Objectif : L’intoxication au monoxyde de carbone (ICO) est un diagnostic souvent difficile en urgence. Son incidence restant faible, les médecins urgentistes (MU) y sont rarement confrontés mais la ...pertinence de leur prise en charge est essentielle pour limiter la morbi-mortalité. L’objectif principal de cette étude était d’évaluer le niveau de connaissance des MU sur la prise en charge des ICO dans une région française de 8,1 millions d’habitants. L’objectif secondaire était d’individualiser les facteurs associés à une bonne connaissance de la prise en charge en urgence de cette pathologie.
Matériel et méthodes : Étude descriptive multicentrique et déclarative, réalisée auprès de MU travaillant au sein de cette région à l’aide d’un questionnaire en ligne.
Résultat : 246 MU ont répondu à l’enquête, représentant 82 % des structures de médecine d’urgence de la région. Parmi eux, 27 % estimaient prendre en charge moins de deux ICO par an. Le protocole territorial était connu par 59 % des répondeurs. La médiane de réponses justes au questionnaire de connaissance était de 43 40-47 sur 60. Un taux de réponses justes plus faible (< 70 %) était retrouvé sur les questions traitant du diagnostic (65 %) et des indications et contre-indications de l’oxygénothérapie hyperbare (61 %). Les facteurs associés à un meilleur taux de réponses justes étaient : la connaissance du protocole territorial (63 vs 46 %,
p
= 0,035), une ancienneté d’exercice ≥ 5 ans (60 vs 40 %,
p
= 0,014), une formation complémentaire à la médecine hyperbare (85 vs 53 %,
p
= 0,018), un nombre estimé de prise en charge d’ICO ≥ 2 (60 vs 43 %,
p
= 0,022) et une auto-évaluation de ses connaissances > 7/10 (68 vs 50 %,
p
= 0,007).
Conclusion : Cette étude a montré un niveau de connaissance perfectible des MU sur cette pathologie en rapport avec un faible nombre de prise en charge annuel. La création d’un consensus national est à encourager pour améliorer les pratiques.
Aim: Carbon monoxide poisoning (CMP) is an often-difficult diagnosis in emergency medicine. The incidence of CMP remains low and emergency physicians (EPs) are rarely confronted with it, but the relevance of their management is essential to limit morbidity and mortality. The main objective of this study was to evaluate the level of knowledge of EPs on the management of CMPs in a French region of 8.1 million inhabitants. The secondary objective was to identify factors associated with good knowledge of emergency management of this condition.
Procedure: Multicenter, declarative, descriptive study of EPs working in this region using an online questionnaire.
Results: 246 EPs responded to the survey, representing 82% of the region’s emergency medicine departments. Among them, 27% estimated that they manage less than two CMPs per year. The territorial protocol was known by 59% of respondents. The median number of correct answers to the knowledge questionnaire was 43 40-47 out of 60. A lower rate of correct answers (<70%) was found for questions dealing with diagnosis (65%) and indications and contraindications of hyperbaric oxygen therapy (61%). Factors associated with a better rate of correct answers were: knowledge of the territorial protocol (63 vs 46%,
p
=0.035), seniority of practice ≥5 years (60 vs 40%,
p
=0.014), additional training in hyperbaric medicine (85 vs 53%,
p
=0.018), an estimated number of CMP treatments ≥ 2 (60 vs 43%,
p
=0.022) and self-assessment of one’s own knowledge >7/10 (68 vs 50%,
p
=0.007).
Conclusion: This study showed a perfectible level of knowledge of EP on this pathology in relation to a low number of annual managements. The creation of a national consensus should be encouraged to improve practices.
Single-cell technologies offer insights into molecular feature distributions, but comparing them poses challenges. We propose a kernel-testing framework for non-linear cell-wise distribution ...comparison, analyzing gene expression and epigenomic modifications. Our method allows feature-wise and global transcriptome/epigenome comparisons, revealing cell population heterogeneities. Using a classifier based on embedding variability, we identify transitions in cell states, overcoming limitations of traditional single-cell analysis. Applied to single-cell ChIP-Seq data, our approach identifies untreated breast cancer cells with an epigenomic profile resembling persister cells. This demonstrates the effectiveness of kernel testing in uncovering subtle population variations that might be missed by other methods.
Mountainous areas pose a challenge for the out-of-hospital cardiac arrest (OHCA) chain of survival. Survival rates for OHCAs in mountainous areas may differ depending on the location. Increased ...survival has been observed compared to standard location when OHCA occurred on ski slopes. Limited data is available about OHCA in other mountainous areas. The objective was to compare the survival rates with a good neurological outcome of OHCAs occurring on ski slopes (On-S) and off the ski slopes (OffS) compared to other locations (OL).
Analysis of prospectively collected data from the cardiac arrest registry of the Northern French Alps Emergency Network (RENAU) from 2015 to 2021. The RENAU corresponding to an Emergency Medicine Network between all Emergency Medical Services and hospitals of 3 counties (Isère, Savoie, Haute-Savoie). The primary outcome was survival at 30 days with a Cerebral Performance Category scale (CPC) of 1 or 2 (1: Good Cerebral Performance, 2: Moderate Cerebral Disability).
A total of 9589 OHCAs were included: 213 in the On-S group, 141 in the Off-S group, and 9235 in the OL group. Cardiac etiology was more common in On-S conditions (On-S: 68.9% vs OffS: 51.1% vs OL: 66.7%, p < 0.001), while Off-S cardiac arrests were more often due to traumatic circumstances (OffS: 39.7% vs On-S: 21.7% vs OL: 7.7%, p < 0.001). Automated external defibrillator (AED) use before rescuers' arrival was lower in the Off-S group than in the other two groups (On-S: 15.2% vs OL: 4.5% vs OffS: 3.7%; p < 0.002). The first AED shock was longer in the Off-S group (median time in minutes: OffS: 22.0 (9.5–35.5) vs On-S: 10.0 (3.0–19.5) vs OL: 16.0 (11.0–27.0), p = 0.03). In multivariate analysis, on-slope OHCA remained a positive factor for 30-day survival with a CPC score of 1 or 2 with a 1.96 adjusted odds ratio (95% confidence interval (CI), 1.02–3.75, p = 0.04), whereas off-slope OHCA had an 0.88 adjusted odds ratio (95% CI, 0.28–2.72, p = 0.82).
OHCAs in ski-slopes conditions were associated with an improvement in neurological outcomes at 30 days, whereas off-slopes OHCAs were not. Ski-slopes rescue patrols are efficient in improving outcomes.
The silencing of large chromosomal regions by epigenetic mechanisms has been reported to occur frequently in cancer. Epigenetic marks, such as histone methylation and acetylation, are altered at ...these loci. However, the mechanisms of formation of such aberrant gene clusters remain largely unknown. Here, we show that, in cancer cells, the epigenetic remodeling of chromatin into hypoacetylated domains covered with histone H3K27 trimethylation is paralleled by changes in higher-order chromatin structures. Using fluorescence in situ hybridization, we demonstrate that regional epigenetic silencing corresponds to the establishment of compact chromatin domains. We show that gene repression is tightly correlated to the state of chromatin compaction and not to the levels of H3K27me3-its removal through the knockdown of EZH2 does not induce significant gene expression nor chromatin decompaction. Moreover, transcription can occur with intact high-H3K27me3 levels; treatment with histone deacetylase inhibitors can relieve chromatin compaction and gene repression, without altering H3K27me3 levels. Our findings imply that compaction and subsequent repression of large chromatin domains are not direct consequences of PRC2 deregulation in cancer cells. By challenging the role of EZH2 in aberrant gene silencing in cancer, these findings have therapeutical implications, notably for the choice of epigenetic drugs for tumors with multiple regional epigenetic alterations.
Since 2015, the emergence of mechanical thrombectomy as standard care in acute stroke has involved organizational changes not only for stroke centers, but also for entire emergency regional networks. ...The aim of our study was to assess the proportion of ischemic stroke patients, admitted to stroke units in the Northern French Alps within the first 6h of onset, eligible for thrombectomy.
This study retrospectively analyzed the clinical and radiological data of all acute stroke patients hospitalized at three stroke units of the Northern French Alps Emergency Network (RENAU) in 2014. Eligible patients had proximal arterial occlusions of the anterior and posterior cerebral circulation, as confirmed by brain imaging, which could be treated by thrombectomy within 6h of symptom onset.
Of the 435 cases of acute ischemic stroke, 152 patients were treated by intravenous thrombolysis (IV rtPA). Of these patients, 83 (55%) had intracranial occlusions and were eligible for combined thrombectomy. Of the 283 patients not treatable by IV rtPA, 32 patients (11%) were eligible for primary thrombectomy.
Thrombectomy could be performed in 26% of our acute ischemic stroke patients (n=115/435), and a large increase in endovascular procedures is expected over the next few years that will require close collaboration among all partners in the emergency networks. Using our RENAU stroke database, it will be possible to compare various factors contributing to effective activity.
X-chromosome inactivation (XCI) in mammals relies on XIST, a long noncoding transcript that coats and silences the X chromosome in cis. Here we report the discovery of a long noncoding RNA, XACT, ...that is expressed from and coats the active X chromosome specifically in human pluripotent cells. In the absence of XIST, XACT is expressed from both X chromosomes in humans but not in mice, suggesting a unique role for XACT in the control of human XCI initiation.
PDF
