Objectives
Patients who develop upper gastrointestinal bleeding (UGIB) while in hospital appear to have a poor prognosis. Our study aims at analysing the difference in outcome between in‐patients ...(IPs) and out‐patients presenting with variceal and non‐variceal UGIB.
Methods
We conducted a multicentre prospective study by collecting data about variceal and non‐variceal UGIB cases through 46 hospitals in France between November 2017 and October 2018. We then compared baseline demographic features, endoscopic findings and outcome between patients who developed variceal and non‐variceal UGIB on admission (OPs) and those at least 24 h after hospitalisation (IPs). Our primary end‐point was mortality and re‐bleeding rates at 6 weeks of bleeding onset.
Results
A total of 2498 UGIB cases were identified, of whom 634 (25.4%) occurred in IPs. IPs were older than OPs (72.5 vs. 67.2 years old, p < 0.001) and had a higher rate of comorbidities (38.9% vs. 26.6%, p < 0.0001). Their bleeding was more severe with a Rockall score of >5 present in 40.9% (vs. 30.3% in OPs, p < 0.0001). The 6‐week mortality rate was significantly higher in IPs when compared to OPs (21.7% vs. 8%, p < 0.0001). Prothrombin time <50% and rebleeding were the only independent predictors of mortality (p = 0.001 and 0.003, respectively). Six‐week rebleeding occurred more frequently among IPs (18.6% vs. 14.4%, p = 0.015) and predictors included female sex, active bleeding upon endoscopy and a Blatchford score >11 (p = 0.017, 0.011 and 0.008, respectively).
Conclusion
IPs who develop variceal and non‐variceal UGIB are more likely to be elderly with more comorbidities. They have a higher rate of mortality and rebleeding. Independent predictors of mortality were underlying coagulopathy and bleeding recurrence. An optimal bleeding management and efficient rebleeding prevention may improve outcome in these patients.
Key Point
Summarize the established knowledge on this subject
Upper gastrointestinal bleeding (UGIB) in already hospitalised patients (IPs) appears to have a worse prognosis when compared to UGIB in out‐patients (OPs).
Few studies have addressed this issue, most of which are retrospective. They found a poor short‐term outcome in IPs without being able to identify modifiable risk factors that could affect the prognosis.
Significant and/or new findings of this study?
We demonstrated in this prospective and multicentre study a greater 6‐week mortality and rebleeding rates in IPs versus OPs.
IPs were older and had a higher rate of comorbidities. Prothrombin time <50% and rebleeding were independently associated with a higher mortality rate in IPs.
An appropriate bleeding management and an optimal rebleeding prevention plan might improve the outcome of UGIB in already hospitalised patients.
Le Gallais Daniel, Rambourg Bertrand, Bile A., Préfaut Christian, Messner-Pellenc Patrick, Ximenes C., Leclercq F., Davy Jean-Marc, Grolleau Robert. Métabolisme aérobie au décours d'un triathlon ...olympique : aspects cardiovasculaires, ventilatoires et biologiques. In: Les Cahiers de l'INSEP, n°20, 1997. Un sport, deux enchaînements, trois disciplines : le triathlon. Actes du 1er symposium international de l'entraînement en triathlon. pp. 111-117.
Cardiac conduction disorders in the elderly Davy, Jean-Marc; Cransac, Frédéric; Roubille, François ...
La revue du praticien,
2009-Dec-20, Letnik:
59, Številka:
10
Magazine Article
While the left bundle branch block frequently reflects underlying cardiac disease, conductive disorders occurring at three levels (sinus node, atrioventricular node, and branches of the bundle of ...His), are usually part of the aging heart. In addition, AV nodal block and sinus node dysfunction are readily compounded with drugs, often indispensable (beta-blockers, calcium-blockers, digoxin, antiarrhythmic), and very common among the elderly. Indications for permanent pacing are accurately described and come in four classes: I, recommended (mandatory) - IIa, raisonable - IIb, possible - III, contraindicated. In 2009, 24H ECG Holter and electrophysiological study are generally disappointing in the positive diagnosis of syncope, so the clinical characteristics of syncope are essential in the decision of device implantation. Indeed, in the absence of ECG recorded at the time of the syncope, the diagnosis of BAV or BSA cannot be certain, and on the contrary, vague symptoms should not be attributed to a patent bradycardia of sinus or AV block origin without any precaution. Finally, the relationship between sinus dysfunction and carotid sinus syndrome remain poorly understood, dysautonomia is common among the elderly, and the existence of conduction disorders associated with syndrome of sleep apnea should not be ignored.
The deformation of the eastern Asian lithosphere during the first part of the India-Asia collision was dominated by subduction-related extension interacting with far effects of the collision. In ...order to investigate the role of large-scale extension in collision tectonics, we performed analogue experiments of indentation with a model of lithosphere subjected to extension. We used a three-layer rheological model of continental lithosphere resting upon an asthenosphere of low viscosity and strained along its southern boundary by a rigid indenter progressing northward. The lithosphere model was scaled to be gravitationally unstable and to spread under its ownweight, so that extension occurred in thewhole model. The eastern boundarywas free or weakly confined and always allowed eastward spreading of the model. We studied the pattern of deformation for different boundary conditions. The experimental pattern of deformation includes a thickened zone in front of the indenter, a major northeast-trending left-lateral shear zone starting from the northwest corner of the indenter, antithetic north-south right-lateral shear zones more or less developed to the east of the indenter, and a purely extensional domain in the southeastern part of the model. In this domain, graben opening is driven by gravitational spreading, whereas it is driven by gravitational spreading and indentation in the northeastern part where grabens opened along strike-slip faults. The results are compared with the Oligo- Miocene deformation pattern of Asia consecutive to the collision of India. Our experiments bring a physical basis to models which favour distributed deformation within a slowly extruded wide region extending from the Baikal Rift to the Okhotsk Sea and to southeast Asia and Indonesia. In this large domain, the opening of backarc basins (Japan Sea, Okinawa Trough, South China Sea) and continental grabens (North China grabens) have been associated with approximately north-south-trending right-lateral strike-slip faults, which accommodated the northward penetration of India into Eurasia.
La peinture murale : héritage et renouveau (GRPM), Groupe de Recherches sur la Peinture Murale; Angheben, Marcello; Aucouturier, Marc ...
In situ (Paris),
11/2013, Letnik:
22
Journal Article
In this paper, a CMOS gate driver in 180nm technology is presented. The gate driver implements an integrated and independent ultra-fast dV/dt control circuit dedicated to manage switch-on transients ...for GaN HEMT technology. In order to mitigate a detrimental effect in EMI spectrum for wide bandgap transistors, a novel method to reduce dV/dt without increasing so much switching losses is proposed. A comprehensive benchmark with the classical method is also presented, where the gate driver resistance is typically adjusted. Simulations are conducted to show the feasibility of the proposed method and the amount of switching energy that can be saved. Time responses of a feedback loop lower than 200ps are expected. The preliminary characterization of the integrated CMOS circuit is shown.
The dual performance, both economic and environmental, is a major challenge for the wine industry, which remains highly dependent on the use of pesticides. Fungicide control alone accounts for 80% of ...inputs in France. A DSS (DeciTrait®) gathering all the information necessary for the implementation of a low pesticides protection against the main fungal diseases (downy mildew - powdery mildew - black-rot - grey mould) was conceived in a collaborative approach within a CASDAR project. This DSS is easy to use and offers the user a protection strategy at the plot level based on the information and knowledge collected. The bioassays carried out within the CASDAR project clearly demonstrate the potential for reduction of phytosanitary inputs allowed by this DSS, for reducing both the number of treatments and the dose applied.
La double performance, économique et environnementale, constitue un enjeu majeur pour la filière viticole qui demeure très dépendante de l’utilisation des pesticides. A elle seule, la lutte fongicide représente 80% des intrants. Un OAD (DeciTrait®) regroupant l’ensemble des informations nécessaires à la mise en œuvre d’une protection économe en intrants vis-à-vis des principales maladies cryptogamiques (mildiou - oïdium - black-rot - botrytis) a été conçu dans une démarche collaborative ausein d’un projet CASDAR. Cet OAD est simple à utiliser et propose à l’utilisateur une stratégie de protection personnalisée sur la base des informations et connaissances recueillies. Les essais biologiques conduits au sein du projet CASDAR mettent clairement en évidence le potentiel deréduction des intrants phytosanitaires permis par cet OAD, tant sur la réduction du nombre de traitements que sur la dose appliquée.
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