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Back to Journals » Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy » Volume 13
Analysing the Clinical Features of Pneumomediastinum Associated with Diabetic Ketoacidosis in 79 Cases
Authors Zhang W, Chen J, Wu X, Chen L, Wei J, Xue M, Liang Q
Received 12 September 2019
Accepted for publication 10 February 2020
Published 17 February 2020 Volume 2020:13 Pages 405—412
DOI https://doi.org/10.2147/DMSO.S230799
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Antonio Brunetti
Weidong Zhang,* Jingfang Chen,* Xiaoming Wu, Luyu Chen, Jinxing Wei, Mingqiang Xue, Qingzheng Liang
Department of Thoracic Surgery, Henan Provincial Chest Hospital, Zhengzhou, Henan Province 450003, People's Republic of China
*These authors contributed equally to this work
Correspondence: Weidong Zhang Room 1, Weiwu Road, Zhengzhou City, Henan Province 450003, People's Republic of China
Email zhangweidong0371@126.com
Objective: To analyse the clinical features of pneumomediastinum associated with DKA (diabetic ketoacidosis) to improve clinicians' understanding of the disease.
Methods: A total of 78 patients with pneumomediastinum associated with DKA were identified in the literature search, and one patient treated in our hospital was included. The clinical features of the 79 patients were retrospectively analysed, and the pathogenesis, clinical symptoms, diagnostic methods, treatment strategies and prognoses were explored.
Results: All cases were confirmed by chest CT (computed tomography), and Kussmaul respiration, severe vomiting, chest pain were common symptoms. The main treatment principle was to correct acidosis and treat the primary disease. The majority of patients recovered within 1– 2 weeks, and only 2 patients died.
Conclusion: Pneumomediastinum associated with DKA is a rare disease, and it has a benign course when an early diagnosis is made and aetiological treatment is administered.
Keywords: pneumomediastinum, diabetic ketoacidosis, treatment, diagnosis
Pneumomediastinum (PM) is a pathological manifestation of air entering the connective tissue space in the mediastinum pleura and being stored in the mediastinum for various reasons. Most cases of PM are caused by chest trauma, oesophageal perforation, or iatrogenic injury. The incidence of PM is low, approximately 1/33,000, and the proportion of the population with PM between 5 and 34 years old is slightly higher, approximately 1/25,000.1–4 Pneumomediastinum caused by DKA is rare. The first complete report of this condition was described by Hamman5 in 1939, and approximately 78 cases have been reported in the literature to date. This paper reports a 17-year-old female patient who was admitted to our hospital because of pneumomediastinum. After excluding various common causes of pneumomediastinum, we finally diagnosed DKA as the cause of pneumomediastinum. The data of 78 patients with DKA complicated with pneumomediastinum were analysed retrospectively, and the characteristics of diabetic ketoacidosis complicated with pneumomediastinum were summarized. The pathogenesis, clinical symptoms, diagnostic methods and treatment strategies were analysed, and this information can improve clinicians' understanding of the disease.
A 17-year-old female patient with complaints of "chest tightness, shortness of breath for 4 days and blurred consciousness for 5 hrs" was admitted to our hospital in July 2017. The patient had symptoms of nausea, vomiting, drinking and polyuria one week prior. At that time, she was given symptomatic treatment for gastroenteritis, and no improvement was observed. The symptoms of chest tightness and shortness of breath appeared 4 days prior and were not considered in the treatment. One day ago, chest tightness and shortness of breath were obviously aggravated. Mediastinal gas was found by a chest CT examination in the local hospital, so she was sent to our hospital through the emergency channel. On the way to the hospital, she exhibited a gradual vagueness of consciousness and a slow response. The patient denied that she had a previous history of diabetes or other diseases, we learned that the patient had a habit of drinking sweet drinks (such as Coca Cola, Sprite), and the patient did not smoke or drink alcohol.
According to the physical examination, her temperature was 36.6°C, pulse was 130 bpm, respiratory rate was 35 per minute, and blood pressure was 108/61 mmHg. She had poor spirits, lethargy, mild dehydration, and a small amount of crepitation at the entrance to the anterior thoracic neck, her breathing was deep and rapid (Kussmaul breathing), she were smelled the smell of rotten apple, and both lungs were auscultated and exhibited clear sounds without dry or wet sounds. Her heart rate was 130 bpm (normal rhythm), the precordial auscultation heart sound was remote, the friction sound was synchronized with the heart rhythm (Hamman sign, the unique sign of pneumopericardium), and pathological noises were not heard.
According to the assistant examinations, the chest CT showed extensive air in the neck subcutaneously and mediastinum, which had spread along the bronchovascular bundle, and no pneumothorax was found in the bilateral chest (Figure 1). The arterial blood gas analysis results were as follows (oxygen inhalation 3 L/min): pH of 6.90 (reference range: 7.35 to 7.45), partial pressure of oxygen of 144 mmHg (83~108 mmHg), partial pressure of carbon dioxide of 10 mmHg (35~48 mmHg), residual alkali could not be detected, and bicarbonate concentration of 9.0 mmol/L. Her white blood cell count was 22.45 × 109/L (4–10×109/L), neutrophil level was 79.1% (50–70%), blood glucose concentration was 40.62 mmol/L (3.5–6.1 mmol/L), HbA1C1 level was 3.5% (4.0–6.0%), creatinine concentration was 123.6 μmol/L (40–97 μmol/L), urea nitrogen concentration was 7.2 mmol/L (1.7–8.3 mmol/L), serum potassium concentration was 3.24 mmol/L (3.5–5.5 mmol/L), serum sodium concentration was 119.0 mmol/L (135–155 mmol/L), serum chlorine concentration was 89 mmol/L (90–110 mmol/L), glutamic pyruvic transaminase concentration was 13.2 U/L (0–40 U/L), glutamic oxaloacetic transaminase concentration was 19.9U/L (0–40U/L), and total protein concentration was 72.4g/L (60.0–85.0g/L). Her urine glucose level was 3+, urinary ketone body level was 3+, urinary protein level was 2+, and urinary pH level was 5.0 (6.0–7.0).
Figure 1 Pathogenesis of DKA complicated with PM. Under normal physiological conditions, the intra-alveolar pressure > pulmonary interstitial pressure > mediastinal pressure. Kussmaul breathing and severe vomiting caused a sudden increase in intra-alveolar pressure, which caused alveolar rupture and gas from the ruptured alveoli to flow to the pulmonary interstitial region and the mediastinum, resulting in mediastinal emphysema. The Kussmaul breathing and severe vomiting symptoms caused by diabetic ketoacidosis aggravated the changes in the alveolar pressure gradient, making it more likely that pneumomediastinum formed.
After admission, she underwent oxygen inhalation, mediastinal gas drainage through the neck, massive fluid replacement, and correction of acidosis, regulating her blood glucose level and other symptomatic support treatment was provided. The symptoms of nausea and vomiting were gradually relieved, the breathing gradually became stable, and the heart rhythm dropped to the normal range after 24 hrs. Three days later, when the patient's condition was stable, the oesophageal barium meal examination excluded oesophageal rupture. The accumulation of gas in the mediastinum of the patient evident in the chest CT had completely disappeared after 10 days. Standard hypoglycaemic therapy was continued after discharge. To date, which is after approximately 2 years, the patient has not exhibited recurrence.
Literature Review and Summary
With "pneumomediastinum, diabetic ketoacidosis" as keywords, 79 patients with diabetic ketoacidosis associated with pneumomediastinum were identified in the CNKI (China National Knowledge Infrastructure), Wanfang, Google Scholar and PubMed databases. The characteristics of the 79 patients are shown in Table 1.
Table 1 Clinical Data of 79 Cases with DKA Complicated with PM
There are many causes of pneumomediastinum in clinical practice, such as chest trauma, oesophageal perforation, iatrogenic injury (tracheotomy, artificial pneumothorax pneumoperitoneum, bronchoscopy, esophagoscopy, tooth extraction, etc.). Childbirth, diving, drug abuse, cough, and asthma are unusual, and pneumomediastinum caused by diabetic ketoacidosis is very rare.2,6–8
Because it is extremely rare, clinicians often fail to make a definite diagnosis early. If patients cannot be diagnosed and treated in a timely manner, malignant events can occur in patients. Diabetic ketoacidosis with pneumomediastinum is often associated with pneumopericardium and subcutaneous emphysema, occasionally epidural pneumatosis,1,3,9–11 and even pneumothorax3,12,13 and stress-induced cardiomyopathy.14 Therefore, it is of great importance to thoroughly understand the pathogenesis, clinical symptoms, diagnostic methods and treatment of pneumomediastinum caused by diabetic ketoacidosis.
Most scholars1,3,15 believe that the cause of mediastinal gas accumulation in patients with diabetic ketoacidosis complicated with pneumomediastinum is gas entering the pulmonary interstitium due to various causes of alveolar rupture. The bronchus and blood vessels located around the hilum of the lung in the mediastinum are surrounded by interstitial sheaths containing gaps that extend along the segmental bronchi, sub-bronchus, and parallel vessels to the lung parenchyma, and the pressure in the mediastinum is generally less than that in the alveoli. This pressure difference causes the pulmonary interstitial gas to flow backwards into the mediastinal space after alveolar rupture, leading to pneumomediastinum. This gas flow was described in detail by the Macklin16 brothers as early as 1944, and they pointed out that after the alveolar gas flows backwards into the mediastinum, with an increase in the gas and pressure in the mediastinum, it enters the pericardium and epidural, retroperitoneal, and subcutaneous spaces and even breaks through the mediastinal pleura to form pneumothorax, this mechanism is called the Macklin effect by some scholars.17 Why does diabetic ketoacidosis cause alveolar rupture? Based on the previous literature,1–4,17,18 it was found that the cause of alveolar rupture is a change in the pressure difference between internal and external alveoli, and most of the patients with acidosis also had Kussmaul breathing (deep and laboured breathing) and severe vomiting. There are root causes of pneumomediastinum in patients with diabetic ketoacidosis. Bullaboy reported that Kussmaul respiration can increase the alveolar pressure to 20–30 mmHg, which is sufficient to cause alveolar rupture.18 Severe vomiting could lead to changes in the alveolar pressure gradient in the chest. Mediastinal air accumulation caused by tracheal rupture is rare because severe vomiting is caused by diabetic ketoacidosis. However, it is not clear whether mediastinal air is caused by tracheal rupture or alveolar rupture.19 According to the previous literature, almost all patients had Kussmaul respiratory disease, approximately 70.9% of the patients (56 patients) had definite vomiting symptoms before chest discomfort developed, and almost all of them had no history of complicated lung diseases. The average respiratory rate of the patients was approximately 33 times per minute. That is why diabetic ketoacidosis patients associated with pneumomediastinum. It is interesting to note that the average age of all the patients was 21 years, and 68.4% of the patients were male. This result may be due to the stronger muscle strength of the ventilator in young men. Deep rapid breathing and severe vomiting are more likely to cause greater alveolar pressure differences, so it is more likely to cause pneumomediastinum, which confirms the above mechanism (Figure 1).
Clinical Symptoms and Signs
Kussmaul breathing, severe vomiting and chest pain are common symptoms in patients with diabetic ketoacidosis associated with pneumomediastinum. Some patients have complications such as dysphagia, dysphonia, somnolence and so on. Excessive accumulation of polyketone bodies and acidic substances in patients with diabetic ketoacidosis causes deep and rapid breathing, and the patient can develop a mental disorder after a long period of time without remission. Some patients develop severe vomiting due to an electrolyte imbalance, and increased secretion of prostacyclin in the body stimulates the gastrointestinal mucosa.20
Retrosternal pain is a concomitant symptom in almost all patients, mainly due to the traction and displacement of mediastinal tissue by gas in the mediastinum, which is often located behind the sternum. It increases with activity and breathing. Pain can radiate to the neck, back, shoulders, arms and even the abdomen. When the mediastinal gas enters the posterior pharyngeal wall or the larynx, a small number of patients may have difficulty swallowing and pronouncing words. When air gathered in the mediastinal space enters the retroperitoneum, abdominal discomfort may also develop in some patients.21
The common signs of diabetic ketoacidosis associated with pneumomediastinum are crepitus in the anterior cervical region, deep and laboured breathing (Kussmaul breathing), an increased ventricular heart rate, a positive Hamman sign, and the smell of rotten apples when breathing. In most patients, the blood pressure is normal, bilateral lung auscultation is generally not positive (unless complicated with pneumothorax), the heart rhythm is regular, and the oxygen saturation is normal. As mentioned above, excessive mediastinal gas can cause subcutaneous emphysema in the anterior neck and chest wall, and ketoacidosis can lead to deep and laboured breathing, an accelerated heart rate and a rotten apple smell when breathing. Hamman's crunch is a typical sign of pneumomediastinum, and it is synchronous with cardiac systole and is composed of crepitus and popping noises that are the louder where is located at the apex of the heart, the lower end of the sternum or the left edge of the sternum.5 This is especially true in the inspiratory and left recumbent position. The cause of Hamman's crunch is retrograde flow of the gas accumulated from the vascular sheath after alveolar rupture into the pericardial cavity, resulting in pericardial gas accumulation. Severe pericardial gas accumulation leads to pericardial tamponade, resulting in circulatory disturbance and failure, which can lead to the death of patients with diabetic ketoacidosis with pneumomediastinum.
Diagnostic Methods
Most diabetic ketoacidosis patients with pneumomediastinum were admitted to the hospital because of Kussmaul respiration, severe vomiting and chest pain. Chest X-ray or chest CT scans can reveal mediastinal air accumulation. For patients who additionally have subcutaneous gas, a chest X-ray can be used to easily detect pneumomediastinum, but for patients with a small amount of mediastinal air, chest CT scans are more accurate. It is also easier to detect pneumopericardium and epidural pneumatosis with chest CT scans. In some patients, chest CT examinations revealed scattered air shadows in the bilateral pulmonary stroma, intravascular sheath, bronchial sheath and mediastinum (Figure 2), which can be used to determine whether the cause of mediastinal gas is rupture of the oesophagus or trachea. Gas accumulation due to oesophageal and tracheal rupture is limited to the periphery of the rupture and causes soft tissue swelling and even local gas-liquid level performance. Chest CT scans have a more intuitive performance in determining the degree of pericardial tamponade, so these scans provide a basis for a timelier detection and treatment of serious cases of pericardial tamponade. Therefore, all patients suspected of having pneumomediastinum should be examined by chest CT scans because chest CT scan also allow clinicians to better evaluate the progress and remission of the lesion.
Figure 2 In (A1-3) a large amount of gas has collected in the pericardium (green arrow), in the interstitial lung (red arrow), in the bronchial sheath (blue arrow), and in the pulmonary vascular sheath (yellow arrow), before entering the mediastinum (black arrow), which is a unique manifestation of diabetic ketoacidosis with pneumomediastinum. (B1-3) shows that there is no accumulation of gas in the pericardium, interstitial lung, bronchial and pulmonary vascular sheath, and mediastinum after correction for acidosis and hyperglycemia.
Arterial blood gas, blood glucose and urinary ketone body analyses are used for the diagnosis of diabetic ketoacidosis. The arterial pH values of diabetic ketoacidosis patients with pneumomediastinum were low, with an average of 7.08, because severe acidosis can aggravate the symptoms of Kussmaul respiration and severe vomiting, resulting in alveolar rupture and mediastinal gas accumulation. According to a review of the literature, the average number of white blood cells for these patients were 24.2 × 109 L, but a careful analysis of the imaging data showed that most of the patients had no imaging manifestations of infection in the lungs. Therefore, the authors believe that the higher white blood cell count found in these patients is not related to pulmonary infection but is mainly related to the stress response of acidosis and may also be related to mediastinal infection caused by the accumulation of gas in the mediastinum.
The symptoms of pneumomediastinum caused by esophageal rupture are similar to those of diabetic ketoacidosis with pneumomediastinum, and esophageal rupture is harmful, with a mortality rate of 40%; some cases can require emergency surgical treatment.9 Therefore, the exclusion of esophageal rupture is the primary task in the diagnosis of diabetic ketoacidosis complicated with pneumomediastinum.
According to the literature analysis,1,3,10,11,13,22–36 21 patients with diabetic ketoacidosis complicated with pneumomediastinum underwent esophagography or gastroscopy. Only one patient was found to have a tear in the cardia. (The authors considered that it might be caused by vomiting. However, it was not the cause of pneumomediastinum).25 The remaining patients did not have esophageal rupture.
One of the patients was admitted to the hospital because of a coma complicated with pneumomediastinum. Because esophageal rupture could not be ruled out at the time, thoracotomy was performed, and esophageal rupture was not found. After the symptomatic treatment of ketoacidosis, the mediastinal gas disappeared. However, hyperglycaemia was found in this patient upon and after admission, but the attending physician did not pay attention to it. Therefore, the author believes that attending doctors may not fully understand the existence of diabetic ketoacidosis complicated with pneumomediastinum, leading them to open the chest blindly.22
Most of the cases of esophageal rupture are triggered by an event, such as trauma, eating sharp and hard foods, and invasive operations, etc., and most of them are accompanied by obvious symptoms of mediastinal infection. Combined with those results in the previous literature,9,32 the authors believe that for patients with diabetic ketoacidosis complicated with pneumomediastinum, if there is no definite cause of esophageal rupture and no obvious signs of mediastinal infection, symptomatic support treatment ketoacidosis should be administered first. Then, esophagography and gastroscopy should be performed to determine whether there is any injury to the esophagus if necessary.
Treatment and Prognosis
When the diagnosis of diabetic ketoacidosis complicated with pneumomediastinum is clear, these patients are mainly treated for diabetic ketoacidosis with treatments such as fluid replacement, hypoglycaemia, correction of acidosis and preventive anti–infection treatments. However, for some patients with severe subcutaneous pneumatosis and pericardial tamponade, for whom the stability of respiratory circulation is affected, subcutaneous pneumatosis decompression and even pericardial decompression should be performed immediately. For this patient in our hospital, a large amount of pneumopericardium was observed on the chest CT scans, and the heart structure could not be detected with Doppler echocardiography. However, after acidosis treatment, the patient's circulation became stable, and the sound of the heart gradually became clear. The author did not further address the pericardial gas tamponade.
The analysis of the previous literature showed that no patients was given pericardial decompression, but one patient died of cardiac arrest after admission.33 It is not known whether the cause of death was related to severe pericardial tamponade. Therefore, the authors believe that the treatment of patients with severe pericardial tamponade should mainly include acidosis treatment; if the symptoms of pericardial tamponade are not relieved after the correction of acidosis or when the accumulation of pericardial gas increases, an additional invasive operation can be carried out to alleviate the symptoms of pericardial tamponade.
The rapid progression of acute ketoacidosis can also lead to stress-induced cardiomyopathy. It is necessary to fully understand the comorbidities and provide symptomatic supportive treatment. If it cannot be identified and treated in a timely manner, a malignant event can easily occur.14 However, for some patients with epidural pneumatosis, pneumothorax and stress-induced cardiomyopathy, after the correction of acidosis, the symptoms of Kussmaul respiration and vomiting were relieved, and the accumulation of gas in the mediastinum, epidural and subcutaneous regions and even the thoracic cavity was gradually absorbed. Most of the patients were fully cured and discharged from the hospital within 1 to 2 weeks.
Most of the patients with diabetic ketoacidosis complicated with pneumomediastinum had a good prognosis, and the mortality was low. In China, a patient suffered from sudden cardiac arrest and respiratory arrest 10 hrs after admission. She died of aggravation of mediastinal pneumatosis and subcutaneous gas after rescue measures such as tracheal intubation and assisted breathing were administered.33 One patient died in the UK due to a failure to control the severe pulmonary infection.34 In the previous literature,35 only one patient had recurrence twice after the treatment of pneumomediastinum, but the specific reason is not clear. It may be that other patients with diabetic ketoacidosis also develop pneumomediastinum again, but their symptoms are mild, and chest CT scans were not performed, so pneumomediastinum could not be diagnosed. Therefore, it is necessary to review chest CT scans when respiratory and circulatory abnormalities occur in patients with ketoacidosis.
Diabetic ketoacidosis with pneumomediastinum is a rare disease that is relatively common in young men. The cause of diabetic ketoacidosis with pneumomediastinum is alveolar rupture, which is caused by a change in the alveolar pressure gradient caused by Kussmaul respiration and severe vomiting, which occur due to ketoacidosis. The prognosis is generally good, but it can be fatal when complicated with severe pneumopericardium.
Written informed consent had been provided by the patient to have the case details and any accompanying images published. This was an observational case and institutional approval was not required, because all treatment received by this patient is conventional therapy. The other patients' information in this article comes from the references.
The study was supported by a grant from the Henan Medical Science and Technology Research Program (no. 2018020567) as part of the Capital Characteristic Clinical Application Research project.
The authors declare no conflicts of interest in this work.
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Cézembre est une île côtière située en baie de Saint-Malo (en Ille-et-Vilaine, au nord-est de la Bretagne). D'une superficie de , elle est inhabitée, à l'exception d'un restaurant ouvert durant la saison estivale. L'île est située sur le territoire communal de Saint-Malo.

Au Moyen Âge, Cézembre était reliée au continent par des prairies où paissaient des animaux. Progressivement submergées par la mer, elles disparaissent au milieu du .

Peuplée dès le néolithique, Cézembre est occupée à l'époque celte et constitue une place forte, d'où dérive son nom (Segisamabriga, « la hauteur fortifiée la plus puissante »). Au début du Moyen Âge, elle abrite des ermites puis un monastère à partir du , détruit en 1693 à la suite d'une attaque anglaise. L'île a ensuite à partir de la fin du  une vocation militaire pour la défense de la cité malouine et devient une colonie pénitentiaire au . Dans l'entre-deux guerres, elle retrouve une vocation touristique. Pendant la Seconde Guerre mondiale, l'île est largement fortifiée par les Allemands et résiste en août 1944 aux troupes américaines lors de la libération de Saint-Malo. Elle subit pendant plus de  un bombardement intensif, tant aérien, maritime que terrestre, dont l'île garde encore les stigmates aujourd'hui.

Gérée de 1945 à 2017 par la Marine nationale, Cézembre a été longtemps interdite au public au-delà de la plage en raison de la présence de bombes et de munitions non explosées. L'île a connu plusieurs opérations de déminage et en avril 2018, un sentier sur la moitié ouest est ouvert au public. La gestion de l'île a été transférée au Conservatoire du littoral en octobre 2017.

Toponymie

Le premier élément du nom de Cézem-bre provient de l'adjectif celtique segisama formé sur sego , « fort, puissant », accompagné du suffixe augmentatif -sama et de la  finale celtique -bre -briga, « hauteur, forteresse ». Il s'agit de *Segisamabriga qui signifie donc « la hauteur fortifiée la plus puissante». On retrouve ce toponyme dans le Var (cap Cézembre à Sainte-Maxime) et au Portugal (Sesimbra).

César, lors de sa conquête de l'Armorique, se heurte à ce type de défense sur des îles côtières accessibles qu'à marée basse :

L'orthographe de l'île varie dans le temps : l'évêque Bili la surnomme ironiquement ad insulam September au , fournissant la première occurrence connue du nom. Elle est nommée Sézambre en 1445, Sainct Zambre ou Saizambre en 1593, Cézambre en 1518, forme qui perdure aux  et s.

Géographie

Cézembre est l'île la plus importante des îles de la baie de Saint-Malo. Elle se situe à  de Saint-Énogat, à Dinard, et à  de Saint-Malo intramuros. Allongée dans la direction sud-ouest nord-est, elle est formée de deux plateaux séparés par une profonde coupure. L'île est longue d'environ  pour une largeur maximale de . Son point le plus haut, non nommé, s'élève à . L'île présente une plage de sable fin orientée au Sud, face au continent, et une côte rocheuse et escarpée face au large. Trois rochers se trouvent à proximité immédiate de Cézembre : le rocher du Murier à son extrémité sud-ouest, le rocher Saint-Michel au sud, coupant sa plage en deux et le rocher Saint-Aaron à son extrémité nord-est. Le phare du Grand Jardin se trouve à environ  au sud-ouest de Cézembre et le fort de la Conchée à  au nord-est. Le principal chenal d'accès au port de Saint-Malo passe au sud-est de l'île. Des courants de 8 à 10 nœuds limitent l'accès à l'île par bateau.

Évolution géographique

Les prairies de Cézembre

Au sud de Cézembre, probablement jusqu'à la fin du , existait une étendue de terre, similaire aux prés salés que l'on trouve aujourd'hui dans la baie du mont Saint-Michel. Ces « prairies » n'étaient recouvertes par la mer que lors des marées d'équinoxe. Elles étaient reliées au Grand Bé lors de la découverte de l'estran aux grandes marées, ce qui permettait d'y faire paître du bétail. Plusieurs noms des actuels rochers émergeant au sud de Cézembre — Grand Jardin, Grand Murier, Pierre de la Vache, le rocher du Dragon ou les Herbiers — rappellent cette période.

L'existence d'un gué reliant les prairies à la terre ferme (Alet) à marée basse est attestée dans le roman d'Aiquin, une chanson de geste du  ou . La première submersion des prairies s'est sans doute produite lors d'un tremblement de terre qui a secoué la région du Cotentin et des îles Anglo-Normandes en 1160 ou 1161. Néanmoins, une partie de ces prairies subsistent et sont exploitées jusqu'à la fin du , ce qui est attesté dans des archives de l'époque. Vera Kornicker relate l'existence d'un légendaire raz-de-marée qui aurait eu lieu en 709 et aurait séparé Cézembre de la côte malouine, mais son existence est mise en doute. Il est plus probable que les terres reliant l'île au continent se soient progressivement affaissées. Les prairies de Cézembre semblent avoir définitivement disparu en 1438.

Transformations du paysage à la suite des bombardements de 1944
À cause des bombardements intensifs de 1944, l'île présente une végétation rare et un relief tourmenté. On y dénombre plus de  de bombes. La flore et la faune originelles ne sont pas complètement revenues, sans doute du fait de la présence de polluants comme les métaux lourds dus aux bombardements. Entre un et trois points d'eau douce semblent avoir existé dans le passé mais ont disparu depuis les bombardements.

Zone interdite
Cézembre n'est toujours pas complètement déminée et l'accès à la plus grande partie est interdit. L'île est divisée en deux zones : la zone verte (autour de la plage) ouverte au public, et la zone rouge, interdite d'accès. En 2018, un sentier pédestre a été aménagé, permettant de circuler sur la partie ouest de l'île.

Une zone interdite de 200 mètres existe en mer sur tout le tour de l'île, excepté l'accès à la plage.

Les tempêtes peuvent modifier l'aspect de la plage de Cézembre : ainsi, en février 2020, à la suite des tempêtes Ciara et Dennis, une partie du sable s'est envolé et a disparu.

Faune et flore
En 1882, il est fait mention de lapins qui vivent sur l'île. Le bombardement de Cézembre en 1944 a fait disparaître la végétation de l'île  : . La flore d'origine a laissé place à des espèces nitrophiles (plantes qui ont besoin d'azote).

Du fait de l'interdiction de circuler à l'intérieur de l'île, celle-ci représente un lieu particulièrement favorable pour les oiseaux de mer (goélands, mouettes, cormorans) qui s'y reproduisent en grand nombre.

On trouve aussi des pétrels fulmars, quelques pingouins torda (au nord-est de l'île). Les lapins sont également présents sans que l'on sache précisément s'ils ont survécu au bombardement ou ont été réintroduits depuis. Par contre plusieurs espèces de poulpes présents en grand nombre autour de l'île avant guerre n'y sont pas revenus.

Les dimanches et jours fériés d'avril, mai, juin et septembre et tous les jours en juillet et août, des navettes de bateaux assurent la liaison entre Dinard, Saint-Malo et l'île. Les visiteurs apprécient Cézembre pour sa plage qui est une des seules de la côte d'Émeraude à être orientées plein sud (avec celles de Saint-Jouan-des-Guérets et du parc des Corbières mais qui donnent elles sur la Rance). Sur l'île se trouve un bar-restaurant « Le repaire des corsaires », seule activité humaine sur l'île.

Histoire

Préhistoire et Antiquité
Une présence néolithique sur l'île est attestée, une hache de cette époque ayant été retrouvée en 1939.

Cézembre signifie la hauteur la plus haute en langue celte. L'île était alors la pointe orientale de l'estuaire de la Rance et correspond probablement à la Segisama Briga de l'époque pré-romaine qui abritait un oppidum contrôlant l'entrée du fleuve côtier. Cézembre était en effet à cette période reliée au continent à marée basse par un gué.

Moyen Âge
D'après le roman d'Aiquin, Charlemagne se serait emparé de Cézembre lors de sa conquête de la Bretagne. Le roman d'Aiquin relate son attaque sur Cézembre et le massacre des troupes franques.En réalité, l'empereur n'y a jamais été personnellement et s'est contenté d'y envoyer ses lieutenants. Les Vikings font plusieurs incursions dans la région vers 870-880 puis au , mais n'y restent pas longtemps.

Jusqu'au , une vocation religieuse

La légende raconte qu'au , saint Maclou (Mac'h Low), après avoir traversé la Manche depuis le Pays de Galles, y aurait accosté vers 538, puis aurait rejoint l'ermite Aaron sur le rocher qui portera son nom et sur lequel la ville de Saint-Malo allait se développer. À la mort d'Aaron, Maclou reviendra à Aleth, l'ancienne capitale des Coriosolites située juste en face de l'île, pour en devenir le premier évêque et releva la cité de ses ruines. L'île hébergea par la suite, plusieurs ermites au cours des siècles.

Le 22 mai 1420, un prêtre de Saint-Malo, nommé Raoul Boisserel, obtint de l'évêque Robert de la Motte et du Chapitre de Saint-Malo l'autorisation d'y mener à son tour la vie érémitique. Le prélat et les chanoines étaient à cette époque seigneurs de Césembre, où ils avaient établi des garennes et « refuges à conils », dont .

En 1468, les Cordeliers de l'Observance y construisent un monastère, François  le visite le 4 octobre 1518, souhaitant honorer son patron, saint François. Outre le monastère, plusieurs chapelles se dressent alors sur l'île. En 1544, le monastère est dévasté par une attaque anglaise, mise en fuite par l'arrivée d'une troupe malouine. Le 24 mai 1570, le roi Charles IX accompagné de sa mère Catherine de Médicis, de son frère le duc d'Anjou et de sa sœur Marguerite de Valois visitent à leur tour le monastère. Les Récollets y remplacent les Cordeliers en 1612. En novembre 1693, lors de l'attaque anglaise sur Saint-Malo, les Anglais mettent le feu au monastère, marquant la fin de la vocation religieuse de l'île.

À partir du , une vocation militaire
À la suite de l'attaque anglaise de 1693, Vauban fait construire en 1696 quatre batteries et deux jetées. Une petite garnison de  dont  s'y installent, opérant .

En 1720, sur l'emplacement de l'ancien couvent sont construits des bâtiments pour mettre en quarantaine malades et marchandises suspectes avant leur débarquement à Saint-Malo pour faire face à l'épidémie de peste de Marseille. L'année suivante, les tapis et étoffes de  venant de contrées atteintes par la maladie y sont brûlés. Les navires eux sont coulés sur des hauts-fonds pour y être « éventés pendant plusieurs marées » avant leur renflouement.

En 1756, puis en 1758, les fortifications et l'armement de l'île sont renforcés. En avril 1779, la « légion Nassau »,  recrutés par le Prince de Nassau, y campe dans l'attente d'un débarquement sur Jersey, expédition qui finalement sera annulée.

En 1786, des batteries plus puissantes sont installées et pendant la Révolution, en 1792 à la veille de la guerre contre l'Angleterre, un corps de garde est installé mais il ne servira que pour la douane et l'octroi.

En 1832, l'île passe sous le contrôle de l'administration des domaines. Vont y être construit deux fortins rectangulaires avec pont levis pouvant abriter une centaine d'hommes.

Sous le Second empire, le sportif et futur académicien  Louis Duchesne s'y rendait régulièrement en doris depuis Saint-Servan.

En 1870, Cézembre sert de centre pour le tir au canon pour les mobiles bretons. Les fortifications de Vauban sont détruites. À la fin de ce siècle, en période de tension avec la Grande-Bretagne, l'île est à nouveau sérieusement fortifiée. En 1899, sauf autorisation de l'armée, il est interdit de débarquer sur l'île. L'armée française y effectuera certains essais militaires au début du .

Avant la Première Guerre mondiale, Cézembre devient temporairement un camp de discipline pour une centaine de soldats de l'armée coloniale et de la marine, sous la garde du  d'infanterie. Mais face aux protestations des malouins, ces soldats repartent et la garnison française est réduite à quelques hommes.

L'armée belge y installe à son tour pendant le conflit une compagnie disciplinaire, la Belgique étant alors presque totalement envahie par les Allemands. L'oratoire Saint-Brendan est restauré par des disciplinaires pendant cette période, qui construisent également une cale et deux casemates.

Les abords rocheux de l'île sont le lieu de plusieurs naufrages dont celui, sur les rochers des Courtils, du SS Hilda, un vapeur britannique assurant régulièrement la liaison entre Southampton et le port malouin. Pris dans la nuit du 18 au 19 novembre 1905 dans une tempête de neige et un violent coup de vent, il coule aux abords de Cézembre. Le naufrage fait plus d'une centaine de victimes dont de nombreux saisonniers cultivateurs bretons rentrant chez eux. Deux autres naufrages ont lieu en 1912 et 1919.

Après la guerre, les canons sont retirés et Cézembre est ouverte au public (mais uniquement aux Français) en 1920. Les casernes sont transformées en hôtel-restaurant et les touristes sont nombreux à fréquenter l'île.

En 1929, le poète Théophile Briant réussit la traversée à la nage entre Cézembre et la plage de Rochebonne, située entre Saint-Malo intramuros et Paramé, soit  parcourus en .

Seconde Guerre mondiale
Au début de la Seconde Guerre mondiale, l'île est légèrement réarmée en 1939 mais évacuée par l'armée française avant l'arrivée des Allemands en juin 1940. Sous l'occupation allemande, Cézembre est solidement fortifiée par l'organisation Todt. Ses principales pièces d'artillerie,  de , sont du matériel français de la Première Guerre mondiale récupéré, d'une portée de . Sous le nom d'Ostwall, l'île devient un des principaux éléments de la Festung Saint-Malo (la « Forteresse de Saint-Malo »), fortifiée comme les principales villes portuaires le long du mur de l'Atlantique.

En août 1944, lors de la libération de Saint-Malo, face à la résistance de la garnison allemande, l'île est intensément pilonnée pendant près d'un mois par l'artillerie terrestre américaine et par des bombardiers alliés, qui utilisèrent, outre des bombes classiques, des bombes au phosphore et au napalm. Contrairement à ce qui est parfois affirmé, Cézembre ne fut pas le premier lieu où fut utilisé le napalm pendant la guerre. La première utilisation de cette nouvelle arme eut lieu quelques semaines auparavant, en juin 1944, lors de la prise de l'île de Titian dans le Pacifique mais l'utilisation sur Cézembre fut la première très documentés par l'armée américaine. Près de  bombes et obus sont larguées sur Cézembre. L'île est probablement le site le plus bombardé au kilomètre carré des zones de combats lors de la libération de l'Europe de l'occupation allemande. Le 1er septembre, un cuirassé britannique, le HMS Malaya, tire également sur l'île et détruit des infrastructures. La garnison ne se rend que le 2 septembre, deux semaines après la reddition du fort d'Aleth qui est alors le dernier point de résistance continental allemand de la Forteresse Saint-Malo. Cette reddition est autorisée par le commandement allemand à la suite d'une tentative manquée pour ravitailler l'île depuis les îles Anglo-Normandes. Sans eau potable, comptant 90 % de blessés, il était devenu impossible à la garnison allemande-italienne de se défendre contre un assaut amphibie que les Américains s'apprêtaient à lancer. Les soldats allemands et italiens survivants ayant résisté dans cet intense bombardement sont salués militairement par les officiers américains prenant pied sur l'île.

Après guerre

L'île fait l'objet de deux grandes campagnes de déminage juste après guerre, suivies d'autres plus ponctuelles, principalement sur l'estran lors des marées d'équinoxe. La plage est accessible au public dans les années 1950 mais la majeure partie de l'île reste interdite d'accès pour des raisons de sécurité.

La famille Gauthier obtient les autorisations de s'installer et d'ouvrir un hôtel-restaurant sur Cézembre, même si l'île est depuis la fin de la guerre un terrain militaire, gérée par la Marine nationale.

Le 5 novembre 1945, Cézembre est inscrite à l'inventaire des sites et est depuis un site classé.

À compter de 1962 et pendant plus d'une dizaine d'années, Cézembre abrite des mouflons corses.

De mars à mai 2008, l'île et les eaux environnantes ont été de nouveau entièrement interdites d'accès au public pour permettre à la Marine nationale de mener une vaste opération de déminage. La plage principale a ainsi été déminée sur plus de  de profondeur, ce qui n'avait jamais encore été fait. Lors du déminage de seulement le tiers de la plage, plus de  avaient déjà été récupérés. Malgré cela, des bombes ou obus réapparaissent encore quelquefois. Ainsi en mai 2016, un promeneur et son fils trouvèrent sur la plage, à marée basse, un obus de  et en mai 2020, les démineurs interviennent pour faire exploser un obus ; les tempêtes et les grandes marées font régulièrement remonter des munitions à la surface, comme en février 2020.

Les blockhaus restent également dangereux et leur accès est interdit.

Une fois complément dépolluée, l'île devait être acquise par le Conservatoire du littoral mais cette acquisition fut plusieurs fois reportée du fait des retards et de la complexité de cette dépollution. Finalement le transfert est intervenu en octobre 2017.

Il a été décidé de ne pas dépolluer intégralement l'île, trop compliqué et couteux et qui aurait impliqué de détruire la végétation et donc les espaces de nidification des oiseaux. Au contraire, il a été décidé de dépolluer un sentier balisé de 800 mètres qui est clôturé de part et d'autre. Parcourant une partie de l'île, ce sentier permet aux visiteurs de découvrir les vestiges de la Seconde Guerre mondiale et la faune et la flore de Cézembre. Cette opération a été faite par le groupe de déminage brestois de la Marine nationale en février et mars 2016  et l'ouverture du sentier initialement prévu à l'été 2017 a été reportée à avril 2018.

La pandémie de Covid-19 en France entraîne la fermeture au public de Cézembre durant le premier confinement ; l'île rouvre en juillet 2020.

Le 4 août 2020, Franck Meslier, le seul habitant de Cézembre et exploitant du restaurant Le Repaire des Corsaires, décède après 28 ans passés sur l'île.

Incendie de septembre 2019
Le vendredi 20 septembre 2019, un incendie se déclare sur l'île. Le départ de feu trouve son origine au niveau du groupe électrogène de l'île dont l'échappement a produit une étincelle qui a embrasé la végétation à proximité du restaurant Repaire des Corsaires. L'intervention rapide des clients ainsi que des pompiers permet d'éteindre l'incendie rapidement sans qu'il n'y ait de dégâts.

Micronation
La micronation de Talossa revendique l'île de Cézembre depuis 1982.

Galerie de photos

Hommages

Lieux nommés d'après Cézembre
En 1950, l'expédition polaire française nomme un sommet de la Terre Adélie « Point Cézembre » en l'honneur de l'île malouine. Un îlot des îles Kerguelen est également appelé îlot Cézembre.

L'île dans des ouvrages de fiction

Notes et références

Notes

Références

Voir aussi

Bibliographie

Articles connexes
 Bombardement de Cézembre

Liens externes

 Dossiers électroniques de l'Inventaire général, Bretagne
 Opérations de déminage 2008 menées sur l'île
 Les oiseaux de mer sur Cézembre

Île face à Saint-Malo
Île inhabitée en France
Patrimoine naturel en Ille-et-Vilaine
Aire protégée en Ille-et-Vilaine
Micronation
Île fortifiée

redpajama_set_name: RedPajamaWikipedia


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text:
Cochlear partition anatomy and motion in humans differ from the classic view of mammals
Stefan Raufer, John J. Guinan Jr., and Hideko Heidi Nakajima
PNAS July 9, 2019 116 (28) 13977-13982; first published June 24, 2019 https://doi.org/10.1073/pnas.1900787116
Stefan Raufer
aEaton-Peabody Laboratories, Massachusetts Eye and Ear, Boston, MA 02114;bSpeech and Hearing Bioscience and Technology Program, Harvard University, Cambridge, MA 02138;
ORCID record for Stefan Raufer
For correspondence: sraufer2@gmail.com
John J. Guinan
aEaton-Peabody Laboratories, Massachusetts Eye and Ear, Boston, MA 02114;bSpeech and Hearing Bioscience and Technology Program, Harvard University, Cambridge, MA 02138;cDepartment of Otolaryngology, Harvard Medical School, Boston, MA 02115
ORCID record for John J. Guinan
Hideko Heidi Nakajima
ORCID record for Hideko Heidi Nakajima
Edited by Christopher A. Shera, University of Southern California, Los Angeles, CA, and accepted by Editorial Board Member Thomas D. Albright June 6, 2019 (received for review January 16, 2019)
This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
Basic properties of hearing such as its sensitivity and frequency tuning arise from the mechanical responses in the cochlea. Such responses have been measured extensively in the cochlear base of laboratory mammals, and our understanding of human cochlear mechanics is largely founded on the assumption that cochlear mechanics is similar in all mammals. Here we show that the anatomy and motion of the human cochlear partition differ in crucial ways from the generalized classic view of mammalian cochlear mechanics. Our results call into question this classic view. Establishing the features of human cochlear anatomy and function is important for understanding human hearing and for comparison with results from laboratory animals.
Mammals detect sound through mechanosensitive cells of the cochlear organ of Corti that rest on the basilar membrane (BM). Motions of the BM and organ of Corti have been studied at the cochlear base in various laboratory animals, and the assumption has been that the cochleas of all mammals work similarly. In the classic view, the BM attaches to a stationary osseous spiral lamina (OSL), the tectorial membrane (TM) attaches to the limbus above the stationary OSL, and the BM is the major moving element, with a peak displacement near its center. Here, we measured the motion and studied the anatomy of the human cochlear partition (CP) at the cochlear base of fresh human cadaveric specimens. Unlike the classic view, we identified a soft-tissue structure between the BM and OSL in humans, which we name the CP "bridge." We measured CP transverse motion in humans and found that the OSL moved like a plate hinged near the modiolus, with motion increasing from the modiolus to the bridge. The bridge moved almost as much as the BM, with the maximum CP motion near the bridge–BM connection. BM motion accounts for 100% of CP volume displacement in the classic view, but accounts for only 27 to 43% in the base of humans. In humans, the TM–limbus attachment is above the moving bridge, not above a fixed structure. These results challenge long-held assumptions about cochlear mechanics in humans. In addition, animal apical anatomy (in SI Appendix) doesn't always fit the classic view.
basilar membrane
↵1To whom correspondence may be addressed. Email: sraufer2{at}gmail.com.
Author contributions: S.R. and H.H.N. designed research; S.R. and H.H.N. performed research; S.R., J.J.G., and H.H.N. analyzed data; and S.R., J.J.G., and H.H.N. wrote the paper.
This article is a PNAS Direct Submission. C.A.S. is a guest editor invited by the Editorial Board.
Published under the PNAS license.
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, Observations of the vibration of the basilar membrane in squirrel monkeys using the mossbauer technique. J. Acoust. Soc. Am. 49, 1281–1231 (1971).
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, Basilar membrane mechanics in the 6–9kHz region of sensitive chinchilla cochleae. J. Acoust. Soc. Am. 121, 2792–2804 (2007).
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, Basilar membrane and osseous spiral lamina motion in human cadavers with air and bone conduction stimuli. Hearing Res 181, 131–143 (2003).
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, Schuknecht's Pathology of the Ear, S. N. Merchant, J. Nadol, Eds. (PMPH, ed. 3, 2010).
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, Basilar membrane mechanics in the hook region of cat and Guinea-pig cochleae: Sharp tuning and nonlinearity in the absence of baseline position shifts. Hearing Res. 63, 163–190 (1992).
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, In vivo impedance of the gerbil cochlear partition at auditory frequencies. Biophysical J 97, 1233–1243 (2009).
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, Basilar-membrane responses to clicks at the base of the chinchilla cochlea. J. Acoust. Soc. Am. 103, 1972–1989(1998).
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, Frequency selectivity in Old-World monkeys corroborates sharp cochlear tuning in humans. Proc. Natl. Acad. Sci. U.S.A. 108, 17516–17520 (2011).
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, Mammalian behavior and physiology converge to confirm sharper cochlear tuning in humans. Proc. Natl. Acad. Sci. U.S.A. 115, 11322–11326 (2018).
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, Revised estimates of human cochlear tuning from otoacoustic and behavioral measurements. Proc. Natl. Acad. Sci. U.S.A. 99, 3318–3323 (2002).
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, Otoacoustic emission estimates of human basilar membrane impulse response duration and cochlear filter tuning. Hearing Res. 342:150–160.(2016).
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, Study of mechanical motions in the basal region of the chinchilla cochlea. J. Acoust. Soc. Am. 107, 3317–3332 (2000).
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, The spatial and temporal representation of a tone on the Guinea pig basilar membrane. Proc. Natl. Acad. Sci. U.S.A. 97, 11751–11758 (2000).
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, Olivocochlear efferents: Their action, effects, measurement and uses, and the impact of the new conception of cochlear mechanical responses. Hearing Res. 362, 38–47 (2018).
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, The "inverse problem" solved for a three-dimensional model of the cochlea. III. Brushing-up the solution method. J. Acoust. Soc. Am. 105, 3410–3420 (1999).
, Intracochlear pressure measurements related to cochlear tuning. J. Acoust. Soc. Am. 110, 349–367 (2001).
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S. Farrahi,
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, Tectorial membrane traveling waves underlie sharp auditory tuning in humans. Biophysical J. 111, 921–924 (2016).
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, Measurements of stapes velocity in live human ears. Hearing Res. 249, 54–61 (2009).
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, Unraveling the mystery of hearing in gerbil and other rodents with an arch-beam model of the basilar membrane. Scientific Rep 7, 228 (2017).
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, Cochlear model including three-dimensional fluid and four modes of partition flexibility. J. Acoust. Soc. Am. 70, 426–436 (1981).
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, Cochlear micromechanics-A physical model of transduction. J. Acoust. Soc. Am. 68, 1660–1670 (1980).
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, Theory of cochlear mechanics. Hearing Res. 2, 171–182 (1980).
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, Nanomechanics of the subtectorial space caused by electromechanics of cochlear outer hair cells. Proc. Natl. Acad. Sci. U.S.A. 103, 2120–2125 (2006).
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Proceedings of the National Academy of Sciences Jul 2019, 116 (28) 13977-13982; DOI: 10.1073/pnas.1900787116

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text:
Kenneth Cole Appointed UNAIDS International Goodwill Ambassador
Published Tuesday, June 7, 2016
amfAR Chairman Kenneth Cole and UNAIDS Executive Director Michel Sidibé (Photo courtesy of UNAIDS)
In recognition of his 30 years as a passionate champion for people living with HIV, amfAR Chairman Kenneth Cole has been appointed UNAIDS International Goodwill Ambassador. The announcement was made at a press conference on the eve of the United Nations General Assembly High-Level Meeting on Ending AIDS in New York City, June 8−10.
"We are entering a crucial phase of the response to HIV and I know that Kenneth can make a significant and powerful contribution towards our shared vision of ending the AIDS epidemic by 2030," said Michel Sidibé, the Executive Director of UNAIDS. "His commitment, compassion and resolve will magnify our efforts to include everyone and to ensure that no one is left behind."
In his new role, Cole will work to rally the global community by continuing his longstanding efforts to advocate for an inclusive response to the AIDS epidemic. "I am confident that if people are put at the center of the AIDS response we can realize one of this century's greatest humanitarian achievements—the end of the AIDS epidemic," said Cole. "I am honored by this appointment as a UNAIDS International Goodwill Ambassador. It is my hope to help intensify efforts to end the epidemic for everyone, everywhere."
Read the full UNAIDS press release here.


Fenerbahce Ulker improved to 20-3 atop the Turkish League standings by downing Pinar Karsiyaka 82-66 at home on Saturday. Oguz Savas and Roko Ukic paced the winners with 16 points apiece. Omer Onan added 13, Emir Preldzic had 11 while Marko Tomas got 10 for Fener, that led 51-29 and kept full control of the game until the final buzzer. Galatasaray stayed second now at 18-5 by overwhelming Bornova Belediye 49-79 on the road on Friday. Preston Shumpert led the winners with 16 points. Ermal Kuqo added 14 while Luksa Andric had 10 for Galatasaray, that led 10-23 after 10 minutes and sealed the outcome, 38-60, at the end of third quarter. Efes Pilsen improved to 18-7 by topping Aliaga Petkin 76-88 on the road on Saturday behind 19 points from Igor Rakocevic. Kerem Gonlum added 16, Nikola Vujcic had 10 while Kerem Tunceri dished 11 assists for Efes, that led 37-47 at halftime and never looked back. Besiktas Cola Turka moved up to 17-8 with a convincing 92-76 home win against Erdemir. Cehver Ozer led the winners with 19 points. Michal Ignerski added 16, Marcelus Kemp had 13 while Mire Chatman, AJ Ogilvy and Serkan Erdogan each got 12 in an easy home win for Besiktas. Chatman added 10 rebounds and 10 assists from a triple-double. Banvit improved to 19-6 by topping Mersin 84-74 at home on Sunday. Vladimir Golubovic paced the winners with 20 points. Keith Simmons added 14, Baris Ermis had 12, 9 rebounds and 9 assists while Juan Dixon and Lance Williams each had 10 points for Banvit, that trailed 63-67 with under 6 minutes left. Simmons led a 18-3 run that sealed the outcome. In other games, Tofas bested Oyak 66-81, Olin Edirne topped Antalya 71-62 while Turk Telekom defeated Trabzonspor 84-75.


text:
Q: Display output from a Symfony task on a template I am executing a task from an action in Symfony. I wish to capture the output from the task & display it to the (admin) user. Do I extract it from the dispatcher / log or somewhere else?

A: This might not be the answer you're looking for, however, in a task you can log to a seperate file like so (within the execute function in the task class):
$fileLogger = new sfFileLogger($this->dispatcher,
                               array('file' =>$this->configuration->getRootDir().'/log/foobar.log'));
$this->dispatcher->connect('command.log', array($fileLogger, 'listenToLogEvent'));

And then in your task when you use:
$this->logSection('something', 'Log whatever message you want....', 1000);

It will automatically log to the custom log file.
Hope this helps. :-)

A: Why not just perform the task within the action - and format the output in the template ? why are you running a separate task from an Action ? (i know this thread is old)

redpajama_set_name: RedPajamaStackExchange


Who married Sir Winston Churchill?
Which artist, born in Leeuwarden in 1898, is famous for his optical illusions such as "Ascending And Descending", "Convex and Concave", and "Metamorphosis I"?
In Britain, rationing ended, the London gold market reopened, Roger Bannister was first to run a mile in under 4 minutes, and the Queen returned from a tour of the Commonwealth in which year?
Which of these countries has the highest population density?
What infectious disease, occurring commonly in epidemics and caused by a virus, is characterised by blotchy rash preceded by a running nose and eyes, with a rise in temperature and lassitude?
The Bartle Test of Gamer Psychology is a specialised personality test relating to which of the following activities?
Which piece on a chessboard can move only one space in any direction?


Ekiti State University, EKSU prayed for safe release of kidnapped staff.
At a special prayer meeting organised by the University Management, held at the Main Auditorium of the University on Tuesday, 19th May, 2015, the Vice-Chancellor, Professor Patrick Oladipo Aina sought for calm, and asked the community to seek the face of God for the safe release of Ekiti State University (EKSU) staff abducted in the series of kidnapping episodes recently witnessed in the State. Notably, he was emphatic on the powers of corporate prayers and absolute trust in God's divine interventions in situations such as this.
The Vice-Chancellor sought for the cooperation of all and sundry at a trying time like this, and importantly, spoke on the need to be united in spirit and purpose to ensure that the abducted colleagues are safely returned to their respective families. The Vice-Chancellor commended the efforts of the State Governor Ayodele Fayose in involving the high ranks of the Nigeria Police to treating the kidnapping cases with dispatch. He reiterated that the effort of the State Governor has paid off as the Inspector General of Police is reliably sending with dispatch a rapid response squad to check these inhuman escapades. He therefore enjoined the University Community not to take law into their hands, but to work assiduously with the State Government to bring these culprits to book.
The Vice-Chancellor empathized with staff on the issue of outstanding salaries, noting that this seems to be a nation-wide phenomenon which will soon be resolved. He, however, commended the State Government for releasing to the University the subvention for the month of April, 2015, meaning that salary for the month of April, 2015 will be paid any time from now. Prof. Aina, however, assured on favourable dialogues with government on the payment of the outstanding monthly subventions for the months of August and September, 2014 owed by the previous administration as soon as the financial situation of the state improved. He therefore implored staff to remain calm and cooperate with the State Government in this trying period.


Forgiveness is one of the fastest and most effective ways of releasing upsets, tensions, and judgments. All you need to do is forgive yourself for the judgments you have made.
Forgiving yourself for your judgments usually releases the negative charge you have on yourself or the situation. To begin the process, you can simply say, "I forgive myself for judging…," then add a reference to the person or issue in question. When you do this, you will often find that, almost miraculously, something lets go inside and you feel as if a weight has lifted.
You can say these statements of forgiveness out loud or internally. You may only need to say the statement once, or you may need to say the statement a number of times until you connect with it and experience the release.
How can you tell if you've released the judgement? You might spontaneously let out a sigh or take a deep breath. You might feel a surge of energy or warmth in your body, or a feeling of relief. Whenever you make a judgement against another person, it is stored in your body.
Forgiving yourself releases the other person from your energy field.
As you go through your day, give yourself forgiveness breaks. Take ten seconds to sit quietly and forgive yourself for judging yourself or others.
God has an answer that supersedes every condition extending through all of his creation. The answer, now and forevermore, is to love.


text:
Q: Round BigDecimal to the nearest integral value How would I CORRECTLY round a BigDecimal to the nearest whole value?
For instance
1.2 --> 1

1.5 --> 2

1.6 --> 2.

I tried
BigDecimal val = new BigDecimal(1.5);
System.out.println(val.setScale(0, RoundingMode.HALF_UP))

But this still gives me 1. NOT 2 as anticipated.
Does anyone happen to know how to correctly do this?
Thanks

A:     BigDecimal val = new BigDecimal(1.2);
    System.out.println(val.setScale(0, RoundingMode.HALF_UP));
    val = new BigDecimal(1.5);
    System.out.println(val.setScale(0, RoundingMode.HALF_UP));
    val = new BigDecimal(1.6);
    System.out.println(val.setScale(0, RoundingMode.HALF_UP));

Result:
1
2
2
I don't see where is the problem


Introducing - the River Romper!
Perfect for all the sunshine the year has to offer! This pattern has so many variations and is, above all, comfortable! The pattern includes an integrated (optional) skirt, an elastic waistline, loose fitting bodice and several lengths of shorts to choose from!


The world of home entertainment is in a state of constant flux and evolution. Plus, the rate at which it changes and evolves is always speeding up, introducing new technology and killing off old methods of media consumption. Consider movie rental shops, for example: once a mainstay of at-home entertainment, they've all but gone under in favour of digital streaming and other options that don't require us to get off the couch.
While it isn't always easy to predict what will happen in the realm of entertainment and technology during the upcoming 12 months, we've noticed some settling in certain areas. Here are three trends that we feel pretty confident anticipating.
When it comes to entertaining the masses from the comfort of their own homes, it's an adapt or die world. Broadcast and cable networks have been paying attention as more and more consumers have been cutting the cable connection and ditching the satellite dish in favour of subscription services like Netflix, Hulu, and Amazon Instant. In an effort to adapt to this ever-changing digital landscape, these networks have begun to create their own subscription services. This allows them to not only compete with the aforementioned services, but to retain their audience and market share in the absence of their traditional service providers.
Many networks already offer free content on their websites, and HBO's new GO service allows consumers who already subscribe to the channel via their cable or satellite provider to watch HBO any time. In the coming year, look for more networks to move from a free model to a subscription-based one.
It used to be that a new movie was released into theatres, and then a year later you could watch it on home video or on a premium cable channel. In the past decade or so, the time between a theatrical release and home viewing has collapsed, so much so that a movie could be in theatres one month and available on demand through a cable or satellite provider the next. This may seem fast, but in the coming year, it's about to get even faster.
Following the lesson of Sony Pictures's The Interview, as well as less publicised but no less important films like Steve James's Roger Ebert documentary Life Itself, we believe that more and more films will be given a simultaneous theatrical and online release. For films that do get a theatrical debut, we expect the time it takes for those films to be available for home viewing to get even shorter. Plus, with the increasing popularity of smart TVs and devices like Google's Chromecast, streaming content can be played right on a big screen TV. While it may not replicate the cinema experience, it's not bad for kicking back in the comfort of your own home.
Despite the fact that many libraries offer ebooks to their patrons for free, avid readers have demonstrated that they are willing to pay for the privilege of reading whatever they want, whenever they want, all on their ereaders. We saw subscription ebook services like Oyster (AKA the Netflix of books) and Amazon's Kindle Unlimited take off in the past year or two, and they're showing no signs of slowing down. In the coming year, look for more companies to throw their hats in the ebook subscription ring, and also look for each one to vie for a competitive edge by offering perks like audiobooks, better content, and more.


Members! Join us Sunday August 16th at Camp Robin Rogers (1090 S. Conant rd) for our annual CIAO family picnic!
Come anytime between 11 a.m. and 10 p.m.
Fried chicken will be provided at lunchtime, and we will also provide beverages and table service. Please bring a covered dish to share as well as any indoor or outdoor games you'd like, maybe a lawn chair, swimsuits and sunscreen. The pool will be open with certified lifeguard on duty for several hours in the afternoon and reserved just for CIAO.
There is a large playground for the kids under the shade trees. We will also have bocce for anyone who wants to play. Eat in the shelter house outside or in the cool comfort of the air conditioned banquet hall. We'll see you there!
The combine organization work for the America and Italy work for the humanity with the help of paper writing service. The help for ten needy and desire one is done inaccurate way. The combine efforts provide the result for special out comes.
See the complete August 2015 newsletter here.


These Coasters come in a range of sizes.
Extra large, large, medium and small.
They are fused glass with one side having the coloured glass being tack fused. This means that there is texture.
Each coaster is individual although there is often colour ways.
I do these to commission.


text:
Commentary: Will Orlando drive us from our corners?
By E.J. Dionne Jr.The Washington Post
Jun 14, 2016 at 9:15 AM Jun 14, 2016 at 10:00 AM
It only compounded the horror that the deadliest mass shooting in U.S. history called forth talking points that had been composed long before 50 innocents were murdered early Sunday.
The immediate reactions on social media to the killings at Pulse Orlando, a popular gay dance club, etched a portrait of our national divisions, our mutual mistrust and our inclination to know what we think even when we lack all the facts.
Even before President Obama spoke Sunday afternoon, there were declarations of great certainty that he would attribute the massacre to guns and not "Islamism" — and would therefore feed support for Donald Trump.
Trump did not disappoint. At 12:43 p.m., he turned to his communications medium of choice and tweeted: "Appreciate the congrats for being right on radical Islamic terrorism, I don't want congrats, I want toughness & vigilance. We must be smart!"
It is no day for partisanship, but how could Trump even think of using a moment of national trauma and mourning as an occasion to tout his own genius — or to reach sweeping conclusions on the fly?
But it's entirely true that those of us who have long believed that our scandalously lax national gun laws make sickening slaughters inevitable had predictable reactions of our own.
I freely admit that I identified entirely with Sen. Chris Murphy (D-Conn.) when he declared: "This phenomenon of near constant mass shootings happens only in America — nowhere else. Congress has become complicit in these murders by its total, unconscionable deafening silence."
Note that phrase "near constant." We are far from alone in the world in confronting terrorism. What is different about our nation — enragingly, dispiritingly, depressingly different — is that from Virginia Tech to Sandy Hook to Orlando, attacks of this sort happen here again and again and again.
Why can we never include a reappraisal of our weapons laws as part of democracy's arsenal of responses to terrorism and mass violence?
Why are those who tout themselves as being the toughest among us in calling out terrorism inspired by Islam so timid as soon as any plausible answer is labeled "gun control"?
Nonetheless, those of us who hold these views must find ways of reaching out to fellow citizens with whom we have been battling for decades. Terrorism terrorizes advocates of gun control and supporters of gun rights alike.
And those on both sides of the gun issue will want to know why three FBI interviews with the killer, Omar Mateen, did not raise more alarms in light of evidence of his apparent terrorist sympathies. What we know so far underscores the challenges of fighting terrorism in a free society.
When the president did address the nation, his sobriety and restraint reflected the reaction of a man who had been required too often to speak about the unspeakable and whose calls for action have gone unheeded.
He gave his critics who despise his views on guns nothing, turning the tables on them by saying simply that failing to act to keep deadly weapons out of the hands of those who would use them against innocent fellow human beings "is a decision as well." And it is.
He also did something important, showing how futile it is to force an act of evil into the boxes we prefabricate. The Orlando slaughter was, he said, "an act of terror and an act of hate."
We should despise what happened if our fellow citizens were gunned down by a man who was inspired by foreign terrorists. And we should despise what happened if people had their lives snuffed out because of their sexual orientation.
We gain nothing by arguing about which form of moral revulsion is superior or more appropriate. We set ourselves back by responding to an act of violence against Americans who are gay by turning on Americans who are Muslim.
The only appropriate response to Orlando is solidarity harnessed to intelligent determination. So far, no body count, however repulsive, has forced us to abandon our ideological cul-de-sacs. The dead on the floor of a night club cry out to us.


Yes! You can Become competent in Tennis this quickly in our all ages tennis training course in Armington IL. Our company's Tennis Explained course will very much help you achieve that! .
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From there henceforth, the coach commences the explanations towards an all natural knowledge of the tennis game. During these Armington IL tennis lesson explanations the scholars discover the reason as the reasons gamers always prefer striking the tennis ball way over the tennis court and high within the small internet and in to the opponent's court, the ball never touching the floor within this entire instance. This time within the overall explanation is after emphasizing the truth that the ball must remain within the tennis court play area, in the process of staying away from a score concession.
Do you want to learn 20 new techniques in the next 2 weeks? TennisProNow Instructors teach the copyrighted Tennis Explained learning system. This is the fastest step-by-step system out available in Armington IL.


text:
You are here: Home / The Project / EuroFIT Launch
Launch of EuroFIT: Promoting active lifestyles to improve public health delivered through professional football clubs
Date: 31st October 2018
Venue: Scotland House, Rond-Point Schuman 6, 1040 Brussels, Belgium
Partners from the EU-funded 'European Football Fans in Training (EuroFIT)' programme will be launching EuroFIT to Europe's football community on 31st October.
Funded by the European Commission's FP7-research programme, EuroFIT harnesses the loyalty that many football fans feel to their club to attract them to a lifestyle change programme delivered by community coaches in the club's stadium. Building upon the Football Fans in Training programme used in Scotland, nine universities have developed this scientifically rigorous, European programme through inter-sectoral collaboration with over 20 leading football clubs in the UK, Netherlands, Norway and Portugal.
This project has already been a major success, using cutting-edge behavioural science and technology in a bid to prevent, rather than treat, chronic ill health, changing the lives of over 1,100 fans who have made long-term, sustainable, changed to their lifestyles. But this is just the start.
New football clubs are now adopting the programme, which has already become a key component of the Portuguese Government's national physical activity strategy, owing to its evidence-based approach and clinically proven effectiveness. At the event in Brussels, we will launch a scaled-up implementation of EuroFIT, as an evidence-based, quality-assured programme that is now available under license for football clubs and leagues across Europe. The launch event is supported by UEFA, with representatives from football leagues, clubs and European institutions in attendance.
Speaker organisations on the day will include:
University of Glasgow (Principle research institute for EuroFIT)
Portuguese Football Federation
European Healthy Stadia Network
DG Research and Innovation
Scottish Professional Football League Trust
EuroHealthnet
Plus, participating pilot clubs and fans.
A draft programme is now available!
Further details on the event will be announced shortly.
EuroFIT Launch – the Press Release
EuroFIT Programme


Vandals have admitted graffiti-ing paths and seating in the Land of Canaan following a public appeal by Ottery police.
PCSO Jonathan Sims thanked the community for pulling together to provide information and cleaning up the 'mindless vandalism' last Friday evening.
Three young people have admitted to causing the damage and will work with the police and the district council.
Police took to Facebook to appeal for information after seats and pathways in the Land of Canaan had been painted white by vandals, but had hoped the paint would be able to wash off.