Discovery of the acetyl cation, CH3CO+, in space and in the laboratory.

Using the Yebes 40m and IRAM 30m radiotelescopes, we detected two series of harmonically related lines in space that can be fitted to a symmetric rotor. The lines have been seen towards the cold dense cores TMC-1, L483, L1527, and L1544. High level of theory ab initio calculations indicate that the best possible candidate is the acetyl cation, CH3CO+, which is the most stable product resulting from the protonation of ketene. We have produced this species in the laboratory and observed its rotational transitions Ju = 10 up to Ju = 27. Hence, we report the discovery of CH3CO+ in space based on our observations, theoretical calculations, and laboratory experiments. The derived rotational and distortion constants allow us to predict the spectrum of CH3CO+ with high accuracy up to 500 GHz. We derive an abundance ratio N(H2CCO)/N(CH3CO+)~44. The high abundance of the protonated form of H2CCO is due to the high proton affinity of the neutral species. The other isomer, H2CCOH+, is found to be 178.9 kJ mol-1 above CH3CO+. The observed intensity ratio between the K=0 and K=1 lines, ~2.2, strongly suggests that the A and E symmetry states have suffered interconversion processes due to collisions with H and/or H2, or during their formation through the reaction of H 3 + with H2CCO.

[Dermatological manifestations of COVID-19]. / Les manifestations dermatologiques de la COVID-19.

Besides the principal respiratory symptoms, the COVID-19 has been associated with an important array of dermatological manifestations. However, it is not always easy to distinguish whether these skin manifestations are the result of a direct action of the virus on epidermal and/or dermal cell populations, represent a paraviral phenomenon or are a rather fortuitous association. In this review the principal cutaneous manifestations associated with COVID-19 are described as well as their eventual value in terms of diagnostic aid or as prognostic factor. The palmoplantar ischemic pseudo-chilblains lesions are the most frequently observed and are useful for epidemiological purposes. The disseminated vesicular eruptions affect about 23 % of the patient and may witness an initial COVID-19 infection, whereas the vasculitic lesions are rather rare but are currently considered as a factor of bad prognosis.

Outre les symptômes principaux respiratoires, la COVID-19 a été associée avec toute une série de manifestations cutanées. Néanmoins, dans de nombreuses publications, il est assez difficile de discerner si la COVID-19 est directement causale des lésions cutanées, s'il s'agit plutôt d'un phénomène cutané paraviral ou si l'association est fortuite. Dans cette revue, les manifestations cutanées associées à la COVID-19 sont décrites ainsi que leur éventuelle valeur diagnostique et/ou pronostique. Les lésions de type acral (pseudo-engelure) sont les plus fréquentes et surtout utiles pour des données épidémiologiques. Les éruptions vésiculeuses disséminées touchent environ 23 % des patients et peuvent suggérer une infection récente par la COVID-19. Les lésions de type vasculite sont plutôt rares, mais peuvent être considérées comme un facteur de mauvais pronostic.

Discovery of the Ubiquitous Cation NS+ in Space Confirmed by Laboratory Spectroscopy.

We report the detection in space of a new molecular species which has been characterized spectroscopically and fully identified from astrophysical data. The observations were carried out with the 30m IRAM telescopea. The molecule is ubiquitous as its J=2→1 transition has been found in cold molecular clouds, prestellar cores, and shocks. However, it is not found in the hot cores of Orion-KL and in the carbon-rich evolved star IRC+10216. Three rotational transitions in perfect harmonic relation J' = 2/3/5 have been identified in the prestellar core B1b. The molecule has a 1Σ electronic ground state and its J=2→1 transition presents the hyperfine structure characteristic of a molecule containing a nucleus with spin 1. A careful analysis of possible carriers shows that the best candidate is NS+. The derived rotational constant agrees within 0.3-0.7% with ab initio calculations. NS+ was also produced in the laboratory to unambiguously validate the astrophysical assignment. The observed rotational frequencies and determined molecular constants confirm the discovery of the nitrogen sulfide cation in space. The chemistry of NS+ and related nitrogen-bearing species has been analyzed by means of a time-dependent gas phase model. The model reproduces well the observed NS/NS+ abundance ratio, in the range 30-50, and indicates that NS+ is formed by reactions of the neutral atoms N and S with the cations SH+ and NH+, respectively.

Pain after tonsillectomy: effectiveness of current guidelines?

BACKGROUND: Tonsillectomy is one of the most common major surgical procedures performed in children. In 2013, the use of codeine in children was severely restricted. French guidelines for treating tonsillectomy's postoperative pain at home have been reconsidered OBJECTIVE: The aim of our study was to measure effectiveness and safety of two schedules: acetaminophen + ibuprofen (A + I) and acetaminophen + tramadol (A + T) in children who underwent tonsillectomy. SETTING AND PATIENTS: We undertook a 1 year prospective and observational single-center study. All children who underwent tonsillectomy were eligible. The choice of the regimen, A + I group or A + T group, was left for the anesthesiologist in charge, done during the pre-anesthetic assessment. After hospital discharge, parents had to give systematically A + I or A + T, 4 times a day during 5 days and then acetaminophen alone for the next 5 days The primary endpoint was the home pain assessed using Parents' Postoperative Pain Measurement Short Form (PPPM-SF) scale. Secondary endpoints were the rate of further hospitalization and/or surgery due to tonsillectomy-related adverse events. RESULTS: Over the study period, 342 tonsillectomies were performed. The return rate of PPPM-SF scales was 58%. Two hundred patients were analyzed. The median age was 4 [3; 5.2] years and was lower in group A + I (4 [3; 5]; 5 [4; 7]; p < 0.0001). PPPM-SF scores were greater than or equal to 3 in both groups during the first 6 postoperative days. The mean decrease of PPPM-SF score over time was higher in group A + I than in group A + T (p = 0.007). Readmission rate was significantly higher in group A + T (A + I: 0; A + T: 7; p = 0.002) as the rate of reoperation for bleeding (A + I: 0; A + T: 3; p = 0.049). CONCLUSION: Home pain management after tonsillectomy should be improved. In clinical practice, A + I seems at least as effective as the combination A + T, without increasing readmission and/or additional surgery for bleeding.

Fourier transform microwave and millimeter-wave spectroscopy of bromoiodomethane, CH2BrI.

Bromoiodomethane, CH2BrI, is a molecule of natural origin emitted in significant amount into the marine boundary layer. It can easily be decomposed by solar radiation, releasing Br and I atoms in the troposphere, which in turn impacts the atmospheric chemistry. Spectroscopy is an invaluable tool to monitor species present in the atmosphere. Since no high-resolution spectroscopic studies are available for this dihalomethane, we have investigated the rotational spectra of the two bromine isotopologues of CH2BrI in its vibrational ground state in the microwave and millimeter-wave regions. Transitions of b-type have been recorded by Fourier transform microwave spectroscopy below 25 GHz while both a- and b-type spectral lines have been measured below 230 GHz. Observed transitions correspond to energy levels with J ≤ 132 and Ka ≤ 14. Molecular constants including those describing the nuclear quadrupole coupling tensors for (79)Br, (81)Br, and (127)I were accurately determined from the least-squares analysis of a total of 1873 distinct transition frequencies (of which 943 belong to the CH2(79)BrI isotopologue). An experimental (r0) structure of the title species has been derived from the two sets of rotational constants.

Bronchogenic cyst of the tongue in an infant.

Bronchogenic cyst of the tongue is rare. We report the case of a 17-month baby who has a lingual lesion. MRI shows a well-defined cystic lesion. Treatment consisted of a complete resection and histology found a pseudostratified respiratory type epithelium. Only 10 pediatric cases of bronchogenic cyst of the tongue have been reported in the literature. MRI is the imaging modality of choice and treatment is always surgical. The final diagnosis is made by histology.

[What evidence for chest physiotherapy in infants hospitalized for acute viral bronchiolitis?]. / Place actuelle de la kinésithérapie respiratoire dans la prise en charge de la bronchiolite aiguë du nourrisson hospitalisé

This article updates the respiratory physiotherapy technique used in France, and the rationale for its use. This paper reports the results of a recent randomized clinical trial that did not show any efficiency of respiratory physiotherapy (using increased expiratory acceleration) in infants hospitalized for a first episode of bronchiolitis. Further trials are necessary for evaluating this technique in infants who are not hospitalized.

Melanotic neuroectodermal tumor of infancy: case report and review of the literature.

Melanotic Neuroectodermal Tumor of Infancy (MNTI) is a rare but distinct neoplastic entity in infancy. Diagnosis is usually made before the age of 12 months. The common clinical presentation is a rapidly growing mass of the pre-maxillary area. Its surface is unevenly pigmented. To affirm the diagnosis a biopsy is necessary. Few cases of malignancy have been described (5% of cases). Adequate surgical excision is the treatment of choice. Recurrence rate is about 10 to 15% within 5 years. We report in this article the case of a newborn with MNTI illustrating that an R0 surgical excision can be correlated to a favourable prognosis. In this case the 5 years follow up didn't show any local or distant recurrence.

Inter-observer agreement between physicians, nurses, and respiratory therapists for respiratory clinical evaluation in bronchiolitis.

Care providers for children with bronchiolitis use various tools to evaluate respiratory status. The use of a single tool by different types of care provider requires a high level of inter-observer agreement, an aspect rarely studied. This study, involving 82 physicians, nurses, and respiratory therapists aimed to evaluate inter-observer agreement for clinical evaluations in children hospitalized for a first episode of bronchiolitis. Respiratory evaluation included three frequently reported parameters of respiratory status: respiratory rate, retraction signs, and wheezing. The frequency of concordance for observers from the same and from different care provider groups was assessed using a weighted kappa statistic and considering all possible combinations of care providers. We also calculated inter-provider agreement as a function of patient age, regardless of care provider type. Overall inter-observer agreement for all provider pairs was 93.1%, with a weighted kappa statistic of 0.72 (95% CI, 0.66-0.78), indicating substantial agreement, with no difference as a function of pair composition. Inter-observer agreements for the various age groups ranged from 87% to 93%, with kappa scores ranging from 0.62 to 0.78. We conclude that a simple clinical evaluation for respiratory status assessment has a high level of inter-observer agreement within and between physicians, nurses and respiratory therapists. Thus, once the validity of this test has been confirmed in a large population sample, it should be possible to use this test to monitor children hospitalized with bronchiolitis and as an endpoint in clinical trials.

Dispersion of light and heavy pollutants in urban scale models: CO(2) laser photoacoustic studies.

The distribution of pollutants in two urban scale models (point emission source and street canyon with extensive transport) was investigated by means of CO(2) laser photoacoustic spectroscopy in the region of the atmospheric window (9-10 mum). The experimental results of physical modeling are in a good agreement with the numerical calculations performed in the frame of computational fluid dynamic (CFD) modeling. Methanol, ethanol, and ozone (examples of light pollutants), as well as sulfur hexafluoride and 1,2 dichlorethane (examples of heavy pollutants), were selected on the basis of their high resolution spectra acquired by Fourier transform and laser diode spectroscopy.

Hyperfine resolved spectrum of the bromomethyl radical, CH2Br, by Fourier transform microwave spectroscopy.

Pure rotational spectra of the bromomethyl radical, CH(2)Br, were measured by using a Fourier transform microwave (FT-MW) spectrometer in order to fully resolve hyperfine structures arising from both the bromine and hydrogen nuclei. We detected a total of 124 lines for the (79)Br and (81)Br isotopomers, including K(a)=0 (ortho species) and K(a)=1 (para species). No hyperfine splitting due to the hydrogen nuclei was observed for the para species, directly confirming the planarity of the radical. We conducted a global analysis of our present FT-MW results and previous measurements in the millimeter-wave region and obtained an exhaustive list of molecular constants. The sign of the Fermi constant of the bromine nucleus was unambiguously determined to be positive, which is opposite to that found in previous work in the millimeter-wave region and in electron spin resonance experiment on this radical. The present study permitted a systematic comparison to be made of the hyperfine coupling constants of both the halogen and hydrogen nuclei for CH(2)X-type compounds, where X=F, Cl, and Br.

[Early PTH assay after total thyroidectomy: predictive factor for post operative hypocalcemia?]. / Dosage précoce de la PTH après thyroïdectomie totale: facteur prédictif d'hypocalcémie post opératoire?

OBJECTIVES: Hypocalcemia is the most common complication of total thyroidectomy. During surgery the blood supply to preserved parathyroid glands may be compromised, monitoring for post operative hypocalcemia is often the primary reason patients remain in hospital. The aim of this prospective study was to evaluate the role of early parathyroid hormone (PTH) assay for predicting thyroidectomy-related hypocalcemia. MATERIAL AND METHODS: 62 patients underwent total thyroidectomy between November 2004 and April 2005 in our institution. Quick PTH assay was performed 1 hour post thyroidectomy. Based on the result (PTH > or <16 pg/mL) the patients were separated into two groups. Serum calcium levels and ionised fractions were determined 24, 48 and 72 hours after surgery. Post operative hypocalcemia was defined as calcium levels <2.00 mmol/L and/or ionised calcium levels <1.00 mmol/L. RESULTS: In 16 cases hypocalcemia occurred in the first 72 hours (25.8 %). In all of these cases, PTH measured 1 hour after thyroidectomy was < or = 16 pg/mL. All patients with PTH >16 pg/mL one hour after the operation remained normocalcemic. Of the 29 patients with a PTH < or =16 pg/mL at one hour post surgery, 13 remained normocalcemic. Quick PTH measurements which were < or =16 pg/mL post thyroidectomy were an excellent predictive factor of hypocalcemia with a sensibility of 100%, a specificity of 71.7%, a positive predictive value of 55.2% and a negative predictive value of 100%. CONCLUSION: PTH measurement 1 hour post thyroidectomy can potentially highlight those patients at risk of hypocalcemia. This would allow more efficient replacement therapy with calcium and vitamin D thus avoiding complications and reducing total hospital stay.

Thyroid surgery and recurrent laryngeal nerve monitoring.

UNLABELLED: Recurrent laryngeal nerve paralysis is a much-dreaded complication of thyroid surgery. OBJECTIVE: To study the feasibility and the reliability of a recurrent laryngeal nerve monitoring technique. MATERIALS AND METHODS: This was a prospective study including 36 patients proposed for thyroid surgery with recurrent laryngeal nerve monitoring. They underwent post-operative fibre-optic laryngeal examination and speech therapist consultation. RESULTS: Our technique of nerve monitoring showed a 98 per cent sensitivity and 86 per cent specificity. CONCLUSIONS: Recurrent laryngeal nerve monitoring is a feasible and reliable technique. It can be used to avoid bilateral nerve injury and to increase the surgeon's confidence but not to replace a systematic nerve identification and a careful dissection.

Anatomy of the presacral venous plexus: implications for rectal surgery.

The presacral venous plexus results from anastomoses between the lateral and median sacral veins, and courses into the pelvic fascia covering the anterior aspect of the body of the sacrum. The presacral venous plexus is not directly visible during rectal surgery, and injuries to this plexus may be life-threatening. Dissection of the retrorectal plane or anchoring of the rectum to the sacral promontory as in rectal prolapse surgery exposes the patient to the risk of injury to the presacral venous plexus. The aim of this study was to identify some avascular areas in the anterior aspect of the sacrum in order to lower the occurrence of such injuries during rectal surgery. The pelvis of 10 fresh cadavers was dissected after injection of a colored resin into the inferior vena cava, and the presacral venous plexus was studied. Four avascular tetragonal areas were common to all the specimens. The corners of a square with a side of 3 cm, centered on the anterior aspect of the body of sacrum, were always contained in the avascular areas. The upper side of this square was parallel to a line passing through the sacral promontory, at a 3 cm distance from it. Staples or sutures should be placed in the avascular areas to avoid injuries to the presacral venous plexus.

[Evaluation of rhinologic signs among smokers]. / Evaluation des signes rhinologiques chez le sujet tabagique.

OBJECTIVE: As well as others usually irritative factors, cigarettes smoke has many medical consequences that aren't well known at the present time. The aim of this study is to describe the rhinologic signs caused by cigarettes consumption. MATERIAL AND METHODS: Two groups (smoker and control) of 20 patients (10 men and 10 women) were contituted. Individual patient status was evaluated by questionnaire, analogic visual scale, clinical examination and rhinomanometry. RESULTS: Nasal resistances, nasal obstruction and posterior rhinorrhea evaluated by, analogic visual scale are significantly higher in the smoker group as compared to the control group (Mann-Whitney test; total nasal resistance: p<0.00001, uninasal resistances: p<0.00001, nasal obstruction: p<0.0001, posterior rhinorrhea: p<0.01). They are significantly higher among smokers of 20 cigarettes a day than among smokers of 10 cigarettes a day. DISCUSSION: The control group was completly safe of rhinologic signs, so we used it to confirm the normal values of nasal resistances. Posterior rhinorrhea and nasal obstruction are 2 important signs which should be researched in smokers; its severity is correlates with cigarettes consumption. CONCLUSION: Tobacco is an important irritative factor for nasal mucosa.

[Evaluation of rhinologic manifestations of gastro-oesophageal reflux]. / Evaluation des signes rhinologiques liés au reflux gastro-oesophagien.

OBJECTIVE: As well as other usually irritative factors, the acidity of gastro-oesophageal reflux (GOR) has many medical consequences that are not well known at the present time. The aim of this study is to describe the rhinologic signs caused by this common disease. MATERIALS AND METHODS: Prospective study; two groups (GOR proved by pH-metry and control) of 20 patients (10 men and 10 women) were formed. Individual patient status was evaluated by questionnaire, visual analogue scale (AVS), clinical examination and rhinomanometry. RESULTS: Nasal resistance, nasal obstruction and posterior rhinorrhea evaluated by AVS are significantly higher in the GOR group as compared to the control group (Mann-Whitney test; total nasal resistance: p < 0.01, uninasal resistances: p < 0.001, nasal obstruction: p < 0.00001, posterior rhinorrhea: p < 0.00001). DISCUSSION: The control group was completely free from rhinologic signs, so we used it to confirm the normal values of nasal resistance. Nasal obstruction and posterior rhinorrhea are two new signs which should be researched in patients affected by GOR. CONCLUSION: GOR is an important irritative factor for nasal mucosa responsible for nasal obstruction and posterior rhinorrhea. (full article translated in english available on www.ent-review.com).

[Interest of MIBI scintigraphy in the preoperative investigation of primary hyperthyroidism]. / Valeur de la scintigraphie au MIBI dans le bilan des hyperparathyroïdies primaires.

OBJECTIVE: The purpose of this study is to show the place of MIBI scintigraphy in the preoperative investigation of primary hyperthyroidism, and then to demonstrate the extent to which this test allows us to formulate new surgical strategies, thus reducing the need for neck exploration in favour of minimally invasive techniques. MATERIALS AND METHODS: We have carried out a retrospective study related to 118 cases of primary hyperthyroidism. A MIBI scintigraphy has been applied on all the patients, so that we have been able to compare its results with the surgical and histological findings. RESULTS: Our study shows a great accuracy of MIBI scintigraphy, with respect to the localization of parathyroid adenoma, which represents the major cause of primary hyperparathyroidism. Furthermore, these results prove the reliability of the new surgical strategies: unilateral neck exploration and minimally invasive surgery, when facing a single scintigraphic site. CONCLUSION: As of now, MIBI scintigraphy must be part of preoperative investigation in cases of primary hyperparathyroidism, so that by limitating the surgical neck exploration, it allows us to decrease operative time and the risks, length and cost of the hospital stay.

[Laryngeal tuberculosis: report of a case]. / Tuberculose laryngée: à propos d'un cas.

The larynx as a site of tuberculosis represents less than 1% of the total of this disease. Primary tuberculous laryngitis is even more rare. The authors report a case of an 89 year-old man presenting with swallowing disorders (dysphagia and overspill) consulting for suspected laryngeal carcinoma. Finally, the diagnosis was laryngeal tuberculosis. The outcome was favourable with appropriate treatment, obtaining complete healing without any after-effects. The diagnosis of tuberculosis must cross the clinician's mind, even when there are no general symptoms.

H(3)Si(37)Cl Revisited with High Resolution: The Ground State and the v(2) = 1; v(3) = 1, 2, and 3; v(5) = 1; v(6) = 1 and 2; and v(3) = v(6) = 1 States.

The infrared spectrum in the range 400-1600 cm(-1) of isotopically pure H(3)Si(37)Cl has been recorded at high resolution (2.4-6.6 x 10(-3) cm(-1)) and analyzed. Fifteen bands have been studied, namely the four fundamentals nu(3) (543.968 cm(-1)), nu(6) (663.738 cm(-1)), nu(2) (947.982 cm(-1)), and nu(5) (950.657 cm(-1)), the overtone bands 2nu(3), 2nu(0)(6), and 2nu(-/+2)(6), the combination band nu(3) + nu(6), and seven hot bands. Improved ground state constant parameters have been obtained, including all four sextic distortion constants. As for the J-independent parameters A(0), D(0)(K), and H(0)(K), they were determined mainly through the "loop method" involving nu(6), 2nu(-/+2)(6), and 2nu(-/+2)(6)-nu(+/-1)(6) and checked through the strong interactions between nu(2) and nu(5), producing some "forbidden lines." The nu(2)/nu(5) dyad was fitted with success using two different reduced Hamiltonians. Concerning nu(3) and nu(6), in spite of their relatively large separation, a Coriolis interaction could be evidenced. In both nu(2)/nu(5) and nu(3)/nu(6) interacting systems the sign of the interaction was found positive. As for the overtones, 2nu(3) was treated as isolated and 2nu(0)(6) and 2nu(-/+2)(6) as linked together by an l(2, 2) interaction. The data on the v(3) = v(6) = 1 levels were obtained mainly from the two hot bands nu(3) + nu(6) - nu(3) and nu(3) + nu(6) - nu(6), and marginally from the weak band nu(3) + nu(6), and also fitted as for an isolated level. A weak x,y-Coriolis interaction with level crossing between K/(kl - 1) = 21 and 22, and a local l(1, -2) resonance at K = 13/kl = -15 between 2nu(3) and nu(5) were furthermore detected. Copyright 1999 Academic Press.

Sub-Millimeter-Wave Spectroscopy of the Ar.H+3 and Ar.D+3 Ionic Complexes.

An investigation of the sub-millimeter-wave spectra of the ionic complexes Ar.H+3 and Ar.D+3 is presented. These complexes were produced in a negative glow electric discharge, in mixtures of argon with either H2 or D2. About 80 new transitions were assigned in the 485-680 GHz frequency range using a sub-millimeter-wave spectrometer built with Russian made backward wave oscillators (BWO) sources. These measurements enabled us to observe the first Ka = 2 transitions for Ar.H+3 and the first Ka = 3 transitions for Ar.D+3. Analyses of the line frequencies were carried out using an IAM-like approach, which accounts for the large amplitude internal rotation motion displayed by both species. Insights into the geometry of the intermediate configuration for this large amplitude motion were gained. Copyright 1998 Academic Press.