytic" anemias are iron, folate or vitamin B12 deficiencies, severe renal impairment, endocrine diseases, inflammation and medullary disorders. In a non-exceptionnal way no cause is found, sometimes because of a wrong interpretation of analysis results and sometimes because of a little known etiology. The goal of this review is to point out analytical difficulties and to remember some rarer etiologies.

[Two cases of myeloid sarcomas with review of literature]. / Sarcome granulocytaire : à propos de 2 cas et revue de la littérature.

INTRODUCTION: Myeloid sarcomas are uncommon proliferations of immature myeloid cells occurring in any extramedullary organ. We report here two cases of myeloid sarcomas in patients with, respectively, a polycythemia vera and a myelodysplastic syndrome. CASE REPORTS: The first is an 81-year-old woman who presented with osteolytic lesions. Diagnosis has been highlighted using anatomopathological study after bone marrow biopsy, but it was delayed because of a very localized basin lesion and few positive myeloid markers. The second patient is an 86-year-old man who presented with pancytopenia and several lymph nodes. Lymph node cytology failed because of the rarity of blast cells. Diagnosis was done after anatomopathological study on lymph node biopsy which revealed a localized form of myeloid sarcoma. CONCLUSION: The diagnosis of myeloid sarcoma must be considered when unusual tumors occur in patients with a chronic myeloid disease. In that case, therapeutic options are those of an acute myeloid leukemia.

The semi-seated position slightly reduces the effort to breathe during difficult weaning.

PURPOSE: The influence of posture on breathing effort in patients with difficult weaning is unknown. We hypothesized that posture could modulate the breathing effort in difficult-to-wean patients. METHODS: A prospective, crossover, physiologic study was performed in 24 intubated patients breathing with pressure support who had already failed a spontaneous breathing trial or an extubation episode. Their median duration of mechanical ventilation before measurements was 25 days. Breathing pattern, occlusion pressure (P (0.1)), intrinsic PEEP (PEEP(i)), and inspiratory muscle effort evaluated by the pressure-time product of the respiratory muscles and the work of breathing were measured during three postures: the seated position in bed (90°LD), simulating the position in a chair, the semi-seated (45°), and the supine (0°) positions consecutively applied in a random order. A comfort score was obtained in 17 cooperative patients. The influence of position on chest wall compliance was measured in another group of 11 sedated patients. RESULTS: The 45° position was associated with the lowest levels of effort (p ≤ 0.01) and occlusion pressure (p < 0.05), and tended to be more often comfortable. Respiratory effort was the lowest at 45° in 18/24 patients. PEEP(i) and PEEP(i)-related work were slightly higher in the supine position (p ≤ 0.01), whereas respiratory effort, heart rate, and P (0.1) values were increased in the seated position (p < 0.05). CONCLUSION: A 45° position helps to unload the respiratory muscles, moderately reduces PEEP(i), and is often considered as comfortable. The semi-seated position may help the weaning process in ventilator-dependent patients.

Comparison of patient-ventilator interfaces based on their computerized effective dead space.

PURPOSE: Non-invasive ventilation is largely used to treat acute and chronic respiratory failure. This ventilation encounters a non-negligible rate of failure related to the used interface/mask, but the reasons for this failure remain unclear. In order to shed light on this issue and to better understand the effects of the geometrical design of interfaces, we aimed to quantify flow, pressure and gas composition in terms of CO(2) and O(2) at the passage through different types of interface (oronasal mask, integral mask and helmet). In particular, we postulated that due to specific gas flow passing throughout the interface, the effective dead space added by the interface is not always related to the whole gas volume included in the interface. METHODS: Numerical simulations, using computational fluid dynamics, were used to describe pressure, flow and gas composition during ventilation with the different interfaces. RESULTS: Between the different interfaces the effective dead spaces differed only modestly (110-370 ml), whereas their internal volumes were markedly different (110-10,000 ml). Effective dead space was limited to half the tidal volume for the most voluminous interface, whereas it was close to the interface gas volume for the less voluminous interfaces. Pressure variations induced by the flow ventilation throughout the interface were negligible. CONCLUSIONS: Effective dead space is not related to the internal gas volume included in the interface, suggesting that this internal volume should not be considered as a limiting factor for their efficacy during non-invasive ventilation. Patient's comfort and synchrony have also to be taken into account.

[Acquired factor XI inhibitor and chronic lymphocytic leukemia]. / Allongement du TCA chez un patient atteint de leucémie lymphoïde chronique : à propos de la très rare découverte d'un autoanticorps antifacteur XI.

Autoimmune phenomena, most frequently autoimmune hemolytic anemia, is a well-known complication of lymphoproliferative diseases. We report a very rare association of a chronic lymphocytic leukemia with an acquired factor XI inhibitor. A 87-year-old man presented with auto-immune hemolytic anemia. He had untreated chronic lymphocytic leukemia for the past three years and renal insufficiency. Before surgical procedure for arteriovenous fistula, we discovered a very prolonged activated partial thromboplastin time (APTT), and an acquired factor XI inhibitor was detected. The patient was successfully treated with immunosuppressive therapy. Among patients with lymphoproliferative disorders the discovery of a prolonged APTT implies to search for rare autoimmune phenomena like acquired coagulation factor inhibitors.

Adults with spontaneous aerobic Gram-negative bacillary meningitis admitted to the intensive care unit.

The characteristics of spontaneous aerobic Gram-negative bacillary meningitis (AGNBM) were determined in 40 adults requiring admission to an intensive care unit (ICU) during a 16-year period in ten French ICUs. Eight infections were hospital-acquired and most patients had predisposing factors, mainly chronic alcoholism and an immunocompromised status. Three immunosuppressed patients had disseminated strongyloidiasis. Gram's stain, cerebrospinal fluid and blood cultures were positive for 85%, 98% and 80% of cases, respectively. Escherichia coli (57%) and Klebsiella pneumoniae (17%) were the most frequent pathogens. In-ICU mortality was 38%. Spontaneous AGNBM is a rare complication of bacteraemia in adults. The severity of predisposing underlying diseases might explain the poor prognosis despite appropriate antimicrobial therapy.

Successful treatment of brain aspergillosis with voriconazole.

Until recently, brain aspergillosis was almost always fatal, with a response rate to amphotericin B of < 10%. This study describes a retrospective analysis of eight consecutive cases of brain aspergillosis. All patients were immunosuppressed and five required mechanical ventilation. Antifungal treatment included amphotericin B (n = 7), itraconazole (n = 3), voriconazole (n = 2) and flucytosine (n = 1). Three (38%) patients survived following prolonged azole therapy after initial amphotericin B treatment, combined with a reduction in their immunosuppressive treatment. The prognosis of brain aspergillosis might be improved if immunosuppression could be reduced and prolonged oral azole therapy used.

Allele frequencies of hereditary hemochromatosis gene mutations in a local population of west Brittany.

Hereditary hemochromatosis (HH) gene mutations, C282Y and H63D, have been screened in a cohort of 254 presumably healthy persons originating from a western region of France. The carrier frequencies of these mutations and the incidence of HH have been estimated and compared with those of other studies. This cohort contains two C282Y/C282Y genotypes and has the highest C282Y heterozygosity frequency (17.46%) ever reported.