3,4‐dihydroxybenzalacetone (DBL) and Caffeic acid phenethyl ester (CAPE) are both catechol‐containing phenylpropanoid derivatives with diverse bioactivities. In the present study, we analyzed the ...ability of these compounds to activate the unfolded protein response (UPR) and the oxidative stress response. When human SH‐SY5Y neuroblastoma cells were treated with DBL or CAPE, the expression of endoplasmic reticulum (ER) stress‐related genes such as HSPA5, HYOU1, DDIT3, and SEC61b increased to a larger extent in response to CAPE treatment, while that of antioxidant genes such as HMOX1, GCLM, and NQO1 increased to a larger extent in response to DBL treatment. DNA microarray analysis confirmed the strong link of these compounds to ER stress. Regarding the mechanism, activation of the UPR by these compounds was associated with enhanced levels of oxidized proteins in the ER, and N‐acetyl cysteine (NAC), which provides anti‐oxidative effects, suppressed the induction of the UPR‐target genes. Furthermore, both compounds enhanced the expression of LC3‐II, a marker of autophagy, and 4‐Phenylbutyric acid (4‐PBA), a chemical chaperone that reduces ER stress, suppressed it. Finally, pretreatment of cells with DBL, CAPE or low doses of ER stressors protected cells against a neurotoxin 6‐hydroxydopamine (6‐OHDA) in an autophagy‐dependent manner. These results suggest that DBL and CAPE induce oxidized protein‐mediated ER stress and autophagy that may have a preconditioning effect in SH‐SY5Y cells.
3,4‐dihydroxybenzalacetone (DBL) and Caffeic acid phenethyl ester (CAPE) are both catechol‐containing phenylpropanoid derivatives with diverse bioactivities. We demonstrate here that both compounds induce oxidized protein‐mediated ER stress and autophagy that may have a preconditioning effect in SH‐SY5Y cells.
Introduction
Family members of critically ill patients suffer from high levels of anxiety and depression in the ICU, and are at risk of developing post-ICU syndrome following ICU discharge. In the ...case of brain death, and potential organ donation, the family is at the center of the decision process: within a limited time frame, the family will be informed that the patient is brain-dead and will be approached about potential organ donation.
Materials and methods
Family experience with organ donation has been the topic of several research papers allowing one to gain knowledge about family members’ experience of organ donation, emphasizing specific needs, adequate support, and pointing out gaps in current delivery of family-centered care. In this narrative review, experts, clinicians, and researchers present the various legal systems regarding family implication in organ donation decisions; describe factors that influence the decision-making process; highlight family perspectives of care and respect for potential donors in the ICU environment; describe the impact of organ donation discussions and decisions on post-ICU syndrome; and suggest communication skills and support to be developed in the future. A research agenda for the next decade is also encouraged.
Conclusion
Overall, challenges remain and concern all persons involved in the process, ICU doctors and nurses, the organ procurement organization, family members, and, in some cases, the patients themselves. Looking at the big picture will provide opportunities for further improvements.
La sédation est une thérapeutique dont les effets tant bénéfiques que délétères nécessitent une évaluation adaptée aux besoins du patient et ce, à toutes les étapes de son évolution clinique. ...L’objectif à cibler dans la majorité des cas que sont les sédations légères, est un patient calme, coopérant et non douloureux, adapté au ventilateur. Durant ces sept dernières années, faute de développement d’autres outils permettant une évaluation objective, huit nouvelles échelles ont été développées et majoritairement testées pour leurs qualités métrologiques. Le choix d’une échelle, à ce jour, peut se discuter entre le score de Ramsay, de par sa simplicité, l’échelle de vigilance–agitation de Richmond (RASS) traduite et partiellement validée en français et l’échelle
Adaptation to The Intensive Care Environment-ATICE d’origine francophone, pour une échelle incluant le niveau de conscience. L’échelle
Behavioral Pain Scale (BPS) de Grenoble évalue la douleur et le confort. Deux échelles sont méthodologiquement valides et robustes : ATICE, RASS. Les critères de choix des échelles par le personnel soignant semblent être : le niveau de reproductibilité, la clarté, la représentativité des niveaux de sédation et d’agitation, la convivialité et la rapidité. In fine, le choix entre une échelle globale, facile d’utilisation et une échelle précise, plus complexe est à déterminer au sein de chaque service, dans l’attente d’études randomisées comparatives prouvant la supériorité d’une échelle. Le BIS est moins performant que l’application d’une échelle pour évaluer l’état d’éveil dans les sédations légères. L’enregistrement concomitant de l’électromyogramme induit une surestimation des valeurs de BIS. En revanche, dans les quelques situations où une sédation profonde est requise, les échelles ne permettent pas d’éliminer une sédation excessive. La capacité du BIS à mesurer la profondeur de la sédation en réanimation, notamment dans les situations de sédation profonde, chez le patient curarisé ou sous pentobarbital, reste à être démontrée. Les études pharmacoéconomiques manquent.
Sedative and analgesic treatment administered to critically ill patients need to be regularly assessed to ensure that predefinite goals are well achieved as the risk of complications of oversedation is minimized. In most of the cases, which are lightly sedation patients, the goal to reach is a calm, cooperative and painless patient, adapted to the ventilator. Recently, eight new bedside scoring systems to monitor sedation have been developed and mainly tested for reliability and validity. The choice of a sedation scale measuring level of consciousness, could be made between the Ramsay sedation scale, the Richmond Agitation Sedation scale (RASS) and the Adaptation to The Intensive Care Environment scale-ATICE. The Behavioral Pain Scale (BPS) is a behavioral pain scale. Two of them have been tested with strong evidence of their clinimetric properties: ATICE, RASS. The nurses’preference for a convenient tool could be defined by the level of reliability, the level of clarity, the variety of sedation and agitation states represented user friendliness and speed. In fine, the choice between a simple scale easy to use and a well-defined and complex scale has to be discussed and determined in each unit. Actually, randomized controlled studies are needed to assess the potential superiority of one scale compared with others scales, including evaluation of the reliability and the compliance to the scale. The usefulness of the BIS in ICU for patients lightly sedated is limited, mainly because of EMG artefact, when subjective scales are more appropriated in this situation. On the other hand, subjective scales are insensitive to detect oversedation in patients requiring deep sedation. The contribution of the BIS in deeply sedation patients, patients under neuromuscular blockade or barbiturates has to be proved. Pharmacoeconomics studies are lacking.
L’objectif était de décrire le vécu du parcours du don, ses déterminants et son retentissement sur la qualité de vie (QV), un an après le don de rein.
Cinq cents donneurs vivants (DV) prélevés ont ...été inclus entre octobre 2009 et janvier 2012 pour une évaluation avant don (T0) puis suivis à 3 (T1) et 12 mois après don (T2). Leur vécu du parcours, la QV (SF-36 et Euroqol), l’anxiété et la dépression (HAD) et l’estime de soi ont été analysés par questionnaires envoyés au domicile. Les données médicales provenaient du registre CRISTAL.
Trois cents quatre-vingt-quatre DV ont répondu aux 3 temps de mesure soit 68 % de taux de participation complète de la cohorte. Le parcours avant don a été en moyenne de 11 mois, jugé trop long par 1 donneur sur 5, opaque et stressant par un sur 3. Cinquante-sept déclarent au moins une complication après don (douleurs 73 %, complications sévères 3 %). Le prélèvement par cœlioscopie (80 %) est associé à moins de complications pulmonaires, d’HTA, de douleurs et à une meilleure récupération physique et QV. Ils ont repris le travail après une durée d’arrêt médiane de 63jours (9/10) ; tous n’ont pas complétement récupéré (3/10) et ressentent encore des douleurs (3/10). Ils ont retrouvé le niveau d’estime de soi pré-don (3/4), avec un sentiment de fierté (2/3). Avant le don, un donneur de 75ans a la même QV physique qu’un homme de 35ans en population générale. Un an après, ils n’ont pas tous retrouvé leur niveau de QV physique (4/10) et mentale (1/2) restant supérieurs à ceux de la population générale. Les donneurs regrettent un suivi médical et psychologique insuffisant et déclarent un préjudice financier (3/10), influençant l’évolution à un an. Le parcours est lourd et l’expérience jugée stressante mais positive et enrichissante. Ils seraient prêts à le refaire (98,2 %) et à le conseiller (96 %).
Cette étude nationale met en lumière le fort engagement des DV et confirme leur bon état physique et mental mais met en lumière les difficultés rencontrées même si l’expérience vécue n’altère ni l’élan initial, ni le sens attribué au don. Elle conduit à des recommandations visant à améliorer les facteurs potentiellement modifiables : développement de la cœlioscopie, mieux préparer et informer sur le geste chirurgical et ses suites, les obligations et la longueur du parcours, assurer une prise en charge complète de la douleur, anticiper le besoin de soutien et détecter le risque de survenue d’anxiété/dépression, informer clairement sur les aspects professionnels et financiers.
Small and medium-sized enterprises (SMEs) face significant challenges in today's rapidly changing business landscape. Due to limited resources and managerial capabilities, some of these businesses ...struggle to survive in the face of technological advances and economic recession. To address this issue, this research seeks to explore how SMEs can leverage information technology (IT) to overcome crises, capitalize on innovative opportunities, adapt to shifting market conditions, and drive new competitive initiatives. This study uses partial least squares structural equation modeling (PLS-SEM) to analyze the data collected from 247 SMEs in Vietnam. The results show that IT capabilities play a crucial role in stimulating organizational ambidexterity, resilience, and SME performance. In addition, the study emphasizes the potential impact of government support in enhancing organizational resilience. These findings provide empirical evidence supporting the Resource base theory with dynamic capabilities view and offer guidance to SMEs on allocating resources effectively and taking advantage of government support. The study also provides theoretical contributions and managerial implications to enhance business performance and achieve sustainable development.
To examine risk factors for early-onset ventilator-associated pneumonia (EOP) in patients requiring mechanical ventilation (MV), we performed a prospective cohort study that included 747 patients. ...Pneumonia was defined as a positive result for a protected quantitative distal sample. EOP was defined as pneumonia that occurred from day 3 to day 7 of MV. Eighty patients (10.7%) experienced EOP. Independent predictors of EOP were male sex (odds ratio OR, 2.06; 95% confidence interval CI, 1.18-3.63), actual Glasgow Coma Scale value of 6-13 (OR, 1.95; 95% CI, 1.2-3.18), high Logistic Organ Dysfunction score at day 2 (OR, 1.12 per point; 95% CI, 1.02-1.23), unplanned extubation (OR, 3.19; 95% CI, 1.28-7.92), and sucralfate use (OR, 1.81; 95% CI, 1.01-3.26). Protection occurred with use of aminoglycosides (OR, 0.36; 95% CI, 0.17-0.76), β-lactams and/or β-lactamase inhibitors (OR, 0.47; 95% CI, 0.28-0.83), or third-generation cephalosporins (OR, 0.33; 95% CI, 0.16-0.74). Sucralfate use and unplanned extubation are independent risk factors for EOP. Use of aminoglycosides, β-lactams/β-lactamase inhibitors, or third-generation cephalosporins protects against EOP.
We suggest an extremely wide class of asymptotically distribution free goodness of fit tests for testing independence in two-way contingency tables, or equivalently, independence of two discrete ...random variables. The nature of these tests is that the test statistics can be viewed as definite functions of the transformation of
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Recommendations for triage to intensive care units (ICUs) have been issued but not evaluated.
In this prospective, multicenter study, all patients granted or refused admission to 26 ICUs affiliated ...with the French Society for Critical Care were included during a 1-month period. Characteristics of participating ICUs and patients, circumstances of triage, and description of the triage decision with particular attention to compliance with published recommendations were recorded.
During the study period, 1,009 patients were and 283 were not admitted to the participating ICUs. Refused patients were more likely to be older than 65 yrs (odds ratio OR, 3.53; confidence interval CI, 1.98-5.32) and to have a poor chronic health status (OR, 3.09; CI, 2.05-4.67). An admission diagnosis of acute respiratory or renal failure, shock, or coma was associated with admission, whereas chronic severe respiratory and heart failure or metastatic disease without hope of remission were associated with refusal (OR, 2.24; CI, 1.38-3.64). Only four (range, 0-8) of the 20 recommendations for triage to ICU were observed; a full unit and triage over the phone were associated with significantly poorer compliance with recommendations (0 0-2 vs. 6 2-9, p =.0003; and 1 0-6 vs. 6 1-9, p <.0001; respectively).
Recommendations for triage to intensive care are rarely observed, particularly when the unit is full or triage is done over the phone. These recommendations may need to be redesigned to improve their practicability under real-life conditions, with special attention to phone triage and triaging to a full unit.
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