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Résumé But de l’étude L’insuffisance cardiaque est une pathologie fréquente et son évolution vers l’insuffisance cardiaque terminale est responsable d’une mortalité élevée. L’objectif de cette étude rétrospective était d’évaluer l’accès à une prise en charge palliative intégrée à la prise en charge cardiologique les 6 mois précédant leur décès, et plus particulièrement, au cours de la dernière hospitalisation. Patients et méthodes Une étude rétrospective a été réalisée chez les patients décédés d’insuffisance cardiaque en 2009 sur 2 centres hospitaliers. L’analyse a été réalisée sur 20 dossiers de chaque établissement. Les dossiers des patients consécutifs ont été inclus de façon anti-chronologique à partir du 31 décembre 2009. Résultats Pour leur dernière hospitalisation, 37 patients (93 %) ont été hospitalisés en urgence. Dans les 3 jours précédant le décès, les symptômes les plus retrouvés étaient la dyspnée ( n = 33 ; 82 %), et la douleur ( n = 30 ; 75 %). Les thérapeutiques les plus utilisées étaient l’oxygénothérapie ( n = 31 ; 77 %) et les antalgiques ( n = 30 ; 75 %). Aucun patient n’a bénéficié d’un suivi par une psychologue. La décision de limitation de traitements au profit des soins de confort a été notifiée pour 24 patients (60 %) et la médiane du délai moyen entre cette décision et le décès était de 2 jours (Q1–Q3 ; 1–5 jours). Conclusion Les patients en insuffisance cardiaque terminale présentent de nombreux symptômes nécessitant souvent une prise en charge multidisciplinaire. Ce type d’étude observant les pratiques montre le chemin restant à parcourir pour intégrer les soins palliatifs dans la prise en charge habituelle des patients insuffisants cardiaques. Purpose Heart failure is a common disease and its progression to end-stage heart failure is responsible of high mortality. The aim of this retrospective study was to assess the access to integrated palliative care to the usual management, 6 months prior to their death, and especially during the last hospitalization. Patients and methods A retrospective study was performed in patients who died of heart failure in 2009 in two hospitals. The analysis was performed on 20 cases of each institution. The records of consecutive patients were included in an anti-chronological order from 31st December 2009. Results For their last hospitalization, 37 patients (93%) were hospitalized in emergency. Within 3 days prior to death, the most frequent symptoms were dyspnea ( n = 33, 82%), and pain ( n = 30, 75%). Therapeutic most frequently used were oxygen ( n = 31, 77%) and analgesics ( n = 30, 75%). No patient was seen by a psychologist. The decision to limit treatment for comfort care was reported for 24 patients (60%) and the median of the average time between the decision and death was 2 days (Q1–Q3, 1–5 days). Conclusion Patients with terminal heart failure have many symptoms often requiring multidisciplinary care. This type of study relating practices shows that there is still a lot to do to integrate palliative care in the usual management of patients with heart failure. [ABSTRACT FROM AUTHOR]

Metastable β Ti–6Mo–5Ta–4Fe (wt.%) alloy was synthesized by cold crucible levitation melting and then quenched in water from the β-phase field. In order to investigate the transformation sequence on heating, thermal analysis methods such as electrical resistivity, dilatometry and neutron thermodiffraction were employed. By these methods, the different temperatures of transition were detected and solute partitioning was observed in the β matrix during omega and α nanophase precipitation. [Copyright &y& Elsevier]

Abstract: Context. – Some patients, although they present no severe diseases, consult frequently, either for somatoform disorders, or for mild chronic diseases. A “Caisse Nationale d''Assurance Maladie” [National Health Insurance Fund] survey, built on care consumption criteria, has evaluated this sort of patient as constituting 3,6% of a vast sample of members of the national insurance scheme. They represent 8% of general practice acts and 14% of the whole care expenses. The aim of this survey is to describe, in general practice, the clinical reality of this category of patients recognised as high care consumers. Method. – Four urban or rural General Practitioners selected non-psychotic adult patients, consulting more than six times a year for more than two years, for at least two minor motives. Twelve of them accepted to meet the investigator for a detailed interview inspired by the method of “récit de vie” (life story) used in sociology. Interviews lasted between one and three hours, and were directed toward biography, complaints, pathologies, and care. Results. – The patients, ten women and two men, between 29 and 70-years-old, belonged to rather disadvantaged social categories. They had consulted their General Practitioner an average of 20.8 times over a period of a year. Pains, digestive or ORL disorders were the main motives for consultation. Objective diseases were rare and minor. Seven of them consumed psychotropic drugs in the absence of any well-argued psychiatric diagnosis as we found out afterwards in the files. Only one of them presented HARD scale depression criteria. Specialist consultations were rare; only three patients had consulted a psychiatrist. No actual addiction to alcohol or to illicit products was noted. They were all faithful to their General Practitioner; the link, solid in each case, could be of a submissive or aggressive nature. They all had known situations of lasting affective frustrations from childhood, such as abandonment or parental unavailability. Seven of them were also concerned by parental failures when they entered adulthood when, furthermore, they were already weakened by disease or pregnancy. For five patients, it was a complicated mourning which began the period of high care consumption. Nine patients had witnessed one parent''s serious disease during childhood. And six insisted on their own childhood diseases. The identification of a sick relative and the need for the support of a medical person were retained as an explanatory hypothesis for adopting the status of patient. Narcissistic weakness and the central role of an analytic relation with their General Practitioner, without any other psychological trouble, revealed a borderline condition. Conclusion. – High care consumption studied, as a “life situation” via these twelve stories seems to be characterized by an experience of past affective frustrations and more recent traumatisms of the patients. The survey permits, in the absence of located psychiatric pathologies, to assume as possible meaning a behaviour that is not socially adapted. It also put forward the modest but central role of the General Practitioner in receiving complaints. [Copyright &y& Elsevier]

Abstract Infective endocarditis is a severe disease with high mortality. Despite a global trend towards an increase in staphylococcal aetiologies, in older patients and a decrease in viridans streptococci, we have observed in recent studies great epidemiologic disparities between countries. In order to evaluate these differences among Mediterranean countries, we performed a PubMed search of infective endocarditis case series for each country. Data were available for 13 of the 18 Mediterranean countries. Despite great differences in diagnostic strategies, we could classify countries into three groups. In northern countries, patients are older (>50 years old), have a high rate of prosthetic valves or cardiac electronic implantable devices and the main causative agent is Staphylococcus aureus. In southern countries, patients are younger (<40 years old), rheumatic heart disease remains a major risk factor (45–93%), viridans streptococci are the main pathogens, zoonotic and arthropod-borne agents are frequent and blood culture–negative endocarditis remains highly prevalent. Eastern Mediterranean countries exhibit an intermediate situation: patients are 45 to 60 years old, the incidence of rheumatic heart disease ranges from 8% to 66%, viridans streptococci play a predominant role and zoonotic and arthropod-borne diseases, in particular brucellosis, are identified in up to 12% of cases. [ABSTRACT FROM AUTHOR]

Sigma-phase precipitation in a 316Nb “stabilized” austenitic stainless steel was studied through complementary CALPHAD-based and dedicated experimental investigations. Thermokinetic calculations performed using Thermo-Calc (with the DICTRA module) and MatCalc software showed that the sigma phase (σ) precipitated directly at γ-austenite grain boundaries (GB) via a common solid-state reaction when carbon and nitrogen contents fell below a critical threshold. Residual δ ferrite was found to be more susceptible to σ-phase precipitation; this type of precipitation occurred via two mechanisms that depended on the concentration profiles of δ-ferrite stabilizing elements induced by previous thermomechanical processing: direct σ precipitation (δ → σ) along the periphery of δ islands followed by a eutectoid decomposition (δ → σ + γ 2 ) within these islands. Both simulations and experiments revealed that the σ phase at γ GB contained higher amounts of Mo and Ni, while σ within δ ferrite possessed higher contents of Fe and Cr. Finally, the simulated time–temperature–precipitation diagrams for the σ phase in residual δ ferrite were found to be in very good agreement with the experimental ones and comparable to those observed in duplex stainless steels. [ABSTRACT FROM AUTHOR]