Une recherche paléoenvironnementale et géoarchéologique pluridisciplinaire a été conduite dans le bassin supérieur du fleuve Loire en vue d’apprécier, à partir d’une chronostratigraphie multi-proxy, ...la variabilité des flux hydro-sédimentaires dans les têtes de bassin du réseau hydrographique à l’échelle de l’Holocène. Sur la base de 107 datations par le radiocarbone obtenues sur l’ensemble du secteur étudié, une analyse statistique par densité de probabilité a permis de dégager une périodisation de l’évolution du bassin versant à l’échelle des trois derniers millénaires. Celle-ci concorde avec les connaissances déjà acquises sur l’axe voisin de la moyenne vallée du Rhône. Quatre crises érosives majeures se manifestent au début de La Tène (vers 400 av. J.-C.), à la transition entre la fin de l’Âge du Fer et le Haut-Empire romain (100 av. J.-C.-100 ap. J.-C.), dans la seconde partie du Bas-Empire romain et au début du haut Moyen Âge (350-550 ap. J.-C.) puis entre le xive et la fin du xixe siècle. La tripartition classique du PAG est également vérifiée dans cet environnement de moyenne montagne, mais ici enrichie par la mise en évidence d’une période inédite de stabilisation temporaire des hydrosystèmes élémentaires au xviiie siècle. Entre ces crises principales, le haut Moyen Âge apparaît comme une période d’instabilité environnementale, tandis qu’une longue période de grande stabilité se développe entre la fin du ixe siècle et le début du xiiie siècle, en coïncidence avec le Petit Optimum Médiéval.
Les dysarthries résultent de lésions neurologiques qui dégradent la phonation, la prosodie, l’articulation et l’intelligibilité de la parole, pouvant induire de fortes répercussions psycho-sociales ...et émotionnelles.
Les études sur les dysarthries ont principalement porté sur des données instrumentales ou physiopathologiques. Notre étude vise à identifier les différents impacts psycho-sociaux que les dysarthries peuvent induire.
Nous avons réalisé une comparaison clinique, de qualité de la voix, d’impact psycho-social (Dysarthria Impact Profile) et de qualité de vie entre des dysarthries hyperkinétique (e.g. dystonie), hypokinétique (Parkinson), ataxique et mixte (e.g. sclérose latérale amyotrophique) ainsi qu’avec un groupe de sujets sains. Des analyses statistiques de variance, de corrélations, ainsi que des analyses factorielles discriminantes ont été réalisées, permettant d’identifier les spécificités d’impact psycho-social des dysarthries.
Les premiers résultats montrent que les patients ayant une dysarthrie mixte sont ceux qui ont la plus forte dégradation tant de la parole que de leurs fonctions cognitives et de leur qualité de vie. Toutefois, tous les patients ressentent des difficultés psycho-sociales, bien que plus importantes pour ceux qui présentent une dysarthrie mixte. Plus encore, la qualité de vie est négativement corrélée à l’impact psycho-social des dysarthries indépendamment de la perte d’intelligibilité ou d’autres fonctions.
Nos résultats montrent que, indépendamment des variables cliniquement observables comme l’altération cognitive ou la perte d’intelligibilité, les dysarthries peuvent induire des perturbations psycho-sociaux importants. Ce sont ces impacts qui contribuent le plus à la dégradation de la qualité de vie des patients, et cela tant pour des dysarthries extrapyramidales (hypokinétique et hyperkinétique) que cérébelleuses ou mixtes.
L’effet des dysarthries sur le quotidien dépend en partie de facteurs non visibles cliniquement. L’impact psycho-social évalué à partir d’auto-questionnaires pourrait être un déterminant de l’orientation vers l’orthophonie.
Cystic fibrosis is a hereditary disease caused by a mutation in the Cystic Fibrosis Transmembrane conductance Regulator (CFTR) gene that encodes a chloride (Cl-) channel. Cystic fibrosis pulmonary ...pathophysiology is characterised by chronic inflammation and bacterial infections. Azithromycin, a macrolide antibiotic, has shown promising anti-inflammatory properties in some inflammatory pulmonary diseases. Moreover, all clinical studies have presented an improvement of the respiratory condition of cystic fibrosis patients, but the molecular and cellular mechanisms remain unknown. The aim of this study was to investigate, in bronchial epithelial cells, the effects of azithromycin on inflammatory pathways involved in cystic fibrosis. We have analysed the effects of azithromycin on cystic fibrosis and non-cystic fibrosis bronchial epithelial cell lines but also in non-immortalized non-cystic fibrosis human glandular cells. To create an inflammatory context, cells were treated with Tumor Necrosis Factor (TNF)-α or Interleukin (IL)1-β. Activation of the NF-κB pathway was investigated by luciferase assay, western blotting, and by Förster Resonance Energy Transfer imaging, allowing the detection of the interaction between the transcription factor and its inhibitor in live cells. In all conditions tested, azithromycin did not have an anti-inflammatory effect on the cystic fibrosis human bronchial epithelial cells and on CFTR-inhibited primary human bronchial glandular cells. More, our data showed no effect of azithromycin on IL-1β– or TNF-α–induced IL-8 secretion and NF-κB pathway activation. Taken together, these data show that azithromycin is unable to decrease in vitro inflammation in cystic fibrosis cells from airways.
Corinne Bonnet : Il n’est pas facile de résumer en quelques phrases une carrière aussi brillante et foisonnante que celle de Laurent Pernot. Paraphrasant l’Éloge de Rome d’Ælius Aristide, je ...pourrais dire : « Tout ici n’est que force » (καὶ οὐδὲν ἀλλ᾽ ἢ ῥώμη τὰ τῇδε). Ce serait une façon élégante d’introduire une trop brève présentation de votre parcours. Vous êtes un ancien élève de l’École normale supérieure, agrégé des lettres. Vous avez été pensionnaire de la Fondation Thiers et vous ...
Cardiac output measurements may inform diagnosis and provide guidance of therapeutic interventions in patients with hemodynamic instability. The FloTrac™ algorithm uses uncalibrated arterial pressure ...waveform analysis to estimate cardiac output. Recently, a new version of the algorithm has been developed. The aim was to assess the agreement between FloTrac™ and routinely performed cardiac output measurements obtained by critical care ultrasonography in patients with circulatory shock.
A prospective observational study was performed in a tertiary hospital from June 2016 to January 2017. Adult critically ill patients with circulatory shock were eligible for inclusion. Cardiac output was measured simultaneously using FloTrac™ with a fourth-generation algorithm (CO
) and critical care ultrasonography (CO
). The strength of linear correlation of both methods was determined by the Pearson coefficient. Bland-Altman plot and four-quadrant plot were used to track agreement and trending ability.
Eighty-nine paired cardiac output measurements were performed in 17 patients during their first 24 h of admittance. CO
and CO
had strong positive linear correlation (
= 0.60,
< 0.001). Bias of CO
and CO
was 0.2 L min
(95% CI - 0.2 to 0.6) with limits of agreement of - 3.6 L min
(95% CI - 4.3 to - 2.9) to 4.0 L min
(95% CI 3.3 to 4.7). The percentage error was 65.6% (95% CI 53.2 to 77.3). Concordance rate was 64.4%.
In critically ill patients with circulatory shock, there was disagreement and clinically unacceptable trending ability between values of cardiac output obtained by uncalibrated arterial pressure waveform analysis and critical care ultrasonography.
Clinicaltrials.gov, NCT02912624, registered on September 23, 2016.
Background
To evaluate the association between ventilator type and hospital mortality in patients with acute respiratory distress syndrome (ARDS) related to COVID-19 (SARS-CoV2 infection), a ...single-center prospective observational study in France.
Results
We prospectively included consecutive adults admitted to the intensive care unit (ICU) of a university-affiliated tertiary hospital for ARDS related to proven COVID-19, between March 2020 and July 2021. All patients were intubated. We compared two patient groups defined by whether an ICU ventilator or a less sophisticated ventilator such as a sophisticated turbine-based transport ventilator was used. Kaplan–Meier survival curves were plotted. Cox multivariate regression was performed to identify associations between patient characteristics and hospital mortality. We included 189 patients (140 74.1% men) with a median age of 65 years IQR, 55–73, of whom 61 (32.3%) died before hospital discharge. By multivariate analysis, factors associated with in-hospital mortality were age ≥ 70 years (HR, 2.11; 95% CI, 1.24–3.59;
P
= 0.006), immunodeficiency (HR, 2.43; 95% CI, 1.16–5.09;
P
= 0.02) and serum creatinine ≥ 100 µmol/L (HR, 3.01; 95% CI, 1.77–5.10;
P
< 0.001) but not ventilator type. As compared to conventional ICU (equipped with ICU and anesthesiology ventilators), management in transient ICU (equipped with non-ICU turbine-based ventilators) was associated neither with a longer duration of invasive mechanical ventilation (18 IQR, 11–32 vs. 21 13–37 days, respectively;
P
= 0.39) nor with a longer ICU stay (24 IQR, 14–40 vs. 27 15–44 days, respectively;
P
= 0.44).
Conclusions
In ventilated patients with ARDS due to COVID-19, management in transient ICU equipped with non-ICU sophisticated turbine-based ventilators was not associated with worse outcomes compared to standard ICU, equipped with ICU ventilators. Although our study design is not powered to demonstrate any difference in outcome, our results after adjustment do not suggest any signal of harm when using these transport type ventilators as an alternative to ICU ventilators during COVID-19 surge.
Abstract only Blood heart failure (HF) biomarkers such as the natriuretic peptides (NP) are widely used but the NP biomarker family has limitations and HF diagnosis remains too often complicated ...because of atypical presentations and the need of specialized care access. More specific and accurate biomarkers with detection method allowing for facilitated large scale HF screenings are required. Indeed, 30 % of the patients admitted to emergency care for acute dyspnea have a BNP concentration in a « grey zone » that do not allow for diagnosis. Thus, diagnosis of these patients is costly and time-consuming while a rapid medical care of the patient has a positive impact on his health and reduces the treatment cost. Therefore, we have launched a prospective multicentric case-control study and investigated for urinary polypetides specific to acute (AHF) or chronic heart failure (CHF), using a capillary electrophoresis-mass spectroscopy strategy (CE-MS). Based on a screen of the urinary proteome of patients (CHF, AHF, and healthy controls matched for cardiovascular risk factors), we revealed a panel of polypeptides specific to HF. One polypeptide (X64, patent pending) seemed very relevant because it could discriminate AHF and CHF with a high specificity and specificity (AUC = 0,99; p<0,0001). X64 plasma levels were assessed within Atlanta (n=340, follow-up 3 years) and Toulouse (n=187, follow-up 6 years) cohorts. The Atlanta cohort revealed that X64 level is associated with major clinical events: HR: 1.23 per 100 ng/mL (95% CI: 1.06 to 1.43); P=0.005 and with HF admissions: IRR: 1.20 per 100 ng/mL (95% CI: 1.00 to 1.44); P=0.05. Moreover, the Toulouse cohort revealed that high X64 levels were strong predictors of cardiac death (p<0.0001). Our work provides with new biomarkers allowing for HF diagnosis in the BNP « grey zone » or prognosis and therefore allow for a better care of the HF patients at the hospital but also in general care.
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