Acute phase

Analysis of the condition of the coracoclavicular lig- aments is vital to the management of grade 3 injuries. Radiographs alone are not sufficient to evaluate the in- tegrity of the coracoclavicular ligaments. Bossart et al. found that grade 2 injuries are difficult to differentiate from grades 3 injuries on radiographs [ 22 ]. Our results support Bossart et al.’s findings: in 17 of the 47 cases, both ultrasound imaging and MRI found grade 3 inju- ries that may require surgical treatment, while these cases were classified as grade 2 injuries on radiographs. Ultrasound is relevant in this indication as it allows direct evaluation of the coracoclavicular ligaments, just like with MRI. Its low cost and accessibility are major assets of ultrasound imaging. When performed in the acute phase, MRI can be difficult to interpret because of movement artefacts caused by the patient being un- able to stay still for a long period to time due to pain. Ultrasound performed in the neutral position is better tolerated by patients. Ultrasound could be combined with radiography for the diagnostic work-up of acromioclavicular injuries in the acute phase.

Escherichia coli (serotype 0153-K 2 -H 2 ; 7 3 10 8 colony- forming units) into a lateral tail vein. Control animals of the INF group (PF) received saline intraperitoneally 1 h before an intravenous saline injection; because infection dramatically decreases food intake (11), the animals were pair fed to the intake of infected rats. In the PX-INF group, PX (100 mg/kg) was injected intraperitoneally 1 h before bacteria administra- tion. Control animals of the PX-INF group (PX-PF) received an equal volume of PX injected intraperitoneally 1 h before saline intravenous injection. Because PX treatment increases voluntary food consumption in infected rats, this control group (PX-PF) was pair fed to PX-INF animals. Pair feeding was conducted as previously described (11). Animals were weighed every day until the completion of the study. Animals of each group were studied at days 2 and 6 after the infection, which represents, respectively, the acute and chronic septic phases previously described (11). In infected rats, the mortal- ity was 7%, and there was no mortality in infected rats pretreated with PX. After anesthesia with pentobarbital sodium (6.0 mg/100 g body wt), gastrocnemius and soleus muscles were dissected and weighed. Blood samples were collected into EDTA tubes, and plasma was stored at 220°C for acute phase protein assays. Liver samples were taken by freeze clamping and kept at 280°C until analysis. The protocol was approved by the Ethics Committee of the Insti- tute National de la Recherche Agronomique and was con- ducted in conformity with the guiding principles in the care and use of laboratory animals.

Conclusions: Peptidomics of LCH have revealed that the level of acute-phase ITIH4 distinguishes MS-LCH-RO ( −) from SS-LCH-RO ( −). Acute-phase proteins serve non-specific, physiological immune functions within the innate immune system. LCH may be a reactive disorder with both underlying neoplastic potential of antigen presenting cells harboring BRAF mutations and hyper-immunity of other inflammatory cells against MCPyV infection. Among LCH-RO ( −), MCPyV-DNA sequences were present in both MS-LCH tissues and SS-LCH tissues without significant differences. ITIH4 may show that LCH activity or LCH subtypes correlates with the systemic or localized reactions of MCPyV infection.

is clearly present for stage N3, while paradoxical sleep is often significantly reduced or absent (Friese et al. 2007; Gabor et al., 2003; Gehlbach et al., 2012; Kavey & Ahshuler, 2003). More recently, sleep in hospital and inpatient rehabilitation settings was specifically investigated among patients with TBI (Duclos et al., 2013; Makley et al., 2009; Makley et al., 2008; Nakase-Richardson et al., 2013). A recent study using actigraphy in a hospital setting has shown that in the acute phase of TBI, patients experience rest-activity cycle disturbances, which globally improve over time (Duclos et al., 2013). In fact, among the 16 patients studied, only 3 (18.8%) had a consolidated rest-activity cycle while in ICU. This is defined as sustained periods of activity during the day and sustained periods of rest during the night. Overall, this study showed that of all days of actigraphy recording in the ICU, only 28.6% days showed a consolidated rest-activity cycle, whereas this proportion increased to 61.1% on the regular units. In the subacute phase of TBI, a study carried out using actigraphy in a rehabilitation unit showed that sleep-wake cycle was altered in 68% of patients (Makley et al., 2009). These patients with sleep-wake cycle disturbances had longer stays in both acute and rehabilitation settings, implying that sleep-wake disturbances may be associated with more severe injury (Makley et al., 2008). Another study showed that, based on item 1 of the Delirium Rating Scale-revised-98 (Trzepacz et al., 2001), mild to severe sleep disturbances were present among 84% of TBI patients (mainly severe) upon admission to a rehabilitation hospital, and persisted for 66% of patients one month post-injury. Results also showed that the presence of such sleep disturbances at one month post-injury was a significant predictor of' the duration of post-traumatic amnesia (Nakase-Richardson et al., 2013).

protracted rehabilitation, poor quality-of-life outcomes, and permanent disability [4,5,9]. The suffering and economic impact for the health care system and the society are high [10]. Earlier, we observed disturbed glucose utilization in skeletal muscle from CIM patients caused by insufficient translocation of the glucose transporter GLUT4 to the membrane [11]. Nonethe- less, the pathophysiology of CIM is poorly understood [12]. General inflammation with sepsis, immobilization, sedation, hyperglycemia and corticosteroids contribute to CIM [13,14]. Among these the mediators of inflammation interleukin 6 (IL-6) and tumor necrosis factor-alpha (TNF-a) are particularly impor- tant [15,16]. Serum levels of IL-6 [14,15] and TNF-a [16] are increased in systemic inflammatory response syndrome and sepsis patients and are associated with increased mortality [14]. Both IL- 6 [17,18] and TNF-a [19–21] contribute to muscular atrophy by increasing protein degradation [22,23]. Both cytokines increase the expression of acute phase response proteins, such as serum amyloid A 1 (SAA1) in muscle and other tissues [24]. SAA1 is associated with muscle wasting and atrophy in cachectic mice [25]. In addition, IL-6 and SAA1 cooperate to enhance angiotensin (Ang) II-induced muscle atrophy [26]. However, it is unknown if inflammation induces acute phase response directly in myocytes of critically ill patients which contributes to CIM. We hypothesized that early identification of non-excitable muscle membranes indicative for CIM could be helpful to identify pathways involved in the pathogenesis of CIM. A gene expression array performed on skeletal muscle biopsies from CIM and non-CIM patients drew our attention to increased muscular SAA1 gene expression indicative for acute phase response in muscle of CIM patients. We investigated factors regulating SAA1 synthesis in skeletal myocytes and tested conservation of this pathway in a sepsis mouse model.

The changes in the expression levels of CD182, CD11b, CD15 and TLR2 were not correlated to any of the clinical and biological markers of disease and tissue injuries. The levels of expres- sion of these receptors and PMN counts were further obtained from convalescent patients eval- uated at 1 month after discharge (M1). The median value of PMN decreased at M1: 4.7 x10 9 cells/L (4.1–6.1) compared to 8.9 x10 9 cells/L (7.5–10.3) at M0 (P = 0.04). The levels for CD182 and CD11b between M0 and M1 remained identical. The level of CD15 expression on PMN at 1 month was significantly higher compared to the acute phase of leptospirosis: P = 0.02 with non-parametrical Wilcoxon test for paired data, Fig 3B . Of note, the MFI values at M1 post infection were not significantly different from the healthy controls and indicating a return to basal levels of expression for all PMN markers analyzed in our study.

fragmentation and prolonged rest duration were also identified using actigraphy among mild to severe TBI patients within 24 hours of being admitted to a neurosurgical ward. 5 In addition to the effects of the hospital environment on sleep, and considering the major structural, biochemical and pathophysiological changes that occur during the acute phase of severe TBI, including diffuse axonal injury, focal lesions, elevated intracranial pressure, hypoxemia, reduced metabolism, apoptosis, and inflammation, 6 we predict that significant modifications to sleep stages and architecture may occur. In accordance with this hypothesis, recent rodent models of TBI have reported an increase in the amount of sleep, reduction in wakefulness, and more transitions between sleep and wakefulness in the first hours post-injury. 7- 10 However, no alterations in the amount of rapid eye movement (REM) or non-REM (NREM) sleep were observed, suggesting that acute TBI decreases the ability to maintain prolonged wakefulness rather than altering the proportion of each sleep stage.

Introduction The Kaïnic Acid model (KA) is one of the most validated models of temporal lobe epilepsy (TLE) (Lévesque et al.,2016). Its administration induces status epilepticus (SE), characterized by an extensive neuronal damage in limbic structures (Sperk et al.,1983). Post-mortem studies, such as the epilepsy model presented in (Wang et al., 2014), show a reduction of SV2A protein levels during the chronic phase, however, no data have been reported during the acute phase (0-48h after KA injection).. The present pilot study is undertaken to evaluate in vivo, with the specific radiotracer [ 18 F]UCB-H (Bretin et al., 2015; Warnock et al., 2014), the SV2A expression 24h after a SE produced by KA administration.

ϰϵ 6. Effet antiarythmique de la stimulation vagale après occlusion coronaire : rôle de la fréquence cardiaque: (Article en [PDF] par Waheed Manati et al., (81): The antiarrhythmic effect of vagal stimulation after acute coronary occlusion)/https://journals.viamedica.pl/cardiology_journal/article/download/CJ.a2017.../42606 ďƐƚƌĂĐƚ ĂĐŬŐƌŽƵŶĚ͗ ^ƚƌŽŶŐ ĞǀŝĚĞŶĐĞ ƐƵŐŐĞƐƚƐ Ă ĐĂƵƐĂů ůŝŶŬ ďĞƚǁĞĞŶ ĂƵƚŽŶŽŵŝĐ ĚŝƐƚƵƌďĂŶĐĞƐ ĂŶĚ ǀĞŶƚƌŝĐƵůĂƌ ĂƌƌŚLJƚŚŵŝĂƐ͘ ,ŽǁĞǀĞƌ͕ ƚŚĞ ŵĞĐŚĂŶŝƐŵƐ ƵŶĚĞƌůLJŝŶŐ ƚŚĞ ĂŶƚŝĂƌƌŚLJƚŚŵŝĐ ĞĨĨĞĐƚ ŽĨ ǀĂŐĂů ƐƚŝŵƵůĂƚŝŽŶĂƌĞƉŽŽƌůLJƵŶĚĞƌƐƚŽŽĚ͘dŚĞǀĂŐĂůĂŶƚŝĂƌƌŚLJƚŚŵŝĐĞĨĨĞĐƚŵŝŐŚƚďĞŵŽĚƵůĂƚĞĚďLJĂĚĞĐƌĞĂƐĞŝŶ ŚĞĂƌƚƌĂƚĞ͘DĞƚŚŽĚƐ͗ƚŚĞƉƌŽdžŝŵĂůĂŶƚĞƌŝŽƌŝŶƚĞƌǀĞŶƚƌŝĐƵůĂƌĂƌƚĞƌLJǁĂƐŽĐĐůƵĚĞĚŝŶϭϲƉŝŐƐďLJĐůĂŵƉŝŶŐ ƵŶĚĞƌŐĞŶĞƌĂůĂŶĂĞƐƚŚĞƐŝĂ͘'ƌŽƵƉϭ͗ŚĞĂƌƚƌĂƚĞƐƌĞŵĂŝŶĞĚƐƉŽŶƚĂŶĞŽƵƐ;Ŷсϲ͖ϭϮŽĐĐůƵƐŝŽŶƐͿ͖'ƌŽƵƉϮ͗ ŚĞĂƌƚ ƌĂƚĞƐ ǁĞƌĞ ĨŝdžĞĚ Ăƚ ϭϵϬ ďĞĂƚƐ ƉĞƌ ŵŝŶƵƚĞ ;ďƉŵͿ ǁŝƚŚ ĂƚƌŝĂů ĞůĞĐƚƌŝĐĂů ƐƚŝŵƵůĂƚŝŽŶ ;Ŷ с ϭϬ͖ ϮϬ ŽĐĐůƵƐŝŽŶƐͿ͘ĂĐŚƉŝŐƌĞĐĞŝǀĞĚƚǁŽŽĐĐůƵƐŝŽŶƐ͕ϯϬŵŝŶĂƉĂƌƚ͕ŽŶĞǁŝƚŚŽƵƚĂŶĚŽŶĞǁŝƚŚǀĂŐĂůƐƚŝŵƵůĂƚŝŽŶ ;ϭϬ ,nj͕ Ϯ ŵƐ͕ ϱʹϮϬ ŵͿ͘ dŚĞ ĂŶƚŝĂƌƌŚLJƚŚŵŝĐ ĞĨĨĞĐƚ ŽĨ ǀĂŐĂů ĂĐƚŝǀĂƚŝŽŶ ǁĂƐ ĚĞĨŝŶĞĚ ĂƐ ƚŚĞ ƚŝŵĞ ƚŽ ƚŚĞ ĂƉƉĞĂƌĂŶĐĞŽĨǀĞŶƚƌŝĐƵůĂƌĨŝďƌŝůůĂƚŝŽŶ;s&ͿĂĨƚĞƌŽĐĐůƵƐŝŽŶ͘ZĞƐƵůƚƐ͗/Ŷ'ƌŽƵƉϭ͕ǀĂŐĂůƐƚŝŵƵůĂƚŝŽŶƚƌŝŐŐĞƌĞĚ ĂƐŝŐŶŝĨŝĐĂŶƚĚĞĐƌĞĂƐĞŝŶďĂƐĂůŚĞĂƌƚƌĂƚĞ;ϭϯϮцϰǀƐ͘ϭϭϬцϭϳďƉŵ͕ƉфϬ͘ϬϱͿ͕ĂŶĚĚĞůĂLJĞĚƚŚĞƚŝŵĞƚŽs& ĂĨƚĞƌĐŽƌŽŶĂƌLJŽĐĐůƵƐŝŽŶ;ϭϭϬϮцϴϱǀƐ͘ϵϮϱцϰϭƐ͕ƉфϬ͘ϬϱͿ͘/Ŷ'ƌŽƵƉϮ͕ǀĂŐĂůƐƚŝŵƵůĂƚŝŽŶĚŝĚŶŽƚŵŽĚŝĨLJ ƚŚĞ ƚŝŵĞ ƚŽ s& ;ϭϬϯ ц ϯϵ ǀƐ͘ ϵϭ ц ϮϬ ƐͿ͘ ŶĂůLJƐĞƐ ƌĞǀĞĂůĞĚ ƚŚĂƚ ŚĞĂƌƚ ƌĂƚĞ ĂŶĚ ƚŚĞ ƚŝŵĞ ƚŽ s& ǁĞƌĞ ƉŽƐŝƚŝǀĞůLJ ůŝŶĞĂƌůLJ ƌĞůĂƚĞĚ͘ ŽŶĐůƵƐŝŽŶƐ͗ DĂŝŶƚĂŝŶŝŶŐ Ă ĐŽŶƐƚĂŶƚ ŚĞĂƌƚ ƌĂƚĞ ǁŝƚŚ ĂƚƌŝĂů ĞůĞĐƚƌŝĐĂů ƐƚŝŵƵůĂƚŝŽŶ ŝŶ ƉŝŐƐ ƉƌĞǀĞŶƚĞĚ ǀĂŐĂů ƐƚŝŵƵůĂƚŝŽŶ ĨƌŽŵ ŵŽĚŝĨLJŝŶŐ ƚŚĞ ƚŝŵĞ ƚŽ s& ĂĨƚĞƌ ĂĐƵƚĞ ĐŽƌŽŶĂƌLJ ŽĐĐůƵƐŝŽŶ͘

typeset indicates significant differences. The numbers are shown as a percentage of the total of the peaks quantified.. However, gamma globulin , showed an increasing upper [r]

Perfusion MRI Based on the passage of a contrast agent through the brain, perfusion-WI is sensitive to microscopic tissue-level changes in CBV, CBF or MTT. Some studies(95,96) found low CBV in regions of focal pathology in patients at the sub acute phase of TBI with contusions and oedema visible on conventional MRI and transient hypo perfusion was also observed in non injured contro lateral hemisphere although there was no evidence of oedema formation(97). An important limitation of this technique is that quantification remains difficult, together with the limited application in the emergency setting. Moreover, standard perfusion is based on T2* weighted imaging and may then be artifacted by bleeding through susceptibility effect.

Abstract. Acute Q fever cases were identi fied from a hospital-based acute febrile illness study conducted in six com- munity hospitals in rural north and northeast Thailand from 2002 to 2005. Of 1,784 participants that underwent Coxiella burnetii testing, nine (0.5%) participants were identi fied in this case-series as acute Q fever cases. Eight case-patients were located in one province. Four case-patients were hospitalized. Median age was 13 years (range: 7 –69); five were male. The proportion of children with acute Q fever infection was similar to adults (P = 0.17). This previously unrecognized at-risk group, school-age children, indicates that future studies and prevention interventions should target this population. The hetero- geneity of disease burden across Thailand and milder clinical presentations found in this case-series should be considered in future studies. As diagnosis based on serology is limited during the acute phase of the disease, other diagnostic options, such as polymerase chain reaction, should be explored to improve acute case detection.

graves relève de décisions stratégiques majeures dès la phase pré- hospitalière et tout au long de la chaîne de soins. Des lésions cérébrales secondaires, ayant comme conséquence une ischémie cérébrale glo- bale ou focale, s’ajoutent rapidement aux lésions mécaniques primai- res constituées lors de l’impact (hématomes intracrâniens, contusions, lésions axonales diffuses…). Le but de notre étude était d’évaluer la prise en charge en milieu de réanimation polyvalente du TC.

Matériels et méthodes : Étude de cohorte prospective effectuée dans deux services de réanimation, l’un utilisant la naC, l’autre non. Soixante-dix examens avec injection de PCI ont été inclus dans chaque centre. la nPCI était définie par : une augmentation de créatinine (créat) > 0,3 mg/l ou > 0,5 mg/l (définition classique) ou > 25 % en asso- ciant ou non un débit urinaire < 0,5 ml/kg/h > 6 h. Dans une deuxième phase nous avons comparé l’évolution de la créat et de la cystatine C (Cys C) avant et 48–72 heures après 42 examens avec PCI et naC.

mortalité en réanimation de 73 % chez 15 patients atteints de fibrose pulmonaire idiopathique (FIp) admis dans le service pour insuffisance respiratoire aiguë (IRA) et traités par vent[r]

2 C‑CLIN, centre hospitalier Lyon‑Sud, Saint‑Genis‑Laval, France 3 C‑CLIN, centre hospitalier Lyon‑Sud, Saint‑Genis‑Laval, France 4 Service de réanimation, centre hospitalier, Toulon, Fr[r]

Résultats : De mai 2011 à août 2012, 98 patients associés à 355 hémo- filtres ont pu être inclus. Les populations ne présentaient pas de dif- férences significatives entre la phase « avant » et la phase « après ». La durée de vie des hémofiltres présentait une différence significative lorsque nous étudions les patients thrombopéniques (numération pla- quettaire > 50 g/l) : 26,3 ± 18,8 heures, n = 109 vs 35,6 ± 18,1 heures, n = 154 ; p = 0,001). Cette différence ne se retrouvait pas dès lors que nous étudions l’ensemble de la population (31,95 ± 21,9 heures vs 36,34 ± 19,2 heures, p = 0,15). Le site de positionnement du cathé- ter d’EER n’apportait pas de différence significative sur ce paramètre. Les mesures responsables de cette amélioration semblent être l’adop- tion d’un régime de sécurité, d’une prédilution suffisante et l’usage de cathéters adaptés.

Dans cette étude, la VNI a été évaluée chez deux groupes de patients : les patients avec contre-indication à la VNI (groupe « trop grave » incluant les patients recevant des catéchol[r]

2 Cardiologie et maladies vasculaires, hôpital européen Georges‑Pompidou (HEGP), Paris, France 3 Chirurgie cardiaque et vasculaire, HDZ, Bad Oeynhausen, Allemagne Introduction: The ratio of early diastolic transmittal flow velocity to tissue Doppler mitral annular early diastolic velocity, E/e′, and pulmo‑ nary capillary wedge pressure (PCWP) have been shown to be correla‑ ted. The validity of E/e’ for predicting PCWP in DESHF patients was recently challenged, but the influence of inotropes was not taken into account, despite the reported influence of these drugs on left ventricu‑ lar relaxation properties. We investigated the impact of inotropes on the accuracy of E/e’ ratio as a surrogate for PCWP in acute decompen‑ sated end‑stage systolic heart failure (DESHF) patients.

Réanimation (2012) 22:S259-S262 S261 3 [1–7] à j1 soulignant l’inadéquation du score chez ces patients à la phase aiguë inaugurale. Les principaux motifs d’admission étaient : syndrome de lyse tumorale (70 %), détresse respiratoire aiguë (10 %) et état de choc (7 %). Au cours du séjour, l’épuration extrarénale a été instaurée dans 80 % des cas principalement pour un syndrome de lyse tumorale, la ventilation mécanique dans 43 % et les catécholamines dans 30 %. Tous les patients ont reçu une chimiothérapie en réanimation. La durée de séjour était de 11 [2–18] jours en réanimation. Dans 36,7 % des cas (n = 11), une chimio‑ thérapie intensive a pu être administrée. Une toxicité du MTX est alors survenue chez 81 % des patients. Il s’agissait d’atteintes cutanéomuqueuse dans 78 % des cas (mucite de grades III–IV), hématologique dans 55 % des cas (aplasie fébrile) et hépatique dans 43 % des cas (cytolyse hépatique de grade IV). Aucune toxicité rénale n’a été observée. Les toxicités rapportées ont été réversibles dans 100 % des cas. Aucun décès de cause toxique n’a été constaté parmi les patients ayant reçu une chimiothérapie contenant du MTX à forte dose. La surveillance systématique des taux résiduels de MTX dans les 96 heures suivant l’administration a mis en évidence deux surdo‑ sages modérés sans conséquences cliniques. La mortalité en réanimation des patients ayant reçu du MTX à forte dose a été de 18 %, toujours de cause septique. La survie à un an était de 82 %, tous les patients étaient en rémission complète. Dans 63 % (n = 22) des cas, la chimiothérapie admi‑ nistrée n’a pas comporté de MTX forte dose malgré une indication théori‑ que formelle en raison de contre‑indications majeures de type insuffisance rénale (79 %) et/ou une altération majeure de l’état général (79 %). Tous ses patients ont été traités avec des protocoles alternatifs dits curatifs. Leur mortalité en réanimation était de 41 %, liée à des complications septiques dans 85 % des cas. Dans les suites du séjour en réanimation, 78 % des patients n’ont pas pu recevoir le protocole de chimiothérapie prévu. Leur survie à un an était de 5 %. Le décès est survenu au cours de l’hospitalisa‑ tion initiale dans 90 % des cas. Il était secondaire à une progression tumo‑ rale dans deux tiers des cas et d’origine septique dans un tiers des cas.